Permit Support Document (33) ligCITY OF TIGARD PLUMBING PERMIT
s ' COMMUNITY DEVELOPMENT _f. f Permit#: PLM2017-00356
TIGrARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 CJ��,-��► Date Issued: 08/31/2017
((`( Parcel: 2S110DCO2200
Jurisdiction: Tigard
Site address: 15570 SW PACIFIC HWY
Project: Safeway-Starbucks Kiosk Subdivision: 1997-016 PARTITION PLAT Lot: 2
Project Description: Cap and relocate existing plumbing fixtures: (2)2"floor sinks,(1)2"floor drain,(1)ice machine,(1)non-food
related hand sink;install 200'new interior waste piping. 9/5/2017: REPRINT permit to add(1)grease trap.
Contractor: EVOLUTION PLUMBING LLC Owner: ROIC OREGON LLC 1
7715 NE 33RD DR SUITE D ATTN: SCHOEBEL, RICHARD
PORTLAND, OR 97211 8905 TOWN CENTRE DR, STE 108
SAN DIEGO, CA 92122
PHONE: 503-655-3388 PHONE:
FAX: 503-305-8373
FEES
Quantity Description Date Amount
5 ea Fixture/Sewer Cap 08/31/2017 $125.10
Specifics: 3 ea Floor Drain/Floor Sink/Hub 08/31/2017 $75.06
1 ea Ice Maker 08/31/2017 $12.51
Type of Use: COM 1 ea Sink 08/31/2017 $25.02
Class of Work: ALT 25 Misc Other Fee 08/31/2017 $25.02
Type of Const: 1 12%State Surcharge- 08/31/2017 $31.53
Occupancy Grp: Plumbing
Stories: 1 ea Interceptor/Grease Trap 09/05/2017 $25.02
0 12%State Surcharge- 09/05/2017 $3.00
Plumbing
Total $322.26
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: :, le / Permittee Signature:
Fr
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 ApplicatioW"
LC Fl En
. •...1 V
Building Fixtures
F1.- (�
City of Tigard 2_U 17 Received Permit No /,� �7-a
111 u 13125 SW Hall Blvd.,Tigard,OR 97223 U DateBy: �7 /�`V/ ' /ou/cs' ?�/ Gsl'��49
Plan Revie
-.,- '_' Phone: 503
.7i 18.2439 Fax: 503.598Q'YFIGA"� ID-- Dai teBy
Other Permit No.:
Inspection Line: 503.639.4175 ... ADate Ready/By: Juris: 3 See Page 2 f
orTIGARDInternet www.ti and or ov INUV 0 NsIotified/Method: � Supplemental information
1.* Gi�"�� HP0 � � � 'i +�� � fiPk '
i
El New construction 0 Demolition For special information use checklist
Description I Qty. I Ea. I Total
Ca Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
>; ® 0 0 ,,T (S �
SFR(1)bath 312.70
� 4ks uu a e as .,olatullbla> AU, "1 . .. _.,, SFR(2)bath 437.780 1-and 2-family dwelling Commercial/industrial
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
B 1, W , Site ulities:a3NO ;It t ATION 011!1;;;
Job site address: 15570 SW Pacific Hwy Catch basin or area drain 18.76
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.: Project name: Safeway - Starbucks Kiosk 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: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
l !G1 , .,; Backwater valve 12.51
'' Clothes washer 25.02
Add (1)grease trap to existing plumbing permit#PLM2017-00356 . Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
4 TNA "' Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
C .:1:;:'-:!:1:11011t10:::;,p. „ 4: CONTACT i:ILO 1fi, , Interceptor/grease trap 1 25.02 25.02
Medical gas(value:$ ) Page 2
Business name: Evolution Plumbing LLC
Primer 12.51
Contact name: Shaina Pasi
Roof drain(commercial) 12.51
Address: 7715 NE 33rd Drive Suite I Sink/basin/lavatory 25.02
City/State/ZIP: Portland, OR 97211 Solar units(potable water) 62.54
Phone:( 50a 655-3388 Fax: :( 503)305-8373 Tub/shower/shower pan 12.51
E-mail: Shaina.Pasi@evoplumbing.net Urinal 25.02
25.02 i- tR6 Water closet
a , ' �.� NA4 .." V;
Water heater 37.52
Business name: Evolution Plumbing LLC Water piping/DWV 56.29
Address: 7715 NE 33rd Drive Suite I Other: 25.02
City/State/ZIP: Portland, OR 97211 Subtotal 25.02
Phone:(503 ) 655-3388 Fax:( 503)305-8373 Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.: 1$9876 Plumbing Lic.no.: PB$34 State surcharge(12%of permit fee) . ,LIv
Authorized signature: 3"1.4.44.4„. ,0a� TOTAL PERMIT FEE 1.9-4e; .'...-
Print name: Shaina Pasi Date: g/1/17 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 Boaz
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616x(10/02/COM/WEB)
qCITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2017-00356
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/31/2017
Parcel: 2S110DCO2200
Jurisdiction: Tigard
Site address: 15570 SW PACIFIC HWY
Project: Safeway-Starbucks Kiosk Subdivision: 1997-016 PARTITION PLAT Lot: 2
Project Description: Cap and relocate existing plumbing fixtures: (2)2"floor sinks,(1)2"floor drain,(1)ice machine,(1)non-food
related hand sink;install 200'new interior waste piping.
Contractor: EVOLUTION PLUMBING LLC Owner: ROIC OREGON LLC
7715 NE 33RD DR SUITE D ATTN: SCHOEBEL, RICHARD
PORTLAND, OR 97211 8905 TOWN CENTRE DR, STE 108
SAN DIEGO, CA 92122
PHONE: 503-655-3388 PHONE:
FAX: 503-305-8373
FEES
Quantity Description Date Amount
5 ea Fixture/Sewer Cap 08/31/2017 $125.10
Specifics: 3 ea Floor Drain/Floor Sink/Hub 08/31/2017 $75.06
1 ea Ice Maker 08/31/2017 $12.51
Type of Use: COM 1 ea Sink 08/31/2017 $25.02
Class of Work: ALT 25 Misc Other Fee 08/31/2017 $25.02
Type of Const: 1 12%State Surcharge- 08/31/2017 $31.53
Occupancy Grp: Plumbing
Stories:
Total $294.24
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: /
,� J i Permittee Signature: // ./(y am
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.
From: d 08/30/2017 14:27 #231 P.002/003
Plumbing Permit Applicata � ` f'^`'
Building Fixtures AUG! 3 0 )ui,i FOR OFFICI: ('SF ONI.v
City of Tigard EEew ' /"
4q-7----Permit No.
13125 SW Hall Blvd.,Tigard,OR 9 t @ ,/7Ti35,
0 R " '16; i.�9 Other Permit No.:
C Phone: 503.718.2439 Fax: 503.548-.?9te/6
TI G.A K D Inspection Line: 503.639.4175 'ail
7 til D NG 1)11/19( tte Ready/By: lu is: 0 See Page 2 for
Internet: www.tigard-or.gov p? Notified/Method: Supplemental Information
k* W*V 4 _ _ r... n s _rte .i_it L i;',. •.r.:., efi<y F i v t-
❑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)
r W 03;FaC.i E3'fll"+ 'C i 4.t"'. := p_ SFR(1)bath
312.70
-
0 1-and 2-family dwelling [ m
Comercial/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
rOB Ste.IN AT1OJ tND L A'TIOi11;- r ` Site utilities:
Job site address: 16 ,-10 J� Ta��L T11� Catch ll,le ch linaree drain to 18.76
Drywall,leach line,or trench drain 18.76
City/State/ZIP: 'C't�rn✓�1 IC �1 ZZ
{ Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: (Project name:S ot� t.1< Manufactured home utilities 50.03
Cross street/directions to job site: UC,/1C,‘0 tC,jOSK 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 31.27
,.
z _- Backwater valve 12.51
tl£SCItlih1EyN i1F
Clothes washer 25.02
`Rumion' t1` JIatYY,{1/t,C�b t"tbc5L Dishwasher 25.02
eAc lY c o6 h OV Drinking fountain 25.02
Ejectors/sump 25.02
Tttoi try Cdr ❑ T0ANT Expansion tank 12.51
Fixture/sewer cap I 25.02 / 5,/c)Name:
Floor drain/floor sink/hub 25.02 /5,ab
Address: Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 1 12.51 D„...61
AYPTie-... l ❑ Ct)i1T ,C'T ii$6T+1 Interceptor/grease trap 25.02
�V
Business name:�\,1 �
V� '1 i(yl. 'plt,Ayy\ op) Medical gas(value:$_) Page 2 l
,(� ,,, '"'JJ Primer 12.51
Contact name: v I^�4jnat. pA.si Roof drain(commercial) 12.51
Address:1---tic- t ,6, 0,.. 1W. &Wit. 1 Sink/basin/lavatory I 25.02 25.C)2.
City/State/ZIP: To0-1Aoatl 012. 1124 I Solar units(potable water) 62.54
Phone:( a3) v66. ?39)$1 Fax::( )0 , 6.�'�j,I-17j Tub/shower/shower pan 12.51
EmailSV I nA OAS e.V02 iWy
v 211 at Urinal 25.02
Water closet 25.02
Ci�NTRr1CTt}il
Water heater 37.52
Business name: n1 fiVpikjt �21� 'Lu Y Ig L.L-C W erpiping/DWV 56.29
Address:/1 I.6 N SN411 DY. ,S141C- I v"ther:200' lntcvir 11p1�iLtS1( ( 25.02 ( 5,11„;-,L.
City/State/ZIP:-pQ1/-1'IA 1 -p
be onZ1 1lr�'1'J Subtotal °� �iL.'7/
Phone:(G2 C)r-) , • 9 Fax:(Uj) '3t) •(6 17) Minimum permit fee: $72.50
f 11619
O V P)C � Plan review (25%of permit fee) %r-5-3CCB Lic.: l 1' PlumbingLic.no.:
State surcharge(12%of permit fee)
Authorized signature: VDate: v_ � TOTAL PERMIT FEE .:;.607;62/
1 7r
Print name: U i lin l PY,&'1 ';D 117 This permit application expires if a permit is not obtained within 180 days
r.� after it has been accepted as complete. ,
*Fee methodology set by Tri-County Building Industry Service Board./x+r/V `..
i9Building.Permils,PLMU-PermitApp.doc 10'01x09 440-4616T(10'O2iCOM WEB)
From: 08/30/2017 14:30 #231 P.003/003
Plumbing Permit Application- City of Tigard
Page 2-Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
total -
Sxtil<Tt ,�I�1�'1e:3 s z._ _ �:'� a . _,: .,`�� �� .. liii�'e�?�4�� wt .. :T :f'te"<. -.g:'46-,1.- i,.'",4-5.
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-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52 i
Storm&Rain Drain-1st 100' 62.54 $1.00 to S5,000.00 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
�t5a Fee ) o each additional$100.00 or fraction thereof to
Qtheit hipettitlinS 1i Fres: , ;< and including$10,000.00.
Inspection of existing plumbing or for S 10,001.00 to$25,000.00 S148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional S100.00 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 S50,001.00 and up S742.00 for the first$50.000.00 and$1.20 for
each additional$100.00 or fraction thereof.
(minimum charge-1/2 hour)
Subtotal;
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*. ,_
t a,tit by F xture Type_ Plan=Rev ftor Ptuml ng Installations
Fixture i afor'.' • ""-1!,14#1.'
Y[? Plan review is required for any of the following.
Work,Prforrned: Capped,• Added Relohate
Please check all that apply.
Baptistry/Font
Bath -Tub/Shower ❑ Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
-Jacuzzi/Whirlpool
Car Wash -Each Stall engineer.
-Drive Thru 0 New exterior plumbing site utilities for any complex structure
Cuspidor;Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" yes 3 Submit 2 sets of plans with any of the above.
Istntnetfric o>r R>tseI<agram
Car Wash Drain
0 Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach.Refrig.Drains ye.S
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station =)tiv ,Shower -Gang !A t Th(tt,AY art =)tiv J� ird o(ML4:
stall (2 ROW$i+r 5 C i� tcL 1C;V1t t .
Sink/Lav -Non-food related yes
-Bradley L, F-lt*W thritIn
-Commercial-food related i 4-totrok 5init
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-clothesincrease of sewer EDUs,a sewer permit will be issued and
Water Extractor
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
http:/iwww.tigard-or.gov/document_center/Building/PLM F_PermitApp.dS
From: 08/30/2017 14:27 #231 P_001/003
ev '!T
'..'',; lIff
plumbing, IIc AUG 3 0 ZOIi
OR CCB#189876*WA Lic#EVOLUPL908DK
CITY OF II GARP
FAX COVERSHEET 8 I;II,PING DIVIFAW,
Date: August 30,2017
To: City of Tigard-Permits
From: Shaina Pasi
Fax: 503-598-1960
Subject: Commercial Plumbing Permit Application—15570 SW Pacific Hwy
To Whom This May Concern,
The following is a Plumbing Permit Application for the above mentioned address.
Should you have any questions,please contact me via email at
Shaiiia.Pasifil,evoplumbinulei or call 503-655-3388. Thank you.
Sincerely,
Shaina Pasi
Office Manager
Total#of pages(including coversheet)3
Office 503-655-3388*Fax 503-305-8373*7715 NE 33rd Drive Suite D.,Portland,OR 97211
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15570 SW PACIFIC HWY, TIGARD, OR, 97224
Record Type: Record ID:
Commercial - Plumbing PLM2017-00356
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor