Permit (179) III CITY OF TIGARD PLUMBING PERMIT
_§ COMMUNITY DEVELOPMENT
Permit#: PLM2018-00384
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/09/2018
T l( h I=.C) 9 Parcel: 2S102CC00500
Jurisdiction: Tigard
Site address: 13560 SW PACIFIC HWY
Project: Starbucks Subdivision: None Lot: None
Project Description: Replace and/or relocate existing fixtures: (7)floor drains/floor sinks,(1)grease interceptor,(1)primer,(2)backflow
devices and(5)food related sinks for tenant improvement.
Contractor: COLUMBIA CONSTRUCTION INC Owner: ROIC OREGON LLC
28170 BOBERG RD 8905 TOWNE CENTRE DR, STE 108
WILSONVILLE, OR 97070 SAN DIEGO, CA 92122
PHONE: 503-427-0304 PHONE:
FAX:
FEES
Quantity Description Date Amount
2 ea Backflow Preventer 08/09/2018 $62.54
Specifics: 7 ea Floor Drain/Floor Sink/Hub 08/09/2018 $175.14
1 ea Interceptor/Grease Trap 08/09/2018 $25.02
Type of Use: COM 1 ea Primer 08/09/2018 $12.51
Class of Work: ALT 5 ea Sink 08/09/2018 $125.10
Type of Const: 1 12%State Surcharge- 08/09/2018 $48.04
Occupancy Grp: Plumbing
Stories:
Total $448.35
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: i(.9. Permittee Signature:
)0..itfrCtAA_, IIVMAIV
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 Application ,t- . , a 7 c''
BuP eol3- oozo:
Building Fixtures ' �� a„IV "` '"
City of Tigard H U U9 Z018 Received (:' ��p 4 Permit No/[/7 ,/,-423 5/
III13125 SW Hall Blvd.,Tigard,OR 97223Date/By: !/
i ;,;.',:.;i„\11,::.2;..:-'-;
Plan Review
Phone: 503.718.2439 Fax: 503.598.1 1' 0 4 ate/By: Other Permit No.:
Inspection Line: 503.639.4175 r pp �I ,o r ('? f?1 ;(__,I.'15ate Ready/By: Juris: H See Page 2 for
T I G A R D Internet: www.tigard-or.gov ��4 � �" Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
0 New construction 0 Demolition For special information use checklist
Description Qty. Ea. I Total
14 Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ 1-and 2-family dwelling [.ti Commercial/industrial SFR(2)bath 437.78
0 Accessory buildingMulti-family SFR(3)bath 500.32
0
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
1 Catch basin or area drain 18.76
Job site address: 1,3 s--6 0 S Gd PcLc �y c 14(1
- �{{ pp Drywell,leach line,or trench drain 18.76
City/State/ZIP:
Cl iird i9/ ct 7 Z Z? Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: S'At.r b'vr 41 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: 1 Lot no.: Fixture or item: _
Tax map/parcel no.: Backflow preventer 31.27
;{ Backwater valve 12.51
DESCRIPTION OF WORK ;
r 6
fy '` Clothes washer 25.02
C- 1(,�,VL5 V I Afi Q 1�J.�'C(/ (7l^ 6 -a ' S/h�v Dishwasher 25.02
6 £lit F10. C- hkG1 t/I✓ Drinking fountain 25.02
Ejectors/sump 25.02
C] PROPERTY OWNER I 9 TENANT ' ' Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
ri= Interceptor/grease
APC.A.NT ' ❑ CONTACT PERSON trap ' 25.02
Medical gas(value:$ ) Page 2
Business name:
Contact name: Primer12.51
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory ,5 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: Colli Wt,hl`L( � Th, Water piping/DWV 56.29
Address: k k�
�.,�� ck Ke, Other: 25.02
City/State/ZIP: +�O�L,,t d` R c170.0 0 Subtotal ;�2C' , /
VMinimum permit fee: $72.50
Phone:(,SVS) q?7 _ Os og Fax:( )
? Plan review (25%of permit fee)
CCB Lic.: 1 et q UL) Plumbing Lic.no.: Fe._11(6) State surcharge(12%of permit fee) �/J r i ti
Authorized signature:vTOTAL PERMIT FEE
Print name:
Oatite1414, Cik- Date: SIC Ii g This permit application expires if a permit is not obtained within 180 days
[ / after it has been accepted as complete.
v *Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(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-15'100' 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' 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 •
Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee:
$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*. Plan Review for Plumbing Installations
Quantity by Philtre Type Plan review is required for any of the following.
Fixture Type for Replace! Please check all that apply.
Work Performed: Capped Added Relocate
Baptistry/Font
0 Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
-Jacuzzi/Whirlpool
Car Wash: Each Stall
0 New exterior plumbing site utilities for any complex structure
Drive tall as defined in OAR918-780-0040.
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system.
Domestic 0 Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
3" Isometric or Riser Diagram
4,>
0 Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related fik
-Bradley
-Com/Serv/Util food related
-Service *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\PLMF PermitApp.doc 08/04/2011 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13560 SW PACIFIC HWY, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2018-00384
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . Plumbing final approved.
2. 1/2" Watts RP device serial #108758 & #180730 Approved with test
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13560 SW PACIFIC HWY, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2018-00384
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor