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Permit
CITY OF TIGARD PLUMBING PERMIT ''�! COMMUNITY DEVELOPMENT Permit it: PLM2014 00276 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/08/2015 Parcel: 1 S135BA00102 Jurisdiction: Tigard Site address: 10230 SW WASHINGTON SQUARE RD Project: Panera Bread Subdivision: OAKBURG Lot: 9 Project Description: Convert former retail store to restaurant. See itemized plan review list for fixture identification. Contractor: R A WARNER PLUMBING Owner: PPR SQUARE TOO LLC PO BOX 820785 PO BOX 847 VANCOUVER,WA 98682 CARLSBAD, CA 92018 PHONE: 360-772-2490 PHONE: FAX: 360-263-5354 FEES Quantity Description Date Amount 2 ea Backflow Preventer 01/08/2015 $62.54 Specifics: 1 ea Dishwasher 01/08/2015 $25.02 1 ea Expansion Tank 01/08/2015 $12.51 Type of Use: COM 19 ea Floor Drain/Floor Sink/Hub 01/08/2015 $475.38 Class of Work: ALT 1 ea Hose Bib 01/08/2015 $25.02 Type of Const: 1 ea Ice Maker 01/08/2015 $12.51 Occupancy Grp: 1 ea Interceptor/Grease Trap 01/08/2015 $25.02 Stories: 1 ea Primer 01/08/2015 $12.51 6 ea Sink 01/08/2015 $150.12 4 ea Lavatories 01/08/2015 $100.08 1 ea Urinal 01/08/2015 $25.02 3 ea Water Closet 01/08/2015 $75.06 1 ea Water Heater 01/08/2015 $37.52 726 Misc Other Fee 01/08/2015 $725.58 1 Plan Review 01/08/2015 $440.97 1 12%State Surcharge- 01/08/2015 $211.67 Plumbing Total $2,416.53 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: �i 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 t , -1r s7D /q/a" Building Fixtures 8.AV /y yFOR OFFICE USE ONLl City of Tigard ('��‘ Date/By: !i`- s /T I Permit No.: oai�!(�QD ?� 74 13125 SW Hall Blvd.,Tigard,OR 'Z 1, V Plan Review '� ■ r •!/►' Other Permit No.: 4 Phone: 503.718.2439 Fax: 503.5' ;•1 Date/By: / /� Q�IT' gO Inspection Line: 503.639.4175 201 Date Read /B / lnris: ® See Page 2 for T I G A R D Internet: www.ti ard-or. ov y y 8 g g O ff •"_ Notifed/M od:��/j� ��� Supplemental Information TYPE OF WORK CT '��� 14 '✓/J1 � 480. rE * SCHEDULE ❑New construction ❑ tCTX ON /For special information use checklist.' � Ci ° Description I Qty. Ea. I Total Iddition/alteration/replacement ID WIN 1?l New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 El 1-and 2-family dwelling -4Z1 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: ;� Catch basin or area drain 18.76 Job site address: /0230 k,,,..1 t. ..)s. t l /� Drywell,leach line,or trench drain 18.76 City/State/ZIP: (t`� � ?1U`3 `` Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: Project name:1 .e. (�g..Lac Manufactured home utilities 50.03 Cross street/directions to job site: r.�ryc..r� 11" Manholes 18.76 I 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 / Ir, 31.27 tpa -5 DESCRIPTION OF WORK Backwater valve 12.51 / / Clothes washer 25.02 (tt ( &IU'el p(t.t,+ tL4 Dishwasher i f J 25.02 - a'S•� r Drinking fountain 25.02 Ejectors/sump 25.02 ❑ PROPERTY OWNER 1 ❑ TENANT Expansion tank ( 12.51 s).5/ Fixture/sewer cap 25.02 S 3e Name: Floor drain/floor sink/hub iq 25.02 Address: Garbage disposal 25.02 City/State/ZIP: Hose bib ✓ 1 25.02 d5 ,,�A Phone:( ) Fax:( ) Ice maker ✓ f 12.51 /, S/ ❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap / ( 25.02 a-S U� F Business name: Medical gas(value:$ ) Page 2 Primer / / 12.51 4,4 S Contact name: Roof drain(commercial) 12.51 �p Address: t� �5..r Sink/basin/lavatory �� �(�,� 25.02 ��?�- City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax: :( ) Tub/shower/shower pan f j 12.51 E-mail: Urinal v I 25.02 , 0,4 CONTRACTOR Water closet i7 3 25.02 t Water heater j ( 37.52 13 7_5-41. Business name: �✓Q_ FI1 rl)t t �-c Water piping/DWV 56.29 Address: '_ eir)'7 Other:(6 vl aq 25.02 79,S'51 City/State/ZIP: j t _IN Z Lt b'T') Subtotal AliklOcc Phone:('?(,r... ) 7 72-2476 Fax:(3%6 ) 263 -S3S ?17&' ' .1 Minimum permit fee: $72.50 41140'`17 Plan review (25%of permit fee). A4 CCB Lic.:( Ll(t{li° Plumbing Lic.no.: ?)7-S2,( j>e xi t. le7 State surcharge(12%of permit fee) ' Authorized signature: 7 Pt Lit 5 3 - TOTAL PERMIT FE:' }-p1- ?�ra37 = .7--.70 Print name: ■ Al-f-(-X--• Date:/1IV/z)/rl This permit application expires if a permit is not obtained wi hin 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. L\Building\Pennits\PLMU-PermitApp.doe 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-151 100' 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- Ist 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 ec Ins tions or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to Inspections 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", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees*. Plan Review for Plumbing Installations 1 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 greater,except systems designed and stamped by licensed Bath: -Tub/Shower -Jacuzzi/Whirlpool engineer. Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure Drive"Chia as defined in OAR918-780-0040. Cuspidor/Water Aspirator ❑ Medical 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" I 3" Isometric or Riser Diagram 4 ❑ Isometric or riser diagram is required for new buildings -car Wash Drain , Garbage -Domestic non-food,. '` that meet the qualifications above. Disposal: -Domestic food related' -Commercial food related -Industrial food related Ice Mach./Refrig.Drains i Comments regarding fixture work: Oil Separator(Gas Station) Q74' t:)-7 �7 y, oc to A t4 7i,.... Rec.Vehicle Dump Station S � fly A Shower: -Gang ��'T / y '% J . -Stall `10 Sink: -Lav/Bar non-food reltated riot!.,p.•...urci. _ l 7 -Bradley z • 0 l -Com/Serv/Util food related /�1. -Service *Note: If the fixture work under this permit results in an Swimming Pool Filer increase of sewer EDUs,a sewer permit will be issued and Washer-Clothes Water Extractor fees assessed for the sewer increase must be paid before the WaterCloset-Toilet ^�, plumbing permit can be issued. L Urinal Other Fixtures: 1:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 A 6_ eliA__ .* .e,4,\)) ef- ithfolc c -r c 's ZQan.. sin - .341 ` I If '_ f -i'{3- FLooy� c, — - IfeCZoc .rWA: 2 4: 7 111I ! if L 2 _.,,.,p n. ,3 1- '. 11 `` 4rfrin o i si - k (7 c) _ l 44'3- Cs,..-, f'o .S'c,' 6(, 6c15) - 1 ,,or op-to sick c o-ea-P ee (r5)—_._ 1J - Cvv✓i) S,►� K (F5) i it c 7-o,L r-r 5 - II l 3 _ /1 I --,iii - G/t2 ii/l,4 L. 1 02 1/ 1 ---- ar /3 w..-4 s - - Fs I 74 Fr': '-'S4 0 01,447-4/; -Hlrc — 1 F3 e e v ,i A 3 r7-5 Z'is= - - =' ,-(A(::1) 0 —' >rA fro vl €77- r'LL(«S f/ARE'-9 --I r I l d� .6_,t-G,e,frviRc,� 5--r ±-5) 1 f b c es r/-' /rte /715P. r1SP,40e -D)(F.1i Hui /1 J 4- 14'ALL *IT /J4 5/if l< ('Dcio� ,t 1/ 11 4 I CL- CA boy �-0) (s1-,A,e54 / - -1 et' w1Rc do/lye (P:5}rS/-IA✓ °-D. I P (,v h Tf 2 SO r rC/wE'R-(S 61 i& - )i1--„P if 4 610 trt.C So IL--r1=-A-,5 t 1-- (D) rill,4Ac 0) 4 G- ow L-' I rfJ T'N c e -r-o '2 , * 11-2 C v. 5 - 0ic --o ex r ,tc- '16. IDIe,t-t -//6,,*.-1-4--2 * Li 4TE: / H5 of,) 1%f ti c r+E�,„..c£ c►. PeQh r r A PPL,c/3-71e`- , A on+t.2 Ira---1s — "Te T•i` = act XrtA. k� '7` 'i`` f � tl�a/� 76 I f (4 6T ,-r 2 / /2e&ei Eco L,4g 11 / ✓� .¢►.J, SO-04 01;f k--r 2 Ofr Q .v r HA rr►Op/1- A/?e'e/T„'. 1 T2A4p Pr oi ASS/ — / I SoPd P r lI ▪ L- ieep.so MACJ4/&i f?P / (it"v) / A lea •3ree,2-- if q C c .P 11 • D gLL= PA(k • P(200 c e,2 Co 01_5%4- al- 0141 ,2-4---a- NOT I 1 w 4-r 12 /J1 rp czi C 1 Plumbing Permit Appli caRECEIV ED •• • S 3LL.LIZ,.Jce r,icri. vek s City of Tigard ( Received n- �} ... ll 0 20�4 Date/By: y/1V /N Permit No.: L/l.�/J i _00/27/_ • 13125 SW Hall Blvd.,Tigard,OR 9 Z3 •r vri 5� Plan Review Phone: 503.718.2439 Fax: 5p31i�1�1 Date/By: Other Permit No.61„de p,�j��•4�i19 Inspection Line: 503.639.41751,1]11 U'TIGARD Date Read/B i�r�: TIGARD Ready/By: ® See Page 2 for Internet: www.tl rd-or.gov(2 Notified/Method: Supplemental Information VT114. OF RK f, _._ , .. FEE* SCHEDULE . ❑New construction ❑ Demolition For special information use checklist. r , - Description I Qty. I Ea. I Total ®Addition/alteration/replacement ❑Other: 11 . ' New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION ►-.7 � SFR(I)bath 312.70 ❑ I-and 2-family dwelling ®Commercial/industrial QQ SFR(2)bath 437.78 y brit SFR(3)bath 500.32 ❑Accessory building ❑Multi-famil rrrr rr R,g 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:10230 SW Washington Square Road Catch basin or area d 18.76 Drywell,leach lin- or trench drain 18.76 City/State/ZIP:Tigard,OR 97223 Footing drain •s.linear ft.:_) Page 2 Suite/bldg./apt.no.: Project name:Panera Bread Manufactu •i home utilities 50.03 Cross street/directions to job site:SW Greenburg Road Manhol . 18.76 h Rai 'rain connector - 18.76 , ,N 0 I},'1 Storm sewer(no.linear ft.:_) Page 2 pou.,p1� Water service(no.linear ft.:_) Page 2 Subdivision: PLA I Lot no.: 102 Fixture or item: Tax map/parcel no.:Tax Map 1 S135BA l :ackflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 ( Clothes washer 25.02 TI of a portion of a former bookstore for a ne■■ Panera Bread restaura • •.. washer 1 25.02 25.02 \if t Drinking fountain 25.02 Ejectors/sump 25.02 ❑ PROPERTY OWNER ® NANT w Expansion tank 12.51 Fixture/sewer cap 25.02 Name:Panera,LLC • „(� ,�`JS' Floor drain floor sink/hub 14 25.02 350.28 Address:3630 S.Geyer Road,Suite 100 Garbage disposal 25.02 City/State/ZIP:Sunset Hills,MO 63127 r Hose bib 25.02 Phone:(314)984-1000 Fa (314)909-33 Ice maker 1 12.51 12.51 ❑ APPLICANT ® C Y T ON . Interceptor/grease trap 25.02 ' Business name: Panera,LLC ‘\ Medical gas(value:$ ) Page 2 Contact name:John Sturges r^J \ Primer 12.51 \ Roof drain(commercial) 12.51 Address:3187 Airway Avenue,Suite Sink/basin/lavatory 11 25.02 275.22 City/State/ZIP:Costa Mesa,CA 92. 6 rr Solar units(potable water)(po ) 62.54 Phone:(714)966-9400 ax::(949)258-5655 Tub/shower/shower pan 12.51 E-mail: Urinal 1 25.02 25.02 im. Water closet 3 25.02 75.06 CONTRACTOR Water heater 37.52 Business name: Water piping/DWV 56.29 Address: Other: 25.02 ►1 City/State/ZIP: Subtotal -11.26.1-1'10' ( ) Phone:( ) Fax: Minimum permit fee: $72.50 Plan review (25%of permit fee) 20052 41 CCB Lic.: Plumbing Lic.no.: 41' State surcharge(12%of permit fee) T.f3 Authorized signature: TOTAL PERMIT FEE ,1„132 This permit application expires if a permit is not obtained within ISO days J.4 Print name: Date: after it has been accepted as complete. 5....4.• *Fee methodology set by Tri-County Building Industry Service Board. 1 1:\Building Termits,PLMU-PermitApp.doc 10/01/09 440.4616T(10/02/COM/WEB) n Plumbing Permit Application - City of Tigard �v " � Page 2 - Supplemental Information 6 Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qt . Fee(ca) Total Square Footage.: Permit Fee: IL Footing drain- l'' I110' 5' u; 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' 1 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 Value, Permit Feel Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum Ice$72.50 Storm&Rain Drain-each additional I lt) 37.51 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for Other ec Ins tions or Fees Qt}. Fee(ca) Total each additional$100.00 or fraction thereof,to Inspections 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: Other Fixtures: 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 Fixture Ty pe for Replace/ Plan Review for Plumbing Installation Work Performed: Capped Added Relocate Baptise, Font Plan review is required for any of the following. Bath Tub/Shower Please check all that apply. -Jacuzzi/Whirlpool ❑ Any new commercial building with water service 2"and Car Wash -Each Stall greater,except systems designed and stamped by licensed -Drive Thru engineer. Cuspidor/Water Aspirator ❑ New exterior plumbing site utilities for any complex structure Dishwasher -Commercial I as defined in OAR918-780-0040. -Domestic ❑ Medical gas and vacuum systems for health care facilities. Drinking Fountain ❑ Any multipurpose fire sprinkler system. Eye Wash ❑ Any complex structure as defined in OAR918-780-0040. Floor Drain/sink -2" Submit 2 sets of plans with any of the above. 4" 14 Car Wash Drain Isometric or Riser Diagram Garbage -Domestic-non-food Disposal -Domestic-food related ❑ Isometric or riser diagram is required for new buildings -Commercial-food related that meet the qualifications above. -Industrial-food related Ice Mach./Refrig.Drains I Oil Separator(Gas Station) Rec.Vehicle Dump Station Comments regarding fixture work: Shower -Gang -Stall Sink/Lav -Non-food related 4 -Bradley -Commercial-food related 7 -Service Swimming Pool Filter Washer-Clothes *Note: If the fixture work under this ermit results in an Water Extractor p Water Closet-Toilet 3 increase of sewer EDUs,a sewer permit will be issued and Urinal I fees assessed for the sewer increase must be paid before the C:\Users\Debbie\AppData\Local\Microsoft\Windows\Temporary Internet!iles\Content.Outlook\D I M 75Z A\P LM U- PermitApp_Rev_Complete.doc Plumbing Permit Application ` Building Fixtures RECEIVED FOR OFFICE USE ONLY City of Tigard Received `, g an Date/By: J' I . it4' j Permit No../.i: f./ley _..6b a74, • 13125 SW Hall Blvd.,Tigard, 7 3 9n (mow IN---7 RR `t Plan Review ` ' Phone: 503.718.2439 Fax: .� 9b0 Date/By: Other Permit No.: c�W�.2O/t-1�Op8O 1 I i, i< I Inspection Line: 503.639.4 7 Date Ready/By: Juris I 0 See Page 2 for Internet: www.tigard-or.gtr ITY OF TIGA RD Notified/Method: 1 Supplemental Information TLBIN DIVISION FEE* SCHEDULE ❑New construction ❑Demolition For special information use checklist Description I (Ay. I Ea. I Total ®Addition/alteration/replacement ❑Other: New 1-2-family dwellings i cludes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 ❑ 1-and -family dwelling ®Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 ❑Accessory . ilding ❑Multi-family Each addition, tath/kitchen 25.02 ❑Master builder ❑Other: Fire sprin -r( sq.ft.) Page 2 JO: ITE INFORMATION AND LOCATION Site tit' ies: Job site address: 10230 SW ashington Square Road Cat .asin or area drain 18.76 City/State/ZIP:Tigard,OR 972 well,leach line,or trench drain 18.76 Footi :drain(no.linear ft.: ) Page 2 \31 Suite/bldg./apt.no.: l Proj- name:Panera Bread Manu • red home utilities 50.03 Cross street/directions to job site:SW Gree •urg Road Ma nhr 18.76 r rain connector 18.76 a tary sewer(no.linear ft.: ) Page 2 orm sewer(no.linear ft.: Page 2 ‘ ater service(no.linear ft.: ) _ Page 2 Subdivision: Lot 102 Fixture or item: Tax map/parcel no.:Tax Map 1S135BA v Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 TI of a portion of a former bookstore for a new fie ,a ead estaurant Dishwasher I / 25.02 25 .yAIIIIIIIK. Drinking fountain 25.02 MAIllEablkEjectors/sump 25.02 ❑ PROPERTY OWNER /w' ® TENAN Or Expansion tank 12.51 Name: Panera,LLC -Igillk xture/sewer cap 25.02 Address:3630 S.Geyer Road,Suite 100 ; TI Fl drain floor sink/hub 14 / 25.02 350 Garin:-disposal 25.02 City/State/ZIP: Sunset Hills,MO 63127 , Hose bib 25.02 3) Phone:(314)984-1000 Fax:(314)909-3 Ice maker 3 / 12.51 37 ❑ APPLICANT ® CONTACT PERSON Interceptor/grease •ap 1 25.02 25 Business name:Panera,LLC Medical gas(value:$ ) Page 2 Primer 12.51 Contact name:John Sturges Roof drain(commercial) 12.51 Address:3187 Airway Avenue,Suite Sink/basin/lavatory ? 10 25.02 250 City/State/ZIP:Costa Mesa,CA 926 6 Solar units(potable water) 62.54 Phone:(714)966-9400 Fax: :(949)258-5655 Tub/shower/shower pan 12.51 E-mail: Urinal 2 1 25.02 25 Water closet 2 3 25.02 75 CONTRACTOR ' Water heater 1 37.52 38 Business name: Water piping/DWV 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal 825 Phone:( ) Fax:( ) Minimum permit fee: $72.50 CCB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee) 206 State surcharge(12%of permit fee) 99 Authorized signature: TOTAL PERMIT FEE 924 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-PennitApp.doc 10/01/09 440-4616T(10/02/COM/WFB) 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- l'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- Ist 100' 62.54 $1.00 to$5,000.00 Minimum fee$7 .50 Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for th- first$5,000.00 and$1.52 for Other Inspections or Fees Qty. Fee(ea) Total each additi• al$100.00 or fraction thereof,to and incl mg$10,000.00. Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.5: for the first$10,000.00 and$1.54 for which no fee is specifically indicated 90.00/hr eac additional$100.00 or fraction thereof,to (minimum charge-1/2 hour) a including$25,000.00. Inspections outside of normal business 90.00/hr $25,001.00 to$ 000.00 79.50 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 f)0 and u $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: P'j\it\\6 Commercial Fixture Work: Are you capping,adding or replacing fixtures? If"yes", ! p� 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 q Y g Baptistry/Font Please check all that apply. Bath Tub/Shower ❑ Any new commercial building with water service 2"and Jacuzzi/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 I 7 ❑ 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. 4 / Isometric or Riser Diagram Car Wash Drain Garbage Domestic-non-food ❑ 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 3 / Oil Separator(Gas Station) Comments regarding fixture work: Rec.Vehicle Dump Station Shower -Gang -Stall Sink/Lav -Non-food related / 7 -Bradley l-- -Commercial-food related 2 -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 WaterCloset-Toilet fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. Other Fixtures: Macintosh HD:Users:RSIGroupPM:Desktop:PLMF-PermitApp_Completedoc Plumbing Permit Applica r I IT CEIVED S4 e.utwties t IcT4 02S'` ' t,�J� f FOR OFFICE USE ONLY ,` City of Tigard p 2 0 2014 Received L i e0;74 `, g A Date.Received / Permit No.: • 13125 SW Hall Blvd.,Tigard,OR 97 Plan Review 6/t+n /4 `e Phone: 503.718.2439 Fax: 5,03.5.98..1 Date By: Other Permit No.. t t �/ I 1 C.A R I) Inspection Line: 503.639.4175%,11 'OF TIGARD Date Ready!By: turis: ® See Page 2 for Internet: www.tigard-or.govn i ` r ` r a v,. Notified Method: Supplemental Information V TYPE OF WORK ( FEE* SCHEDULE 0 New construction Demolition For special information use checklist. a 1 Description 1 Qty. I Ea. 1 Total ®Addition/alteration/replacement ❑Other: I New 1-2- dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION ii ;?c /4 ,A„., SFR(1) t Op 312.70 ❑ I-and 2-family dtvellin__ y� SFR('_I ball 437.78 ®Commercialindustrial tit Accessory building y t L� SFR(3)bath 500.32 ❑ ry ID Q. Each additional bath/kitchen 25.02 ❑ Master builder ❑Other: �,C�` Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: 10230 SW Washington Square Road Catch basin or area drain 18.76 Drywell.leach line,or trench drain 18.76 City/State/ZIP:Tigard,OR 97223 Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: I Project name: Panera Bread Manufactured home utilities 50.03 Cross street/directions to job site:SW Greenburg Road Manholes 18.76 1d- Rain drain connector 18.76 5 tN' Storm sewer(no.linear ft.:_) Page 2 ' Water service(no.linear ft.:_) Page 2 Subdivision: 1 Lot no.: 102 Fixture or item: Tax map/parcel no.:Tax Map 1S135BA Backtlow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 ' Clothes washer 25.02 TI of a portion of a former bookstore for a new Panera Bread restaurant Dishwasher 1 25.02 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ❑- PROPERTY OWNER I ® TENANT Expansion tank 12.51 Name:Panera,LLC Fixture/sewer cap 25.02 Floor drain/floor sinkltub 14 25.02 350.28 Address:3630 S.Geyer Road,Suite 100 Garbage disposal 25.02 City/State/ZIP:Sunset Hills,MO 63127 Hose bib 25.02 Phone:(314)984-1000 Fax:(314)909-3300 Ice maker 1 12.51 12.51 ❑ APPLICANT ® CONTACT PERSON Interceptodgrease trap 25.02 Business name: Panera.LLC Medical gas(value:S ) Page 2 Primer 12.51 Contact name:John Sturges Roof drain(commercial) 12.51 Address:3187 Airway Avenue,Suite A Sink.basin/lavatory 11 25.02 275.22 City/State/ZIP:Costa Mesa,CA 92626 Solar units(potable water) 62.54 Phone:(714)966-9400 Fax::(949)258-5655 Tub/shower/shower pan 12.51 E-mail: Urinal I 25.02 25.02 Water closet 3 25.02 75.06 CONTRACTOR • Water heater 37.52 Business name: Water piping/DWV 56.29 Address: Other: 25.02 6l City/State/ZIP: Subtotal 5261.1 i V Phone:( ) Fax:( ) Minimum permit fee: S72.50 Plan review (25%of permit fee) 296752, 47 CCB Lic.: Plumbing Lic.no.: gr. State surcharge(12%of permit fee) -94773 Authorized signature: TOTAL PERMIT FEE J,y3.2 This permit application expires if a permit is not obtained within 180 days ,. vL q Print name: Date: after it has been accepted as complete. i t/ *Fee methodology set by Tri•County Building Industry Service Board. L I' F Building Permits PLMC•PermitAppdoc 10.01 09 440-46161(104)2 COM WEB) Plaything Permit Application - City of Tigard , 1!) - ► . Page 2 - Supplemental Information iiigsgt0 Fee Schedule: Residential Fire Su s s ression Systems: Site Utilities Qty. eee t S t uare Foota e: Permit Fee: Footing drain- I'' 10)) to 2,000 5121.90 Footing drain-each additional 100' 37.52 2.001 to 3.600 S169.69 Sewer-1st 100' I 62.54 3.601 to 7.200 $233 20 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 S1.00 to$5.000.00 Minimum fee 572.50 Storm&Rain Dram-each additional 100' 37.52 $5.001.00 to S10.000.00 $72.50 for the first$5.000.00 and$1.52 for Other ec Ins tions or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to Inspections and including S10,000.00. Inspection of existing plumbing or for 510,001.00 to$25.000.00 5148.50 for the first 510.000.00 and$1.54 for which no fee is specifically indicated 90.00/hr each additional 5100.00 or fraction thereof.to (minimum charge—1:2 hour) and including 525.000.00. Inspections outside of normal business 90.00 hr 525.001.00 to$50.000.00 $379.50 for the first$25.000.00 and S 1.45 for hours(minimum charge—2 hours) each additional S100.00 or fraction thereof:to Reinspection Fees 90.00,hr and including S50.000.00. Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first 550,000.00 and S1.20 for (minimum charge I:'2 hour) each additional$100.00 or fraction thereof. Subtotal: Other Fixtures: 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 Fixture Type for Replace/ Plan Review for Plumbing Installations Work Performed: Capped added Relocate b Baptistry/Font Plan review is required for any of the following. Bath TubiShower Please check all that apply. Jacuzzi/Whirlpool ❑ Any new commercial building with water service 2"and Car Wash -Each Stall greater,except systems designed and stamped by licensed -Drive Thru engineer. Cuspidor/Water Aspirator ❑ New exterior plumbing site utilities for any complex structure Dishwasher -Commercial I as defined in OAR918-780-0040. -Domestic ❑ Medical gas and vacuum systems for health care facilities. Drinking Fountain ❑ Any multipurpose fire sprinkler system. Eye Wash ❑ Any complex structure as defined in OAR918-780-0040. Floor Drain sink -2" 3" Submit 2 sets of plans with any of the above. 4" 14 Car Wash Drain Isometric or Riser Diagram Garbage -Domestic-non-food Disposal -Domestic-food related ❑ Isometric or riser diagram is required for new buildings -Commercial-food related that meet the qualifications above. -Industrial-food related Ice Mach./Refrig.Drains I Oil Separator(Gas Station) Rec.Vehicle Dump Station Comments regarding fixture work: Shower -Gang -Stall Sink/Lay -Non-food related 4 -Bradley -Commercial-food related 7 -Service Swimming Pool Filter Washer-Clothes *Note: If the fixture work under this permit results in an Water Extractor uner P Water Closet-Toilet 3 increase of sewer EDUs,a sewer permit will be issued and Urinal l fees assessed for the sewer increase must be paid before the C:\Users\Debbie\AppData\Local\Microsoft\Windows\Temporary Internet!iles\Content.Outlook\DIM75ZHA\PLMU- PermitApp_Rev_Complete.doc Plan ibing Permit Application • Site Utilities RECEIVED FOR OFFICE LSE ONLY City of Tigard Received ty g Date/By: j/ /( Date c J'J Permit No.: e#,9/ i D�aZ 7s- II 13125 SW Hall Blvd.,Tigard,OR/ /L I 11 Plan Review Phone: 503.718.2439 Fax: 5035,:"9.6 Date/By: Other Permit No.: Inspection Line: 503.639.4175 T I GA R D NDoatte ifi Reed ad hy o d: // r � / ® See Page 2 for Internet: www.tigard-or.gov T Y OF TIGARO Supplemental Info rmaton TYPE 9Ur1�f. J2J J DIVISION F /f /i FEE* SCHEDULE ❑New construction ❑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) CATEGORY OF CONSTRUCTION SFR(I)bath 312.70 ❑ 1-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: 10230 SW Washington Square Road Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP: Tigard,OR 97223 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: I Project name: Panera Bread Manufactured home utilities 50.03 Cross street/directions to job site:SW Greenburg Road Manholes 18.76 Rain drain connector 18.76 ,t,l Sanitary sewer(no.linear ft.:40) 1 Page 2 -, .i Storm sewer(no.linear ft.: ) Page 2 l� Water service(no.linear ft.: ) Page 2 Subdivision: Lot no.: 102 Fixture or item: Tax map/parcel no.:Tax Map 1S135BA Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 TI of a portion of a former bookstore for a new Panera Bread restaurant Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ❑ PROPERTY OWNER I ® TENANT Expansion tank 12.51 Name: Panera,LLC Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25,02 Address:3630 S.Geyer Road,Suite 100 Garbage disposal 25.02 City/State/ZIP: Sunset Hills,MO 63127 Hose bib 25.02 Phone:(314)984-1000 Fax:(314)909-3300 Ice maker 12.51 ❑ APPLICANT ® CONTACT PERSON Interceptor/grease trap 25.02 Business name: Panera,LLC Medical gas(value:$ ) Page 2 Primer 12.51 Contact name:John Sturges Roof drain(commercial) 12.51 Address:3187 Airway Avenue,Suite A Sink/basin/lavatory 25.02 City/State/ZIP: Costa Mesa,CA 92626 Solar units(potable water) 62.54 Phone:(714)966-9400 Fax: :(949)258-5655 Tub/shower/shower pan 12.51 E-mail: Urinal 25.02 CONTRACTOR Water closet 25.02 Water heater 37.52 Business name: Water piping/DWV 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal Phone:( ) Fax:( ) Minimum permit fee: $72.50 Zi.sv 7-3' CCB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee) --6,- la"' State surcharge(12%of permit fee) S.IC -9-' Authorized signature: TOTAL PERMIT FEE ?/,22 -8.2' Print name: Dale: 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. L\Building'Pernits`PLMU-PernitApp.doe 10/01/09 410-46 16T(l0/02/COM/WEB) Debbie Adamski From: Debbie Adamski Sent: Tuesday, August 19, 2014 7:33 AM To: Moni Dosanjh (rsi.monid @gmail.com) Subject: Panera Bread, Washington Square Mall, Tigard, OR Attachments: SPC_Permits 14081906210.pdf Moni, I am calculating the sewer system development fees for this project and there is a discrepancy on the building fixtures plumbing permit application between page 1 and the commercial fixture work table on page 2. The figures on page 2 need to match the figures on page 1. Page 1 indicates there are 10 sinks/lays and the fixture table only accounts for 9 sinks/lays. Also, if a hand wash sink is required for food prep, it is considered a food prep sink, not a lay. Usually it is only bathroom lays that get counted as non-food related. The water closets and the urinal are also not listed on the fixture table, are they replacements, relocates or additional fixtures to the space? I would appreciate it if you could correct the figures on the fixture table on page 2, or change the figures on page 1, then return this to me. Once I receive it I can finish calculating the sewer fees for this project. Thanks and let me know if you have any questions on this. Debbie Adamski Senior Permit Technician City of Tigard I Community Development 13125 SW Hall Blvd., Tigard, OR 97223 503-718-2450 1 Dianna Howse From: Branden Taggart Sent: Thursday, December 11, 2014 8:15 AM To: John Sturges; Debbie Adamski; Dianna Howse Cc: Moni Dosanjh Subject: RE: Panera Bread/Tigard Fees Attachments: Branden Taggart.vcf Hello John, We processed the landlord's check on November 17 for$43,512. However,on Monday your plumbing contractor submitted a plumbing application with all new fixtures that totaled over$27,000 in SDC fees. That same day we received plumbing plans for our inspector,George Heimos,to review. As soon as we can verify the fixture count,we will let you know what the balance due will be. I spoke with George on Tuesday, and he said it will take him approximately a week to complete plan review. Thanks, Branden Taggart IN City of Tigard Permit Technician Community Development 13125 SW Hall Blvd Tigard, OR 97223 (503)718-2449 brandent@tigard-or.gov From: John Sturges [mailto:rsi.johns@gmail.com] Sent: Wednesday, December 10, 2014 12:37 PM To: Debbie Adamski; Branden Taggart Cc: Moni Dosanjh Subject: Panera Bread/Tigard Fees Hi Debbie/Branden, I just wanted to verify your receipt of the landlord's check ($43,512) for sewer fees. Also, a plumber for our project is reporting that we owe approximately $28,000 in additional fees. This is third hand hearsay to me at this point, but I wanted to confirm with you all one more time that the attached invoices represent the total fees Panera owes for this project. • Sewer fees: $43,512 • Misc. Plan Review, Permit, Dev. Fees: $18,942.41 Thanks again for all your help on this project. Thank you, 1 John Sturges Project Manager RSI Group, Inc. 3187 Airway Avenue, Suite A Costa Mesa, CA 92626 RSI.johns@gmail.com 619.947.0762 cell 714.966.9400 office 949.258.5655 fax This email and any files transmitted with it are confidential and intended solely for the use of the individual or entity to whom they are addressed. If you are not the named addressee, you should not disseminate, distribute, or copy this email. 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." 2 RECEIVED DEC 92014 1 '11 CITY OF"TIGARD BUILDING DIVISION Letter of Transmittal TO: From: City of Tigard Zaid Al-Mawsawi Building Department zalmawsawi @bigredrooster.com 13125 SW Hall Boulevard 480-626-6304 ext.110 Tigard, OR 97223 Attn. George Heimos (CC)John Sturges Company and Address: Date:12-5-14 City of Tigard Building Department Total pages including cover: 13125 SW Hall Boulevard 3 SETS OF 24X36 SHEETS Tigard, OR 97223 Phone Number: E-mail: Cell: Project Number: Pan002 Project Name: Panera Bread#1828 We are sending you the following: x Plans Shop Drawings Change Order Specifications Prints Samples Copy of Letter Other Copies Date No. Description 3 12-5-14 3 (3) set of the Panera Bread #1828. All the plumbing sheets. 3 12-5-14 3 (3) set of the Panera Bread #1828. Equipment plans and schedules These are transmitted as checked: x For your use For review and comment _ Approved as submitted For your approval Reviewed Approved as noted As requested Reviewed as noted Returned for corrections submittal Signed: Zaid Al-Mawsawi Copy To: File Design Specifications : SureSeal Waterless Floor Drain Trap Sealer Page 1 of 5 MENU The Green Solution°TM Inline Floor Drain Trap Sealer 1 (877) 201-2663 ICC-ES Listed: PMG-1070•ASSE 1072 Approved Listing#1409• IAPMO Listed: C-4165 Patents: US 6,273,124 B1 • CA 2,450,304 • Other Patents Pending STOP floor drain odors before they start with waterless trap protection. 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Follow us on facebook pr J http://www.thesureseal.com/design 11/25/2014 Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 10230 SW WASHINGTON SQUARE RD, TIGARD, OR, 97223 Commercial - Plumbing 399 Plumbing final PASS - No C of O PLM2014-00276 George Heimos Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 10230 SW WASHINGTON SQUARE RD, TIGARD, OR, 97223 Commercial - Plumbing 399 Plumbing final FAIL PLM2014-00276 George Heimos 1. Correction dated 01/12015 not completed, pressure reducing valve. 2. Caulk brewer sink top at wall. 310.3/407.2 3. Complete water heater PVC 3/4" support. Table 3-2 4. Provide backflow device test results for soda and espresso machines. 310.3/407.2. 5. Provide grout on all three grease interceptor top cleanout rings. 314.4 Recall inspection when corrections have been completed. Re-inspection required. 103.5.6.1 Violation Summary: Inspector Contractor