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Permit CITY OF TIGARD PLUMBING PERMIT 1111 I" Permit#: PLM2014 00151 _ COMMUNITY DEVELOPMENT Date Issued: 05/07/2014 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 5/07/2 D00102 Jurisdiction: Tigard Site address: 11681 SW PACIFIC HWY Project: Jimmy John's Subdivision: 2006-016 PARTITION PLAT Lot: 3 Project Description: Plumbing fixtures for new tenant: CAP(1)drinking fountain&(1)4"floor drain;ADD(1)4"floor sink&(1)grease trap;RELOCATE(6)4"floor drain/sinks,(1)ice machine,(2)lays,(3)food-related sinks and(2)water closets. Contractor: VICON MECHANICAL CONTRACTOR INC Owner: WILSAL LLC 3651 KASHMIR WAY SE 834 SW ST CLAIR ST SALEM, OR 97317 PORTLAND, OR 97205 PHONE: PHONE: 503-507-7864 FAX: 503-540-5616 FEES Quantity Description Date Amount 1 ea Backflow Preventer 05/07/2014 $31.27 Specifics: 2 ea Fixture/Sewer Cap 05/07/2014 $50.04 7 ea Floor Drain/Floor Sink/Hub 05/07/2014 $175.14 Type of Use: COM 1 ea Ice Maker 05/07/2014 $12.51 Class of Work: ALT 1 ea Interceptor/Grease Trap 05/07/2014 $25.02 Type of Const: 3 ea Sink 05/07/2014 $75.06 Occupancy Grp: 2 ea Lavatories 05/07/2014 $50.04 Stories: 2 ea Water Closet 05/07/2014 $50.04 1 ea Water Heater 05/07/2014 $37.52 1 12%State Surcharge- 05/07/2014 $60.80 Plumbing Total $567.44 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. ' Issued By: Tz'k_____ Permittee Sign. . :. - .- Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept In a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Plumbing Permit Applicati�ECEI�ED Building Fixtures I•OOR 1)1 I I( I I `I (1\I 1 City of Tigard Received _ g u1t DateBy: 7 / Permit No. �,r iS 13125 SW Hall Blvd.,Tigard,OR 97216 IAY 120 4 y �Z�OCv�y a� / : U Phone: 503.718.2439 Fax: 503.598.1960 Dan By: Other Permit No.: Date/By: Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Juris ® See Page 2 for\ : ) Internet: www.tigard-or.gov Notified/Method: l/6-' Supplemental Information TYPE OF OWING DIVISION FEE* SCHEDULE `C For special information use checklist 1 ❑New construction ❑Demolition � 1 % Description 1 Qty. 1 Ea. Total ®Addition/alteration/replacement ❑Other: New I-2-family dwellings(includes 100 ft.for each utility comection) O �'ee CATEGORY OF CONSTRUCTION SFR(I)bath 312.70 kil CI I-and 2-family dwelling 1'Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 ❑Accessory building ❑Multi-family Each additional bath/kitchen 25.02 ❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: ��'b C/z 5 i)e L j c_ 14 W `i Catch basin or area drain 18.76 City/State/ZIP: r( (-.% d y Drywell,leach line,or trench drain 18.76■ � Footing drain(no.linear ft.: ) Page 2 J Suite/bldg./apt.no.: I Project name: ,iv" L b4 v16 Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 "()O 1..(-1)y 1111 Lcc4M Rain drain connector 18.76 Sanitary sewer(no.linear ft.: ) Page 2 Storm sewer(no.linear ft.: ) Page 2 Water service(no.linear ft.: ) Page 2 Subdivision: Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer I 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 L ‘= ruAki 104 0' 1Ky 4' K. 5µ13 A6r Dishwasher 25.02 LL Drinking fountain 25.02 Ejectors/sump 25.02 ❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: Fixture/sewer cap 2_, 25.02 Address: Floor drain/floor sink/hub 4? 25.02 Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone:( ) Fax:( ) Ice maker 12.51 ❑ APPLICANT ICI CONTACT PERSON Interceptor/grease trap i 25.02 R5.0a Business name: 3 INWM, jet . 5�� S Medical gas(value:$ ) Page 2 To1�' An A Primer 12.51 Contact name: r, ,i, t r �5 1J a"• ' Roof drain(commercial) 12.51 Address: 1 _ l L4✓ Ira OS r►�, LA g(U(1• l7J Sink/basin/lavatory(1)\CoN Sl`� S 25.02 City/State/ZIP: !�s ./ !�n 553J3 Solar units(potable a ) 62.54 Phone:(60 ) Ot q Q (?(V Fax: :(46,) 3 T9 q?7 3 Tub/shower/shower pan 12.51 E-mail: 'RkKl54,4, ,�OS L. V. of 5 04,;(,,(6V4t Urinal 25.02 CONTRACTOR Water closet ,Z 25.02 Water heater I 37.52 Business name: VI cm `�I ttilm I(Pk Water piping/DWV 56.29 Address: 3 ✓ .4 4`l ' W A.y S` Other: 25.02 City/State/ZIP: k lot rot b R, i ''>)' Subtotal Phone:64 4)) 567 Fax:( ) >104 Minimum permit fee: $72.50 CCB Lic.: I(14 AZ $/„1,5 Plumbing Lic.no.: Y'7)3Y Plan review (25%of permit fee) QState surcharge(12%of permit fee) Authorized signature: , l 6 Vtija,j F d ye/6 r A - '& V?Iv TOTAL PERMIT FEE Print name: � i Q Date: This permit application expires if a permit is not obtained within 180 days ��,111...�� ✓ 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(I0/02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee: Footing drain-In 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 Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to P 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*. Plan Review for Plumbing Installations Quantity by Fixture Type Plan review is required for any of the following. Fixture Type for Replace/ Please check all that apply. Work Performed: Capped Added Relocate ❑ Any new commercial building with water service 2"and Baptistry/Font greater,except systems designed and stamped by licensed Bath: -Tub/Shower engineer. -Jacuzzi/Whirlpool Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure Drive Thru as defined in OAR918-780-0040. Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system. Domcstic ❑ Any complex structure as defined in OAR918-780-0040. Drinking Fountain Eye Wash ' Submit 2 sets of plans with any of the above. Floor Drain/sink: -2" 3" ..1:>M,rJ 51/41 Isometric or Riser Diagram * - ❑ Isometric or riser diagram is required for new buildings -Car Wash Drain Garbage Domestic non-food that meet the qualifications above. Disposal: -Domestic food related -Commercial food related _ -Industrial food related Ice Mach./Refrig.Drains Comments regarding fixture work: Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower: -Gang -Stall Sink: -Lav/Bar non-food related # 1� -Bradley -Com/Serv/Util food related -Service *Note: If the fixture work under this permit results in an Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and Washer-Clothes fees assessed for the sewer increase must be paid before the Water Extractor Water Closet-Toilet a plumbing permit can be issued. Urinal Other Fixtures: I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 Accumulative Sewer Tally III = Tenant Name: Jimmy John's SWR# N/A Site Address: 11681 SW Pacific Hwy PLM# 2014-00151 TIGARD Parcel#: 1S136CD00102 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 0 0 0 -Domestic 2 0 0 0 0 0 Drinking Fountain 1 0 1 1 0 -1 -1 Eye Wash 1 0 0 0 0 0 Floor Drain/Sink: -2 inch 2 0 0 0 0 0 -3 inch 5 0 0 0 0 0 -4 inch 6 0 1 6 1 6 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 1IP) 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 Living Unit 16 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: -Lay/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 Previous EDU Count 0 0 Capped EDU Credit 0 TOTALS 0 0 2 7 1 6 -1 -1 Current Fixture Value -1 divided by 16= -0.063 Current EDU 1 EDU= $4,800.00 Previous Fixture Value 0 divided by 16= 0.000 Previous EDU Change -1 divided by 16= -0.063 over (under) $ (288.00) Enter EDU Change Here -0.060 Notes: .06 EDU CREDITS Authorized Name/Signature: Dianna Howse Date: 5/7/2014 Building Division Note: The property owner shall retain the ORIGINAL sewer tally record. I f 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. I:\Building\Sewer Tally\Sewer TallySheet_4800._070113.xlsx Accumulative Sewer Tally III _ q Tenant Name: Jimmy John's SWR# N/A Site Address: 11681 SW Pacific Hwy PLM# 2014-00151 TIGAxU Parcel#: 1S136CD00102 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: -rub/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 0 0 0 -Domestic 2 0 0 0 0 0 Drinking Fountain 1 0 1 1 0 -1 -1 Eye Wash 1 0 0 0 0 0 Floor Drain/Sink: -2 inch 2 0 0 0 0 0 -3 inch 5 0 0 0 0 0 -4 inch 6 0 1 6 1 6 0 0 -Car Wash 6 0 0 0 0 0 Garbage Disposal: -Domestic(to 3/4 11P) 16 0 0 0 0 0 -Commercial(to 5 1 IP) 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 hiving Unit 16 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 Previous EDU Count 0 0 Capped EDU Credit 0 '1'O'l'ALS 0 0 2 7 1 6 -1 -1 Current Fixture Value -1 divided by 16= -0.063 Current EDU 1 EDU= $4,800.00 Previous Fixture Value 0 divided by 16= 0.000 Previous EDU Change -1 divided by 16= -0.063 over (under) $ (288.00) Enter EDU Change Here -0.060 Notes: .06 EDU CREDITS Authorized Name/Signature: Dianna Howse Date: 5/7/2014 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. I:\Building\Sewer Tally\Sew er Pally Shee t_4800._070113.xlsx Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 11681 SW PACIFIC HWY, TIGARD, OR, 97223 Commercial - Plumbing 399 Plumbing ﬁnal FAIL PLM2014-00151 George Heimos 1. Correct water leak on kitchen hand wash sink. 310.0 2. Correct splashing on prep sink drain. 310.0 3. Provide cleanout on 3-compartment sink. 707.4 exception #4 4. Provide approved thread sealant on rear outside sanitary cleanout. 316.1.1 5. Protect water service from freezing. 313.6 6. Corrections from inspection dated 06/09/14 not completed! Recall permit PLM2014-00176 to ﬁnal out. 7. Recall inspection when corrections have been completed. Re-inspection required. 103.5.6.1 Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 11681 SW PACIFIC HWY, TIGARD, OR, 97223 Commercial - Plumbing 399 Plumbing ﬁnal PASS - No C of O PLM2014-00151 George Heimos Violation Summary: Inspector Contractor