Permit 'PICITY OF TIGARD PLUMBING PERMIT
2. . COMMUNITY DEVELOPMENT Permit#: PLM2019-00333
T f G, R.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/19/2019
Parcel: 1S 134 BC00500
Jurisdiction: Tigard
Site address: 12388 SW SCHOLLS FERRY RD
Project: McDonald's Subdivision: 1993-057 PARTITION PLAT Lot: 1
Project Description: CAP(2)lays,ADD(1)urinal and RELOCATE(2)lays,(3)water closets and(1)urinal.
Contractor: RECON INC DBA MANZCO PLUMBING Owner: MCDONALDS CORPORATION(36-0105)
PO BOX 822964 PO BOX 182571
VANCOUVER,WA 98682 COLUMBUS, OH 43218
PHONE: 360-772-8149 PHONE:
FAX:
FEES
Quantity Description Date Amount
2 ea Fixture/Sewer Cap 08/19/2019 $50.04
Specifics: 2 ea Lavatories 08/19/2019 $50.04
2 ea Urinal 08/19/2019 $50.04
Type of Use: COM 3 ea Water Closet 08/19/2019 $75.06
Class of Work: ALT 1 12%State Surcharge- 08/19/2019 $27.02
Type of Const: Plumbing
Occupancy Grp:
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 952-00 -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 By: . Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspec,on 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 Application
Building Fixtures RECEIVED
City of Tigard Received c`/? /F �p
Permit r L-/7� 3
13125 SW Hall Blvd.,Tigard,OR 97223A G 1 9 2019 Date/By: -(f'
_ Phone: 503.718.2439 Fax: 503.598.1960 Plan Review CC� ""�//��
Date/By: Other Pennicrid le, -"'(V I
TI G n R D Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Anis. ® See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION
Notified/Method: Supplemental Information
4:rvti .l1:I.4 F}11Y`
❑New construction $0 Demolition For special information use checklist
Description I Qty. I Ea. I Total
Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY 9FCONSTRUCTION .% SFR(1)bath 312.70
❑ 1-and 2-family dwelling Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
❑Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler( sq.ft.) Pa e 2
JOB SITE INFORMATION-ANDrLOCA`Tlolg
1 3 rr` := Site utilities:
Job site addressk_9_60-5,- - 5 ,4 o d R"
Catch basin or area drain 18.76
S /s f ��
City/State/ZIP: v Z Drywell,leach line,or trench drain 18.76
I J pe›,,
� J S Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: ,,,1 Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
j ., 1../at i t F r ` '- Backwater valve 12.51
Clothes washer 25.02
iki Ve-__ (.`, 14 4Z' Z /S Dishwasher 25.02
G rt 2- H5 Drinking fountain 25.02
Ejectors/sump 25.02
,1"'' „* '_? 0 ,�° : x°= ., h- Expansion tank 12.51
Name: Fixture/sewer cap r -- 25.02
Address: Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51 -
A r ANI' p ' CONTI.CT N r Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Contact name: Primer 12.51
Roof drain(commercial) 12.51
Address:
Sink/basin/lavatory -2i 25.02
City/State/ZIP: Solar units(potable water) 62.54
r Phone ( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal Z 25.02
t" Water closet 3 25.02
O$,
i ( Water heater 37.52
Business name: MCVAZ G� t•-6,...1.04 L .)
Water piping/DWV 56.29
Address: 7U. SAX 2 Z�/��f Other:
V25.02
City/State/ZIP: oa, 6..oU,.._ e , Z 90(,,Q Z Subtotal
Phone:(.. .iC)--7 7 Z 'j(1 f Fax:(.5(0C,) £4-r-c-747( -/'-1 Minimum permit fee: $72.50
CCB Lic.: /e/i /L Plumbing Lic.no.: ?8 5-7,3 Plan review (25%of permit fee)
State surcharge(12%of permit fee) '?,V -
Authorized signature: 4.------ -- > / TOTAL PERMIT FEE .5..2. :j 0
/✓t
Print name: L e / 77 e-cam_ I Date: e)3/ g// $ This permit application expires if a permit is not obtained within 180 days
/ P after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.d°c 10/01/09 440-4616T(t0/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
w
x .
Site Utilities Qty. ,M F ces)' tom' Square Footage: P.er 't;Eee: s .1: w N m
Footing drain-151 100' 50.03 0 to 2,000 $121.90
2,001 to 3,600 $169.69
Footing drain-each additional 100' 37.52 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 Pal lat on., pe)f tnif Feet M
Storm&Rain Drain-1st 100' 62.54 $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
each additional$100.00 or fraction thereof,to
'tee �� � � and including$10,000.00.
er'�nt�io�s or Fees�� , ' F
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
each additional$100.00 or fraction thereof.
(minimum charge-1/2 hour)
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to x
accurately report fixtures could result in increased sewer fees*. ,, ' tl ;. �'_ �� 'R o 1:::1
' Quantity by F9rtureTy11e Plan review is required for any of the following.
Fixture iyp+cfor ' C Please check all that apply.
yl'or k performed: tipped r
0 Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
-Jacuzzi/Whirlpool 0 New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru 0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator 0 Any multipurpose fire sprinkler system.
Dishwasher: -Commercial 0 Any complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2" `
7+<� . y ,v a�.
issnm Jnr.Riser Iiia "a11n
4"
0 Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related Comments regarding fixture work:
Ice Mach./Refrig.Drains
Oil Separator(Gas Station)
Rec.Vehicle Dump Station (4%) (Z,,,) Z-47/-C
Shower: -Gang 0 Ce-1-7 ( 2) /47/S-
-Stall
Sink: -Lav/Bar non-food related '7.--- '�
-Bradley
-Com/Sery/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 �/ plumbing permit can be issued.
Water Closet-Toilet J
Urinal I i
Other Fixtures:
I:\Building\Permits\PLMF_PermitAPP.doc 08/04/2011 2