Permit (35) CITY OF TIGARD PLUMBING PERMIT
' COMMUNITY DEVELOPMENT Permit#: PLM2018-00296
13125 SW Hall Blvd.,Ti Date Issued: 06/13/2018
T[ r1 R.J and OR 97223 503.718.2439 9
Parcel: 1 S 136AD06000
Jurisdiction: Tigard
Site address: 11437 SW PACIFIC HWY
Project: Carl's Jr Subdivision: None Lot: None
Project Description: Repair 3'of broken sanitary sewer line.
Contractor: JRD EXCAVATION LLC Owner: BENNETT FAMILY LLC
PO BOX 2440 633 CONCORD PL
CLACKAMAS, OR 97015 SAN MARCOS, CA 92069
PHONE: 503-422-9830 PHONE:
FAX: 503-658-698
FEES
Quantity Description Date Amount
3 If Sanitary Sewer 06/13/2018 $62.54
Specifics: 1 12%State Surcharge- 06/13/2018 $8.70
Plumbing
Type of Use: COM 10 ea Minimum Fee Adjustment- 06/13/2018 $9.96
Class of Work: OTR Plumbing
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.
Asp
Issued By: Permittee Signature: • _-
Call 503.639.4175 by 7:00 a.m.for the next available inspection d. •.
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 Applicati lit Et
Building Fixtures
City of Tigard JUN 1 3 Z O 18 Received /_�/� %
Date/By: (GJ /� ,a ° Permit Ni1,y //te e)0 02 9'
4,
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.5stm OF TIGARD Date/By: Other Permit No.:
TIGARD
Inspection Line: 503.639.4175 v Date Ready/By: tuns: ® See Page 2 for
Internet: www.tigard-or.gov k� �I l()N Notified/Method: Supplemental Information
TYPE OF„IIVORK -'FEE* SCHEDULE
❑New construction 0 Demolition For special information use checklist
Description Qty. Ea. Total
71-Addltlon/alteration/replacement
❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORYP CONS UCTIQI�I SFR(1)bath 312.70
0 1-and 2-family dwelling Commercial/industrial SFR(2)bath 437.78
buildingSFR(3)bath 500.32
❑Accessory ❑Multi-family
Each additional bath/kitchen 25.02
0 Master builder 0 Other:
Fire sprinkler(_sq.ft.) Page 2
rru
N'I/57 JOB SITE INFORMATION;AND LOCATION ' Site utilities:
Catch basin or area drain 18.76
Job site address: _. 3' 5k.,DFa, ,,c. io1q
City/State/ZIP: ! Drywell,leach line,or trench drain 18.76
��( & Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: 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: 1 Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTIO OP.WORK ;„c4.1:11
,�< • Backwater valve 12.51
` Clothes washer 25.02
vS`r b eo , c -"r til:Ne..- Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER 0 TENANTExpansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
APPLICANT `' Interceptor/grease 25.02
❑ CONT �T PERSONtrap
Medical gas(value:$ ) Page 2
Business name:
Contact name: Primer 12.51
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
Water closet 25.02
CONTRACTOR Water heater 37.52
Business name: J Q Ey_c_r_LATu ;i,Jn Water piping/DWV 56.29
Address: `pO f3O, 26,4,f Other: 25.02
City/State/ZIP: 0
C�� a Q� �0�3Subtotal
Minimumpermit fee: $72.50
Phone:(5 p�j) 44ZZ 3 sr3 I Fax:( 5 c_73) b 30 , vi/o� 7,2,_co
CCB Lic.: r "741 ye/ 5.ii it( Plumbing Lic.no.: p6/2.25" Plan review (25%of permit fee)
J State surcharge(12%of permit fee) J, 7e)
Authorized signature: \ 7J// TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180 days
Print name:
J ZSS¢._ e.S j� ' Date:co(r 3 I after it has been accepted as complete. k
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PennitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site U Fee(ea) Total Square Footage; .emit Fee:
Footing drain-1 s`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 greater $327.54
Sewer-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 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
Other ectionS or Fees 414r' Fe (ea) 1.o `; each additional$100.00 or fraction 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/hr each additional$100.00 or fraction thereof,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 $379.50 for the first$25,000.00 and$1.45 for
hours(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 for the first$50,000.00 and$1.20 for
(minimum 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*. 7 tian w for Plumbing Installations
Quantiy by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed; Capped =Added Relocate
Baptistry/Font 0 Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
-Jacuzzi/Whirlpool
Car Wash: Each Stall
0 New exterior plumbing site utilities for any complex structure
Drive tall as defined in OAR918-780-0040.
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial
0 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"
3" Isometric or Riser Diagram
4"
0 Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
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 be paid before the
Water Extractor
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11437 SW PACIFIC HWY, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2018-00296
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . Note: no work was being done on the private side for this permit number, no
inspection required. Repair was made in the right of way.
Violation Summary:
Inspector Contractor