Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2009 -00258
T IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/18!2009
Parcel: 2S 102AA00903
Jurisdiction: Tigard
Site address: 12090 SW MAIN ST
Subdivision: Lot: 0
Project: McDonalds
Project Description: Replace 150' of sanitary sewer line.
Owner: FEES
MCDONALDS CORPORATION 036/0041 Quantity Description Date Amount
DOUBLE K VENTURES INC, 8255 SW
HUNZIKER ST STE 101 150 If Sewer Service 09/18/2009 $101.40
1 12% State Surcharge - 09/18/2009 $12.17
PHONE: 503 - 598 -9995 Plumbing
Contractor:
APOLLO DRAIN & ROOTER SERVICE
2208 NW BIRDSDALE #8
GRESHAM, OR 97030
PHONE: 503 - 239 -8801
FAX: 503- 669 -9568
•
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $113.57
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 • ter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or • ect questions to O• C by calling 503.246.6699 or 1.800.332.2344.
Is ued By: — Permittee Sl
Call 503.639.4175 by 7:00 a.m. for an inspection that busin s day.
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.
Sep. 18. 2009 1:09PM No. 4340 P. 1
Plumbing Permit Application ‘ - `___,
Building Fixtures stilt 0I1FII.7E USE (NIA'
lig City of Tigard RECEIVED R otel ` Yd 09
a 13125 SW Fall Blvd., Tigord, OR
RECEIVED Date/a : �J Permit No.: I r ° ' 00- •
Phone: 503.639.4171 Fax: 503.598.1960 Plan Review
P D Other Permit No.;
'I I u A IW Inspection Line: 503.639.4175
SE 1 00 Date Ready/By: Jug I 6d See Page 2 for
Internet, www.tigard or.gov
Notified/Method: PPt emenlo) information
•... ......:: ,::*.TYPE:.OP W '''lr :. • . .... .: ° . • ]FEE +.�SCIIEDiI
.0 New construction �iT�1I ` nn IV1SI0 1 �'
!;1 �1bEri16hTib11' For rpeclallefornrrrllar ('Sc checklist
Descrinlion Qly. Ea, Total
Addition/alteration/replacement ❑Other: New I- 2- family dwellings (includes 100 A. for each utility connection)
:.... ' CATEGORY : OF CONSTRUCTION.. ..
SFR (I) bath 0
❑ I - and 2- family dwelling ,Conmtercial/industrial SFR (2) bath 350.00
El Accessory • building ❑ Multi- family SFR (3) bath 399.00
CI Master builder ❑Other. Each additional bat /kitchen 45.00
- ( sq. ft.) Page 2
•• -' . JOB SITE INFO AND LOCATION
Site utilities
Job site address; . a 0 - b rj(,U -ct i' s4- Catch basin or area drain 16.60
City /Stale/LlP: 'r. ch L. teR , dr • . - Drywell, leach line, or trench drain 16.60
Suite/bldg./apt. no.; ki Project name: Fooling drain (no. linear fl.: ) Page 2
Cross street/directions to job site: Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear fl.:MD ` 1 Page 2. Mi. et
Storm sewer (no. linear R.: ) Page 2
Subdivision: i Lot no.: Water service (no. linear R.: ) Page 2
Tax map /parcel no.: Fixture or item
-....
DESCRIPTION. OF NVORIC.::•: • onve v e
sore
16.60
i ' BaCkRow prevenler Page 2
g. • ia # 0 id ,50 • Backwater valve
16.60
r-e f \ ' IP 1•., • r Clothes washer 16.6.0
Dishwasher 16.60
. •;. , :.:.� •PItOPEItTY:O'VIjN1ER •• :: :... •..:: .. A .. Drinking fountain 16.60
rectors/sum ,; p 16.60
• ` , ... U. I C Expansion tank 16.60
Address: <a1S S L.0 1- u 1'
T � �1 ` �.\ 1r-- •`'t -4- $1-, I U ( Fixture / sewer cep 16.60
City /Stale/ZIP: \ \ C c 4 1 -1_9, 2 floor drain/floor sink/hub 16.60
Phone: (503) 5'1 - J G' 15 Fpx; ( ) Garbage disposal 16.60
J w
......: .::...0' APPLIC :. ' ..: ... Hose bib
... .. .. - ... El PERSON , : ' : 1660
Business name:
• Ice maker 16.60
interceptor /grease trap ' 16.60
Contact name: Medical gas (value: $ _) r-- g Pa e 2
Address: Primer 16.60
City /State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) 1 Fax: : ( ) SinklbasiMavatory 16.60
E -mail:
Tub /shower /shower pan 16.60
Urinal •
:.. CON1'IW CTOR ::: . .
••:'
....... . , ... :: : Water closer 16.60
Business name: @A \\ \ 7 1 Water heater 16.60
Address: • . 0 • l _ t, t t( A t ' Other:
•
City /Stale/ZiP `'e a A _ 'i O , _ _ Subtotal 72.50
Phone: _ �� Minimum permit fee: $72.50 / , �G
�) . Fax: , i I Residential backflow minimum permit fee; $36.25 O� - '
CCB Lie.: / 1 -% Numbing Lic. no. :.1i.'�I, / jo Plan review (25 %ofpemtit fee) .-.
Authorized signature: P '/
WilState surcharge (12% of permit fee) /a. i 7
�� -' TOTAL PERMIT PEE //3 .,57
Print name; ar�� ti 01/27/ Date: - - awe: This permit application expires if a permit is not obtained within
180 days after It has been accepted as complete.
*Pee methodology set by Tri- County Building Industry Service Board.
I: 1DuildingPcrmllswLMF- PermiIApp.doc 17/27106 4J0.e616
T(to/ovCOMrwEa) •
Sep. 18. 2009 1:10PM No. 4340 P. 2
' Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
rte
_ :- ite. tilities :L Qry tap).. Tottil Square Footage: : Permit •Fie; •
. •
Footing drain -1' 100' 55.00 0 to 2,000 $115.00
Fooling drain - each additional 100' 46.40 2,001 to 3,600 $160.00
Sewer - 1st 100' 3b01 to 7 ,200 $220.00
55.00 7, and greater $309.00
Sewer • each additional 100'
) 46.40
Water Service - 1st 100' 55.00
Medical Gas Systems:
Water Service • each additional 100' 46.40 . • •
ihiation: • • - : Permit Fee . .. •...... .....:.....:
Storm Bt Rain Drain - 1st 100' • 55.00 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.90 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
Fixture: or Item Qty. 12 (ea) . . T otal • additional $100.00 or fraction thereof, to and
Commercial Back Flow Prevention Device 46,40 including $10,000.00.
$10,001,00 to $25,000.00 $148.50 for the first $10,000.00 and SI.54 for
Residential Backflow Prevention Dev each additional $100.00 or fraction thereof, to
(minimum permit fee $36.25) _ 27.55 and includin: $25,000.00.
Rain Drain, single family dwelling 6525 $25,001.00 to $50,000.00 $379.50 for the first 525,000.00 and $1.45 for
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
specially requested inspections per hour 72.50 and including $50,000.00.
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Commercial Fixture Work:
:.•....: Plan. Re'v><ew:for•Plumbmg Installations:.: = ....
Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
. accurately report fixtures could result in increased sewer fees *. ❑ Any new commercial building with water service 2" and
..
_Otani* by ([future) Work Perforated greater, except systems designed and stamped by licensed
nixfure: .Type: 1're : c app ed Added :� ..::E �tio� .� engineer.
New exterior plumbing site utilities for any complex structure
•Baptistry/font _ as defined in OAIt.918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health cart facilities.
-Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash - Each Stall [1 Any complex structure as defined in OAR91$ 780 0040.
-Drive Thru
Cuspidor/WaterA$pirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial _
-Domestic
Drinking Fountain sometric or ise
, r •I�i Cltm
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain/sink • 2" _ ,_____. that meet the qualifications above.
-3
4" _`
Car Wash Drain
Garbage - Domestic Comments regarding fixture work: •
Disposal - Conintcrcial g
- Industrial
Ice Mach./Refrig. Drains
-
Oil Separator (Gas Station)
-
Rea. Vehicle Dump Station
Shower -Gang -
-Stall
Sink •Bar/Lavatory
'Bradley ■ "Note: If the fixture work under this permit results in an
-Commercial - increase of sewer f~DUs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be paid before the
Swimming Pool Filler plumbing permit can be issued. - Washer - Clothes t tlng p
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures: t
is Tuitdina■PermuAPi.M- Pcrm3IApp.doc 12/27/06