Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2019-00161
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/08/2020
Parcel: 2 S 115BA02500
Jurisdiction: Tigard
Site address: 16200 SW PACIFIC HWY Z3
Project: Starbucks Subdivision: 2004-015 PARTITION PLAT Lot: 1
Project Description: Site utilities for conversion of Home Street Bank into a Starbucks coffee shop.
Contractor: HALS CONSTRUCTION INC Owner: SN PROPERTIES PARTNERSHIP
20666 S HWY 213 1121 SW SALMON ST
OREGON CITY, OR 97045 PORTLAND, OR 97205
PHONE: 503-656-4999 PHONE:
FAX: 503-656-5961
FEES
Quantity Description Date Amount
1 ea Catch Basin or Area Drain 01/08/2020 $18.76
Specifics: 1 ea Manholes 01/08/2020 $18.76
146 If Storm Sewer 01/08/2020 $100.06
Type of Use: COM 1 Plan Review 01/08/2020 $34.40
Class of Work: ALT 1 12%State Surcharge- 01/08/2020 $16.51
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $188.49
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 OU C by c ling 50 232.1987 or .800.332.2344.
Issued By: Permittee Signature:
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
Site Utilities FOR OFFICE USE ONLY
City of Tigard Received / Permit
• 13125 SW Hall Blvd.,Tigard,OR 9722kE
ED Date/By: �( CLr , dolq-g)l6(
111 GE
w Plan Review Other Permit No.:���
Phone: 503.718.2439 Fax: 503.598. {r+ Date/By: 4`)4'/y '/-/-,. 11 -2.a15
Inspection Line: 503.639.4175 Date Read B r __melons. ® See Page 2 for
TIGARD O ��� Notlfied/Method:�f 1 /Z� 'f Supplemental Information
Internet: www.tigard-or.gov !!!
TYPE OF WORK
elix , Iryi,6 ga`,x ' FEE* SCHEDUI:E
(, For special information use checklist❑New construction El De�i�i�rt ,S,Q
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®Addition/alteration/replacement ❑( i�o�, Description I Qty. I Ea. I TotalNew 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION - SFR(1)bath 312.70
❑ I-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
❑Accessory buildingMulti-family SFR(3)bath 500.32
0
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler(_sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:16200 SW PACIFIC HWY Catch basin or area drain 1 18.76 ( (o
Drywell,leach line,or trench drain 18.76
City/State/ZIP:TIGARD,OR 97224 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.:Z3 Project name:STARBUCKS Manufactured home utilities 50.03
Cross street/directions to job site:PACIFIC IIWY W&SW DURIHAM RD Manholes 1 18.76 f q;'-1 6
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.:_) 146% Page 2 100,0 6
Water service(no.linear ft.: ) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.:2S115BA02500 Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve I2.51
Clothes washer 25.02
New length of storm sewer with catch basin and manhole access as part of overall Dishwasher 25.02
site work for tenant build-out Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER l ® TENANT ,Expansion tank 12.51
Name:STARBUCKS COFFEE COMPANY Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:2401 UTAH AVENUE SOUTH
Garbage disposal 25.02
City/State/ZIP:SEATTLE,WA 98134 Hose bib 25.02
Phone:(206)318-1575 Fax:( ) Ice maker 12.51
® APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:GPD GROUP Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:GUY RIPLEY
- Roof drain(commercial) 12.51
Address:4600 E WASHINGTON ST.#310 Sink/basin/lavatory 25.02
City/State/ZIP:PHOENIX,AZ 85034 Solar units(potable water) 62.54
Phone:(602)733-6202 Fax::( ) Tub/shower/shower pan 12.51
E-mail:gripley@gpdgroup.cotn Urinal 25.02
_ Water closet 25.02
. .)f CONTRACTOR
Water heater 37.52
Business name: 1-14 e, C ovt'Si:r u.c..-4a1 .K�, Water piping/DWV 56.29
Address: 90b66 S ai3 c51 usbK Other: 25.02
City/State/ZIP: O C,. enot115 Subtotal I'3y9,5v
Phone:(cbS) Cy-'(y i999 Fax:( ) Minimum permit fee: $72.50
CCB Lic.: 391 Plumbing Lic.no.: 3-519 pia Plan review (25%of permit fee) ,
State surcharge(12%of permit fee) 1
Authorized signature: TOTAL PERMIT FEE i 8 s t elq
�y This permit application expires if a permit is not obtained within 180 days
Print name:GUY RIPLEY Date' 4-1/fr tc / after it has been accepted as complete.
Z.- ._...- *Fee methodology set by Tri-County Building Industry Service Board.
I:tBuilding\Permits\PLMU-PermitApp.doc 10/01/09 440.1616700 'COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities (ea) 3otal Square Footage: Permit
Footing drain-l s`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' 62.54u fee Gu2�54 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain each additional 100' / 37.52 39 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
r x ; 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$100.00 or fraction thereof.
Subtotal: 1 ,.:U4
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accuratelyreport fixtures could result in increased sewer fees*. e
' guanti#y iy � Plan review is required for any of the following.
Fi1ture Type for Please check all that apply.
Work Performed: G$PPe+i ; added R�lgcafe„
❑ 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
Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system.
Domestic ❑ 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 Diiagiraii f _'
4„ ❑ 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
-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:
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