Permit u CITY OF TIGARD PLUMBING PERMIT
114 3 ' COMMUNITY DEVELOPMENT Permit#: PLM2015-00227
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/23/2015
Parcel: 1 S136AD06400
Jurisdiction: Tigard
Site address: 11440 SW PACIFIC HWY
Project: Union 76 Station Subdivision: VILLA RIDGE Lot: 2
Project Description: Connect existing service station to sewer service.
Contractor: ROOT EXCAVATION Owner: TIGARD BP SERVICE CO INC
10824 E OAK ST 11440 SW PACIFIC HWY
MILWAUKIE, OR 97222 TIGARD, OR 97223
PHONE: 503-656-6610 PHONE:
FAX: 503-656-6625
FEES
Quantity Description Date Amount
160 If Sanitary Sewer 07/23/2015 $100.06
Specifics: 1 12%State Surcharge- 07/23/2015 $12.01
Plumbing
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $112.07
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 N 'cation -• er. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or dire questions to OU" by - .ng 503.232.1987 or 1.800.332.2344.
Issu By: i ! Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available insp= tion 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.
Root Excavation 503-656-6625 p.6
Plumbing Permit Application
Site Utilities RECEIVED n
Received Penni'Nu.: aO�5 .e 6 g 7
IliCity of Tigard s 722' L 15 2015 -Dan Ite'. Al i s a �5- ?
u 13125 SW Hall Blvd.,Tigard,OR 9 Plan Review Other Permit Na.
■ Phone; 503.',t8.2A39 Fax: 503.59R.19� Dat y lu+r SeePege2for
Inspection line: 503.639.4175 CITY OF TIGARD I Date Repay/By: 7M///56-../9 , et See Supplemental Information
T l G A S D
Internet: www.tigard or.gov • U` 'I LD , r T7otifiedR.�ethod:
uV rrYt� iON 14 n , FEE" SCHEDULE
TYPE OF WORK A , I _i
- E r, For special Wonrlation use decease.
Q New construction ❑Demo~. a :.tion I Qty. 1 Ea. I Total
)(Addition/alteration/replacement t-2-family dwellings(includes 100 R.for each utility connection)
Addition/alterationrreplacement CI Other: � �
SFR(1)bath 312.70
CATEGORY OF CONSTRUCTION
-SFR(2)bath 437.78
❑ i-and 2-family dwelling ■: CommerciaU'industrial SFR(3)bath 500.32
❑Accessory building ❑Multi-family Each additional bath/kitchen 25.02 -
❑Master builder
❑Other: Fire sprinkler(^sq.({.) 1 Page 2
JOB SiTE INFORMATION AND LOCATION Site utilities: -
Catch basin or area drain 18.76
Job site address:11440 SW PACIFIC IT\1'Y Drywell,leach line,or trench drain 18.76
City/State/ZIP: -1' t up( t Ock, 41 aal5 Footing drain(no.linear ft.: Pape 2
j
Suite/bldg./apt.no.: Project name:UNION 76 GAS.STATION Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76
1g 76
Rain drain connector -1
Sanitary sewer(no.linear ft.:160) 1 2 Page 2
Storm sewer(no.linear ft.: ) l Page 2
Water service(no.linear ft.:___) I t Page 2
Subdivision: . Lot no.: Fixture or item:
34,A006044)0 Backflowpreventer 1 31.27 Tax map/parcel no.: �� Bacicwater valve i 12.51
. DESCRIPTION OF WORK Clothes washer 25.02
NEW Connection-Sanitary Sewer Dishwasher 25.02
Drinking fountain 25.02
VS%c � 1- -
Ejeetorsisump 25.02
Expansion tank 12 51
❑ PROPERTY OWNER ❑ TENANT 12.51
Fixture/sewer cap
Name:v1 r.Sang Lee Floor drainifloorsink/hub 25.02
Address: Garbage disposal 25.02
Hose bib 25.02
City!State/ZIP: T 12.51
Fax:( ) Ice maker _
Phone:(503)860-3333 lnterceptor(grease trap I 25.02
® APPLICANT a CONTACT PERSON
Medical gas(value:5 ) Pace 2
Business name:Root Excavation Primer 12.51
Contact name:Tim Ragland - Roof drain(commercial) 12.51
Sinklbasinrlavatoq 25.02
Address:10824 SE Oak Street#322 62.02
Solar units(potable water)
City/State/ZIP:Milwaukee Oregon 97222 Tub/shmverlshoaerpecn 12.51 _
Phone:(503)656-6610 Fax::(503)656-6625 25 02
Urinal _
E-mail:bridget @ragtandsine.rnm Water closet 25 02
CONTRACTOR heater 37.52
i
i
ppng`DR'V 56.29 Business name:Root Excavation Water -
Other: 25.02
Address:10824 SE Oak#322 Subtotal
City,StatelZlP:Milwaakic Oregon 97222 Minimum permit fee: $72.50 otal
Phone:(503)656-6610 FaY (503)656-6625 - Plan review (25%of permit fee)
Plumbing Lic.no.:3-4 .b 7 /7
CCB Lie.:134498 if A� /7 State surcharge(12%ofperrrrit fee) 1 i3,
� TOTAL PERMIT FEE
Authorized signature: To . - '
� This permit application- expires if a permit is not obtained within ISO days
�� ��� �� � ' Date: . 1! �� after it has hew accepted ang complete.
a
`_� *^ec methodology set by Tri County Building Industry Service Board.
t:'isuiWinb�r+o�ts�t+t.n+tl-aamrtagp,aw taovov
440-1616T(1 Q'02'COMAVEB)
Root Excavation 503-656-6625 p.5
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:
50.03 0 to 2,000 $121.90
Footing drain-I°100' _ 2,001 to 3,600 1 $169.69
-Footing drain-each additional 100' 37.52 3,601 to 7,200 5233.20
Sewer-1st 100' 1 62-54 62.54 7,201 and greater $327.54
Sewer-each additional 100' I 37.52 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
each additional$100.00 or fraction thereof,to
Qty. Fee(ea) Tamil and including$10,000.00.Inspection of existing plumbing or for $10,001.00 to$25,000.00 -
$148.50 for the first 510,000.00 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
hour(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
90.00/hr and including$50,000.00.
_hours
Additional plan n re $50,001.00 and up 1 $742.00 for the first$50,000.00 and$1.20 for
Additional plan review for revisions 90.00/hr 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
accurately report fixtures could result in increased sewer fees*.
Quantity by Fixture Type _ Plan Review for Plumbing Installations
Fixture Type for Reptsce! Plan review is required for any of the following.
Capped Added Relweate
Work Performed: lipp Please check all that apply.
Baptistry/Font ❑ Any new commercial building with water service 2"and
Bath -Tub/Shower greater,except systems designed and stamped by licensed
-Jacuzzi/Whirlpool engineer.
Car Wash -Each Stall - ❑ New exterior plumbing site utilities for any complex structure
-Drive"Ihru as defined in OAR918 780-0040•
Dishwasher s -Commercial ❑ Medical gas and vacuum systems for health care facilities.
Diwaher -Commercial ❑ Any multipurpose fire sprinkler system.
Domestic ❑ Any complex structure as defined in OAR918-780-0040.
_Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
FloorDrain/sink -2" -
-3" , Isometric or Riser Diagram
-4"
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food that meet the qualifications above.
Disposal Domestic-food related -
-Commercial-food related _ .
-Industrial-food related ..
-Ice lelacIVRefrig Drains Co menu regardin lture `work•
Oil Separator(Gas Station) (3) 5'c' 5 ,tea)- o% yit. U IV t(lk
Roe.vehicle Dump Station ♦♦Ol
Shower -Gang , -
-Stall ��Al4o 'Qr�,O £1�1cj f Qg Tr }Sl�'�rl' �tiC 1f{ .
Sink/Lav Non-food related L� I
-Bradley �'.\� `s,a tr r�a� .Q N a1� O (
fiommercial-food related -
Ser•ice
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes - increase of sewer EDUs,a sewer permit will be issued and
Water Extractor a fees assessed for the sewer increase must be paid before the
Water Closet-Toilet t plumbing permit can be issued.
Urinal
Other Fixtures: -
http li www.tigard-or.govl document_centerBuilding/PLMU_Perm itApp.d2e
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Root Excavation 503-656-6625 p.1
Map#1 Cont.
8PM to SAM and steel plates will be placed over any open holes and caution signs put in place. All
existing utilities will be located and exposed during boring of the new line to ensure proper clearance.
Any private properties and sidewalks will be cautioned taped and covered for safety. All asphalt holes
will be compacted and paved back upon completion.
This job is expected to take five nights that is without any unexpected complications or delays.
Door knockers will be hand delivered to all businesses surrounding the work area informing them of
the lane closures,dates,times,and type of work that is being performed. Name of company performing
the work and a contact numbers will also be included. This is given so any possible concerns about the
work being done, before or during,can be addressed and resolved.
ROAD CONSTRUCTION DATE:aimmoromma
ROAD CONSTRUCTION TIME:8PM—5AM
DATE SUBMITTED:July 7,2015
Traffic Control Plan Submitted By:Root Excavation /Tim Ragland
Contact phone numbers:Tim Ragland cell (503) 407-1271 Kathleen Smith 003)425-9931
Root Excavation 503-656-6625 p.2
Legend Cont.
4 Right lane closed transition
2 Bike lane closed ahead ride with traffic
2 Caution Steel Plates in Roadway
2 Type Ill Right lane Closed Barricades
2 lighted directional arrow board
18 Traffic barrels (for tapers only)
Approx.50 barrel cones or tubular markers
Work Area
6 Businesses near project
4 Light plants
TRAFFIC CONTROL DEVICES TO BE USED
Construction signs will be put in place using proper sign spacing. Nine Traffic barrels will be used
to make a taper to close the right lane with tubular cones or barrel cones to complete the closure of the
lane. The right lane will be closed on both sides of the highway to ensure a safe construction area for
the traffic and crew doing the work. Lighted directional arrow boards will be placed in the taper along
with type III barricades to ensure the traffic makes the transition into the left lanes. Extra cones will be
used to make entrances and exits to businesses that directly affected by the lane closure to ensure no
confusion. Double signage is recommended on both lane closure. Second signs shall be put in the
middle turn lane. But do to all the businesses that will still be open during work hours the turn lane may
be too busy and not a safe option. Therefore the second signs may not be an option.
Map#1
Root Excavation is requesting permission to do a sanitary line improvement project at the above
address. The project is located on Pacific HWY 99 so we are requesting a permit to do this job at night
do to excessive amount traffic during the day. Four light plants will be set up in the work area to light up
the work area but carefully set up so that the lights are not affecting traffic vision. The 76 gas station's
septic system is failing and has to switch over to the city system. Root Excavation to replace the line and
will need to boar underground from behind the station out to the highway and bore to the opposite side
of the highway and tap into the existing sanitary main. In order to preform this job safely and
successfully we would like to close the right lane in both directions of 1-IWY99.The closures will be from
Root Excavation 503-656-6625 p.3
Traffic control plan for
Root Excavation Inc.
Project Address:
11440 SW Pacific HWY 99
Tigard,Oregon
Work to be done: Installation of a new sanitary line,tapping in at the station and running
new sanitary line to be connected with existing main
Contractor: Root Excavation
Contact Person on Job:Tim Ragland
Cell#(503)407-1271
Office:(503)656-6620
Fax: (503)656-6625
Traffic Control Plans and Notes
Meets MUTCD Standards(sign spacing table included on map)
Signs and Notes:
Sign spacing refer to MUTCD Chart
Sign spacing at 35 MPH and less, signs spaced at 350FT
Signs recommended for this job are 48"X48" Retro reflective roll-up signs on portable stands
Legend for Map#1
6 Road Work Ahead
4 Right lane dosed
Root Excavation 503-656-6625 p.4
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Root Excavation 503-656-6625 p.8
RAGLANDS INCORPORATED (93-1314558) (503) 656-6620
ROOT EXCAVATION
CCB# 134498
\let) (503) 656-6625 fax
1-p\5 Underground Plumbing Specialist
t1„ta) Locally owned & operated
July 15th 2015
City of Tigard
13125 SW Hall Blvd
Tigard Oregon 97223
Attention: Debbie
Following is the Plumbing Application for the New Sewer Connection for the Union 76
Gas Station located at 11440 SW Pacific HWY.
As discussed there are (6) fixtures in total: I will let the prop7,650.00.owner MR Sang Lee
know that the connection fees at this time are estimated ro
Please let me know when everything is ready and I will have Mr. Lee make payment
arrangements
Please let me know if there is anything else you need
Best regards,
Root Excavation
503-656-6610
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
11440 SW PACIFIC HWY, TIGARD, OR, 97223
Commercial - Plumbing
505 Sanitary sewer
PASS
PLM2015-00227
George Heimos
NOTE. Viewed video of new HDPE sewer piping from building existing 4" clean out to
tie-in at street approx 78' at 1% grade, pass
Septic tank filled with sand and pump receipt provided. AALL Pump and Septic Services
dated 08/21/15
bridget@raglandsinc.com
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
11440 SW PACIFIC HWY, TIGARD, OR, 97223
Commercial - Plumbing
505 Sanitary sewer
Scheduled
PLM2015-00227
George Heimos
NOTE. Viewed video of new HDPE sewer piping from building existing 4" clean out to
tie-in at street approx 78' at 1% grade, pass
Septic tank filled with sand and pump receipt provided. AALL Pump and Septic Services
dated 08/21/15
bridget@raglandsinc.com
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
11440 SW PACIFIC HWY, TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2015-00227
George Heimos
Violation Summary:
Inspector Contractor