Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2017-00519
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/12/2017
Sf1R. Parcel: 1S136DB02600
Jurisdiction: Tigard
Site address: 11201 SW 72ND AVE
Project: McDonald's Subdivision: None Lot: None
Project Description: Relocate(1)floor sink for TI.
Contractor: FIVE STAR PLUMBERS INC Owner: STEWART/BARI PROPERTIES LLC
PO BOX 28 STEWART TRUST
BANKS, OR 97106 BY US BANK
BOX 64142
ST PAUL, MN 55164
PHONE: 503-324-0717 PHONE.
FAX: 503-324-0883
FEES
Quantity Description Date Amount
1 ea Floor Drain/Floor Sink/Hub 12/12/2017 $25.02
Specifics: 1 12%State Surcharge- 12/12/2017 $8.70
Plumbing
Type of Use: COM 47 ea Minimum Fee Adjustment- 12/12/2017 $47.48
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued B / Permittee Signature: j +�J
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Applica ,iJFCFIV
Building Fixtures FOR OFFICE USE OM,,
Cityof TigardLit-1: " O i I Dae
Date/By: 12/L//Ia /.� Permit No.Pb ovi,Z,0/7te)S® S
IN 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
S Phone: 503.718.2439 Fax: 5Q3. 9 Date/By:
Other Permit No.: y�
Inspection Line: 503.639.4175 f T i$G Ri e g 2f���,_ °�
T I G A R D Date Ready/By: Juris: El See Page 2 for
Internet www tigazd or gov r(311)1„ ,,,,,,,Ii\, , fied/M odINotr th . t Supplemental Information
''''P';',1 ew construction ❑Demolition For special information use checklist
Description Qty. Ea. Total
®Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
SFR(1)bathii # e ! 312.70
❑ 1-and 2-famil Y dwellin SFR(2)bath 437.78
g ®Commercial/industrial
❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Q atx Fire sprinkler( sq.ft.) Page
2
' ' J 1 #� <6 t # # # # � Site utilities:
Job site address:11201 SW 72nd Avenue Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97223
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: 1 Project name:McDonald's 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: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
i .g #,; 0 t Bacater ve 12.51
Clothes washer er 25.02
Relocate Floor Sink
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
# r' Fid Expansion tank 12.51
Fixture/sewer cap 25.02
Name:
Floor drain/floor sink/hub 1 25.02 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
P „� 2 2
# # Interceptor/grease trap .�
5
Business name: Medical gas(value:$ ) Page 2
Sri- ��� Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address:
Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
#t Water closet 25.02
' kitiid 4, ,.„.a..', , '' 33R% ��� 0, Water heater
37.52
Business name:Five Star Plumbers,Inc. Water piping/DWV 56.29
Address:PO Box 28 Other: 25.02
City/State/ZIP:Banks,OR 97106 Subtotal 25.02
Phone:(503)324-0717 Fax:(503)324-0883 Minimum permit fee: $72.50 72.50
CCB Lic.:169703 Plumbing Lica no.:PB108 Plan review (25%of permit fee)
State surcharge(12%of permit fee) 14.50
Authorized signature: TOTAL PERMIT FEE8.7:10.
Print name:Jeff Parson Date:12/12/17 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. R.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule:_ { Residential Fire Su s s ression S stems: r
af<riE. E °� ",#rp r w ts, ,gra �y - �.a�,� sr,'.G+,c - "r7 -
. . k x, r t �' `. ,�: a= a ` � __7f4.4- i i t .... $
Footing drain-Pt 100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and i eater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54
Medical Gas S stems:
Water Service-each additional 100' 37.52
Storm&Rain Drain-1st 100' 62.54
$100 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
4 ' • � ��fj s €; g s r y each additional$100.00 or fraction thereof,to
and includin.$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/hr ■ each additional$100.00 or fraction thereof,to
minimum chane-1/2 hour and includin.$25,000.00.
Inspections outside of normal business - 90.00/hr - $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours minimum chane-2 hours each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and includin.$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$1.20 for
(minimum ch. :e-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* w c i 6 ti'( ps 4 1 E
6 ' I` 1AI Plan review is required for any of the following
�� ° Please check all that apply.
4 ❑ Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive Thru as defined in OAR918-780-0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system.
Domestic 0 Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2" y
❑ Isometric or riser diagram is required for new buildings
-Car Wash Dram
Garbage Domestic non-food that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains COm ents regarding fixture work: j/
��
Oil Separator(Gas Station) 4MCA t//'-( I i/C'v-2, J/N �
!
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase must beaid before the
Water Extractor p
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
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