Permit CITY OF TIGARD PLUMBING PERMIT
1111 :'. COMMUNITY DEVELOPMENT Permit #: PLM2011 -00306
Date Issued: 10/11/2011
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718.2439 Parcel: 1S136AD06000
Jurisdiction: TIGARD
Site address: 11437 SW PACIFIC HWY
Project: Carl's Jr Restaurant Subdivision: VILLA RIDGE Lot: 2
Project Description: Interior plumbing.
Contractor: RECON INC Owner: EJM PROPERTIES INC &
PO BOX 822964 MAVERICK DECATUR GEORGIA LLC
VANCOUVER, WA 98682 BY MAVERICK INVESTMENTS
3633 E BROADWAY
LONG BEACH, CA 90803
PHONE 360- 772 -8149 PHONE.
FAX
FEES
Quantity Description Date Amount
2 ea Backflow Preventer 10/11/2011 $62.54
Specifics: 13 ea Floor Drain /Floor Sink/Hub 10/11/2011 $325 26
5 ea Hose Bib 10/11/2011 $125 10
Type of Use: COM 4 ea Roof Drain (Commercial) 10/11/2011 $50 04
Class of Work: ALT 9 ea Sink 10/11/2011 $225.18
Type of Const: 1 ea Urinal 10/11/2011 $25.02
Occupancy Grp: 3 ea Water Closet 10/11/2011 $75 06
Stories: 2 ea Water Heater 10/11/2011 $75.04
1 12% State Surcharge - 10/11/2011 $115 59
Plumbing
Total $1,078 83
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 i . s suspended for more the 180 days. ATTENTION Oregon law require y.t to follow the rules adopted by the Oregon
Utility N 'cation Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952=‘ 1090. You may obtain a copy of the rules
or dir questions to OUNC •, c- m 50 32 1987 or 1 800 332.2344.
Iss ed By: ' / / / Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspection d.te.
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 / , 'I 0 , 4 i A 1 0 c . - J -00/3)
Building Fixtures ..)4r) FOR OFFICE USE ONLY
City of Tigard
�/� � ` Date/By 1. if i %.j Permit No . ai (mil - 30
I - ', !/' rt0 vv
13125 SW Hall Blvd , Tigard, OR 9 1 -
P Review
Phone 503 718.2439 Fax: 503 598 '60 11 Other Permit No .
Inspection ection Line. 503 639.4175 c\ & � �D ate/By Qfj/�p�t / - U[I I CU
TlGARD ��� Q ateReady /By Juns ® See Page 2for
Internet. www tigard -or gov O O`�l , Notified/Method p. Supplemental Information
TYPE OF WORK c1. 1�G� FEE* SCHEDULE
❑ New construction ❑ Denit� For special information use checklist
V Description I Qty I Ea I Total
❑ Addition/alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ 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 ` t �� �[ t Catch basin or area drain 18 76
I �� l Drywell, leach line, or trench drain 18 76
City /State /ZIP:
Footing drain (no. linear ft . ) Page 2
Suite/bldg. /apt. no.: I Project name: t
�, 1 5 J 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 Y 31.27 d2;
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25 02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12 51
Name: \ ? ---1- 1 t 3 1 '\ Fixture /sewer cap 25.02
q Floor drain/floor sink/hub t 3 25.02 ??..,5; 9-(4
Address:
� � 3 E a , ` "`4" y Garbage disposal 25.02
City /State /ZIP: L. c,,, 2.13c c. / C--/-> 9e) S 6 Hose bib 25 02 951 JO
Phone: ( ) Fax: ( ) Ice maker 12 51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name. Medical gas (value $ ) Page 2
Primer 12.51
Contact name:
' (4
- Roof dram (commercial) Li 12.51 ,
Address: Sink/basin/lavatory v 25 02 )45 i r
City /State /ZIP: Solar units (potable water) d 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12 51
E -mail: Urinal I 25 02 2 -ak
CONTRACTOR Water closet 3 25 02 , (IG
- Water heater 37.52 - Qzi
Business name: i Q 1/4 v‘d Water piping/DWV 56.29
Address: ?(� 1' c X C9' 22 l' \ Other. IM D P c-) L ., ) A� 25.02
`
City /State /ZIP: \) ov ,..,c___ = ,„t. s / - 1 t.,_) ‘z. lt2(,W1.- Subtotal 10 a ll
Phone: (3(0D ) <1'1 • ° [ J Fax: ('(oa) .51 P I'S 1 rl Minimum permit fee: $72.50
CCB Lic.: 1 t2 ‘ -3 1 .7 3A_ Plumbing Lic. no.: 1--) /3 jZ'!j Plan review (25% of permit fee)
yt State surcharge (12% of permit fee) f / /5` S
Authorized signature: 7 / i / TOTAL PERMIT FE 1 , )7F, 8
Date: This permit application expires if a permit is not obtained within 180 days
Print name: 1�
� 2 I "' /e i l /, after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
i \Budding\Permits\PLMU- PermrtApp doe 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 Utilities Qty. Fee (ea) Total Square Footage: Permit Fee:
Footing drain - 1 100' 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
Valuation: Permit Fee:
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
Other Inspections or Fees Qty. Fee (ea) Total andh nc udi g $10,000.00 ir fraction thereof, to
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 * .
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/
Work Performed: Capped Added Relocate 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
- Jacuzzi/Whirlpool greater, except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor /Water 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 2 sets of plans with any of the above.
-4"
Car Wash Drain Isometric or Riser Diagram
Garbage Domestic non - food El 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 Mach /Refrig Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav - Non -food related
- Bradley
- Commercial -food related
- Service Air 3
Swimming Pool Filter *Note: If the fixture work under this ermit results in an
Washer - Clothes p
Water Extractor increase of sewer EDUs, a sewer permit will be issued and
Water Closet - Toilet 3 fees assessed for the sewer increase must be paid before the
Urinal l plumbing permit can be issued.
Other Fixtures•
1:\ Building \Permits \PLMF - PermitApp.doc 02/24/2011 2
14 Accumulative Sewer Tally
S r Tenant Name: CARL'S JR. RESTAURANT SWR # N/A
Site Address: 11437 SW PACIFIC HWY PLM # PLM2011 -00306
Parcel #: 1S 136AD06000
Fixture Value Previous Previous Crcdits Capped Fixture Fixture New New
# value count capped #s value count added # added value total #s total values
Baptiscry/Font 4 0 0 0 0 0
Bath: - Tub /Shower 4 0 0 0 0 0
- Jacuzzi /Whirlpool 4 0 0 0 0 0
Car Wash: - Each Stall 6 0 0 0 0 0
- Drive through 16 0 0 0 0 0
Cuspidor /Water Aspirator 1 0 0 0 0 0
Dishwasher: - Commercial 4 0 0 0 0 0
- Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink: - 2 inch 2 0 0 12 24 12 24
- 3 inch 5 0 0 1 5 1 5
- 4 inch 6 0 0 0 0 0
- Car Wash 6 0 0 0 0 0
Garbage Disposal:
- Domestic (to 3/4 HP) 16 0 0 0 0 0
- Commercial (to 5 HP) 32 0 0 0 0 0
- Industrial (over 5 HP) 42 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 0 0 0 0 0
Oil Sep (Gas Station) 6 0 0 0 0 0
Rec. Vehicle Dump station 16 0 0 0 0 0
Shower: - Gang (per head) 1 0 0 0 0 0
- Stall 2 0 0 0 0 0
Sink:
- Lav /Bar - Non -Food Related 2 0 0 4 8 4 8
- Bradley 5 0 0 0 0 0
- Com /Sery /Util - Food Related 3 0 0 5 15 5 15
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 0 0 0 0 0
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 0 3 18 3 18
Urinal 6 0 0 1 6 1 6
Previous EDU Count 0 0
Capped EDU Credit 5 80
TOTALS 0 0 0 0 26 76 26 _ -4
Current Fixture Value -4 divided by 16 = -0.3 Current EDU 1 EDU = $4,500.00
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -4 divided by 16 = -0.3 over (under) $ (1,350.00)
Enter EDU Change Here -0.3
Notes: USED DEMO CREDITS FROM BUP2011- 00131. ** *CREDIT * **
Authorized Name /Signature: BRANDEN TAGGART Date: 10/11/2011
Building Division
Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher which must be
submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
I: \Building \ Sewer Tally \ SewerTallySheet-4500.xls 07/01/11