Permit (17) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT741
Permit#: PLM2019 00456
Date Issued: 11/25/2019
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S 25/201 0903
Jurisdiction: Tigard
Site address: 12090 SW MAIN ST
Project: McDonald's Subdivision: PAYLESS SHOPPING CENTER Lot: 4
Project Description: Site utilities and exterior grease trap replacement.
Contractor: OWEN CONSTRUCTION INC Owner: MCDONALD'S CORP 036/0041
PO BOX 21150 BY DOUBLE K VENTURES INC
KEIZER, OR 97307 8255 SW HUNZIKER ST#101
TIGARD, OR 97223
PHONE: 503-390-6936
PHONE: 425-577-0415
FAX:
FEES
Quantity Description Date Amount
3 ea Catch Basin or Area Drain 11/25/2019 $56.28
Specifics: 1 ea Manholes 11/25/2019 $18.76
155 If Sanitary Sewer 11/25/2019 $100.06
Type of Use: COM 134 If Storm Sewer 11/25/2019 $100.06
Class of Work: ALT 1 ea Interceptor/Grease Trap 11/25/2019 $25.02
Type of Const: 1 Plan Review 11/25/2019 $75.05
Occupancy Grp: 1 12%State Surcharge- 11/25/2019 $36.02
Stories: Plumbing
Total $411.25
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 952-001-0090. 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: 7
Call 503.639.4175 by 7:00 a.m.for the next available in-•- tion da -
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 'Fe,-
( 1� �
lSate. Utilities FOR OFFICE USE ONI.I
City of Tigard Received y�
g ���ED Date/By: a f/Pt I// ,.? -7-)--
. - " Permit No.:"Livia()t(�,,K 5
lig ill 13125 SW Hall Blvd.,Tigard,OAi t r '�
I Plan Review p
Phone: 503.718.2439 Fax: 503. 1960 Date/By: 11 1 ? ,c c�s€S Other Permit No.: fju,p olc/, ,rvv!�•
Inspection Line: 503.639.4175 `' 4 2019 Date Jur s: ® See Pa e 2 for
T I G A R D NAV Ready/By: I h
Internet: www.tigard-or.gov Notified/method:/{ eV 1 I T Supplemental Information
TYPE OF WORT OF i llaHnt% I I . , , ..,
_i„r1 n" -3'"kn. 4 FEE* SCHEDULE
❑New construction ❑ Demolition I 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 312.70
❑ 1-and 2-family dwelling Commercial/industrial I SFR(2)bath 437.78
[7
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 I Site utilities:
Job site address: Catch basin or area drain 18.76 ,`„,i.:.a';,
i/,0610 c,w M+'1iI0 sr 3
City/State/ZIP: Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: /1/j,l�f��`r Manufactured home utilities 50.03
Cross street/directions to job site: Manholes / 18.76 f?..`/;-
Rain
I .`j;_Rain drain connector 18.76
Sanitary sewer(no.linear ft.:t(s') :, Page 2 106,04>
Storm sewer(no.linear ft.:1 ) a Page 2 100,0 b.
Water service(no.linear ft.: ) Page 2
Subdivision: I Lot no.:
Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
T-er+f LSI\ �N�� `Ll 4 Clotheswasher 25.02
lPJ Dishwasher
sher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
54 PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: �AAA ,,�,_,, Fixture/sewer cap 25.02
Yv0�i Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
It APPLICANT El CONTACT PERSON Interceptor/grease trap I 25.02 .5.01
T n /yam Medical gas(value:$ ) Page 2
Business name: "Thvlt-i'�/Nr"A`
r n � Primer 12.51
T f
Contact name: , P1``"' Rte- Roof drain(commercial) 12.51
Address: eZt."00 Si' S OS I4rZ o Sink/basin/lavatory 25.02
City/State/ZIP: az4.4' 43LcL ' 1'�j Solar units(potable water) 62.54
Phone:f O)A j L.
- 3 Fax::( ) Tub/shower/shower pan 12.51
E-mail' Urinal 25.02
pert t(04. x (w�.��t--S.
CONTRACTOR
t�_ Water closet 25.02
IZ> Water heater 37.52
Business name: ._jy vp 4 � v SJL.t tN, Water piping/DWV 56.29�_ v !
Address:
,����/p��~ 1.Other: 25.02
City/State/ZIP: I Subtotal 300, 18
Minimum permit fee: $72.50
Phone:( ) , ai Fax:( ) 1�I
.16,5.t-G,,
tt�5�G I I v �^ I Plan review (25%of permit fee) �5,o5
CCB Lic.: PlumbingLic.no.: LK �y State surcharge(12%of permit fee) i(.. Q a
Authorized signature: TOTAL PERMIT FEE 4//,I5
Print name:Aj v/V...4 ,0 I Date: 0I/4/A G/ I This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
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J
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: 1
Footing drain-15'100' 50.03 l I 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 jI 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20 1
Sewer-1st 100' ; 62.54 ` ,54 7,201 and greater $327.54 1
Sewer-each additional 100' i 37.52 3 ,5.1
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52 I Valuation: Permit Fee: ,,, _
Storm&Rain Drain-1st 100' 62.540,5 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 3r1,sa I $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
Other Inspections or Fees Qty. Fee(ea) Total
and including$10,000.00.
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
I Reinspection Fees 90.00/hr and including$50,000.00.
I 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
I (minimum charge-1/2 hour) each additional$100.00 or fraction thereof.
Subtotal:(`.Al
l
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*. Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for . Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
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
I Car Wash: -Each � 0 New exterior plumbing site utilities for any complex structure
-DriveaStall as defined in OAR918-780-0040.
Cuspidor/Water 0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water
Aspirator-Commercial ❑ Any multipurpose fire sprinkler system.
DDomestic 0 Any complex structure as defined in OAR918-780-0040.
Drinking Fountain 1
Eye Wash Submit 2 sets of plans with any of the above.
•
Floor Drain/sink: -2"
3" I Isometric or Riser Diagram
4" I ❑ 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
I Ice Mach./Refrig.Drains 1 Comments regarding fixture work:
I Oil Separator(Gas Station)
I Rec.Vehicle Dump Station
Shower: -Gang
•
-Stall I
Sink: -lav/Bar non-food related
-Bradley I
-Com/Serv/Util food related I I
-Service I *Note: If the fixture work under this permit results in an
Swimming Pool Filter
Washer-Clothes 1 increase of sewer EDUs,a sewer permit will be issued and
fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures: _
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