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Permit CITY OF TIGARD PLUMBING PERMIT ffi COMMUNITY DEVELOPMENT Permit#: PLM201 8-005 1 1 Date Issued: 3/2/2022 TICARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S110AC01101 Jurisdiction: Tigard Site address: 11290 SW BULL MOUNTAIN RD Project: Jacksons Food Stores 530 Subdivision: None Lot: None Project Description: Site utilities for a new convenience store,fuel canopy,60 ft.trash enclosure,and a 6 ft.covered recycle enclosure. Contractor: COAST PAVEMENT SERVICES INC Owner: PACWEST ENERGY LLC 11060 SW TONQUIN RD 3450 COMMERCIAL CT SHERWOOD, OR 97140 MERIDIAN, ID 83642 PHONE: 503-227-4515 PHONE: 208-888-6061 FAX: FEES Quantity Description Date Amount 5 ea Catch Basin or Area Drain 01/18/2022 $93.80 Specifics: 2 ea Rain Drain Connector 01/18/2022 $37.52 266 If Sanitary Sewer 01/18/2022 $137.58 Type of Use: COM 774 If Storm Sewer 01/18/2022 $325.18 Class of Work: NEW 156 If Water Service 01/18/2022 $100.06 Type of Const: 1 ea Backflow Preventer 01/18/2022 $31.27 Occupancy Grp: 1 ea Interceptor/Grease Trap 01/18/2022 $25.02 Stories: 1 Plan Review 01/18/2022 $187.61 1 12%State Surcharge- 01/18/2022 $90.05 Plumbing Total $1,028.09 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 Issued By: Permittee Signature: Q /, 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. al. r Plumbing Permit ApplicatioIrCEIV .)', Site Utilities FOR OFFICE. I.SF ONE I City of Tigard Nov1 2y 10 Received Pe • 13125 SW Hall Blvd.,Tigard,OR 97223 'vo V 4010 Plan Rev u! ! l /°7%�7/�/ 1// r/(JJ// Phone: 503.718.2439 Fax: 503.598.1 !fit' I 1�P1ate Review (� 04 Q_�) /�- • III OF T�(`���DateBy: I I- U' I `R/w D ,O�/J I/�C71.() T I G A R D Inspection Line: 503.639.4175 Date Ready/By: tuns: Id See Page 2 for Internet: www.tigard-or.gov 7777r/ tiuilicd/Method.4(' ;111 Ly -- Supplemental Information TYPE OF WO , P• / L°<r t FEE* SCHEDULE.. ®New construction ®Demolition / 1 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) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 El1-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 ❑Accessory building ❑Multi-family 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:11290 SW Bull Mountain Rd Catch basin or area drain 4 18.76 75.04 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.: I Project name:Jacksons No.530 Manufactured home utilities 50.03 Cross street/directions tojoh site:Pacific Hwy Manholes 18.76 Rain drain connector 2 18.76 37.52 Sanitary sewer(no.linear ft.:266) 1 Page 2 137.58 Storm sewer(no.linear ft.: 1 Page 2 287.66 Water service(no.linear ft.:145) 1 Page 2 100.06 Subdivision: I Lot no.: Fixture or item: Tax map/parcel no.:2S110AC01101 Backflow preventer _ 31.27 Backwater valve 12.51 DESCRIPTION OF WORK Clothes washer 25.02 Install plumbing fixtures and plumbing system for new convenience store and Dishwasher 25.02 fueling facility Drinking fountain 25.02 Ejectors/sump _ _ 25.02 ® PROPERTY OWNER I 0 TENANT Expansion tank _ 12.51 Name:PacWest Energy,LLC dba Jacksons Food Stores,Inc. Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address:3450 E.Commercial Ct. Garbage disposal 25.02 City/State/ZIP:Meridian,Idaho 83642 Hose bib 25.02 , _ Phone:(208)888-6061 Fax:(208)888-3585 Ice maker 12.51 ® APPLICANT ® CONTACT PERSON Interceptor/grease trap _ 25.02 _ Business name:Barghausen Consulting Engineers,Inc. Medical gas(value:$ ) Page 2 Primer 12.51 Contact name:Ms.Caryl J.Pinner Roof drain(commercial) 12.51 Address:18215 72nd Ave S Sink/basin/lavatory 25.02 - City/State/ZIP:Kent,WA 98032 Solar units(potable water) 62.54 Phone:(425)656-1063 Fax: :(425)251-8782 Tub/shower/shower pan _ 12.51 E-mail:opinner(dbarghausen.com Urinal 25.02 Water closet 25.02 CONTRACTOR - Water heater 37.52 Business name:TBD +' i_Er ^,� v.*r,„.yz'yvl:x -F.,�-_. WaterpipingJDWV _ 56.29 Negress: gr 1 (( Other: 25.02 City/State/ZIP: s1 „�r,J ),4 17,4D Subtotal 72.50 1. Phone:( ) l 7/- ter-a„ Fax:( ) Minimum permit fee:permitfee) CCB Lie.: (/V O'f �'a71 �ci-3 Plumbing Lic.no.: Plan review (25%of fee) y, State surcharge(12%of permit fee) Authorized signature: ,;, _ TOTAL PERMIT FEE tt-Print name:Caryl J.Phmer Dater 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:tgwilding/Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) A 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-Is'100' 1 50.03 50.03 0 to 2,000 $121.90 Footing drain-each additional 100' 2 37.52 75.04 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer-1st 100' 1 62.54 62.54 7,201 and greater $327.54 Sewer-each additional 100' 2 37.52 75.04 Water Service-1st 100' 1 62.54 62.54 J1edical Gas Systems: Water Service-each additional 100' 1 37.52 37.52 Valuation: Permit Fee: Storm&Rain Drain-1st 100' 1 62.54 62.54 $1.00 to$5,000.00 Minimum fee$72.50 Storm&Rain Drain-each additional 100' 6 37.52 225.12 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and S1.52 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 9(1.0(1/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*. Quantity by Fixture Type Plan Review for Plumbing Installations Fixture Type for Replace/ Plan review is required for anyof the following. Work Performed: Capped Added Relocate 4 Baptistry/Font Please check all that apply. Bath Tub/Shower El Any new commercial building with water service 2"and Jaeuzz r Whirlpool greater,except systems designed and stamped by licensed Car Wash -Each Stall engineer. -Drive Thru I 0 New exterior plumbing site utilities for any complex structure Cuspidor/Water Aspirator as defined in OAR918-780-0040. Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities. -Domestic 0 Any multipurpose fire sprinkler system. Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040. Eye Wash Floor Drain/sink -2" Submit 2 sets of plans with any of the above. 3" 3 11 Isometric or Riser Diagram Car Wash Drain 3 Garbage Domestic-non-food 0 Isometric or riser diagram is required for new buildings Disposal -Domestic-food related that meet the qualifications above. -Commercial-food related -Industrial-food related Ice Mach./Refrig.Drains 2 3 Oil Separator(Gas Station) I Comments regarding fixture work: Rec.Vehicle Dump Station Shower -Gang -Stall Sink/Lay -Non-food related 3 5 -Bradley -Commercial-food related 1 1 -Service I Swimming Pool Filter *Note: If the fixture work under this permit results in an Washer-Clothes Water Extractor increase of sewer EDUs,a sewer permit will be issued and Water Closet-Toilet 2 3 fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. Other Fixtures: 1 P:117000s\17858\planning\PH\Commercial Bld Permits-JFS 530\Plumbitt Permit Application-Site Utilities.doc _ 04mbing Permit Application Site Utilities FOR OFFICE USE ONLY City of Tigard Received !Pi g Date/By: Permit No.: r1.n`[7_/1n S t 1 I ■ 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review c oSIJ n W 1 L Phone: 503.718.2439 Fax: 503.598.1960 77_D_/g Q� Other Permit No.: DateBy: T I G ARD Inspection Line: 503.639.4175 Date Ready/By: Avis: ® See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information -// TYPE OF WORK FEE* SCHEDULE D'New construction ❑Demolition For special information use checklist Description Qty. I Ea. I Total ❑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 ' El1-and 2-family dwelling 'Cormnercial/industrial SFR(2)bath 437.78 ❑Accessory building ❑Multi-family SFR(3)bath 500.32 Each additional bath/kitchen 25.02 ❑Master builder ❑Other: Fire sprinkler(_sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: t a LL i S,LJ. n_ r t �f5�`L y, ad Catch basin or area drain 518.76 3og�j Job site address: t ul T Drywell,leach line,or trench drain 18.76 City/State/ZIP: T`%' B . ctrlaa4 t dR, Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: Project name: sac At gait$ NO, 5X, Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Pa-arts_ i'Lwy Rain drain connector a 18.76 .3#. Sanitary sewer(no.linear ft.:916) 3 Page 2 (39.5 3 Storm sewer(no.linear ft.:1114) S Page 2 5,18 Water service(no.linear ft.:151) a Page 2 /0Q..06 Subdivision: I Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer i 31.27 3i=af7 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 5i-k2 (JAI:(itZ4s 4.Cer new CC 'L AO Dishwasher 25.02 .S CcV& ay.& .1-1.At..etivl\ -f QCP L I't( Drinking fountain 25.02 Ejectors/sump 25.02 ❑ PROPERTY OWNER I 0 TENANT Expansion tank 12.51 Name: Fixture/sewercap 25.02 Floor drain/floor sink/hub 25.02 Address: Garbage disposal 25.02 City/State/ZIP: Hose bib 250fi2 Phone:( ) Fax:( ) Ice maker 12.51 0 APPLICANT 0 CONTACT PERSON Interceptor/grease traPOt4 4.11flr fcp 1 25.02 0�S,Oa Business name: Medical gas(value:$_) Page 2 Primer 12.51 Contact name: Roof drain(commercial) 12.51 Address: Sink/basin/lavatory 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 25.02 CONTRACTOR Water heater 37.52 Business name: Water P i P mg/DWV 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal 175643 Phone:( ) Fax:( ) Minimum permit fee: $72.50 Plan review (25%of permit fee) /87, 6( CCB Lic.: Plumbing Lic.no.: State surcharge(12%of permit fee) qb%oS Authorized signature: TOTAL PERMIT FEE /dr79e uq This permit application expires if a permit is not obtained withid 180 days Print name: Date: after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:IBudding\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) .a 7 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-1'100' 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 6d,•S4 7,201 and greater $327.54 Sewer-each additional 100' '. 37.52 II.5, Water Service-1st 100' l 62.54 da.,54 Medical Gas Systems: Water Service-each additional 100' 1 37.52 39,59 Storm&Rain Drain-Ist 100' / 62.54 6a,5 Valuation: Permit Fee: $1.00 to$5,000.00 Minimum fee$72.50 Storm&Rain Drain-each additional 100' fl 37.52 ,6¢ $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 90.00/1 r $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: 511.9). 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*. Quantity by Fixture Type Plan Review for Plumbing Installations Fixture Type for Replace/ Plan review is required for any of the following. Work Performed: Capped Added Relocate Baptistry/Font Please check all that apply. Bath -Tub/Shower ❑ Any new commercial building with water service 2"and J-acuzzi/whirlpool greater,except systems designed and stamped by licensed Car Wash -Each Stall engineer. -Drive Thru ❑ New exterior plumbing site utilities for any complex structure Cuspidor/Water Aspirator as defined in OAR918-780-0040. Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities. -Domestic ❑ Any multipurpose fire sprinkler system. Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040. Eye Wash Floor Drain/sink -2" Submit 2 sets of plans with any of the above. -3" Isometric or Riser Diagram Car Wash Drain ❑ Isometric or riser diagram is required for new buildings Garbage -Domestic-non-food Disposal -Domestic-food related that meet the qualifications above. -Commercial-food related -Industrial-food related Ice MachJRefrig.Drains Oil Separator(Gas Station) Comments regarding fixture work: Rec.Vehicle Dump Station Shower -Gang -Stall Sink/Lav -Non-food related -Bradley -Commercial-food related -Service Swimming Pool Filter *Note: If the fixture work under this permit results in an Washer-Clothes Water Extractor increase of sewer EDUs,a sewer permit will be issued and Water Closet-Toilet fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. Other Fixtures: l:\Building\Permits\PLMU_PermitApp.doc 2 Dianna Ornelas From: #Building Permit Technicians Sent: Monday, September 13, 2021 4:17 PM To: Mark VanDomelen Cc: Tom Hochstatter;Walter Barnett Subject: 11290 SW Bull Mountain Rd -Jacksons Food Store & Fuel Station Attachments: Jacksons Store - 11290 SW Bull Mountain Rd.pdf Hi Mark, We have multiple permits submitted in 2018 for this site to demolish and rebuild a new food and fuel canopy(see attached file). The majority of permits have been reviewed and are ready to issue. The site work and building permits were approved/not released by permit coordinator due to ODOT requirements that had not been met. A recent case MMD2021-00026 was approved to modify the ODOT condition#24 of the land use case CUP2017-00005, but they still have some other outstanding condition land use and engineering conditions that are not met. A contractor is asking about obtaining permits. Will you approve use of the 2018 permits, or will you require that they submit new permits/plans to be reviewed under the new code? Thank you. Dianna L. Ornelas 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 t Branden Taggart From: Branden Taggart Sent: Monday, December 24, 2018 3:33 PM To: 'cpinner@barghausen.com' Cc: #Building Permit Technicians Subject: Jacksons No. 530 Site Utilities Permit: PLM2018-00511 - 11290 SW Bull Mountain Rd Attachments: Branden Taggart.vcf Hi Caryl, The site utilities permit for Jacksons No. 530 is ready to issue. The balance due is$1,028.09, and the permit fees can be paid online now at https://aca.accela.com/TIGARD/Default.aspx or in person between the hours of 8:00 a.m. and 4:30 p.m., Monday through Thursday. We are closed this Tuesday for the holiday and on Fridays. Also, we will need your plumbing contractor's license information prior to issuing this permit. If you pay online, please notify us at tigardbuildingpermitsPtigard-or.gov. Thanks, Branden Taggart 1111 ■ City of Tigard M Senior Permit Technician Community Development 13125 SW Flail Blvd Tigard,OR 97223 (503)718-2449 bra n de nt©tigard-a r,g ov DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained by the City of Tigard in compliance with the Oregon Administrative Rules"City General Records Retention Schedule." 1 Branden Taggart From: Rick Martin <rickm@pacific-earth.com> Sent: Wednesday, March 2, 2022 11:39 AM To: Branden Taggart Subject: Jackson Food Store Bull Mountain Rd Follow Up Flag: Follow up Flag Status: Flagged - You don't often get email from rickm@pacific-earth.com.Learn why this is important Caution!This message was sent from outside your organization. Allow sender I Block sender Brandon, Due to the licensing issue with Pacific Earth Construction,we will be moving forward on this project as Coast Sweeping Service Inc. (Our parent company). Our CCB is#66044, please let us know when the permits will be issued. Thank You Rick Martin (503) 349-0799 Pacific Earth Construction Coast Pavement Services