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Permit CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit#: PLM2015-00372 Date Issued: 11/10/2015 . s 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S102CC00500 Jurisdiction: Tigard Site address: 13500 SW PACIFIC HWY 92 Project: Bon Baguette Subdivision: FREWING'S ORCHARD TRACTS Lot: 15 Project Description: Adding(1)backflow preventer,(1)dishwasher,(2)2"floor drains,(2)3"floor drains, (1)ice machine drain,(1) grease trap,(2)primers,(1)non-food sink(3)food sinks,(1)water closet&(1)water heater.Capping(1)clothes washer. Replacing/relocating(3)non-food sinks&(1)water closet. 1/7/2016:REPRINT to add(1)backflow device. Contractor: MODERN PLUMBING Owner: ROIC OREGON LLC 11120 SW INDUSTRIAL WAY 8905 TOWNE CENTRE DR, STE 108 TUALATIN, OR 97062 SAN DIEGO, CA 92122 PHONE: 503-691-6166 PHONE: FAX: 503-691-6771 FEES Quantity Description Date Amount 1 as Backflow Preventer 11/05/2015 $31.27 Specifics: 1 ea Dishwasher 11/05/2015 $25.02 1 ea Fixture/Sewer Cap 11/05/2015 $25.02 Type of Use: COM 4 ea Floor Drain/Floor Sink/Hub 11/052015 $100.08 Class of Work: ALT 1 ea Ice Maker 11/05/2015 $12.51 Type of Const: 1 ea Interceptor/Grease Trap 11/05/2015 $25.02 Occupancy Grp: 2 ea Primer 11/05/2015 $25.02 Stories: 3 ea Sink 11/05/2015 $75.06 4 ea Lavatories 11/05/2015 $100.08 2 ea Water Closet 11/05/2015 $50.04 1 ea Water Heater 11/05/2015 $37.52 1 12%State Surcharge- 11/05/2015 $60.80 Plumbing 1 ea Backfiow Preventer 01/07/2016 $31.27 0 12%State Surcharge- 01/07/2016 $3.75 Plumbing Total $602.46 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 OO/UNC by calling 503.232.1987 or 1.800.332.2344. / Issued By: Permittee Signature: T� Call 503.639.4176 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. CITY OF TIGARD PLUMBING PERMIT _ = COMMUNITY DEVELOPMENT Permit#: PLM2015-00372 • 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/10/2015 TIGARD Parcel: 2S102CC00500 Jurisdiction: Tigard Site address: 13500 SW PACIFIC HWY 92 Project: Bon Baguette Subdivision: FREWING'S ORCHARD TRACTS Lot: 15 Project Description: Adding(1)backflow preventer, (1)dishwasher,(2)2"floor drains,(2)3"floor drains, (1)ice machine drain,(1) grease trap,(2)primers,(1)non-food sink(3)food sinks,(1)water closet&(1)water heater.Capping(1)clothes washer. Replacing/relocating(3)non-food sinks&(1)water closet. Contractor: MODERN PLUMBING Owner: ROIC OREGON LLC 11120 SW INDUSTRIAL WAY 8905 TOWNE CENTRE DR, STE 108 TUALATIN, OR 97062 SAN DIEGO, CA 92122 PHONE: 503-691-6166 PHONE. FAX: 503-691-6771 FEES Quantity Description Date Amount 1 ea Backflow Preventer 11/05/2015 $31.27 Specifics: 1 ea Dishwasher 11/05/2015 $25.02 1 ea Fixture/Sewer Cap 11/05/2015 $25.02 Type of Use: COM 4 ea Floor Drain/Floor Sink/Hub 11/05/2015 $100.08 Class of Work: ALT 1 ea Ice Maker 11/05/2015 $12.51 Type of Const: 1 ea Interceptor/Grease Trap 11/05/2015 $25.02 Occupancy Grp: 2 ea Primer 11/05/2015 $25.02 Stories: 3 ea Sink 11/05/2015 $75.06 4 ea Lavatories 11/05/2015 $100.08 2 ea Water Closet 11/05/2015 $50.04 1 ea Water Heater 11/05/2015 $37.52 1 12%State Surcharge- 11/05/2015 $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: . -,/ Permittee Signature: /jN �L� Call 503.639.4175 by 7:00 a.m.for the next available inspection date. C �V 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 Appli C�II`°�`i �1, • Building Fixtures FOR FOR OFFICE USE ONLY City of Ti ar(! Received g ^I(�\ Date/By: II 3 1S Pem,il No.: aO/r-G1D37.'t It 13125 S50 .711 Blvd.,Tigard,503.598.1960 2 (u 7 Plan Review c, n g Phone: 503.718.2439 Fax: 503.548.1460 Other Permit No.: orl,0IG 5-'00/i/ Date/By: ��} TIGARD Inspection Line: 503.639.41 S Date Ready/By: I//b I/.5" '"_-/ rods S See Page 2 for ft Uh �1t,AHU / l Internet: w�ti\w.tigard-orgov Notified/Method: Supplemental Information FEE* SCHEDULE . - - ❑Newconstnlction ❑Demolition Fur special Infanwulo,.use checklist. Description I Qty. I Ea. I Total ®Addition/alteration/replacenient ❑Other: New I-2-family dwellings(includes 100 ft.for each utility connection) --p CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 ❑ I-and 2-family dwelling ®ComulcreiuUinduslriai SFR(2)bath 437.78 --_ - SFR(3)bath 500.32 0 Accessory building CI multi-family - t./'I Each additional bath/kitchen 25.02 builder i ❑Master bui ❑Other: Fire sprinkler(_sq.11.) Page 2 O JOB SITE INFORMATION AND LOCATION Site utilities: Q Job site address: 13500 SW Pacific Highway, Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/Stute/ZIP:Tigard,OR 97223 Footing drain(no.linear ft.:^) Page 2 Suite/bldg./apt.no.:92 I Project name:Bon Baguette Manufactured home utilities 50.03 I Cross street/directions to job site: Manholes 18.76 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: Moo I Lot no.: Fixture or item: Tax map/parcel no.: 01 evo a Moo 5DD Backflow preventer I 31.27 3j J Backwater valve 12.51 DESCRIPTION OF WORK Clothes washer 25.02 Tenant lmprovcment Dishwasher I 25.02 ZS`-6Z.- _ Drinking fountain 25.02 -------------- - - Ejectors/sump 25.02 ❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51 Nam: - - Fixture/sewer cap I 25.02 •0 ' Address: Floor drain/floor sink/lmb q 25.02 WO.08 Garbage disposal 25.02 City/State/ZIP: Ilose bib 25.02 Phone:( ) Fax:( ) lee maker 1 12.51 t2-s1 0 APPLICANT ❑ CONTACT I'1•:RSON interceptor/grease trap 1 25.02 7,6'02/ Business name:Modern Plumbing Co, Medical gas(value:$ ) Page 2 Primer % 2 12.51 vc,p - Contact name:Donald George Roof drain(commercial) 12.51 Address: 11120 SW Industrial Way,Bldg.9-3 Sink/basin/lavatory/p09 6Init, f 25.02 r75,1 U City/State/ZIP:Tualatin,OR 97062 Solar units(potable water) 62.54 Phone:(503)691-6166 Fax::(503)691-6771 Tub/shower/shower pan - 12.51 E-mail:deborahrii/modernplumbing.us Urinal 25.02 Water closet 2 25.02 _60,69 (O\'1'lt SCtOR Water heater 1 37.52 J.J z. Business name:Modern Plumbing Co. _ Water piping/DWV 56.29 Address: 11120 SW industrial Way,Bldg.9-3 Other: 25.02 44 City/Slate/ZIP:Tualatin,OR 97062 Subtotal 41-81-701-7-606. 1.g.f- T 0(r. Phone:(503)691-6166 Fax:(503)691-6771 Minimum permit fee: $72.50 CCR Lie.:87906 'lumbing Lie.no.:34.250PB Plan review (25%of permit fee) /040 ��� -- State surcharge(12%of permit fee) V Authorized signature: // , .._ TOTAL PERMIT FEE q n Print name:Deborah George G'� - Date:1,d '30 ---1,5n 'this permit application expires Ira permh Is not obtained\sitbin 180 days N 7 vv after it has been accepted as complete. e •Fve methodology set by Tri-County Building Industry Service Board. 1,�11 1:\nuitdini0Permils'PL\[U-Pe.miiApp.doe 10:01/09 440-1616T(leb2/CO\Uk'En) 6)1° Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site IJtiltties Qt I CC(it) lot ti • Footing drain-l'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 S233.20 Sewer- 1st 100' 62.54 7,201 and greater S327.54 Sewer-each additional 100' 37.52 Water Service-1st 100' 62.54 Medical Gas Systems: wuter se,vice-each addition,' 100, 37.52 Perfliit•sl?,ce: -.„ SWIM&Rain Drain-1st 1(10' 62.54 $1.00 to$5,000,00 Minimum fee S72.50 Storm& Rain Drain-each additional 100' 37.52 $5,001.00 to S10,000.00 S72.50 for the first$5,000.00 and SL 52 for -- each additional S100.00 or fraction thereof,to and including S10,000.00. Inspection of existing plumbing or for S10,001.00 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 S25,000.00. Inspections outside of nonnal business 90.00/hr S25,001.00 to S50,000.00 S379.50 for the first 525,000.00 and$1.45 for hoots(minimum charge-2 hours) each additional$100.00 or fraction thereof,to Reinspeetion Fees 90.00/11r and including$50,000.00. Additional plan review for revisions 90.00/hr S50,001.00 and up $742_00 for the first$50,000.00 and$1.20 for (minimum charge–1/2 hour) each additional S100.00 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 bkvisture-71'Spe Plan Rc%m % fot Plumbing Inst illations Fixture Typ.efor , „ • Repia'ee/.. Plan review is required for any of the following. Work Performed: ' • 'Added Re16.e.:•de.•. 13aptistry/Font Please check all that apply. Bath -Tob/Shower 0 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 Thin 0 New exterior plumbing site utilities for any complex structure Cuspidor/Water Aspirator as defined in OAR918-780-0040. Dishwasher -Commercial — 0 Medical gas and vacuum systems for health care facilities. -Domestic El Any multipurpose fire sprinkler system. Drinking Fountain U Any complex structure as defined in OAR9 I 8-7 80- 0 4 0. Eye Wash Floor Drain/sink Submit 2 sets of plans with any of the above. Car Wash Drain Garbage -Domestic–non-food 0 Isometric or riser diagram is required for new buildings Disposal -Domestic–food related that meet the qualifications above. -Commercial–food related -Industrial-thod related Ice Mach./Refrig.Drains Oil Separator(Gas Station) Comments regarding fixture work: Rec.Vehicle Dunip Station Shower -Gang Sink/Lay -Non-food related — -Bradley -Commercial-food related 3 -Service Swimming Pool Filter Washer-Clothes *Note: If the fixture work under this permit results in an Water Extractor. increase of sewer El)Us,a sewer permit will be issued and Water Closet-Toilet J 1 fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. Other Fixtures: CAUsers\mary\Desktop\PLMF_PermitApp(6).doc 2 • ca. 11120 SW Industrial Way, Bldg. 9 - 3 Tualatin. OR 97062 CCB #87906 PEEZ:a0) 0 info©modernplurnbing.us 503.691.6166 FAX COVER SHEET Attention: Debi City of Tigard Date: October 30, 2015 From: Deborah There are _ 3 page in this transaction, including this one. RE: 13500 SW Pacific Hwy, Suite 92 Attached please find the permit application for the above address. Please let me know when the permit fees are calculated and I will pay them online. Thank you Deborah Deborah @modernplumbing.us Fax 503 691 6771 Tenant Name: Bon Baguette Accumulative Sewer Tally SWR# 2015-00141 1 I GARD Site Address: 13500 SW Pacific Hwy#92 PLM# 2015-00372 Parcel#: 2S 102CC00500 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 1 4 1 4 -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 2 4 2 4 -3 inch 5 0 0 2 10 2 10 -4 inch 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 1 1 1 1 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 1 2 1 2 -Bradley 5 0 0 0 0 0 -Com/Sery/Util-Food Related 3 0 0 3 9 3 9 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 1 6 1 6 0 0 Urinal 6 0 0 0 0 0 Previous EDU Count 0 0 Capped EDU Credit 0 TOTALS 0 0 1 6 11 _ 36 10 30 Current Fixture Value 30 divided by 16= 1.875 Current EDU 1 EDU= $5,100.00 Previous Fixture Value 0 divided by 16= 0.000 Previous EDU Change _ 30 divided by 16= 1.875 over (under) $ 9,588.00 Enter EDU Change Here 1.880 * *Round EDUs to the nearest 1/100th: a count ending in.005 shall be rounded up to.01,and a count ending in.014 or less shall be rounded down to.01. Notes: Authorized Name/Signature: Debbie Adamski Date: 11/5/2015 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. r I:\Building\Sewer Tally\SewerTallySheet_51(X)_070115.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 13500 SW PACIFIC HWY 92, TIGARD, OR, 97223 Commercial - Plumbing 399 Plumbing final PASS - No C of O PLM2015-00372 Chip Barnett Previous corrections have been completed Violation Summary: Inspector Contractor