Permit Support Document (2) ,� CITY OF TIGARD PLUMBING PERMIT
'r'# I ' COMMUNITY DEVELOPMENT Permit#: PLM2019-00119
Date Issued: 01/14/2020
T[G A R.n 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S115BA02500
Jurisdiction: Tigard
Site address: 16200 SW PACIFIC HWY Z3
Project: Starbucks Subdivision: 2004-015 PARTITION PLAT Lot: 1
Project Description: Interior plumbing for a new Starbucks coffee shop with outdoor seating and drive thru facilities:
Contractor: D P PLUMBING Owner: SN PROPERTIES PARTNERSHIP
15825 NE SPRINGBROOK RD 1121 SW SALMON ST
NEWBERG, OR 97132 PORTLAND, OR 97205
PHONE: 503-537-9492 PHONE:
FAX: 503-538-4306
FEES
Quantity Description Date Amount
2 ea Backflow Preventer 01/14/2020 $62.54
Specifics: 1 ea Dishwasher 01/14/2020 $25.02
1 ea Expansion Tank 01/14/2020 $12.51
Type of Use: COM 6 ea Floor Drain/Floor Sink/Hub 01/14/2020 $150.12
Class of Work: ALT 2 ea Hose Bib 01/14/2020 $50.04
Type of Const: 2 ea Ice Maker 01/14/2020 $25.02
Occupancy Grp: 1 ea Interceptor/Grease Trap 01/14/2020 $25.02
Stories: 1 ea Primer 01/14/2020 $12.51
17 ea Sink 01/14/2020 $425.34
2 ea Water Closet 01/14/2020 $50.04
1 ea Water Heater 01/14/2020 $37.52
125 Misc Other Fee 01/14/2020 $125.10
25 If Sanitary Sewer 01/14/2020 $62.54
1 ea Fixture/Sewer Cap 01/14/2020 $25.02
1 Plan Review 01/14/2020 $272.09
1 12%State Surcharge- 01/14/2020 $130.60
Plumbing
Total $1,491.03
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 c ' g 503.23 1987 or 1. .332.2344.
Issued By: ---. ermiXtee Signature:
04)-GLoki Nkiii
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.
Accumulative Sewer Tally
SWR# 2019-00138
11111
• Tenant Name: STARBUCKS
ICAF1 Site Address: 16200 SW PACIFIC HWY PLM# 2019-00119
Parcel#: 2S115BA02500
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 1 J 4 1 4
-Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 0 0 0
Eye Wash 1 0 0 f 0 0 0
Floor Drain/Sink: -2 inch 2 0 0 1 C/ 2 1 2
-3 inch 5 0 0 5 c// 25 5 25
-4 inch 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
f
Ice Machine/Refrigerator Drain 1 0 0 2 �/ 2 2 2
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 5 17 10 4 8
-Bradley 5 0 0 0 0 0
-Com/Scrv/Util-Food Related 3 0 2 / 6 12 ✓ 36 10 30
Swimming Pool Filter 1 0 0 0 0 0
Washer-Clothes 6 0 0 0 0 0
Water Extractor 6 0 0 7 0 0 0
Water Closet-Toilet 6 0 1 / 6 2 t./ 12 1 6
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 4 14 28 91 24 77
Current Fixture Value 77 divided by 16= 4.813 Current EDU 1 EDU= $5,650.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 77 divided by 16= 4.813 over (under) $ 27,176.50
Enter EDU Change Here 4.810 *
*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:BRANDEN TAGGART X2449 Date: 5/2/2019
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:A Building\Sewer Tally\SewerTallySheet 5500_070118.xlsx
Plumbing Permit Application
Building Fixtures Folz OFFICE USE O\1.1
Cityof Tigard Received
g Permit No.:
ll 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By:
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Other Permit No.:
Date/By: _
Inspection Line: 503.639.4175 y ® See Page 2 for
T I G A R D Date Read /By: Juris
www.tigard-or.gov Notified/Method. Supplemental Information
TYPE OF WORK FEE* SCHEDULE
0 New construction 0 Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
.
SFR 1 bath 312.70
y dwelling
and 2-famil
❑ 0 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 ❑Other:
Fire sprinkler( sq.ft.) Page 2
JO :1 Site utilities:
Job site address: Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: 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 a_ 31.27
DESCRIPTION OF WORK Backwater valve 12.51
o.. " Clothes washer 25.02
Dishwasher ( 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I 0 TENANT Expansion tank ' 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 6 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 7. 25.02
Phone:( 9 Fax:( ) Ice maker 12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer I 12.51
Contact name:
Roof dram(commercial) 12.51
Address: Sink/basin/lavatory 1 d 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax: :( Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet N. 25.02
CONTRACTOR I 37.52
Water heater
Business name: Water piping/DWV 56.29
Address: Other: `i 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.: Plumbing Lic.no.:
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name: Date: 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 10/01/09 440-46 16T(10/02/COM/WEB)
SITE COPY
CITY OF TIGARD PLUMBING PERMIT
7111 ■, COMMUNITY DEVELOPMENT Permit#: PLM2019-00119
T i i ,1<,1) 13125 SW Hall Blvd.,Tigard OR 97223 503.718,2439 Date Issued: 01/14/2020
Parcel: 2S 115BA02500
Jurisdiction: Tigard
Site address: 16200 SW PACIFIC HWY Z3
Project: Starbucks Subdivision: 2004-015 PARTITION PLAT Lot: 1
Project Description: Interior plumbing for a new Starbucks coffee shop with outdoor seating and drive thru facilities:
Contractor: D P PLUMBING Owner: SN PROPERTIES PARTNERSHIP,'
15825 NE SPRINGBROOK RD 1121 SW SALMON ST,'
NEWBERG,OR 97132 PORTLAND, OR 97205 ' .,
PHONE: 503-537-9492 PHONE
FAX: 503-538-4306
,
r Quantity Description Date Amou
ii
1 i'; 2 ea Backflow Preventer 01/14/2020 $62.54
`/, Specifics: 1 ea Dishwasher 01/14/2020 $25.02 ` A 4 't
1 ea Expansion Tank 01/14/2020 $12.51 r,'`
Type of Use: COM 6 ea Floor Drain/Floor Sink/Hub 01/14/2020 $150.12 +
4 Class of Work: ALT 2 ea Hose Bib 01/14/2020 $50.04 :,
°a.
Type of Const: 2 ea Ice Maker 01/14/2020 $25.02
Occupancy Grp: 1 ea Interceptor/Grease Trap 01/14/2020 $25.02
Stories: 1 ea Primer 01/14/2020 $12.51
17 ea Sink 01/14/2020 $425.34
2 ea Water Closet 01/14/2020 $50.04
1 ea Water Heater 01/14/2020 $37.52
125 Misc Other Fee 01/14/2020 $125.10
25 If Sanitary Sewer 01/14/2020 $62.54
' 1 ea Fixture/Sewer Cap 01/14/2020 $25.02
1 Plan Review 01/14/2020 $272.09
1 12%State Surcharge- 01/14/2020 $130.60
Plumbing
Total $1,491.03
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 ' g 503.2 1987 or 1.:a Ar.332.2344.
Issued By: 410( / ' Recmittee Signature: ca.4)-U-VPk/
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.
City of Tigard I Permit Center
SIGN-IN SHEET
❑ Planning/Development Services
ll Building 0 Engineering
Date: � ZC * Time in: 1,I3?—
Your Name (First& Lass): ()AtrQL,t
*Phone or email: a7 5/9 7 " '6r-'
Site address(es)/ cation(s):
Permit/Case# (if applicable):
Reason for visit: Check all that apply
❑ Apply for New Permits/Submit Plans
❑ Revise Existing Application/Permit
❑ Pay Fee
❑ Pick Up Ready Permit
❑ OTC Appointment
❑ Scheduled Meeting (with/for):
❑ Code Compliance Case
❑ Public Records Request
$Other: EttiG `t tim,cd-
i
For office use only: Jurisdiction Verification 0 By:
Assisted by Time Assisted:wZ;3 ime Out: /a, rye)
Assisted by: // Time Assisted`,- Time Out:
Assisted by: Time Assisted: Time Out:
Assisted by: Time Assisted: Time Out:
Staff Comments:
1:tCommunity Developments Permit CounterlSign-in Sheets Rev.01/2019
Accumulative Sewer Tally
III Tenant Name: STARBUCKS SWR# 2019-00138
Site Address: 16200 SW PACIFIC HWY PLM# 2019-00119
TIGARD
Parcel#: 2S115BA02500
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 1 4 1 4
-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 1 2 1 2
-3 inch 5 0 0 5 25 5 25
-4 inch 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 2 2 2 2
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 5 6 10 4 8
-Bradley 5 0 0 0 0 0
-i-Com/Serv/Util-Food Related 3 0 2 6 36 10 30
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 2 12 1 6
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 4 14 28 91 24 77
Current Fixture Value 77 divided by 16= 4.813 Current EDU 1 EDU= $5,650.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 77 divided by 16= 4.813 over (under) $ 27,176.50
Enter EDU Change Here 4.810 *
*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: BRANDEN TAGGART X2449 Date: 5/2/2019
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_070118.xlsx
Accumulative Sewer Tally
s Tenant Name: STARBUCKS SWR# 2019-00138
Site Address: 16200 SW PACIFIC HWY PLM# 2019-00119
TIGARU
Parcel#: 2S 115BA02500
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 1 4 1 4
-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 1 2 1 2
-3 inch 5 0 0 5 25 5 25
-4 inch 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 2 2 2 2
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 5 10 4 8
-Bradley 5 0 0 0 0 0
-Com/Serv/Util-Food Related 3 0 2 6 12 36 10 30
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 2 12 1 6
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 4 14 28 91 24 77
Current Fixture Value 77 divided by 16= 4.813 Current EDU 1 EDU= $5,650.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 77 divided by 16= 4.813 over (under) $ 27,176.50
Enter EDU Change Here 4.810 *
*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: BRANDEN TAGGART X2449 Date: 5/2/2019
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.
L\Building\Sewer Tally\SewerTallySheet_5500_070118.xlsx
Table 2.A
FIXTURE UNIT RATINGS (SEWER SYSTEM)
Fixture Fixture Unit
Value
Baptistery/Font 4
Bath
Jacuzzi 4
Tub/Shower Combination 4
Car Wash
Each Stall 6
Drive Through 16
` Cuspidor/Water Aspirator ; 1
Dishwasher
Commercial 4
Domestic 2
Drinking Fountain 1
Eye Wash 1
Floor Drain/Floor Sink(see font note#1)
2-inch 2
3-inch 5 C
4-inch 6
Car Wash Drain 6
Garbage Disposal
horsepower 16 or 0
(see foot note#2) '
%-5 horsepower 32
more than 5 horsepower 42
Ice Machine/Refrigerator Drains 1
Oil Separator(Gas Stations) 6
Recreational Vehicle Dump Station 16
Shower
Gang 1 (per head)
Stall 2
Sink
Hand/Lavatory/Kitchen/Bar Sink-non-food 2
service or utility related use including 5% hp
disposal
Bradley 5
Commercial/Service/Utility Sink-food service 3
related use
Rates and Charges Resolution and Order July 1,2019—June 30,2020
Definition and Application of Fees and Charges
Page 21
. v .
Fixture Fixture Unit
Value
Swimming Pool Filter 1
Washer, Clothes 6
Water Extractor 6
Water Closet,Toilet 6
Urinal 1 6
Any fixture unit rating not addressed in this table shall be calculated pursuant
to the current State Plumbing Code.
1. The District will count the greater of either the number of floor sinks or the units that drain into them, but
not both.
2. Fii.tul C u11i1 V:1uC3 IJ1 gai UC C 7C 11F.:S11Jt Ci1Cu in hut 1-1CSitkni.;:i tlpp1itG iit.n bhci; b
based on the proposed use of the facility. Uses associated with commercial food processing, preparation,
handling,or group food service(cafeterias)shall be charged 16 FU. Uses for individual employee support
(i.e.,employee lunchrooms)shall not be separately charged.
Rates and Charges Resolution and Order July 1,2019—June 30,2020
Definition and Application of Fees and Charges
Page 22