Permit . w CITY OF TIGARD PLUMBING PERMIT
PERMIT #: PLM2005 -00027
��IN DEVELOPMENT SERVICES DATE ISSUED: 1/26/2005
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12388 SW SCHOLLS FERRY RD PARCEL: 1S134BC -00500
SUBDIVISION: PP1993 -057 ZONING: C -G
BLOCK: LOT: 001 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: FLOOR DRAINS; 2 TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Fixtures
FEES
Owner:
Description Date Amount
MCDONALD'S CORPORATION
036/0002 [PLUMB] Permit Fee 1/25/2005 $95.20
PO BOX 66207 [TAX] 8% State Surcharl 1/25/2005 $7.61
CHICAGO, IL 60666 Total $102.81
Phone:
Contractor:
RAY'S PLUMBING
PO BOX 685
BRUSH PRAIRIE, WA 98606 REQUIRED INSPECTIONS
Phone : 360 - 892 -8700 Rough -in Insp
Top- outlnsp
Reg #: LIC 33217 Final Inspection
PLM 37 -149PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR
952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling (503)
246 -6699.
Issued By: 2 Q rt Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
/S & -005 °6
P. umbin2 Permit . 1!., e€1V ED rOu Orrlrl•: 1 'SE ONL.l
City of Tigard Received
5 6.6 Permit No.�� -0:906 -D2 %
13125 SW Hall Blvd., Tigard, OR 97223 2U05
Phone: 503.639.4171 Fax: 503.598.196 AN n , .... , , ■ PIt�e Review Other Permit No.:��
24- Hour Inspection Line: 503.639.4175 _ `LL , y , /B runs: EI See Page 2 for
Internet: www.ci.tigard.or.us T
F� .or.us �� O C TlG -. -•- - -� Notified/Method � Supplemental Information
r T ii FEE* SCHEDULE
1.3 New construction v IL Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement 1 ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
❑ 1- and 2 -family dwelling iil Commercial /industrial SFR (2) bath 350.00
13 Accessory building ❑ Multi -family SFR (3) bath 399.00
1:1 Master builder Each additional bath/kitchen 45.00
❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: I a3 g g cu..) S' c.L0 I k •{-1 - Catch basin or area drain 16.60
City / State/ZIP: - q J, o /L y Drywell, leach line, or trench drain 16.60
-
Suite/bldg. /apt. no.: J I Project name: VAC ors ( LS Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft: Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: (3P 1993-061 I Lot no.: 0 0 / Water service (no. linear ft.: ) I Page 2
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK _ Back flow preventer I Page 2 48, . 90
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
IZI PROPERTY OWNER I ❑ TENANT Drink1ng fountain 16.60
Ejectors sump 16.60
Name: ((1/l4._bdy�.41 d.S C O r o p - A _ - 1 - , - - 0 034 / 0002 Expansion tank 16.60
Address: (9 6 o ( 6, x 0 1 Fixture/sewer cap 16.60
City /State/ZIP: Ci Floor drain/floor sink/hub o2, 16.60 .. „).0 Phone: ( ) 0 Fax: ( ) Garbage disposal 16.60
APPLICANT + ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: e e I t.i b t 1. o-F IQ ry s L. Pte`. �` t �''�-C-.
r Interceptor /grease trap I 16.60
Contact name: ` � y` " k.4 �, L L 0 r n Medical gas (value: $ ) Page 2
Address: e. go )( (og 6 / I 3-oo - C l �5 act . Primer 16.60
Roof drain (commercial) 16.60
City / State/ZIP:
171 e ,,,,,''IL, W N9 ci 8 (0 (p �n. ( Sink/basin/lavatory ( / ( 16.60
Phone: ( 36 6 tg a - 10 0 I Fax: : (3 gq a - 1104
Tub /shower/shower pan - 16.60 -
E-mail.
Kz r. a Ir a. s (21 Uhn t , a 01'11 Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: ,/ _ `i D lj wsT-
r�,
e S Pleb; / r ► -t1{ I c Water heater 16.60
Address: Other:
Po /�o fC 1pgh - % Subtotal
City /State/ZIP: O t , S ti A. t'4 Gv1 C rg�Q o
�- Minimum permit fee: $72.50
Phone: (3/ : t9 a - g 1 0a Fax: (310 8/g.- 9644 4 9')
- Residential backflow minimum permit fee: $36.25 ;4
CCB Lic.: 33a 'I / - 3 - 04 : 7 Plumbing Lic. no.: 75 -1 -ti ?$ Plan review (25% of permit fee)
Authorized signature: --VA., surcharge (8% of permit fee) I 1, �
- < TOTAL PERMIT FEE 1 /0,74/
I Print name: J anx. L - P - v 11,h4.r1 Date: 0 -2.5,- 0 G 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:l Buildin g\Petmits\PLM- PennitApp.doc 12/03 440.4616T(10/02/COM/W®)
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 - I" 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer - 1st 100' 55.00
7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40
Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
Q ty. Fee (ea) Total additional $100.00 or fraction thereof to and
Fixture or Item including $10,000.00.
Commercial Back Flow Prevention Device 46.40 c /f 0 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Backflow Prevention Device each additional $100.00 or fraction thereof to
(minimum permit fee $36.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
Inspection of existing plumbing or each additional $100.00 or fraction thereof to
specially requested inspections - per hour 72.50 and including $50,000.00.
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof
Fixture Work:
Are you capping, moving or replacing existing fixtures? If
"yes", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees *.
Quantity by (Fixture) Work Performed
Fixture Type: Replace
New Moved Existing Capped Comments regarding fixture work:
Baptistry/Font
Bath - Tub /Shower
-Jacuzzi/Whirlpool
Car Wash -Each Stall
-Drive Thru
Cuspidor /Water Aspirator
Dishwasher - Commercial
- Domestic
Drinking Fountain
Eye Wash
Floor Drain/sink - 2" a
-3 „
Car Wash Drain
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
-Industrial increase of sewer EDUs, a sewer permit will be issued and
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stall
Sink - Bar /Lavatory
Quantity Total
- Bradley
-Commercial Isometric or riser diagram is required if fixture quantity
- Service I total is >9.
Swimming Pool Filter
Washer - Clothes
Water Extractor Plan Review
Water Closet - Toilet Plan review is required if fixture quantity total is >9.
Urinal
Other Fixtures:
i:\ awlding \Permits\PLM- PennitApp.doc 3/03
CITY OF TIGARD 24- Hour
BUILDING Inspection Line: (50a) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
Q BUP
Received ? XV q Date Requested _ Z
i �� AM PM BUP
Location l _ 4. S - ' - uite MEC -7
Contact Person Ph (MHIFINMINIMIN 2JS Z O
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS ART FAIL
P M G
Pos Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
/
PART FAIL
M ANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service •
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
_SITE Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line /
ADA
Approach/Sidewalk Date �` 2.) 2.2) DJ Inspector CR � ' `' �`" 1\ ` Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL