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Inspections mbing Permit Application ?51 3-1 _ I ■ "b , Building Fixtures 1-0R 011'ICE USE ONLY City of Tigard RECEIVE • Received C • 13125 SW Hall Blvd., Tigard, OR 97223 Date/B : 0 b r =� Permit No.: 1 3_ , II = Plan Review Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.: 1Q j :43 t: • j Inspection Line: 503.639.4175 0 2013 T I G n K [) P� Date Ready /By: / � See Page 2 for Internet: www.tigard- or.gov Notified/Method: �, �R Supplemental upplemental Information TYPE OF WORK } ton Ili ♦ D FEE* SCHEDULE ® New construction ❑ D`emo i For special information use checklist. Description I Qty. I Ea. I Total g ❑ Addition/alteration/replacement ❑ Other: Ne 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (I) bath 312.70 SFR (2) bath 437.78 ❑ 1- and 2- family dwelling ® CommerciaUindustrial W SFR (3) bath 500.32 ( ❑ Accessory building ❑ Multi- family Each additional bath/kitchen 25.02 g El Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 5l.:i JOB SITE INFORMATION AND LOCATION Site utilities: oq Job site address: 12220 SW SCHOLLS FERRY ROAD Catch basin or area drain 18.76 Drywell, leach line, or trench drain 18.76 City /State /ZIP: TIGARD, OREGON 97223 Footing drain (no. linear ft.: _) Page 2 Suite/bldg. /apt. no.: I Project name: WHOLE FOODS GREENWAY Manufactured home utilities 50.03 Cross street/directions to job site: SW 121" Avenue, at the Greenway Manholes 18.76 Town Center shopping center Rain drain connector 18.76 A P1.-41/;-Y--) ' l� E ail cb *- Sanitary sewer (..linear _) Page 2 Storm sewer (no. linear ft.: ) Page 2 Water service (no. linear ft.: ) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map /parcel no.: IS134BC00300 Backflow preventer I q 31.27 037 Z8" DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 Complete interior TI w/ minor exterior work for new 39,249sf grocery store Dishwasher 25.02 a j , (,W., in existing bldg (exterior, core & shell by others under separate permit) Drinking fountain 1 ./ 25.02 (��- Ejectors/sump 25.02 ❑ PROPERTY OWNER I ® TENANT Expansion tank I. 12.51 2S01- Name: Whole Foods Market Fixture/sewer cap r ✓ 25.02 h L15 I ! 0 Floor drain/floor sink/hub 12 25.02 3. axistc 4 Address: 3535 NE 15 Avenue Garbage disposal 25.02 V City/State/ZIP: Portland, Oregon 97212 Hose bib I a 25.02 .ii ) d0 Phone: (503)729 -8299 Fax: ( ) Ice maker 1 ,,7 12.51 alc, 0,,,1 4.. ® APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 Business name: Cushing Terrell Architects Engineers Medical gas (value: $ ) Page 2 Primer !,D 12.51 3 Contact name: John Borer Roof drain (commercial) 12.51 Address: 200 West Mercer Street, Suite 503 Sink/basin/lavatory 30 "25.02 t' 7So.� City /State /ZIP: Seattle, Washington 98119 Solar units (potable water) 62.54 Phone: (206) 282 -6222 Fax: : (206) 282 -7350 Tub /shower /shower pan 1 12.51 /J, .5 E -mail: johnborer @ctagroup.com Urinal 2 25.02 5 C fl CONTRACTOR Water closet 5.02 ((D Water heater 2. 37.52 7S 011 Business name:�o t o t � 3. piping/DWV 56.29 /tkSs: Ad Rg yf PLk figmi 48 2 /`n /1 n ,72_ /7& -- r� /(ff L Other: / 3 25.02 .°0 . City /State/ZIP: P % p Q (8S ,, ' Sf7 /' z ' /'ley ' W4 Q 6 Subtotal h p p Minimum permit fee: $72.50 . -- Phone: (3�0) C �� �O 70 � \plumbing F ax: ��) �G/� - `f5 CCB Lic.: 33 A J 7 Lic. no.: �7 - /to i� Plan review (2596 of permit fee l ? + j , l State surcharge (12% of permit fee) J $ ,{': (,'4 Authorized signature: ��X TOTAL PERMIT FEF g i+ re 14. Print name: "5OH p, Date: (,p, 0/ .1 This permit application expires if a permit is not obtained within 6o days after it has been accepted as complete. •Fee methodology set by Tri- County Building Industry Service Board. I:\ Building \Permits\PLMU- PermitApp.doc 10/01/09 440- 4616T(10/02/COM/WEBI - umbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea) Tom Square Footage: Permit Fee: Footing drain - I' 100' 50.03 0 to 2,000 $121.90 Footing drain - each additional 100' 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer - 1st 100' 62.54 7,201 and greater $327.54 Sewer - each additional 100' 37.52 Water Service - 1st 100' 62.54 Medical Gas Systems: Water Service - each additional 100' 37.52 Valuation: Permit Fee: Storm & Rain Drain - 1st 100' 62.54 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 37.52 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for Fee (ea) Total each additional $100.00 or fraction thereof, to Other Inspections or Fees Qty. and including $10,000.00. Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $ 1.54 for which no fee is specifically indicated 90.00/hr each additional $100.00 or fraction thereof, to (minimum charge - 1/2 hour) and including $25,000.00. Inspections outside of normal business 90.00/hr $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for hours (minimum charge - 2 hours) each additional $100.00 or fraction thereof, to Reinspection Fees 90.00/hr and including $50,000.00. Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for (minimum charge - 1/2 hour) each additional $100.00 or fraction thereof. Subtotal: Commercial Fixture Work: Are you capping, adding or replacing fixtures? If "yes ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees*. Quantiy by Fixture Type Plan Review for Plumbing Installations Fixture Type for Replace/ Plan review is required for any of the following. Work Performed: Capped Added Relocate lase check all that apply. Baptistry/Font pp Y Bath - Tub /Shower I Any new commercial building with water service 2" and Jacuzzi/Whirlpool greater, except systems designed and stamped by licensed Car Wash - Each Stall engineer. -Drive Thru ❑ New exterior plumbing site utilities for any complex structure Cuspidor/Water Aspirator as defined in OAR918- 780 -0040. Dishwasher - Commercial i / ! ❑ Medical gas and vacuum systems for health care facilities. - Domestic i ❑ Any multipurpose fire sprinkler system. Drinking Fountain I ■ ❑ Any complex structure as defined in OAR918- 780 -0040. Eye Wash , Floor Drain/sink - 2" Ho 103 ' , Submit 2 sets of plans with any of the above. 3" 21 < 4 " 5 ✓ Isometric or Riser Diagram Car Wash Drain ❑ Isometric or riser diagram is required for new buildings Garbage - Domestic - non -food Disposal - Domestic -food related that meet the qualifications above. - Commercial -food related - Industrial -food related / Ice MachfRefrig. Drains 2 v Oil Separator (Gas Station) Comments regarding fixture work: Rec. Vehicle Dump Station f}ly S1rE /gtrECRICie- ANT4 Lee ou'rlot`t woR4- Shower -Gang (S SEINCI PONE AS PART oo A sermaPt"'re - Stall Sink/Lav - Non -food related 4 ( VER4M1 WI OTHERS. - Bradley / - Commercial -food related i 1„ 0 - Service Swimming Pool Filter *Note: If the fixture work under this permit results in an Washer - Clothes Water Extractor increase of sewer EDUs, a sewer permit will be issued and Water Closet - Toilet y 1' (/ -- fees assessed for the sewer increase must be paid before the Urinal 1 / 7 plumbing permit can be issued. Other Fixtures: ' y J :Uobs \Whole Foods \WFGNW\Permitti�ty \CoT PlumbApp.doc 2 Accumulative Sewer Tally IN Tenant Name: SWR # 11,,-,rn Site Address: PLM # Parcel #: Fixture Value Previous Previous Credits Capped fixture Fixture New New # value count capped #s value count added # added value total #s total values Baptisery/Font 4 0 0 0 0 0 Bath: -Tub/Shower 4 0 0 0 0 0 - Jacuzzi /Whirlpool 4 0 0 0 0 0 Car Wash: - Each Stall 6 0 0 0 0 0 - Drive through 16 0 0 0 0 0 Cuspidor /Water Aspirator 1 0 0 0 0 0 Dishwasher. - Commercial 4 0 0 j 0 0 0 - Domestic 2 0 0 0 0 0 Drinking Fountain 1 0 0 } 0 0 0 Eye Wash 1 0 0 ? 0 0 0 Floor Drain /Sink: - 2 inch 2 0 0 6, fQ 0 0 0 - 3inch 5 0 0 .57 0 0 0 - 4inch 6 0 0 0 0 0 - Car Wash 6 0 0 0 0 0 Garbage Disposal: - Domestic (to 3/4 HP) 16 0 0 0 0 0 - Commercial (to 5 HP) 32 0 0 0 0 0 - Industrial (over 5 HP) 42 0 0 0 0 0 Ice Machine /Refrigerator Drain 1 0 0 0 0 0 Oil Sep (Gas Station) 6 0 0 0 0 0 Rec. Vehicle Dump station 16 0 0 0 0 0 Shower. - Gang (per head) 1 0 0 0 0 0 - Stall 2 0 0 0 0 0 Sink: - Lav /Bar - Non -Food Related 2 0 0 0 0 0 - Bradley 5 0 0 0 0 0 - Com /Serv/Util - Food Related 3 0 0 0 0 0 Swimming Pool Filter 1 0 0 0 0 0 Washer - Clothes 6 0 0 0 0 0 Water Extractor 6 0 0 0 0 0 Water Closet - Toilet 6 0 0 0 0 0 Urinal 6 0 0 0`. 0 0 0 Previous EDU Count 0 0 Capped EDU Credit 0 TOTALS _ 0 0 0 _ 0 0 0 0 0 Current Fixture Value 0 divided by 16 = 0.000 Current EDU 1 EDU = $4,665.00 Previous Fixture Value 0 divided by 16 = 0.000 Previous EDU Change 0 divided by 16 = 0.000 over (under) $ - Enter EDU Change Here 0.000 Notes: Authorized Name /Signature: Date: Building Division Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher which must be submitted to the City of Tigard Building Division to redeem credits towards future system development charges. 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CLASS OF WORK: SUBDIVISION: %' LOT#: TYPE OF USE: PROJECT NAME: '1.--7413-.0• - ` `1"-1 DESCRIPTION: OWNER: ■.01..,«‘c PHONE #: CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: t `� ' C)1q Pour Time: Code # Inspection Description Confirm # Contact # Message ur; . slat, Corrections/Comments/Instructions: 1 - H w-t � 4 t"k-r S;h ` 4. 4100 V c& (1- 10("14' c1� l A },� •G,!✓. � • o.(' 01 - ( • PASS PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: �v� Date: )04 Phone #: (503) 718- Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hal Blvd. Tigard, OR 97223 Tel: 503.718.2439 12220 SW SCHOLLS FERRY RD, TIGARD, OR, 97223 Commercial - Plumbing 399 Plumbing final PASS - No C of O PLM2013-00359 George Heimos 1/2" watts model LF009QT, serial no. 23855 ice maker back warehouse 1/2" watts model LF800M4QT, serial no. 006802, I seafood, under counter 1/2" watts model LF009QT, serial no. 27667, in hot case, island cabinet 1/2" watts model LF009QT, serial no. 27553, by dishwasher, kitchen scullery 1/2" watts model LF009QT, serial no. 26760, under two bay kit deli sink 1" watts model LF007M1QT, serial no. 010920, Mech Rm water heaters Violation Summary: Inspector Contractor