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Permit q CITY OF TIGARD PLUMBING PERMIT 1 COMMUNITY DEVELOPMENT Permit#: PLM2015-00103 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/08/2015 Parcel: 2S110DCO2200 Jurisdiction: Tigard Site address: 15570 SW PACIFIC HWY Project: Safeway Subdivision: 1997-016 PARTITION PLAT Lot: 2 Project Description: Installation of(1)2"floor drain and(1)food related sink. Contractor: RAYBORN'S PLUMBING INC Owner: TRC MM LLC PO BOX 69 5973 AVENIDA ENCINAS STE 300 19990 SW CIPOLE RD CARLSBAD,CA 92008 TUALATIN, OR 97062 PHONE: 503-692-4139 PHONE: FAX: 503-691-2328 FEES Quantity Description Date Amount 1 ea Floor Drain/Floor Sink/Hub 04/02/2015 $25.02 Specifics: 1 ea Sink 04/02/2015 $25.02 1 12%State Surcharge- 04/02/2015 $8.70 Type of Use: COM Plumbing Class of Work: ALT 22 ea Minimum Fee Adjustment- 04/02/2015 $22.46 Type of Const: Plumbing Occupancy Grp: Stories: Total $81.20 I 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 1.800332.2344. Issued By: ermittee Signature: Call 503.639.4175 by 7:00 a.m.for the next available inspec' n ate. 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. I 04-01-15;08:36 ;Rayborn's Plumbing ;5036912328 # 1/ 2 -- - 03-31-15;1613 ;Rayborn's PI Ie q,,,��TP - ;5038912325 # 1/ 1 Firm bine Permit Appiicatioq �� �j Building Fixtures APR 1 2015 1,,I< mil, t 1 ,t t IN11 City of Tigird . ;', ' _Mr-do9Of5 60l6 13125 SWNA11BtveL.TiPrd,OR 97273 /k 1L 11(,Al Nom",Martel 503.7182439 Fvv 503.5 430; V! K1 Num QweramatN� x,;' /5-tyre•7 t., t „ lnspeetlem Line: 543.639.4175 win LDJ r nflT1c!r, Dam Itaedy43y. f hrnr 521 Se ingot Z rer Iute nor neww.tipl'd•Or.g v • Nimir.edim.etri.d 1 6vppleeetW[�A►raeH.n T'A?F of WOQSC SEE''SCIAXMLIC _ A 1 1 wv consvnetian ©Derltolition For_/p eaiftfesrarlanbseu erillsr, Ocuw.rdon JQty. I 1_'e. j _Tato1 14 AdditionralIesationJreplaaerme ❑Other: NettI-7-i0m.1 11..01i4o, ■neludes 10011,farmiutlliry comorrIcrr) CAD/GORY OF CONSTltUCTiQ 1 SFr.co twat 312,70 I n 1-And 2-f1mlly dwc111u I.rCvmrtctsinlrndusgirl SFR w WI Q77.7a 0 Accessory building ❑Multi-Rmily �)>selb __ SOOa2 Filth addltionel6atlVkltohcn _ S.C� I D M.osta btu7drs 0 Other Elm sprintsrL.--sq,ft) rAga2 • 3011 SITE INFORMATION AND LOCATION -- I 54e voliticrr r I (� Job 411=addrty7C 6'510 5c Pmt-AC 1-iw Ni Catch bt�in orta,ce drain )13,75 1 I ,p Cly/Stetc2IF:• -1 cs OW y'72-237 p:vWcll.lcnclt llnc.cr 1 c 4reia �E,7L I Ot Far:lnadfstnbtalinalrft:� PtDcZ Soitc/bldghtpt.no- Prgjc name: p (rJ tsSst dIrontc uttlitictt , 50,013 1 Cross stecot/dilcz ions tv jab sites Mmltusles 12,56' / f/ x „ ,- A, / . 1/ Rain drsin easavWP I 13.76 ; �' Snnllcry o.Ken(no.111 car 1.1-1—) I I P3;2 Stn m seder(nu.linear fu_) I Patel.j Want?sctvlcc(to.Basler 74•,,__.) { 1 Pngc 2 I _ Subdivision: l Lot no: VIA tire nrilrm: _ Tax mop/parcel no_ `S i OW el axe QackIlaw prevenicr ) 31.27 D�e�T1oO OF WORK 6Itkwntssvnlw 1:.51 - Olathe:washer 7402 Disltwahcr I 25.02 Drinlotts fouler it I 25,(7/ ___ Pjeera Mural, _ 7$.02I• 0 r crERTY OWNER C3 TLZYArr P..Tputsivn tank ' 12.51 �� Fixtures ctrcreso 1 25.0Z Addret Rm.drnin/Poorsirk6ub -_ I r 2Address: Carhop)disposs1 25.02 Ciry/Suee/L1 Hess bib I 27,07 I I} Phone:( ) Far.( ) kern:6 a I 1251 raArrLTCANT ❑ CONTA,CrPERSOI` Jrarccalodui=imp I 25.02 I �w1 � r �y Mcdietd 0as(v11r1 S_) { Pa6e 2 Conga aamr. r 1J/ r1/ f/ Pr's... 1 12.51 3{ f4..pt .4 /" "t4 —A��+� L" Roofdr (cornmerole1) 12,51 Address: 7f9 , 5t...,. 7..,.. 4:31747,- /F 5lnkfcasin avatery j 25.02 Gp•/Stara/4P: V-1ft r(�+�'/ Y _7D � 5 Mar units(poitllo wstrr) + 62.54 non=(PS) `!1 — 73/ Fax::( ) 61'7--18 ,302,5' ( Tublshowceshowcr/ran I 1251 •?semi,: Urin1J 25.02 fi"n r G4��� Wnm!dos e, 25.02 C .17tACTOR uhtcrhraur 3752 1 k3tnlinas mane �� ' J _• A. Water pfpillgJDUry 3629 L Address; f' 'Q S 42 :.,. 4 Other 25.02 City/Statc.af .,-,---"--, , 0g 06- - Subtotal Phone:( �A ) I Fax:( ) Cr• / ■ _ Minimum pcttnit lks 572..30 rlttil ts+•lcw (7574 of pamdL fey) NEM e .+ f 5tnlcsur (12%ofptmi111c)�r/�„` �, WPM Authorised slaratt / / :.. _. ' � �+ — TOTAL MKT FEE - P[11tltt7jlte ��/� �.w Datr —fir' Tblap Ann ii.rppllu l •I+roaitii.t tadedMWee tl0lyl�Cr1 Su hnn .crqud u aroMnTa 'Fee me hvdeiaa it by Tri-County aalldln;lndutay lemon Hearn, 1:vtultileriNO^11141.4 .14ONIArNeft I Val rao .auuT(111,01CvrvWRL) 04-01-15;08: 36 ;Rayborn's Plumbing ; 5036912328 # 2/ 2 Plumbing Permit Application - City of Tigard Page 2-Supplemental Information Fee Schedule: Residential Fire Su Iression S stems: Site Utilities Qr• Pee(e■) Total [ Square Footage: Permit Fee: Footing drain-1°100' 50.03 I [ 0 to 2.000 , 5121.9D Footing drain•each additional 100' 37,52 2,001 to 3,600 5169.69 Sewer-1st 100' 62.54 -3.601 to 7,200 5739.20 _7201 and greater 5327.54 Sewer-each additional 100' I 37,52 Water Service 1st 100' 6254 : Medical Gas Systems: Water Service-each additional 100' 37.52 Valuation: I Permit Fee: 5lorn&Rain Drain-Ist 100' 62.54 SI.00 to S5,000.00 Minimum fcc 572.50 -- Storm dt Rain Drain•each additional 100' 37.52 55,001.00 to$10,000.00 S72.50 for the first 55,000.00 and$1.52 for Other Inspections or Fees Qt'' Fee(era) Total each ndditionn15100.00 or fraction thereof,to end including$10.000,00. Inspection of existing plumbing or for $10,001.00 to$25,000.00 5148.50 for the first 510,000,00 and$1.54 for which no fcc is specifically indicated 90.00/hr each additional 5100.00 or fraction thereof,to (minimum charge-1/2 hour) and including 125,000.00. Inspections outside of nenitAl business 90.00lhr $25,001.00 to 550,000.00 $379.50 for the first$25,000,00 and$1.45 for (tour%(minimum charge-2 hours) each additional$100.00 or fraction thereof,to Remspcctian Fees 90.00/hr and including 150,000.00. — Additional plan review for revisions 90,00/hr 550,001.00 and up $742.00 for the that 550,000.00 and 5120 for (minimum chargo I/2 hour) _ each additional 5100.00 or fraction thereat 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 15 required for any of the following. Fixture Type for ncomee Please cheek all that apply. Work Performed! C■ppcd Added Relocate Li Any new commercial building with water service 2"and Rnnriauy/Font . greater,except systems designed and stamped by licensed Batt: -Tub/Shower engineer. •Jacuzzl/Whirlpool Car Wash: -Each Stoll ii Ncw exterior plumbing site utilities for any complex structure Drive tall n3 defined in OAP..918-780-0040. Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities. Dishwasher. •Camntercial ❑ Any multipurpose fire sprinkler system. -Domestic ❑ Any complex structure as defined in OAR918-780-0040. Drinking Fountain iyc Wash Submit scU of plans with any of the above. I•loorDrain/sink: -2" •3" / Isometric or Riser Diagram 4„ - - ❑ Isometric or riser diagram is required for new buildings -Car Wash Drain Garbage Domestic non-food that meet the•ualihcations above, Disposal: -Domestic food related -Commercial food related -Industrial food related Ice MnchJRcfrig.Drains i Comments regarding fixture work: Oil Separator(Gar Station) — Rec,Vehicle DunteSlation Shower, -Gang , suit Sink: -Lev/Dar non-food related -oradley -Com/ScrvNtil food related Service - . _ "Note: if the fixture work under this permit results in an Swimming Pool File increase of sewer EDUs,a sewer permit will be issued and washer.Clothes i fees assessed for the sewer increase must be paid before the Wuurr E:ctructur 1 Water Closet-Toilet I plumbing permit can be issued. Urinal ` Other l cures: i It\f3uiltling\Pcmtiui\PLMr PermitApp.doc 011/04/2011 2 1 Accumulative Sewer Tally Io Tenant Name: Safeway SWR# 2015-00037 TI c.AR u Site Address: 15570 SW Pacific I I v\ PI,M# 2015-00103 Parcel#: 2S110DCO2200 Fixture \.ilii, Previous Previous I:redits I.appcd Fixture l'ixture New New # value count i appcd#s % due count added# added value total#s total values Baptisery/Font 4 0 0 0 0 0 Bath: -Tub/Shower 4 II 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.\spirator 1 0 0 0 0 0 Dishwasher: -Commercial 4 (I 0 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 (I 0 0 0 0 -3 inch 5 0 0 0 0 0 -4 inch 6 0 0 (1 0 (I -Car Wash 6 0 0 (I 0 0 Garbage Disposal: -Domestic(to 3/4 HP) 16 0 0 0 0 (I -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 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: -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 1 3 1 3 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 0 0 1 3 1 3 Current Fixture Value 3 divided by 16= 0.188 Current EDU 1 EDU = $4,900.00 Previous Fixture Value 0 divided by 16= 0.000 Previous EDU Change 3 divided by 16= 0.188 over (under) 5 931.00 Enter EDU Change Here 0.190 Notes: The 2"floor drain is not included in the calculation as the sink is indirect to floor drain. Authorized Name/Signature: Debbie,\damski Date: 4/1/2015 Building Division ote: 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\Sever I'allySheet_49(N)._070114.xlsx Accumulative Sewer Tally r : B . Tenant Name: Safeway SWR# 2015-0003' icjA i Site.\ddre s: I55"0 SW Pacific I1w) PJ.1\1#2015-00103 Parcel#: 2S110DCO2200 Fixture Value previous Previous Capped Fixture 1 Fixture New New # \alue count :itiipli 4V value count added# added value total#s total value. Baptiser'/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: -1'.ach Stall 6 0 0 0 0 0 -Drive through 16 0 0 0 0 0,IllIllIl Cuspidor/Water.Aspirator 1 0 M. 0 0 0 0 Dishwasher: -Commercial 4 0 0 0 0 0 -Domestic 2 0 0 0 0 0 Drinking Fountain 1 0 ME 0 0 0 0 Eye Wash 1 0 0 0 0 0 Flour Drain/Sink: -2 inch 2 0 �I 0 -3 inch 5 0 0 0 0 0 - 0 0 0 -4 inch 6 0 0 0 0 0 -Car Wash 6 0 _. 0 0 0 0 Garbage Disposal: -Domestic(to 3,'4 HP) OM 0 0 0 0 0 -Commercial(to 5 IJP) _IMI 0 0 0 0 0 -Industrial(over 5 11P) 0 0 0 0 0 ice Machine/Refrigerator Drain 0 0 0 0 0 Living Unit o 0 0 0 0 Oil Sep(Gas Station) 1111111111 0 0 0 0 0 Rec.Vehicle Dump station 0 0 0 0 0 Shower. -Gang(per head) 0 0 r 0 0 0 -Stall 0 0 0 0 0 Sink: -Lay/Bar-Non-Food Related 2 0 0 0 0 0 -Bradley 5 0 0 0 0 0 -Comi Scn NO-Food Related 3 0 0 1 3 1 3 Swimming Pool Filter 1 0 0 0 _ 0 0 Washer-Clothes 6 0 0 0 0 0 Water l:,tractor 6 0 0 0 0 0 \;atcr Closet-Toilet 6 0 0 0 0 0 'rinal 6 0 0 0 0 0 Pervious EDU Count 0 0 Capped E1)ti Credit 0 l't 1T\IS 0 0 0 0 1 3 1 3 Cumin Fixture Value 3 divided by 16= 0.188 Current FDU 1 EDU= $4,900.00 Previous Fixture Value U divided by 16= 0.000 Previous l l)ll Change 3 divided by 16= 0.188 over (under) S 931.00 Enter EDIT Change Here 0 190 slows: 1-he tl:,or di:in is not,ueludtd in the ealeularion as tin:auk is indirect to Flom drain. Authorized Name/Signature: Debbie 1d:unskr Date: -I I '2015 Building Division :ore: '11w property owner shall retain the ORIGIN.\1.scuer tall'tccord. If credits gist,this document wilt serve as a voucher which must he tbmrtted to the City of 1 ugard Building Division ro redeem credits towards furore system development charges. \Building\Stwer Tully\SewcriallvSheet_49nu 0711114'J.': 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 15570 SW PACIFIC HWY, TIGARD, OR, 97224 Commercial - Plumbing 399 Plumbing final PASS - No C of O PLM2015-00103 George Heimos Violation Summary: Inspector Contractor