Permit CITY OF TIGARD PLUMBING PERMIT
i DEVELOPMENT SERVICES PERMIT #: PLM2001- 00296-
- I I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/17/01
SITE ADDRESS: 13560 SW PACIFIC HIGHWAY STARBUCKS PARCEL: 2S102CC -00500
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: UNK FLOOR DRAINS; 4 TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 2 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 3
TUB /SHOWERS: SEWER LINE: 0 ft
WATER CLOSETS: WATER LINE: 0 ft
DISHWASHERS: 1 RAIN DRAIN: ft
Remarks: Plumbing tenant improvement
FEES
Owner:
Type By Date Amount Receipt
STARBUCKS COFFEE COMPANY PRMT CTR 9/17/01 , $182.60 27200100000
2401 UTAH AVE S PLCK CTR 9/17/01 $45.65 27200100000
SEATTLE, WA 98134 5PCT CTR 9/17/01 $14.61 27200100000
Phone 1: 206 - 318 -1575 Total $242.86
Contractor:
MODERN PLUMBING
11120 SW INDUSTRIAL WAY
• TUALATIN, OR 97062 REQUIRED INSPECTIONS
•
Phone 1: 691 -6166 Sewer Inspection
Reg #: LIC 87906 Water Service Insp •
P Rough -in Insp
LM 34 -250P6
Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. 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
than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued B Permittee Signature: mur 4 � • Call (503) 639 -4175 by 7:00 P.M. for an inspection = - e next business day
Plumbing Permit Application
Datereceived: 7 9 /a/ Penn it no.: 9/„00,,/
ay City of Tigard a p�
t ,
Sewer
" Address: 13125 SW Hall Blvd, Tigard, • • • 223 permit no.: Building permit no.:
City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 Date issued: By: I Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT -
0 1 & 2 family dwelling or accessory D Commercial/industrial 0 Multi - family 0 Tenant improvement 1�
0 New construction ) Addition/alteration/replacement 0 Food service 0 Other: \
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: 135-60 d 1.(3 paG 1 ff Descri Description I }{-� p Fee (ea.) Total
Bldg. no.: Suite no.: New 1- and 2- family dwellings only
Tax map/tax lot/account no.: D (includes 100 R. for each utility connection)
SFR (1) bath
Lot: 26 1--- fBlocic I Subdivision: SFR (2) bath
Project name: - re b 42.& ' .. ,I V _ V r i� , SFR (3) bath
City/county: , • _ . , (7,i : , ZIP:' P - Each additional bath/kitchen
Description and 11 . ;on of work tin premises: t_ .1 - .' Site utilities:
c c i sti KI CAW Mr rr k,J 6A elf lk. . Catch basin/area drain
Est date of completion/mspection: - • . O 1 Drywells/leach line/trench drain
Pit 31 B l N G CONTRACTOR Footing drain (no. lin. ft) NO
Manufactured home utilities
Business name: O -DE � 1,4-4 o 1,4-4 �•1 r ► - • Manholes
Address: / / /gyp to / u 5T2 / A - 4.4.)/*V Rain drain connector - N
City:1 L- , gr,AJ I Statea.- I ZIP: 97o(,P. Sanitary sewer (no. lin. ft)
Phone:3 -( ( I Fax: I E -mail: Storm sewer (no. fin. ft.)
CCB no.: / 74 I Plumb. bus. reg. no: 3y. asp P6 Water service (no. lin. TO --A
City/metro lic. no.: Fixture or item:
4
Contractor's representative signature: j .. r�!' Absorption valve
r Back flow preventer
Print name: l t to Date : f t 7 0
Backwater valve
CONTACT PERSON Basins/lavatory �\
Name: r_ S°�' ` Clothes washer
Address: -1 os- 2..a. a 4 -Ho Dishwasher
City: Sect 44ls_ I State: Lo ii-I ZIP: q8.104 Thinking fountains)
Phone:2a to P4.4,2. - Fax: 20'191 • E -mail: — >� p
Expansion tank
011:\ER Fixture/sewer cap
Floor
Name (print): �Qv 10u c k•-S Co (e c. Gdu.�' , ,( pal
sinks/hub
Mailing address: 24 1 �}u. 1ue. c Q Garbage disposal
ci gad, Hose Bibb
City: ��'�� �' W� �' Ice maker /
Phone: 201r .318 • I g s- I Fax: — I E -mail: — Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Primer(s) •
will be made by me or the maintenance and repair made by my regular Roof drain (commercial)
employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s) a
Owner's signature: Date: Sump
ENGINEER Tubs/shower /shower pan - •
Name: 'ryes U ' Urinal
Address: Water closet
'L702- S 92nd X3 Water heater
City: , 6, •_ I S W PI• I q g4O ct Other.
Phone: 2. Fax: 4 as3 3 I E -mail: Total mo� sin - 1 2v rL76R
Not an jurisdictions accept actin `red', please call *tsarina for more information.' Notice: This permit application Minimum fee $ a 'UDO •
o Visa 0 MasterCard Plan review (at _ %) $ expires if a • to
t card number: / / p permit is not obtained State surcharge 8% / r
Expires within 180 days after it has been ( ) $
Name of cardholder as shown on credit card accepted as complete. TOTAL $ i, g
$
Cardholder signature Amami
440 -4616 (6/00/COM)
PLUMBING PERMIT FEES:
•
•
: ; :} .r;°'�y ;0; ;e ,'07;W. iimii; W A
` TOTLY = • e . d` I :40,111 " rl '., r ,, , tt - ; r�: 0
,,;; � "' �,. � , a�� �a S a° �. �'� � � � 7
�g' > "�3 � ;, � , S.s�,�,.: �1NT� '� �'� � r [� � . � ?�f,8 ` Y., �r a y� �
::xij .TUtiESilutoiidyal •:.n+�-. li&kg, 4:1.3 t may (ea) �_A1MQ n c fies a l) l um° t bi fig'#,,t s- rr`�, = � 9 PRfC ,z` a :
Sink
,war- :.�r: � 00 t ,
o2 16.60 f ie el l irg the fl, ; rstt't �� k �Q'TYF y ., ,( / `z
AR : ct %'utillfj�`conitecttofr) �;';�> �s�: i',..,44 _ ' ,. ��>
Lavatory 16.60 One (1) bath $249.20
Tub or Tub/Shower Comb. 16.60 Two (2) bath $350.00
Shower Only 16.60 Three (3) bath $399.00
Water Closet 16.60 SUBTOTAL ;= = %F PX. t
Urinal 16.60 8% STATE SURCHARGE MM
Dishwasher 1 16.60 PLAN REVIEW 25% OF SUBTOTAL '777_ca yl
Garbage Disposal 16.60
TOTAL r':• - M , :.= - . -°*
Laundry Tray 16.60
Washing Machine 16.60
Floor Drain/Floor Sink 2" 16.60 PLEASE COMPLETE"
3" q 166.660 0 *
4" 16.60
Water Heater 0 conversion 0 like kind I 16.60 'r,
" oved/
Gas piping requires a separate mechanical F,iii ure? p4:4,' <' t } w o v 4 ec�,;. ? 9 . _ _a
permit ,
Ill '" '• `-k-. te r..
MFG Home New Water Service 46.40 x Sink
MFG Home New San/Storm Sewer 46.40 - tory
, ub or Tub/Shower
Hose Bibs 16.60 ,' Combination
Roof Drains 16.60 Shower Only
Drinking Fountain 16.60 Water Closet
1 Urinal
Other Fodures (Specify) a 16.60 , Dishwasher
i ce- m Ac)) lit e_ Garbage Disposal • Laundry Room Tray
/✓inp Sjn k Washing Machine
Floor Drain/Sink: 2"
Sewer - 1st 100' 1 55.00 • 3"
Sewer - each additional 100' 46.40 , 4"
Water Service - 1st 100' 1 55.00 / Water Heater _
/ Other Fixtures
Water Service - each additional 200' 46.40 (Sp fy)
Storm & Rain Drain - 1st 100' .55.00 t\
Storm & Rain Drain - each additional 100' ' 46.40 �I
Commercial Back Flow Prevention Device ' 46.40
Residential Backflow Prevention Device* 27.55
Catch Basin 16.60
Inspection of Existing Plumbing or Specially 72.50
Requested Inspections per/hr COMMENTS REGARDING ABOVE:
Rain Drain, single family dwelling 65.25
Grease Traps 16.60 -
. QUANTITY TOTAL / W j i 6 3) Y
Isometric or riser diagram i required if � O� : - j'` '` . • r te , " ,',
Quantity Total is > 9
* SU TOTAL ""` • ' s`:
8% STATE CHARGE a Pil
tii27
**PLAN REVIEW 25% O SUBTOTAL .: "• `'
Required only i re qty. total is > 9 x . :. :'� } z;; $ : : a -if3=
TOTAL ;� : y { . $
- t.„ :�
* Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow
Prevention Device, which is $36.25 + 8% state surcharge.
** Ali New Commercial Buildings require plans with Isometric or riser diagram and
plan review.
i:\dsts\formskplm- fees.doc 10/10/00
PLUMBING PERMIT FEES: ?L
PRICE TOTAL New 1 and 2- family dwellings only:
FIXTURES (individual) QTY (ea) AMOUNT (includes all plumbing fixtures in PRICE - TOTAL
Sink 2 16.60 33 O the dwelling and the first100 ft. QTY (ea) AMOUNT
16.60
for each utility connection)
Lavatory One (1) bath $249.20
Tub or Tub /Shower Comb. 16.60 Two (2) bath $350.00
Shower Only 16.60 Three (3) bath $399.00
Water Closet 16.60 SUBTOTAL
Urinal 16.60 8% STATE SURCHARGE
Dishwasher ) i 16.60 1 - 6 PLAN REVIEW 25% OF SUBTOTAL
Garbage Disposal 16.60 ��vv TOTAL
Laundry Tray 16.60
Washing Machine 16.60
Floor Drain/Floor Sink 2"
° 16.60 ip 6 go PLEASE COMPLETE:
4" 16.60
Water Heater 0 conversion 0 like kind 16.60 Quantity by Work Performed
Gas piping requires a separate mechanical / // _- /_ 6 Fixture Type: New Moved Replaced Removed/
permit. l� Ui pp
MFG Home New Water Service _ 46.40 Sink
MFG Home New San/Storm Sewer 46.40 Lavatory
•
Tub or Tub /Shower
Hose Bibs 16.60 Combination
Roof Drains 16.60 Shower Only
Drinking Fountain 16.60 Water Closet
Urinal
Other Fixtures (Specify) 16.60 Dishwasher
jCo- (4l_A-c(%4 J. / A 6; 0 Garbage Disposal
Oita ? S` »1c. I ii, - L o Laundry Room Tray
I ,. i••w. Washing Machine
� Floor Drain /Sink: 2"
J
Sewer - 1st 100' - WWa,M 3"
Sewer - each additional 100' 46.40 4"
Water Service - 1st 100' 5 �0 MA/ Water Heater
r - Other Fixtures
Water Service - each additional 200' 1 ' 6.40
(Specify)
Storm & Rain Drain - 1st 100' 55.00
Storm & Rain Drain - each additional 100' 46.40
Commercial Back Flow Prevention Device 46.40
Residential Backflow Prevention Device' 27.55
Catch Basin 16.60
Inspection of Existing Plumbing or Specially 72.50
Requested Inspections per/hr COMMENTS REGARDING ABOVE:
Rain Drain, single family dwelling 65.25
Grease Traps 16.60
QUANTITY TOTAL
Isometric or riser diagram is required if
Quaff Total is > 9
*SUBTOTAL 1111111gMMara
1b1211111• FS%
8% STATE SURCHARGE /4,14 y
**PLAN REVIEW 25% OF SUBTOTAL (./,P d
Required only if fixture qty. total is > 9 I/
TOTAL A LW ( $ . -
* Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow
Prevention Device, which is $36.25 + 8% state surcharge.
** All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
is \dsts \forms\plm - fees.doc 10/10/00
Plumbing Permit Application
Datereceived: P ermitno.:��iji ZO —GO Z 9(
�+.-, " ., i , Ci ty of Ti g Se wer permit no.: B uildin and
' � `•t g permit no.:
" "" Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigard Phone: (503) 639 -4171 Project/appl.no.: Expire date:
Fax: (503) 598 -1960 Date issued: By: I Receipt no.:
Land use approval: Case file no.: Payment type:
TI PE OF PERMIT
O 1 & 2 family dwelling or accessory O Commercial/industrial 0 Multi - family 0 Tenant improvement
0 New construction 0 Addition/alteration /replacement 0 Food service 0 Other:
JOB SITE INFORMATION FEE SCH EDULE (for special information use checklist)
Job address: Description Qty. Fee(ea.) Total
Bldg. no.: Suite no.: New 1- and 2- family dwellings only:
Tax ma /tax lot/account no.: (includes 100 ft. for each utility connection)
p SFR (1) bath
Lot: I Block: I Subdivision: SFR (2) bath
Project name: SFR (3) bath
City /county: I ZIP: Each additional bath/kitchen
Description and location of work on premises: Site utilities:
Catch basin/area drain
Est. date of completion/inspection: Drywells/leach line /trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft.)
Manufactured home utilities
Business name: Manholes
Address: Rain drain connector
City: I State: I ZIP: . Sanitary sewer (no. lin. ft.)
Phone: I Fax: I E -mail: Storm sewer (no. lin. ft.)
CCB no.: I Plumb. bus. reg. no: Water service (no. lin. ft.)
City/metro lic. no.: Fixture or item:
Contractors representative signature: Absorption valve
Back•flow preventer
Print name: Date: Backwater valve
CONTACT PERSON Basins/lavatory
Name: Clothes washer
Dishwasher
Address: Drinking fountain(s)
City: I State: I ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank
Fixture/sewer cap
Floor drains/floor sinks/hub
Name (print): Garbage disposal
Mailing address: Hose bibb
City: I State: I ZIP: Ice maker
Phone: I Fax: I E -mail: Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain (commercial)
employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s) •
Owner's signature: Date: Sump
ENGINEER Tubs/shower /shower pan
Urinal
Name: Water closet
Address: Water heater
City: I State: I ZIP: Other:
Phone: I Fax: I E -mail: Total '
•
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $
Notice: This permit application Plan review (at %) $
❑ Visa 0 MasterCard expires if a permit is not obtained
Credit card number / / within 180 days after it has been State surcharge (8 %) .... $
Expires TOTAL $
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount 440 -4616 (6/00/COM)
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' - CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested /1) — AM PM BLD
Location Cv Suite MEC
Contact Person i Ph 9 / (( C r;,, PLM 07 •04!) 9
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out .
Water Service
Sanitary Sewer
Rain Drains
Sip ii � t►
PART FAIL
' ANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk Date /0/ /O 0 Inspector I / I � • f 4 E
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.