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Permit CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit#: PLM2014-00275 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/08/2015 Parcel: 1 S135BA00102 Jurisdiction: Tigard Site address: 10230 SW WASHINGTON SQUARE RD Project: Panera Bread Subdivision: OAKBURG Lot: 9 Project Description: Installation of approximately 40'of sanitary sewer line. Contractor: R A WARNER PLUMBING Owner: PPR SQUARE TOO LLC PO BOX 820785 PO BOX 847 VANCOUVER,WA 98682 CARLSBAD,CA 92018 PHONE: 360-772-2490 PHONE: FAX: 360-263-5354 FEES Quantity Description Date Amount 40 If Sewer Service 01/08/2015 $62.54 Specifics: 1 12%State Surcharge- 01/08/2015 $8.70 Plumbing Type of Use COM 10 ea Minimum Fee Adjustment- 01/08/2015 $9.96 Plumbing Class of Work: ALT Type of Const: Occupancy Grp: Stories: Total $81.20 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 OU by calling 503.232.1987 or 1.800.332.2344. Issued By: Permittee Signature: C 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. 1 's P1uisabing Permit Application Site Utilities RECEIVED FOR OFFICE USE ONLY City of Tigard Received y ( � �� II Date/By: D//, `s Permit No.: hii)e/ G,U� f + 13125 SW Hall Blvd.,Tigard,OR 3 y ]-u 20�4 Plan Review Phone: 503.718.2439 Fax: 50 9 Date/By: Other Permit No.: T I G A R D Inspection Line: 503.639.4175 Date Ready/By: K/ `//,[��Q luris 6? See Page 2 for Internet: sittiw.tigard-or.gov fiCITYOFTIGARL� Notified/Method:/� �� O�Z5 T ��j Supplemental Information TYPE ®U C DIVISION CA�4A2. " 's' " -- ?4 FEE* SCHEDULE ❑New construction ❑Demolition For special information use checklist Description I Qty. I Ea. I Total ®Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(l)bath 312.70 ❑ 1-and 2-family dwelling ®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: 10230 SW Washington Square Road Catch basin or area drain 18.76 City/State/ZIP:Tigard,OR 97223 Drywell,leach line,or trench drain 18.76 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: I Project name:Panera Bread Manufactured home utilities 50.03 Cross street/directions to job site: SW Greenburg Road Manholes 18.76 Rain drain connector 18.76 414 Sanitary sewer(no.linear ft.:40) 1 Page 2 (► �1 Storm sewer(no.linear ft.: ) Page 2 tP' Water service(no.linear ft.: ) Page 2 Subdivision: I Lot no.: 102 Fixture or item: Tax map/parcel no.:Tax Map 1S135BA Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 TI of a portion of a former bookstore for a new Panera Bread restaurant Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ❑ PROPERTY OWNER I ® TENANT Expansion tank 12.51 Name:Panera,LLC Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address:3630 S.Geyer Road,Suite 100 Garbage disposal 25.02 City/State/ZIP: Sunset Hills,MO 63127 Hose bib 25.02 Phone:(314)984-1000 Fax:(314)909-3300 Ice maker 12.51 ❑ APPLICANT CONTACT PERSON Interceptor/grease trap 25.02 Business name:Panera,LLC Medical gas(value:$ ) Page 2 Primer 12.51 Contact name:John Sturges Roof drain(commercial) 12.51 Address:3187 Airway Avenue,Suite A Sink/basin/lavatory 25.02 City/State/ZIP:Costa Mesa,CA 92626 Solar units(potable water) 62.54 Phone:(714)966-9400 Fax: :(949)258-5655 Tub/shower/shower pan 12.51 E-mail: Urinal 25.02 CONTRACTOR Water closet 25.02 Water heater 37.52 Business name: ,14---. .424 E Water piping/DWV 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal be 34c 70 Minimum permit fee: $72.50 7,z,:sv y3' Phone:( ) 7 72._ Fax:( ) Q CCB Lic.: i 5 j•3 33? 40//////4, Plumbing Lic.no.: 37-591 P+/ Plan review (25%of permit fee) H 18� /t�t 7 State surcharge(12%of permit fee) S.7i' -9" Authorized signature: TOTAL PERMIT FEE g/,30 -8.2 ' Print name: Date: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Pennits\PLMU-PermitApp.doc 10/01/09 440-46161(10/02/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-1"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' 1 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 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*. Quantity by Fixture Type Plan Review for Plumbing Installations Fixture Type for /Replace/ Work Performed: Capped Added 'Relocate Plan review is required for any of the following. Baptist ont % Please check all that apply. Bath -Tub/Shower ❑ Any new commercial building with water service 2"and acuzzi/Whirlpool greater,except systems designed and stamped by licensed Car Wash -E: h Stall _/- engineer. -Drive Thru / ❑ New exterior plumbing site utilities for any complex structure Cuspidor/Water Aspirato as defined in OAR918-780-0040. Dishwasher -Commerc •I , ❑ Medical gas and vacuum systems for health care facilities. -Domestic ❑ Any multipurpose fire sprinkler system. Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040. Eye Wash Floor Drain/sink -2" 1 16 Submit 2 sets of plans with any of the above. -3" 4" Isometric or Riser Diagram Car Was gain -_ ❑ Isometric or riser diagram is required for new buildings Garbage -Domestic-non-fo.. Disposal -Domestic-food lated __- that meet the qualifications above. -Commercial- ..d related __- -Industrial-f•.d related , Ice Mach./Refrig.Drai Oil Separator(Gas S .tion) Comments regarding fixture work: Rec.Vehicle Dum. Station Shower -Ga -S I -©, Sink/Lav -'on-food related -Bradley I, -Commercial-food related 8 -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 fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. Other Fixtures: Macintosh HD:Users:RSIGroupPM:Desktop:PLMU-PermitApp_Complet¢doc 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 10230 SW WASHINGTON SQUARE RD, TIGARD, OR, 97223 Commercial - Plumbing 399 Plumbing ﬁnal PASS - No C of O PLM2014-00275 George Heimos NOTE: sanitary sewer piping was inspected on grease interceptor installation. Piping was inlet and outlet pipes from interceptor to building. Rough test with water ok. PLM2014-00276 Violation Summary: Inspector Contractor