Permit City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223
JAI
March 4 2011
WH Pacific, Inc.
Attn: Brady Berry
9755 SW Barnes Rd., Ste. 300
Portland, OR 97225
Re: Permit No.: PLM2009-00363
Submittal Date: 12/24/2009
Project Name: Dave & Busters
Site Address: 10125 SW Washington Square Rd.
Dear Applicant:
This letter is to notify you that your permit application referenced above has expired in
accordance with the administration chapter of the Oregon Specialty Codes. Applications
are valid for a maximum of 180 days from the submittal date. The City of Tigard has not
received a written request for extension therefore it is expired by limitation.
In order to reactivate this permit, a new application, building plans, if applicable, and
permit fees are required to be resubmitted and a new permit number will be assigned.
If you have any questions, please contact the Building Division at 503.718.2439.
Sincerely,
City of Tigard
Building Division
cc: Property File
Ltr-Sub-Exp.docx 02/01/2011
Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard-or.gov • TTY Relay: 503.684.2772
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`.�►lum[iing Per it Application EXPIRED ,4 // ,..._
Site Utilities FOR OFFICE USE ONLY
FIVED Reccoe: 3
City of Tigard .v Dale/By: lit®/ Per"No.: awro yn
1111 . • 13125 SW Hall Blvd.,Tigard,OR 7 ���ddd Plan Review / i. ^I`✓
Phone: 503.639.4171 Fax: 503.598.Ta-
n q 1 2009 l �O��O Other Permit No. r T r���/
!+�t Date/By:
Inspection Line: 503.639.4175 Date Read /B Juris: ® See Pa e 2 for
TIGARD Ready/By: g
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
OF TIGARD' �
TYPE OF W I L., a , . i FEE* SCHEDULES A �Q 0/I et 6
❑New construction ■�(Semo ition For special information use checklist.
Descri.tion •t . Ea. Total
dition/alteration/replacement ❑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 Iommercial/industrial SFR(2)bath 437.78
Accessory building SFR(3)bath 500.32
El ry g ❑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: /QN� L,,1 �Aa///��-re ti Catch basin or area drain • 18.76 //,Z
Or"f ' Drywell,leach line,or trench drain 18.76 I
City/State/ZIP: (max /Z /vim
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: ,'ll L U11 t
JJAL`i, S � Z'Q,S (3,0 1)/5/, Manufactured home utilities 50.03
Cross street/directions to job site: hh-5//uenk, 4-,, Ail £a A4 f Manholes Fi 18.76
(. ) 6 /.av,eG A Q Rain drain connector 1 8.76 37,5,z_
Sanitary sewer(no.linear ft.: ) Page 2 /00,06- �?
Storm sewer(no.linear ft.:4/7) Page 2 Ole
Water service(no.linear ft.: /4e)) Page 2 ,/ pb.
Subdivision: 1 Lot no.: Fixture or item:
Tax map/parcel no.: )S l 3573A ()C2 C I CC Backflow preventer a 31.27 4,2.5'f
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
.XCk✓A-77U/Uj C✓1.4610V6, lira./77E3 I41/O AV'M' Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
( PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
'7t, Fixture/sewer cap 25.02
Name: (MC/4 M4 t(MC/4 P20PCtaTc-f Mrio..ta( W1 C7VI -- 0 t(.AI EIC
Floor drain/floor sink/hub 25.02
Address: ,,i/U/ h/i t- /,F//Z iQ S v/TLl C7
9 1 Garbage disposal 25.02
City/State/ZIP: 64A/774 Mom C/4l 9(Y/0I Hose bib 25.02
Phone:(4/4/ )3i/7 - -.7-�;-3 C: Fax:( ' to sq7 -7)38 Ice maker 12.51
It APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: WNPat:t G _>-- Medical gas(value:S ) Page 2
Contact name: Primer 12.51
4iwy,,,� Roof drain(commercial) 12.51
Address: 9753 SCE fE444J25 ed J S . 3CJ Sink/basin/lavatory 25.02
City/State/ZIP: .f , ,. OR ci Solar units(potable water) 62.54
Phone:(73) .S 7z 36 0/ Fax::(S73)3-0(,.- 0?7 Tub/shower/shower pan 12.51
l Urinal 25.02
E-mail: �j ,� E. r vftP4 C 1,i( C c'rVl Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: -7-2. Water piping/DWV 56.29
Address: Other. 25.02 �/
City/State/ZIP: Subtotal 700. IG
Phone:( ) Fax:( ) Minimum permit fee: 572.50
CCB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee) /75:I.°
State surcharge(12%of permit fee) (�,.Q
Authorized signature: TOTAL PERMIT FEE q59,55-Print name: Date: /7/Z/ 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 Boaa tt
I:\Building\Permits\PLM -PermitApp.doc 10/01/09 440-4616T(l0/02/COM/WEB) t�
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• Plumbing Permit Application - City of Tigard • 4
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
Sewer- 1st 100'
62.54 3,601 to 7,200 $233.20
f Gal Sq 7,201 and greater $327.54
Sewer-each additional 100' 1 37.52 37,52.
Water Service- 1st 100' 62.54
ea.Sy Medical Gas Systems:
Water Service-each additional 100' I 37.52 34.SZ
Valuation: Permit Fee:
Storm&Rain Drain-1st 100' ' 62.54 (Z $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 3 37.52 Ili,S1:, $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
P 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:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes", Plan Review for Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees*. Please check all that apply.
Quantity by(Fixture)Work Performed (2. Any new commercial building with water service 2"and
Fixture Type: Replace greater,except systems designed and stamped by licensed
Previous Capped Added Existing engineer.
• Baptistry/Font
Bath -Tub/Shower - ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Jacuzzi/Whirlpool
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive Stall ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR91 8-780-0040.
Dishwasher -Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash Isometric or Riser Diagram
Floor Drain/sink -2" ❑ Isometric or riser diagram is required for new buildings
-3 that meet the qualifications above.
-4"
Car Wash Drain
Garbage -Domestic
Disposal -Commercial
Industrial Comments regarding fixture work:
Ice Mach./Refrig.Drains
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink -Bar/Lavatory
-
-Bradley
-Commercial _ *Note: If the fixture work under this permit results in an
-Service increase of sewer EDUs,a sewer permit will be issued and
Swimming Pool Filter fees assessed for the sewer increase must be paid before the
Washer-Clothes
Water Extractor plumbing permit can be issued.
Water Closet-Toilet
Urinal
Other Fixtures:
P:\Macerich Company\033928\Construction\Permits\PLMU-PermitApp.dQc
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IN1 Site Utilities — Plumbing Permit Application
Plan Submittal Requirements
TIGARD
A plumbing permit for site utility plumbing work is required for sanitary sewer, storm sewer
and potable water systems on private property.
1. SITE PLAN and vicinity map showing the geographic location (fully dimensional,drawn
to scale) labeled with:
A. [+ map&tax lot# Erroject name El site address ❑ suite number
❑ zoning Qrapplicant name Erphone number
B. North arrow. •
C. Scale (architectural or engineering only). ✓
D. Street names.✓
E. Building pads with project location.
2. PLUMBING PLANS -Two (2) complete sets, civil only.
All details listed below shall be incorporated into the plumbing plans:
A. Storm drainage plan showing:
1) Finish elevations throughout the developed site. V
2) Grade breaks determining area serving each catch basin.✓
3) Location of catch basins. i/
4) Pipe size. tV
5) Type of material. ✓
6) Slope of piping. ✓
7) Manholes and field drains.✓
8) Cleanouts provided for each 100 feet or fraction thereof. ■
9) Roof drain laterals specifying cleanouts at each upper terminal. '�
10) Location of existing or proposed connection to a public sewer line. ✓
B. Utilities plan showing.
1) Sanitary sewer line location,pipe size,type of material, slope of piping,manholes
and cleanouts provided as required for storm.✓
2) Size and location of domestic water piping and drainage.✓
3) Proposed location of connection to a public water or sanitary sewer line.
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I:\Building\Permits\PLMF-PermitApp.doc 12/30/05
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