Permit (42) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2018 00183
T E GA D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/27/2018
.
Parcel: 1 S 136DB00201
Jurisdiction: Tigard
Site address: 11565 SW PACIFIC HWY
Project: FRED MEYER Subdivision: None Lot: None
Project Description: Plumbing for TI: CAP(2)2"floor drains,(1)water closet,(1)lay;RELOCATE(15)2"floor sinks,(2)sinks;ADD(2)
2"floor sinks&(4)hose bibs.
Contractor: D&F PLUMBING Owner: FRED MEYER STORES INC
4636 N ALBINA AVE STORE#375
PORTLAND, OR 97217 1014 VINE ST
PROPERTY TAX 7TH FLOOR
CINCINNATI, OH 45202
PHONE: 503-282-0993 PHONE:
FAX: 503-288-0604
FEES
Quantity Description Date Amount
4 ea Fixture/Sewer Cap 04/27/2018 $100.08
Specifics: 17 ea Floor Drain/Floor Sink/Hub 04/27/2018 $425.34
4 ea Hose Bib 04/27/2018 $100.08
Type of Use: COM 2 ea Sink 04/27/2018 $50.04
Class of Work: ALT
Type of Const: 1 12%State Surcharge- 04/27/2018 $81.06
Plumbing
Occupancy Grp:
Stories:
Total $756.60
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: 01X7 /e."1-770
e -770
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 ApplicatioRECEIVED
Building Fixtures
FOR OFFICE USE ONLY
City of Tigard Received .., ..,‘ ,,/-
Date/Eir I/ .4.4g' 1#'
..4PArir. - Ferniit N /,-49e/,3-
1:111 . 13125 SW!Tall Blvd.,Tigard,OR 97223 APR 2 6 2018
t Plait Revic v
' LI -
Phone: 503.718.2439 Fax: 503.598er--OF TIGARD Datc/BY; Other Permit No.:
TIARID s
In pection Line: 503.639.4175
G Date Ready/By:
n
Jur iai 672 See Page 2 for
Internet: www.tigard-or.gov
',DING DI
1,(114.otitied/Method: Supplemental Information
. .
, E OF Wa '" ' - -.- - "-- - • - - ' ' ' ', FEE*' C IEDULF
.,. .,
0 New construction El Demolition For s,ecial information use checklist.
.
jk
Qty. Ea. Total Addition/alteration/replacement 0 Other: Description
New I-2-family dwellings(includes 100 ft.for each utility connection)
. ,
. .. .. . . , .
,
• . . ..E.O RY.- F-G.')NS ' • -- - . „ . SFR(1)bath 312.70
, .
„ . . •
SFR(2)bath 437.78
0 I-and 2-family dwelling Commercial/industrial
- SFR(3)bath 500.32
0 Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
0 Master builder 0 Other:
Fire sprinkler( sq.Ii.) Page 2
OD 5' , N 0 IAT, IC) •AND LO Site utilities:
, , -. ,
. . .. . . .. ....
Job site address: if51.4 pot d'f„Ct 4(2,,... i
s41"VyDryCatch basor area drain 18.76 welt,!ineach line,or trench drain 18.76
City/State/ZIP'
8/Z--
.erre" Footing drain(no.linear ft.:_) Page 2
Suite/bldg/apt,no.: Project name: ere"? me. e..r.s: .2 75 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: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
,, ,,,,•,: •„,..,..-, 4, ,,.",',...",,,.,,,, DESCRIPTION,,ijilii.okk: . ,,.. _ .:!-,,:::,;::, , , : _, Backwater valve 12.51
,,,•.i-', ...;L-•--.1.--„, -..4''•.' ••- '-• ' •-. .:--•• -.4•---- -' • '-'- ': "''''---- ' ''' '''''• Clothes washer
11.&1•41- -. k:1C- )re.5-•-•"- I.i i‘.-:(DOI ifloski 717,101-.Cidig(sk.,12-C-4',-*5.. 25.02
_
... Dishwasher 25.02
r, ,,,- 7
4
A. -ci 2-4 i, Drinking fountain 25.02
.t ,
7,Fi
Coy:73 ipff 1ub (4.4:/15,. I 475, , (4.,a.,,,,
(--
Ejectors/sump 25.02
PROPERTY -:•'- - • ' • Expansion tank _ 12.51
Fixture/sewer cap 1-• s/' 25.02
Name:
Floor drain/floor sink/hub 17 V 25.02
Address:
Garbage disposal 25,02
City/State/ZIP:
Hose bib 1.-- ve'- 25.02
Phone:( ) Fax:( ) Ice maker 12.51
. ..., . .. . ...
25.02. •,,.„-,.,•.''-,-,'..-..r.1., ppL, T.- - -, • , '.: •, . , N •r,•i.) 0 - Interceptor/grease trap
Medical gas(value:S ) Page 2
Business name:
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address:
Sinklbasinllavatory 2_ v"25,02
City/State/ZIP:
Solar units(potable water) 62,54
Phone:( ) Fax: :( ) 'fublshower/shower pan 12.51
•
Urinal 25.02
. l•
F-mai
.. .
,• • . ' •' • .• - .-. . - Water Closet
25.02
C' NTR. cr it
7 s7
Business , ,, / , 1 ,
name: „t3)4i it•-a 1-..'(kJ'sii'D.i.:4,-,,S Water pqiingIDWV 56.29
_
Address: •t-t‘,t" 62 Al iiib.i.;-„,.....( I
Other: 25.02
City/State/ZIP: ("ar-4-142 et 0, eitt.„ el 12_4,7 Subtotal
Phone:(05 )2 97,2.-e7(LI 3 Fax:( Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lie.: 1/63--- ,
Plumbing •
Lie.no '' 1
,4- .-2-3 Pig,
State surcharge(12%of permit Ice) if*/i 676
.
Authorized signature: (2... ' -
TOTAL PERMIT FEE 754 r 6e)
, i, ..,
Print niri
iter0 A-. ...ii 7 ,t
1
Date: 'qt.-2.(0-•-•lf,- This t)ertit application expires if a permit is not ohtained within 150 dos
after it has been accepted as conipleie.
'Fee methodology set by.T.,,i-('ounty linilding Industry Service Board.
I:Ititilein.tri'conit,l'I.N111-PconiiApp.iiiic VI hi IN -140-16.16 Er iii(,2 CONIA1T,Iii
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
•
SiteSiteufaitie 'Qty. -Fe. (ea) Total-
quate''' Footage:.
Footing drain-I"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- let 100' 62.54
7201 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
VAlgatign:- PertnifFee:
Storm&Rain Drain-1st 100' 62.54
$1.00 to$5,000.00 Minimum fcc$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
• each additional$100.00 or fraction thereof,to
:L-Fet(OA) Tot"
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 51.54 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 S100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50.000.00.
Additional plan review for revisions 90.00/1u $50.001.00 and up $742.00 for the first$50,000.00 and 51.20 for
each additional$100.00 or fraction thereof.
(minimum charge.-1/2 hour)
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 in inflations'
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for RaPlacei 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 New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall
as defined in OAR918-780-0040.
-Drive Thru
0 Medical gas and vacuum systems for health care facilities.
CuspidorAVater Aspirator
0 Any multipurpose fire sprinkler system.
Dishwasher: -Commercial
Any complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain
Eye Wash
Submit 2 sets of plans with any of the above.
Floor Drain/sink: 2" 2. /7 2.- v(
o Isometric or riser diagram is required for new buildings
-Car Wash Drain
that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Ivlach.fRefrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station) fg(04,449.-394„,
Rec.Vehicle Dump Station 2-.4.'t ci-14 4-14.7r4.11,
Shower: -Gang efiLtitt( SI l+t6 6 .1-2D AAP. ly5.11-eali
-Stall
Sink: -Lay/Bar non-food related / -// os4 )
61t7pe. _ tif 6'19
-Bradley
-Coin/Sem/UM food related
-Service Z-• *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 plumbing permit can be issued.
Urinal
Other Fixtures:
1:).Building\Permits\PLIvIl_PermitApp.doe 08/04/2011
Accumulative Sewer Tally
I Tenant Name: Fred Meyer SWR# N/A
TI G A K D Site Address: 11565 SW Pacific Hwy PLM# 2018-00183
Parcel#: 1S 136DB00201
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 0 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 2 4 2 4 0 0
-3 inch 5 0 0 0 0 0
-4inch 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 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 1 2 0 -1 -2
-Bradley 5 0 0 0 0 0
-Com/Sery/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 1 6 0 -1 -6
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 4 12 2 4 -2 -8
Current Fixture Value -8 divided by 16= -0.500 Current EDU 1 EDU= $5,500.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -8 divided by 16= -0.500 over (under) $ (2,750.00)
Enter EDU Change Here -0.500 *
*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: Dianna Howse Date: 4/26/2018
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\SewerTallySheet_5500_070117.xlsx
S
Dianna Howse
.cam
From: Randy Moya <randy@d-f-plumbing.com>
Sent: Thursday, April 26, 2018 1:25 PM
To: Dianna Howse
Cc: #Building Permit Technicians; Nate Rotzien
Subject: RE: 11565 SW Pacific Hwy - Fred Meyer
So the new fixtures we are pulling the permit for are
17—Floor sinks for the case drains
4—hose bibs for new cases
2—sinks one pharmacy and one floral
Of the 23 fixtures these are what we are relocating
15—floor sinks
2—sinks one pharmacy one floral
Fixtures we are deleting permanently
2—hub drains
1—water closet
1—lavatory
Actual new fixtures we are adding to the system
2—floor sinks
4—hose bibs
Hopefully this is what you are looking for if you need anything else please feel free to contact me and I will see what a I
can do.
Thanks Nate D&F Plumbing Co
Randy Moya
Email: randy@d-f-plumbinq.com
Phone: 503-282-0993
Fax: 503-288-0604
Website: www.dandfplumbing.com
SINCE 1927
CCB OR#465 WA#CCDAE DFPLU**339N8 WBE#7402
From: Dianna Howse [mailto:Dianna@tigard-or.gov]
Sent:Thursday, April 26, 2018 10:32 AM
To: Randy Moya <randy@d-f-plumbing.com>
Cc:#Building Permit Technicians<TigardBuildingPermits@tigard-or.gov>
Subject: 11565 SW Pacific Hwy- Fred Meyer
Importance: High
1
Hello Randy,
I am processing the plumbing permit that you faxed over. The building permit on file describes the work as"relocating
pharmacy, relocating apparel, and increasing food and refrigerated cases".
The plumbing permit application indicates that all fixtures are new to this space. Are these fixtures for the new "food
and refrigerated cases" area?
Are there any fixtures that will be capped now, or will that come later when they close the existing pharmacy area?
It is helpful to know this information before we create the plumbing and sewer permit for system development fees.
Thank you.
Dianna L. Howse
Building Division Services Supervisor
City of Tigard I Community Development
13125 SW Hall Blvd I Tigard, OR 97223
503-718-2430 Direct 1503-718-2439 Permits
DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail
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2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11565 SW PACIFIC HWY, TIGARD, OR, 97223 August 23, 2018 at 9:07:11 AM
Record Type: Record ID:
Commercial - Plumbing PLM2018-00183
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor