Permit CITY OF TIGARD PLUMBING PERMIT
a COMMUNITY DEVELOPMENT Permit #: PLM2012 -00279
T t G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/25/2012
Parcel: 1S136DB02600
Jurisdiction: Tigard
Site address: 11201 SW 72ND AVE
Project: McDonalds Subdivision: AZOIC TERRACE Lot: 1
Project Description: (1) hose bib; (2) lavatories; (1) urinal and (3) water closet
Contractor: EVERGREEN PLUMBING & MECHANICAL Owner: STEWART /BARI PROPERTIES LLC
PO BOX 5564 STEWART TRUST
SALEM, OR 97304 BY US BANK
BOX 64142
ST PAUL, MN 55164
PHONE: 503 -409 -3567 PHONE:
FAX:
FEES
Quantity Description Date Amount
2 ea Fixture /Sewer Cap 09/25/2012 $50.04
Specifics: 1 ea Hose Bib 09/25/2012 $25.02
2 ea Lavatories 09/25/2012 $50.04
Type of Use: COM 1 ea Urinal 09/25/2012 $25.02
Class of Work: ALT 3 ea Water Closet 09/25/2012 $75.06
Type of Const: 1 12% State Surcharge - 09/25/2012 $27.02
Occupancy Grp: Plumbing
Stories:
Total $252.20
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 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 ca ling 503.232.1987 or 1.800.332.2344. / , A
Issued By: t 11 K-r�1 Permittee Signature: Oi �.Pr t/ e iiz
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 Anolicatio� E
Building Fixtures l t 1lz l,l II( I. 1 ,I. ()NI,
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S E P 2 5 2012 Received •
City of Tigard Date/Dr: Q/ar 1-1'' Permit No.pLA jp / oaxiff
13125 SW HaII Blvd., Tigard, OR 972 , 2 RD Plan Review
l • Phone: 503.718.2439 Fax: 503.598.1260 y ii �f Pit l4.r Qata/By Other Permit No.: 0.20fa . 4,0131
I t ; ,� i. r i
Inspection Line: 503.639.4175 BU11 OtNIG VLSI) '' age Delo Ready/B: Internet: www.tigard -or.gov f L Notified/Method: '� l IO ! PEtemental Informadon
TYPE OF WORK FEE" SCHEDULE
❑ Now construction ❑ Demolition For genial Is fornratlon use checklist
' Description I Qty. 1 Ea. j Total
Z .Addilion/aitcration/rcplacement ❑ Other: New 1- 2 -family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 312.70 ` _. ❑ l- and 2- family dwelling KCommercial/industrial SFR (2) bath _ 437.78
SFR (3) bath 500.32
❑ Accessory bui Win g ❑ 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: / i ).O I S G.) 7 4.44.1 .4 •J e. Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City /Staterl.IP: i- q. l`a� 0 k_ y7, 3
Fatting drain (no. linear ft.: ) Page 2
Pr I/,� A A
e �
� L S 1�- tw�a[ �
Suite/bidgJapt. no.: oject name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear R: _) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: ____) I _ Page 2
Subdivision: I Lot nu.: Fixture or Item:
Tax map/parcel no.: i3ackflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
b p.o..0 i'45 )rceel.L. kro.h 4 : +leki cr. S e7r044: 114 51Wf%e" Dishwasher 25.02
' ,ILA.) 44)a / t-.1/.4 h LAG .1.o al 4-e tr+ k..a. s Drinking fountain 25.02
-Expansion 25.02 - --
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap Akita c . .2 . , 25.02 .j , D(
Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City /State/ZIP: [lose bib ) 25.02 ) s.1,X
Phonc: ( ) Fax: ( ) Ice maker • 12.51
in APPLICANT _ gt CONTACT PERSON Interceptor /grease trap 25.02
Business name: • Medical gas (value: S ) Page 2
Primer 12.51
Contact nettle: L I CO �, .. Roof drain (commercial) 12.51
Address: Y C) k a 5 si �uory 1 25.02 54M'
City /State/ZIP: 5,tle,.04. 0o'L ?) 6 AY Solar units potablewater) 62.54
Phone: (So)). of Cof - 3ca. y I Fax: : ( ) Tub/shower /shower pan 12.51
LP b to and ( Got Urinal 25.02 S.
E-mail: ,,y s CD l ,� d,
CONTRACTOR Water closet 6 lcc.,,C4.711, 3 25.02 7
Water heater 37.52
Business name: ,`mil„ a dv , e , iN IA . b - i414 _ Water piping/DWV .. fa. 56.29
Address: ((�� Q_, K \ ole � � � Other. 25.02
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City/Statc/ZIP: S ))' Di- 9, q Subtotal
P Sa a / - 3.�(0 ` I Fax: ( ) Minimum permit fee: 572 50
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CCB Lic.: / Q' /O �''/ , Plumbing Lic. no.: ?X /d a 0 Plan review (25% of permit fee)
� 11 l State surcharge (12% of permit fee)
Authorized signature: i�1 _ T____ - l TOTAL PERMIT FEE
Print name: Date: This wadi application expires Ira permit la not ebtaiaed within 150 days
� Ltr j C O / 6 J l p A. 4)._ . after It has been accepted as complete
*Fee methodology set by Tri -County Building Industry Service Board.
1:1BWidin mluV'1.MU.e.,Upp.doe 10/01/09 e1W616T(INO2/COM/WID)
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Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities ' Qty. Fee ( ' Total ' Square Footage: Permit Fee:
Footing drain - I' 100' — 50.03 0 to 2 , 0 00 5121.90
Footing drain - each additional 100' 37.52 2,001 to 3,600 $169.69
' Sewer - 1st 100' 3,601 to 7,200 $233.20
7,201 and greater $327.54
Sower - each additional 100' ' 37.52
Water service - 1st 100' 62.54 Medical Gas Systems:
Water Service - each additional 100' - 37.52 - .
Storm & Rain Drain - 1st 100' 62 54 Valuation: Permit Fee:
$1.00 to $5,000,00 M fee $72.50
Storm & Rain Drain - each additional IOU' 37.52 $5,001.00 to $10,000.00 $72.50 fbr the first $5,000.00 and $1.52 for -
Other Inspections or Fees QtY* Fee (ea) Total each additional $100.00 or fraction thereof, to
Inspection plumbing or for and including $10,000.00.
ction of Inspe no fee is sting plumbing ing or
90.00/hr
$10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
(minimum charge 1/2 hour) each additions) $100.00 or fraction thereof, to
and including $25,000.00,
Inspections outside of normal business 90.00/hr 525,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
howl (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 $50,001.00 and up $742.00 fur the first $50,000.00 and $1.20 for
1minimum charge -1/2 hour) each additional $100.00 or fraction thereof.
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 hr Quoin y by Future Type Plan Review for Plumbing Installations
Work Performed Capped Added Rebate Plan review is required for any of the following,
Baptistry/Font Please check all that apply.
Bath - Tub/Shower ❑ Any new commercial building with water service 2" and
- Jacutri/Whirlpuol greater, except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
- Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Crrspidor/Watcr Aspirator as defined in OAR918- 780.0040.
Dishwasher - Commercial ❑ Medical gas and vacuum systems for health care facilities.
- Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918 - 780 - 0040,
Eye Wash '
Floor Drain/sink - 2" Submit a sets of plans with any of the above.
- 3"
Car
Wash Drain Isometric or Riser Diagram
Garbage - Domestic non - food ❑ 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 MachJRefrig. Drains
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Oil . . Separator Dump Station Comments aiding fixture work: I
Shower -Gang ��vl �� � e^" '�
-St 'r �!rt�f -
Sink/L av - Non -food related _
- Bradley
-Commercial -food related
- Service -
Swi Clo�fires char - * 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
U rinal plumbing permit can be Issued.
T Other Fixtures:
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