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Permit CITY OF TIGARD PLUMBING PERMIT ~ - �;. - COMMUNITY DEVELOPMENT Permit #: PLM2011 -00281 Date Issued: 09/20/2011 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718 2439 Parcel: 1S136AD06000 Jurisdiction: Tigard Site address: 11437 SW PACIFIC HWY Project: Carl's Jr. Restaurant Subdivision: VILLA RIDGE Lot: PTS 1 -2 Project Description: Site utilities Contractor: JRD EXCAVATION LLC Owner: EJM PROPERTIES INC & PO BOX 2440 MAVERICK DECATUR GEORGIA LLC CLACKAMAS, OR 97015 3633 E BROADWAY LONG BEACH, CA 90803 PHONE: 503 - 422 -9830 PHONE FAX: 503 -658 -698 FEES Quantity Description Date Amount 4 ea Catch Basin or Area Drain 09/20/2011 $75.04 Specifics: 200 If Footing Drain 09/20/2011 $87.55 100 If Sewer Service 09/20/2011 $62 54 Type of Use: COM 400 If Storm and Rain Drain 09/20/2011 $175 10 Class of Work: ALT 2 ea Backflow Preventer 09/20/2011 $62 54 Type of Const: 1 12% State Surcharge - 09/20/2011 $55.53 Occupancy Grp: Plumbing Stories: Total $518 30 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 Notifi - . Center Those rules are set forth in OAR 952 - 001 -0010 through OAR 9 A s •1i You may obtain a copy of the rules or direct . estions . OUNC by calling 503.232.1987 or 1 800.332.2344. • 4 1 Issued -1 : /1(a/ Permittee Signature: 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 th- project. Approved plans are required on the job site at the time of each inspection. Plumbing Permit Application w '�" 1 §"Kt ss ,,, to r1a�i'1 v a'5, N. ya .' "ra+ * i ,S t .� Site Utilities \', it 7e','!=0.',..'":',.' `°� ` „� vF�OR�)OFFICES USE ONL,Yf ""^ :'�a'�' ",�fi _ >,� . y r.!7 ; . a. ;f`k tiu�:z`Y ,a 5.' ,r3� a'e+i4�� , b,� r ; -.`x'+14 )tt, . V(P !�` t y City Of Tigard t ,a�, ",. °�"� Received Pcrnut No . Ill ee s ,,.. Date /By A ar Review -- ���dloga L - ism n 13125 SW Hall Blvd., Tigard, OR 12 3'- \ : r Q ` Phone: 503.718.2439 Fax. 503 59! q l- Other Pcrnut No - g / Date /13} L/ (- 60 o I 1960 '' Inspection Line 503.639.4175 , Ready/By B See Page 2 for .,...-'''..• IGARD� C J ©_ -_ Date Read/B l Q // o / Jut, Internet: www tigard- or.gov 1 �j °tined /Method Way Supplemental Information TYPE OF WORK �'e d ' . C FEE. F SCHEDULE, e ;m Fo special information m ation use checklist. ® New consti action ❑ Dcm���`EAata� l � Description [ Qty. Ea Total ❑ Addition /alteration/replacement ❑ Other New 1- 2- family dwellings (includes 100 It for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 312 70 ❑ I- 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"'tI433 Pacific Hwy f 3 Catch basin or area drain 4 18 76 75.04 Drywell, leach line. of trench drain 18.76 City /State /ZIP: Tigard, OR 97223 - - Footing drain (no. linear ft _ ) Page 2 Suite /bldg /apt. no Project name. Carts ,Jr Manufactured home utilities 50.03 Cross street /directions to job site: Project is on the north side of Niglio ay Manholes 18.76 99 on the west side of Busters BBQ Rain drain connector _ 18.76 - Sanitary sewer (no lineal ft : __) Page 2 Storm sewer (no lineal ft.. ) Page 2 Water service (no. linear It )' 1 Page 2 Subdivision. F Lot no . 6000 Fixture or item: _ Tax map /parcel no . ISI 36AD Backflow preventer lI 2 31.27 6?.54 DESCRIPTION OF WORK Backwater valve I 12 51 Clothes washer -� 25.02 -- New Carts Jr construction, hulk of utility work consists of storm line and catch - -- -- -- -- Dishwashei 1 25.02 sanitary lateral, and run new domestic water - -- t - t basins, will connect to existing Drinking fountain '25.02 line to Highway 99 ROW. Ejectors /sump 25.02 ❑ PROPERTY OWNER ® TENANT Expansion tank 12 51 Fixture /sewer cap 25.02 Name: KWKG, INC - - Floor dram /floor sink /hub I i 25 02 32.5.26 Address: P O Box 1012 Garbage disposal - 25.02 25.02 City /State /ZiP: Wilsonville, OR 97070 _ Hose bib 25.02 50.04 Phone: (503)682 -8474 Fax' (503)682 -7035 ice makes - 12 25.02 ® APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25 02 25.02 Business name: KWKG. INC Medical gas (value ) Page 2 Pnmer 12 51 Contact name Dan G,jurgevich Roof drain (commercial) ,_ 12 51 50.04 Address: P O Box 1012 Sink/basin/lavatory 25.02 175.14 City /State /ZiP: Wilsonville, OR 97070 Solar units (potable water) 62.54 Phone: (503) 682 -8474 Fax (503) 682 -7035 Tub /shower /shower pan 12.51 E-mail: dodgers088 @aoi.com Unnal 1 25 02 25 02 Water closet 3 25.02 75.06 CONTRACTOR - Water heatet 1 37.52 37.52 Business name. MD Excavation LLC Water piping/DWV 56.29 56.29 Address. PO Box 2440 Other: 25.02 City /State /ZiP: Clackamas, OR 97015 Subtotal . 0 Phone (503) 422 -9830 Fax (503) 658 -6098 Minimum permit fee: $72 50 3 � Plan review (25% of permit fee) CCB Lie.: 174641 Plumbing Lac no . '55-, r. J � State surcharge (1 of permit fee) J, Authorized signatur TOTAL PERMIT FEE 57 , 3 Pi mt name. Jesse Deshirlia Date: 9/7/11 This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. "Fee methodology .et h■ To-County Building Iiiiuwv Set vice Board I Ali uttd itt cVPenn u.At t. A I C -Pei rn a App du. 1 n/1 n A)9 441)-- t616T( I I i/t iJCOM /WEt3 I ' Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Q ty. Fee (ea) Total Site Utilities Square Footage: Permit Fee: Footing drain - I" 100 1 50 03 50.03 0 to 2,000 $121.90 Footing drain - each additional 100' I , 37.521 54. 2,001 to 3.600 $169.69 3,601 to 7.200 $233.20 Sewei - 1st 100' I 62.54 62.54 7,201 and greater $327.54 Sewer - each additional 100' 37.52 Wader Medical Gas Systems: Water Service - each additional 100' 37 52 Valuation: Permit Fee: Storni & Rain Drain - 1st 100' 1 02 54 6,4 tj $1.00 to $5,000 00 Minimum fee $72 50 Storm & Rain Drain - each additional 100 3 37 52 1 12.56 $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 ft action thereof, to 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/hi each additional $100.00 or fraction thei cot. 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 8379 50 for the first $25,000.00 and S I.45 for how s (minimum charge — 2 hours) each additional $100 00 or traction thereof, to Reinspecnon Fees 90.00/hi 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 $ 120 for (minimum charge — 1/2 hour) � each additional $100.00 or haction thereof Subtotal: `1 (0` , _fl 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 Plan Review for Plumbing Installations Fixture Type for Replace/ Work Performed: Capped Added Relocate Plan review is required for any of the following Baptistry/Font Please check all that apply Bath TublShowcr ❑ 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 Cuspidoi/Water Aspirator as defined in OAR918- 780 -0040. Dishwasher - Commercial ❑ Medical gas and vacuum systems for health care facilities - Domestic ❑ Any multipurpose lire sprinkler system. Drink Fountain ❑ Any complex structure as defined in OAR9 18-780-0040. Eye Wash Floor Drain/sink - 2" Submit 2 sets of plans with any of the above. - 3" - 4,. Isometric or Riser Diagram Car Wash Drain Garbage Domestic min -rood ❑ 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 Oil Separator (Gas Station) Comments regarding fixture work: Rec. Vehicle Dump Station Shower -Gang - Stall SinkJLav - Non -food related - Bradley - Commercial- food related - Service Swimming Pool Filter Washer - Clothes *Note: If the fixture work under this permit results in an Water Extractor increase of sewer EDUs, a sewer permit will be issued and Water Closet - Toilet fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. Other Fixtures: C:\Documents and Setnnes \KutredgeC \Loral Settings \Temporary Internet 'files \OLK25 \3Plumbing site work- PermitApp (2).doc ACT II1tIl�_II1II1 N • Date 02/24/12 gcheduled 02/24/12 Catch Basin Work Order # W0140985 River City Environmental, Inc. 503- 252 -6144 Complete Industrial P.O. Box 30087 Salem 503- 363 -2464 Vancouver 360 - 896 -5256 Waste Removal Septic Tank Cleaning Portland, OR 97294 Sump Line Cleaning • Site Information T J Nisbet Const TJ Nisbet Const PO Box 40 11437 SW Pacific Hwy. Tigard Clackamas, OR 97015 PL144o j/ c.,c7a 9/ Contact: 503 - 257 -0308 PO# .. Type h Description'of ;.' : • '° . , Units and Price Clean Catch Basin / • - i @ Environmental Fee Notes Called in by Vladamir Clean�Catch Basins Mike DUncan Job MO 360- 518 -3121 • • • • I Total Charges River City Environmental, Inc. is in no way responsible for damage to any vehicles, personal or real property. Terms: Net 10 days. 1.5% per month will be charged on past due accounts (18% per annum). Terms and Conditions The Right to Lien The customer agrees to pay all invoices arising out of services, and any other special services herein within 10 days. The customer agrees to pay such extra and overtime charges as may be invoiced from time to time for services rendered, over and above the normal servicing schedule, on behalf of the customer. / The customer agrees to assume responsibility damage to customer's real or personal property arising from services which take place on customer's premises, where the drivers and vehicles of River City Environmental, Inc. have been instructed to enter. This includes, but is not limited to driveways, trees, power lines or poles and building structures. If River City Environmental finds it necessary to add liquid to the tank on jobsite, customer will be charged for the additional gallonage resulting from these condidtions. Customer agrees to reimburse River City Environmental for all reasonable attorney's fees court costs and other expense incurred by said company to enforce collection or to serve their rights under this agreement. If this work order is not contested in writing within 10 days the full amount is considered due and payable. Customer agrees to the above conditions. A fax on the work order is considered an original. Redeemable in Multnomah County Check # Visa MC Amex Card s� p f Exp Date �y Vcode Work Authorized by ( Iar.se p int) >< L j LI �I k ( ,Q • Date 2 l - Signature K .7/7_ � / � - :33 Service Tech #1 S rvicech #2 Date 2 ?5 // Time A c 141:m 1 11r �� `�'wrafits . . •