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Permit CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit #: PLM2009 -00138 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/03/2009 Parcel: 2S102AC01101 Jurisdiction: Site address: 12562 SW MAIN ST Subdivision: Lot: 0 Project: MAX'S BREW PUB Project Description: Install site storm utilities. Owner: FEES TWO GS REAL ESTATE LLC Quantity Description Date Amount 18395 WOOD THRUSH ST 1 ea Catch Basin or Area Drain 06/03/2009 $16.60 LAKE OSWEGO, OR 97035 134 If Storm and Rain Drain 06/03/2009 $101.40 PHONE: 1 12% State Surcharge - 06/03/2009 $14.16 Plumbing Contractor: LIVESAY BROS PLUMBING INC 30364 S MOLALLA AVE MOLALLA, OR 97038 PHONE: 503 - 829 -5843 - FAX: 503 - 829 -2032 Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Stories: • Total $132.16 Required Items and Reports (Conditions) 1 Pln Gen REMOVE CONCRETE BLOCK PAVING: 2 Pln Gen SUBMIT FRANCHISE HAULER LETTER 3 Pln Gen SUBMIT REVISED LANDSCAPE PLAN 4 Pln Gen INSTALL TREE PROTECTION FENCING 5 Pln Gen SUBMIT JOINT USE/MAINTENANCE AGREEMEI 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 y the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain (copy, of • - 3' Issued By: • 1 Permittee Signature: /' Call 503.639.4175 by 7:00 a.m. for an inspection that busi -ss 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. Plumbing Permit Application Site Utilities Received ? Q }.� �jQ City of Tigard Date/By: ✓ % Permit No.: / i �ev III • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review CM Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit No.: - it G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard- or.gov Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE ® New construction ❑ Demolition For special information use checklist 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 249.20 ❑ 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi- family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder ® Other: UTILITIES Fire sprinkler ( sq. ft.) Page 2 _ JOB SITE INFORMATION AND LOCATION Site utilities Job site address: 12562 SW MAIN STREET Catch basin or area drain 1 16.60 16.60 City /State /ZIP: TIGARD, OR Drywell, leach line, or trench drain 16.60 r Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: Project name: S qX �j n Cross street/directions to job site: SW MAPLEWOOD DR # A Manufactured home utilities 110.00 Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 140 Storm sewer (no. linear ft.: 134) 134 Page 2 Pt 90778 Subdivision: N/A I Lot no.: N/A Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no.: 2S102AC01101 Absorption valve 16.60 DESCRIPTION OF WORK Backflow preventer Page 2 CONSTRUCT SITE STORM SEWER UTILITIES. Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 IS PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60 Ejectors /sump 16.60 Name: TWO G'S REAL ESTATE, LLC - CONTACT: RUSS GODDARD Expansion tank 16.60 Address: 18395 WOOD THRUSH STREET Fixture/sewer cap 16.60 City /State /ZIP: LAKE OSWEGO, OR 97035 Floor drain/floor sink/hub 16.60 Phone: (503)684 -0550 Fax: (503)620 -5583 Garbage disposal 16.60 ® APPLICANT ❑ CONTACT PERSON Hose bib 16.60 Ice maker 16.60 Business name: SAME AS OWNER Interceptor /grease trap 16.60 Contact name: Medical gas (value: $ ) Page 2 Address: Primer 16.60 City /State /ZIP: Roof drain (commercial) 16.60 Phone: ( ) I F es:: ( ) Sink/basin/lavatory 16.60 Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CONTRACTOR Water closet 16.60 Business name: '@O' k 1 J e 56- y 61205, Jij..4 / Water heater 16.60 Address: Other: Subtotal .87:58 City/State /ZIP: Minimum permit fee: $72.50 /17 •v0 Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lic.: ' , ' ng Lic. no.: Plan review (25% of permit fee) IRWir �� State surcharge (12% of permit fee) Mi. 14:149-• 14:149-• Authorized signature: / / TOTAL PERMIT FEE J49,77 • . - K ��IIMMRIIM Date ©/ / I This permit application expires if a permit is not obtained within i 4, 180 days after it has been accepted as complete. 1 34 ► . *Fee methodology set by Tri-County Building Industry Service Board. 1:\ Building \Pennits\PLMU- PermitApp.doc 12 /27/06 440- 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 - I 100' 55.00 0 to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $ 160.00 3,601 to 7,200 $220.00 Sewer - 1st 100' 100 55.00 55.00 7,201 and greater $309.00 Sewer - each additional 100' 34 46.40 15.78 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 Storm & Rain Drain - 1st 100' 55.00 Valuation: Permit Fee: $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof, to and including $10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to (minimum permit fee $36.25) 27.55 and including $25,000.00. Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for Inspection of existing plumbing or each additional $100.00 or fraction thereof, to and including $50,000.00. specially requested inspections - per hour 72.50 Subtotal: 70 78 $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 Review for Plumbing 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 Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed Fixture Type: Replace engineer. Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure Baptistry/Font as defined in OAR918- 780 -0040. Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities. - Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system. Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040. -Drive Thru Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above. Dishwasher - Commercial - Domestic Drinking Fountain Isometric or Riser Diagram Eye Wash ❑ Isometric or riser diagram is required for new buildings Floor Drain/sink - 2" that meet the qualifications above. -4 Car Wash Drain Garbage - Domestic Comments regarding fixture work: Disposal - Commercial - Industrial Ice Mach./Refrig. Drains Oil Separator (Gas Station) Rec. 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 EDUs, a sewer permit will be issued and - Service fees assessed for the sewer increase must be paid before the Swimming Pool Filter plumbing permit can be issued. • Washer - Clothes Water Extractor - Water Closet - Toilet Urinal Other Fixtures: T: \JOBS\2000- 2099\2049 12562 SW Main Street\Engineering \SUBMITTLI \SITE UTILITIES PERMIT APP.doc