Permit CITY OF TIGARD PLUMBING PERMIT
1,111A• 2 • COMMUNITY DEVELOPMENT Permit #: PLM2012 -00042
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/28/2012
Parcel: 2S102BD02800
Jurisdiction: Tigard
Site address: 12995 SW PACIFIC HWY
Project: Autumn Funerals Subdivision: NORTH TIGARDVILLE ADDITION Lot: 36
Project Description: Commercial backflow preventer.
Contractor: WESTERN PLUMBING Owner: AFTER FIVE, LLC
9460 SW TIGARD, AVE STE 101 10330 SW TUALATIN RD
TIGARD, OR 97223 TUALATIN, OR 97062
PHONE: 503 - 639 -5296 PHONE:
FAX: 503 - 684 -9015
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 02/28/2012 $31.27
Specifics: 1 12% State Surcharge - 02/28/2012 $8.70
Plumbing
Type of Use COM 41 ea Minimum Fee Adjustment - 02/28/2012 $41.23
Plumbing
Class of Work: OTR
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
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: 1
AIWA -
Call 503.639.4175 by 7:00 a.m. for the next available inspection 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.
02/24/2012 15:02 5036849015 WESTERN PLUMBING INC PAGE 01/02
—
PlmbingPermit Application RECEIVED
Budding +i' tures
- City of Tigard
FEB 2 4 2012 , . rolz or- } -uSE ;NLy` : :- ::
13125 sw im Blvd., Tigard, OR 97223 CITY OF TIGAR r 1 D 14 " ' = ' it Ny Y020/ 2 —800 2 Received
' R Phone: 503.639.4171 Farr- 503.598.1
ricA,ri Impaction Line: 503.639.4175 B UILDING DIVISI• ► : Other Poomi
crro
see
M , :. : . me 2 TOT
.,. � : ��.. ...:. .... V ,...+. . ..,...; TS ,'0� .';+.., � y L'.. tal Iotbetn
173 New c mst<uc6on "'`> t`' : '' a o .. S p r': ;: .
i.1 Addition/aheration/replaoement Cl •� For special irt[orrrretjpn use dieaklirt
Dawn 5 {, ... s :, Total
<; - _/y yy { �
News, 2 -famgy dweplhgs (includes 100 ft. for each connection)
.. ..: i v CO*1 OF`..t ,,.T f. : '�}," 0Yconneclaon
�. ; :: {" �''r 312.70
❑ 1- and 2- family dwelling
Commercial/ industrial SFR (2) bath MIIIMIEMI
Q Accessory building Mun�i -,il (3) Soo 32
Master builder ❑ Other
additional '�athii. h=
ter,. F ~:t' }�.�� y F 2 2
' r71!rF( A } � Y �1� Y � {yV y rJ �l��p���yyyypl @{�]��]�7! ,' :: - (� sq. S.)' Page 2
': - ",;; ' ••. : :: ,•. ...• •.. ' • '' • 1,. -1 •-•. * v er y . , 1.. 4".. ::11.;;! is
Site ;lathes! Job site address
r l . Catch basin or area drain
City %Smtr1Z�: / .t4. V � D , leach line, or trench drain
MI 15
Suite/bldg./apt. / - , Project acme �� Footing draln(no_ linear R: —� Page 2
rl - ,� J1L J[ I -' Manufactured home
Cross street/directions to job site: 50.03
Manholes r
Rain drain connector 18.76
MEN
tarY rerver (no. linear ft: __) Page 2
—
Storm sewer (no. linear ft.: _,} Elimion
Subdivision: Water service (no. linear 8: _) Pag 2
1 Lot no.: Fixture or item:
Tax map/parcel no."
r' Badd10w preventq
;r:.. 31.27
. r ' . ..' Y " °0*0: *.0. : y : , ,., , Backwater valve IMPAI
�,,._ L ,, _ yt. ,� : ... elotltea washer r
.1 .1 25.02
■ DisAlwarther
fountain 25.02 MIMI
Drinking 25.02
. - .0 a "
Ejectors/sump
,:,:•. :- :'r "rdgllV7; > >.: 5.:':;'. Hxpartsiontan& � NEB �
Name: S: Figu �a ue /sew cap 25.02
Addre
25,02
City�statnfZJP: s _ 25.02
Phone; ( ) Floss bib 25.02 Far
;5 _' F.;; 1�iR!� k'l1 c "; ( :,) Ice 12.51
' ::� . ,.... � •:0; ,i G!f�i:
Business name: . , 'a
N,:: o grease p 25.02
Medical gas (value: $ -�. Page 2 all
Contact name: Pier
Address: ^ -
Roof drain (aommorciaf)
City/State/ZIP:
Sink/basin/lavatory 25.02
Phone: ( ) Solar (potable water) 62.54
I Fart : ( ) • Tub/shower/shower pan Itral
E-mail:
Water 25.02
:' ;'5:^�Fs t'5.. «:.:. .. ; 4 :. ,., Werartlpeet
..... ..� ,�'6! " .. - -� : x.' .. ki.Tr� e, :: ... • J "• t..I.
Business Plumbing, Inc. wake heater 375name.:
Address: 9460 SW Wad pWm�� ■ 56.29
'Tigard Avenue Suite 101 Other:
City/State/ZIP: Tigard, OR 97223 25.02
Phone: (503) 639 -529 F _ Subtotal
(503) 6$4 -9015 Minimum permit foe: $72.30
1 CCB Lin_: 2439 Plumbing Lic. no.: 34-29PD Plan review (25% of permit fee) . ���,
D na Jensen
Authorized signature: 11 State surcharge (1295 of permit fee) �f' d.,,,...--- C��` ` TOTAL PERMIT FEE
r
Print name: This •
Ante: � I p ermit application expire tea emit is out obtato.d rdtbtn too days
alter 2t has been acoep>nd as eomplebr,
•p,, nWhrrtnlr„v at by Tri-Pro m , n.:4+:,b l..,S ...-v a..., :•.■ Rn.ret