Permit q CITY OF TIGARD PLUMBING PERMIT
111111 it COMMUNITY DEVELOPMENT Permit #: PLM2011 -00049
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/10/2011
Parcel: 2S112DD01300
Jurisdiction: Tigard
Site address: 15650 SW UPPER BOONES FERRY RD
Project: Burgerville Subdivision: Lot: 0
Project Description: Replace existing grease trap.
Contractor: PORTLAND MECHANICAL CONTRACTORS Owner: RYAN, JOANNE C &
2000 SE HANNA HARVESTER DR CHARTER PROPERTIES III LLC
MILWAUKIE, OR 97222 BY BOB L SMITH
280 LIBERTY ST SE #300
SALEM, OR 97301
PHONE: 503 - 656 -7400 PHONE:
FAX: 503 - 655 -0620
FEES
Quantity Description Date Amount
1 ea Interceptor /Grease Trap 02/10/2011 $25.02
Specifics: 1 12% State Surcharge - 02/10/2011 $8.70
Plumbing
Type of Use COM 47 ea Minimum Fee Adjustment- 02/10/2011 $47.48
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Noti • . ion . Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct .uestions to OUN ca ' g •03.232.1987 or 1.800.332.2344.
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Issued By: /� // .10 Permittee Signature: 6
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Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
02/10/2011 11:50 5036550620 PMC GROUP PAGE 02/04
Plumbing Permit Application
Building Fixtures �1 ) � Ft)R Ol h'lc'I'. IISE, c)NI,1
City of Tigard 11 Received qq � Q
IN g Date/By: pl I e I Q Permit No.: r o e //_ 7
• 13125 SW Hall Bl vd., Tigard, i ,. , Plan Review
le Phone: 503.639.4171 Fax: 50 98.1961 \. � Date/ Other Permit No.:
T t G A R D Inspection Line: 503.639.4175 V � �� p� Date Ready/By: tuns. ® See Page 2 for
Internet www,tigard o[ gov rt G S , '\. Notified/Meth Supplemental information
1 W : {off WORT ' ` �# A r F,ET2* SZ'1IEI1l.7L' .. , 1
❑ New construction ❑ D .5I*l'ti _ For special information use checklist
Description 1 Qty. I Ea. 1 Total
® Addition /alteration/replacement ❑ ether: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGOI$Y i(jr _CONST.RIICTCflt1N 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 INN?1F'O 1:02il 'ION A1) LOOA' 'II)N Site utilities:
Job site address: 15650 SW Upper Boones Ferry Road Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City /State /ZIP: Tigard, OR 97035 -
Footing drain (no. linear ft.: Page 2
` Suite/bldg. /apt. no.: I Project name: Burgerville #40 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: 1 Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DOCRIa`TI01 OF ,WORK . :
Backwater valve 12.51
Clothes washer 25.02
Replace existing grease trap with new Shier Trapper II PATG -2025. Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
❑ PROPEIRTY OWNER I TENANT Expansion tank 12.51
Name: Burgerville #40 Fixture /sewer cap 25.02
Floor drain /floor sink/hub 25.02
Address: 15650 SW Upper Boones Ferry Road -
Garbage disposal 25.02
City /State/ZIP: Tigard, OR 97035 Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
:12.1 A PUCANT ❑ CONTACT? I?IRSON Interceptor / trap I. 25.02 25.02
Business name: Portland Mechanical Contractors Medical gas (value: $ ) Page 2
Primer 12,51
Contact name: Nick Odle
Roof drain (commercial) 12.51
Address: 2000 SE Hanna Harvester Drive Sink/basin /lavatory 25.02
City /State /ZIP: Milwaukie, OR 97222 Solar units (potable water) 62.54
Phone: (503) 656 -7400 Fax: : (503) 655 -0620 Tub /shower /shower pan 12.51
E -mail: nodle @pmc -g.com Urinal 25.02
C.COR Water closet 25.02 ,
COh"IR
Water heater 37.52
Business name: Same as above. Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal 25.02
Phone: ( ) Fax: ( )
Minimum permit fee: 572.50 72.50
CCB Lie.: 151807 P lumbing Lic. no.: 3 -425PB Plan review (25% of permit fee)
State surcharge (12% of permit fee) 8.70
Authorized signature: akcjed TOTAL PERMIT FEE 81.20
Print name: Pat Sloan Date: 211041 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:\ BuildingporminV 'LMU- PermitApp.doc i0/01N9 440- 4616T(10/09JCOM/WEB)