Permit CITY OF TIGARD PLUMBING PERMIT
1111
s . ' COMMUNITY DEVELOPMENT Permit#: PLM2020-00171
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/30/2020
T t[, +R,L7 9 Parcel: 1 S136AD04001
Jurisdiction: Tigard
Site address: 11539 SW PACIFIC HWY
Project: Burger King Subdivision: VILLA RIDGE Lot: 7
Project Description: CAP(1)urinal, relocate(2)sinks and(2)water closets.
Contractor: AL'S PLUMBING Owner: PACIFIC TERRACE COMMERCIAL TWO L
5655 CROSSLER CT. S. 833 NW 170TH DR
SALEM, OR 97306 BEAVERTON, OR 97006
PHONE: 503-508-0041 PHONE:
FAX: 503-375-3444
FEES
Quantity Description Date Amount
1 ea Fixture/Sewer Cap 04/27/2020 $25.02
Specifics: 2 ea Lavatories 04/27/2020 $50.04
2 ea Water Closet 04/27/2020 $50.04
Type of Use: COM 1 12%State Surcharge- 04/27/2020 $15.01
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $140.11
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:
&X.-6/1-
7i 1z.r ; 9 ef,q,/ '��'/nL� / ! �'�77C/'l�
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
. Building Fixtures ilECEIVED FOR OFFICE USE ONLY
City of Tigard Received / /�O `�. Permit N ���`7/
!PI _ • 13125 SW Hall Blvd.,Tigard,OR 97223 APR 1 b 2020 PlDan By: �Ol
Phone: 503.718.2439 Fax: 503.598.1960 Date/By:an Review Other Permit No.:
r�� �2
Inspection Line: 503.639.41.75 CITY OF 1)GAfiri UateRead/B Juris: ® See Page2for
TIGARDx_� Y y:ey//2404,1 ��
Internet: www.tigard-or.gov -yi yy �,.., .Nolif�ied,/�Method. Supplemental Information
TYPE OF WORK#� I( �� 1b,�r�l� ti "lL leg FEE* SCHEDULE
O New construction 0 Demolition For special information use checklist.
Description I Qty. I Ea. I Total
�]s 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 ❑Conrmerciallindustrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler(_sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 11539 SW Pacific Hwy. Catch basin or area drain 18.76
City/State/ZIP: Tigard, OR 97223 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: Burger King Remodel
Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
SW 71 st Ave and SW Pacific Hwy 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.: 1 S 136AD04001 Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Exterior and interior remodel.Aesthetic&branding upgrades to exterior and
Dishwasher 25.02
interior. Restroom upgrades and finishes. Dining room finishes. Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER I l21 TENANT Expansion tank 12.51
Name: Ambrosia QSR Fixture/sewer cap / 25.02 air 0,�
Address: 522 SW 5th Ave. Suite 925 Floor drain floor sink hub 25.02
Garbage disposal 25.02
City/State/ZIP: Portland, OR 97204
Hose bib 25.02
Phone:(503 ) 781-8967 Fax:( ) Ice maker 12.51
® APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Ken McCracken,Architect Medical gas(value:$_) Page 2
Contact name: Erick Peterson Primer 12.51
Roof drain(commercial 12.51
Address: 19120 SE 34th Street, Suite 115
Sink/basie/lavatory 2 25.02 50.04
City/State/ZIP: Vancouver,WA 98683 Solar units(potable water) 62.54
Phone:(503 ) 851-0359 Fax: :( ) Tub/shower/shower pan 12.51
E-mail: epeterson@pmdginc.com and cgilbert@pmdginc.com Urinal 25.02
Water closet 2 25.02 50.04
CONTRACTOR
Water heater 37.52
Business name:Ai's Plumbing Water PP✓
tP m DWV 56.29
Address:5655 Crossler Ct. S. Other: 25.02
City/State/ZIP:Salem, OR 97306 Subtotal -14G:ee'
Phone:(503)508 0041 Fax:( ) Minimum permit fee: $72.50 /2-.5:it,
Plan review (25%of permit fee)
CCB Lic.:95618 Plumbing Lic.no.:6745
// � ' / A� State surcharge(12%of permit fee) /..re7/
Authorized signature: ck4 -""7 TOTAL PERMIT FEE fyg „//
Print name:Chip Lape l t Date:4/10/20 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\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- 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-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
Valuation: Permit Fee:
Storm&Rain Drain-1st 100' 62.54 $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 fast$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 Fixture 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 ❑ Any new commercial building with water service 2"and
Bath: TubiShower greater,except systems designed and stamped by licensed
-Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
Dr ve Thm as defined in OAR918-780-0040.
Cuspidor/Water Aspirator ElMedical 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 Diagram
0 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 Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lay/Bar non-food related 2
-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 2 plumbing permit can be issued.
Urinal
Other Fixtures:
I:1Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
.IIII Accumulative Sewer Tally
Tenant Name: Burger King SWR# N/A
TIGARD Site Address: 11539 SW Pacific Hwy PLM# 2020-00171
Parcel#: 1 S 136AD04001
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s value count added# added value total#s total values
Baptistry/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 0 0 0 0
-3 inch 5 0 0 0 0 0
-4 inch 6 0 0 0 0 0
-Car Wash 6 0 0 0 0 0
Garbage Disposal:
-Domestic(to 3/4 III') 16 0 0 0 0 0
-Commercial(to 5 I IP) 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
Rue.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 0 0 0
-Bradley 5 0 0 0 0 0
-Com/Serv/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 0 0 0 0
Urinal 6 0 1 6 0 -1 -6
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 1 6 0 0 -1 -6
Current Fixture Value -e divided by 16= -0.375 Current EDU 1 EDU= $5,800.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -6 divided by 16= -0.375 over (under) $ (2,204.00)
Enter EDU Change Here -0.380 *
*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: .38 EDU CREDITS.
Authorized Name/Signature: Dianna Omelas Date: 4/24/2020
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.
1:\Building\Sewer Tally\SewerTallySheet_5800_070119.xlsx