Permit •
C ITY OF T I GA R D PLUMBING PERMIT
� DEVELOPMENT SERVICES PERMIT #: PLM2005 -00106
� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 3/17/2005
PARCEL: 1S134BC-00500
SITE ADDRESS: 12388 SW SCHOLLS FERRY RD ZONING: C -G
SUBDIVISION: PP1993 -057 LOT: 001 JURISDICTION: TIG
Project Description: Installation of double check valve for soda machine.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: M FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
MCDONALD'S CORPORATION Description Date Amount
036/0002
PO BOX 66207 [PLUMB] Permit Fee 3/17/2005 $72.50
CHICAGO, IL 60666 [TAX] 8% State Surchart 3/17/2005 $5.80
Phone : Total $78.30
Contractor:
MECHANICAL SERVICES INT. LLC
21185 NW EVERGREEN PKWY REQUIRED ITEMS AND REPORTS
STE. 106
HILLSBORO, OR 970124
Phone : 503- 439 -9999
Reg #: LIC 126015
PLM 37-421PB
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 r -s are set forth in OAR
952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rules • • irect questions to OUNC by
calling 503 -246 -6 9 or 1- 800 - 332 -234 .
Issued By: �� Permittee Signature:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
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.
JAN-21-2005' VEIR117 MS I 5034662211 P . 01/01
Plumbing Permit Application OFFICE USE ONLY
iy
City of atalatitt-, ----7,21, 01 .4 . _
N Date • ,..., PArrni #
18880 SW Martinazzi Ave' ''' - / ° r ,„ "e0/06
Tualatin, OR 97062 Date ssued : „ i
• Phone 503-691-3044 Fax 503-692-5421 _
Receipt
www.ci.tualatin.or.us
. ._.. :.
' • " ." ',. , ,' - 1 • •• • • • TYPE OF WORK FEE SCHEDULE
0 New construction 0 Demolition For special information use checklist.
Description I Qty. I Ea. I Total
18 Addition/alteration/replacement 0 Other: New 1- 2-family dwellings (mcludcs 100 ft. for cach utility connection)
:: *; - ..-1 i.:1: - -2:: . : .: CATEGORY OF CONSTRUCTION SFR (I) bath 91/0
0 I - and 2-family dwelling 51Commercial/industrial SFR (2) bath 160.00
SFR (3) bath 192.50
0 Accessory building 0 Multi-family
Each additional bath/kitchen 47.00
0 Master builder 0 Other
Fire sprinkler ( sq. ft.)
F ;:'.:•-.. ::•:.:- :'...: ••••• . JOB SITE INFORMATION AND LOCATION
Site utilities
kb site address: 9v 3 t ite 5 •
.4.) S 4iII&t Ref _ Catch basin or arca drain 9.00
City/State/ZIP: T:4 d■.. & 0 17 23 DrywelL leach line, or trench drain 9.00
)
Suitelbldg/apt no.: r Project name: hlc aqua (.&S Footing drain (no. linear ft.:
Manufactured home utilities 25.00
Cross street/directions to job site:
Manholes 9.00
Rain drain connector 9.00
Sanitary sewer (no. linear ft.: ____) 30.00
Storm sewer (no. linear IL: ) 30.00 ..
Subdivision: . . Lot no.: Water service (no. linear ft.: __) 20.00
Fixture or kern
Tax map/parcel no.:
Absorption valve 9.00
i,.; : ":? :: ..!... : 'DESCRIPTION OF WORK
Backflow pro/enter I 9.00
ZA)sraLit T.....i. TT elec.,. 6 i r 1, ef Backwater valve 9.00
aothcs washer
9.00
(fa- i.ti•C.- cc_T SocV2.-Ine•-a.c..3„..1.")-e, ,
Dishwasher 9.00
Drinking fountain 9.00
Ejectors/stunp 9.00 •
PEirri! OWNER : . : • 1 0 TENANT
Expansion tank 9.00
Name: 141 C D e.A".e....(t-S-S er. .19, Fixture/sewer cap 9.00
Address: Floor drain/floor sink/hub 9.00
City/State/ZIP: Garbage disposal 9.00
- - Hose bib 9.00
Phone: ( ) Fax: ( )
Ice maker 9.00
0 :Afiiiti601T ; ...: : .* 0 CONTACT PERSON
Interceptor/grease nap 9.00
Business name: Medical gas (value: $ )
Contact name: • Primer 9.00
Address: . Roof drain (commercial)
9.00
City/State/ZIP: Sink/basin/lavatory 9.00
, Tub/shower/shower pan 9.00
• Phone: ( ) I Fax: : ( )
• Urinal 9.00
E-mail: Water closet 9.00
• '.'......,-. F. '-' :•-• , : • • • - , • : • . • -I CONTRACTOR Water heater 9.00 •
Business name: in .,.,.. I c
v s T,,) r 1.. L c_ Other: Hourly Fee/Residential 40.00
Other: Hourly Fee/Commercial ei--- 25.00 ..tt! • ' '
Address: 1.1 I, VC 12114) FilLuve,,,,,,, PiciAl -#I6
Subtotal c3-q
City/State/ZIP: (i ,(// g harp 6 I' 1 2 if Minimum pcnnit fcc 7A . ff0
Phone: 5 ) q 3/ - II C1 i F ax: ( 003 ) 43/- 0914 Plan review ( % of permit fee) 5 s- 0
CCB liC.: i26 Lie. no.: 7 - 42. , 98 State surcharge (13% of pew& fee) ---
TOTAL PERMIT FEE - 4e , 7
Authorized
This permit applicadon expires if a permit is opt obtained within
signatt ‘ \ Ilijail QA ----
' IRO days after it bas been accepted as compkte.7t. 66 .
• Fee methodology sct by Tri-County Building industry Scrvicc Board
Print na me : 7 A9 creALven I Date:
0 , TS' 440 (10/02/COM/W EB)
TOTAL P.01
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005 -00106
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/17/2005
Phone: (503) 639 -4171 4:f p: ,
Inspection Requests (24 Hrs.): (503) 639 -4175 _..,. s 'I J
INSPECTION WORKSHEET FOR DATE: 4/18/2005 TIME: 7:14AM PAGE: 59
SITE ADDRESS: 12388 SW SCHOLLS FERRY RD CLASS OF WORK:
SUBDIVISION: PP1993 -057 LOT #: 001 TYPE OF USE:
PROJECT NAME: MCDONALD'S
DESCRIPTION: Installation of double check valve for soda machine.
OWNER: MCDONALD'S CORPORATION, PHONE #:
CONTRACTOR: MECHANICAL SERVICES INT. LLG PHONE #: 503 - 439
Inspection Request Scheduled For: Date: 4/18/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP /backflow preventer 004697 -01 503- 439 -9999 N
Corrections /Comments /Instructions:
n 1 12-Q). . / d
/1 /
70raiAlla
i f 4.15 .
ti - , SS ¥PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED ti.
Inspector: /2„, , Date: 1// I Phone #: (503) 718-