Permit (54) t ' PLUMBING PERMIT
CITY OF TIGARD
Fn
COMMUNITY DEVELOPMENT 'WAR�
Permit#: PLM2017-00328
13125 SW Hall Blvd.,Ti Date Issued: 08/15/2017
TIGARD and OR 97223 503.718.2439 9
Parcel: 1S136DC04500
Jurisdiction: Tigard
Site address: 7501 SW DARTMOUTH ST 100
Project: Winco Subdivision: 1995-013 PARTITION PLAT Lot: 2
Project Description: Install new backflow device for new oven in bakery department.8/16/17,REPRINTED to correct work location to
Deli Department
Contractor: EVOLUTION PLUMBING LLC Owner: WINCO FOOD LLC
7715 NE 33RD DR SUITE D ATTN: TAX DEPARTMENT
PORTLAND, OR 97211 PO BOX 5756
BOISE, ID 83705
PHONE: 503-655-3388 PHONE:
FAX: 503-305-8373
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 08/15/2017 $31.27
Specifics: 1 12%State Surcharge- 08/15/2017 $8.70
Plumbing
Type of Use: COM 41 ea Minimum Fee Adjustment- 08/15/2017 $41.23
Class of Work: ALT Plumbing
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 quest'.•- •UNC by calling 503.232.1987 or 1.800.332.2344.
•
Issued =y: Permittee Sign. ure:
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.
Debbie Adamski
From: Shaina Pasi <shaina.pasi@evoplumbing.net>
Sent: Wednesday, August 16, 2017 10:10 AM
To: Debbie Adamski
Subject: RE: PLM2017-00328, 7501 SW Dartmouth, Winco
Good Morning Debbie—
Is it possible to revise our permit to say Deli department and not Bakery?Just got a call from the inspector that it said
Bakery on our permit. Please advise.
Thank you,
Shaina
From: Debbie Adamski [mailto:DEBBIE@tigard-or.gov]
Sent:Tuesday, August 15, 2017 7:54 AM
To:Shaina Pasi
Cc:#Building Permit Technicians
Subject: PLM2017-00328, 7501 SW Dartmouth, Winco
Shaina,
Attached is a copy of the issued permit for Winco. You can request inspections whenever you are ready.
Debbie Adamski
Senior Building Permit Technician
City of Tigard I Community Development
13125 SW Hall Blvd.,Tigard, OR 97223
503-718-2450
DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail
may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained
by the City of Tigard in compliance with the Oregon Administrative Rules"City General Records Retention Schedule."
1
INCITY OF TIGARD PLUMBING PERMIT
'' COMMUNITY DEVELOPMENT Permit#: PLM2017-00328
TGAD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/15/2017
Parcel: 1 S136DC04500
Jurisdiction: Tigard
Site address: 7501 SW DARTMOUTH ST 100
Project: Winco Subdivision: 1995-013 PARTITION PLAT Lot: 2
Project Description: Install new backflow device for new oven in bakery department.
Contractor: EVOLUTION PLUMBING LLC Owner: WINCO FOOD LLC
7715 NE 33RD DR SUITE D ATTN: TAX DEPARTMENT
PORTLAND, OR 97211 PO BOX 5756
BOISE, ID 83705
PHONE: 503-655-3388 PHONE:
FAX: 503-305-8373
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 08/15/2017 $31.27
Specifics: 1 12%State Surcharge- 08/15/2017 $8.70
Plumbing
Type of Use: COM 41 ea Minimum Fee Adjustment- 08/15/2017 $41.23
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct.- • : •UNC by calling 503.232.1987 or 1.800.332.2344.
Issu d By: , / , Permittee Si.nature:
/ ' ,/ AP ! i /eS2----------.
Call 503.639.4175 by 7:00 a.m.for the next available' spection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
From: 08/10/2017 14:34 #227 P.001/002
Plumbing Permit AppI'
Rtt7
tIVEP
Building Fixtures FOR OFFICE USE
ONLY
City of Tigard n^ r yReceived
N . 13125 SW Hall Blvd.,Tigard,ORl-1A7BP33. 0 2017 Date/By: ��y/f� Permit No� ��.�f�
Phone: 503.7182439 Fax: 503.598.1960 Plan Revie �/
TIGnKD Inspection Line: 503.639.41�S1" jOFT[GA .D Date/By:y. Other Permit No.:
Internet: www tigard ocgov Date Ready/By: Ions See Page 2 for
Notified/Method: Supplemental Information
❑New construction 0 Demolition For special information use checklist
Ei Description ! Qty. I Ea. I Total
Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
t ''.1� *_t* ._._ p a ar6. . : '- , �. ,? SFR(1)bath 312.70
❑ 1-and 2-family dwelling El Commercial/industrial SFR(2)bath 437.78
0 Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
0 Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
O,$x31TE Il l'f11<3M AT/JO)l IKI•, ATI J '.: Site utilities:
Job site address: 75 0 1 SW Vt rt U butyl}-}y1 Et Catch basin or area drain 18.76
DryweCity/State/ZIP: l 1 �v/{ Ok o(72,2.$
Footing
i,leach line,or trench drain_ 1ge 2
t ` / Footing drain(no.linear ft: ) Page 2
Suite/bldg./apt.no.: Q Q Project name: N I nL D -22 Manufactured home utilities
✓ 50.03
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: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer1 31.27 M.2"7
` . ' . Backwater valve 12.51
(Y161-A. VIM VAC W`DvN c VICe."':'for._ti: Clotheswasher25.02
n1p'/�t p'n �/� n /��j ,�{.�,�^ y. Dishwasher 25.02
W Dv en �1 I LG� cit,pm 1 !Y l "t ' Drinking fountain 25.02
Ejectors/sump 25.02
_: .411-ii iiki'ra fi 7 1 Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub
Address: 25.02
Garbage disposal 25.02
City/State/ZIP:
Hose bib 25.02
Phone:( ) Fax ( ) Ice maker 12.51
A -i64 t DNTA 3• iii' 1 Interceptor/grease trap 25.02
Business name: ��u bt ykuigi 1t 1(' S Lit, Medical gas(value:$ ) Page 2
Contact name:S V I j/ l li1/1 k J Primer 12.51
1J Roof drain(commercial) 12.51
Address: 7715 m , Dv. Su ii-c,Z Sink/basin/lavatory 25.02
City/State/ZIP: 1)()Vila 1 V l D - an�t I Solar units(potable water) 62.54
Phone:(, 3,) ty✓✓• '�✓Ub Fax::(6,& 366, 9)21 Tub/shower/shower pan 12.51
E-mailt,,�I 1/11 V .DL%!0 O y U P!U ►O i r l�� U Urinal 25.02
S CONT CTOR f l Water closet 25.02
37.52
Business name /(j 1,I t-t D V pi.LA i,i t/ LUG Water pip ng/DW V 56.29
Address: 77 5 N5 L�nV/ 1 Dv S-ul Z Other: 25.02
City/State/ZIP: vo�/�'� fj O . qi') I I Subtotal 7j 1.Z.i
Phone:(SA W% 3o9� Fax:(�O DO• (�7.19 Minimum permit fee: $72.50 -72-6C)-
CCB Lie.: (Bei g7 W v Plumbing Lic.no.: N6(($jj✓✓31.I' Plan review (25%of permit fee)
State surcharge(12%of permit fee) $.10
Authorized signature:-C _ f TOTAL PERMIT FEE 81.1 v
Print name: V► i l i 1/1,91--47,6 f a Date: 7/10/ '1 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 Term itslPLMU-PermitApp.doc 10.0109 440-4616T(10•02,COM•WEB)
From: 08/10/2017 14:34 #227 P.002/002
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
-:n � .,. � � �� »
Footing dram-1"100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37,52 2,001 to 3,600 $169.69
Sewer-1st 100' 62.54 3,601 to 7,200 $233.20
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
Storm&Rain Drain-1st 100' 62.54 � ` ��� y •u "".. -.
$1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to SI 0,000.00 $72.50 for the first$5,000.00 and$1.52 for
each additional$100.00 or fraction thereof,to
and including$I0,000.00.
f 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 fec 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*.
' Quanti v 4 Fixtur4 3 yps .,,4i l w' 1„1t1 $I18 3[1 3
JVYorkE� orme8 _ moped°- Added ]ReToca Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath Tub!Shower ❑ 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 0 Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3.'
Car Wash Drain $ii lletlt'ic orThS£ 11Rg a311.
Garbage -Domestic-non-food 0N Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter
Washer-Clothes *Note: If the fixture work under this permit results in an
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: &G1<f-foi,3 }
http://www.tigard-or.gov/document_center/Building/PLMF_PermitApp.dC
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
7501 SW DARTMOUTH ST 100, TIGARD, OR,
97223
Record Type: Record ID:
Commercial - Plumbing PLM2017-00328
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . 3/4" watts RP backflow device, model LF 009M3, serial #161094, for new oven,
located on wall by fryers - ok with test.
Violation Summary:
Inspector Contractor