Permit v
CITY OF TIGARD PLUMBING PERMIT
.11P1 a COMMUNITY DEVELOPMENT Permit#: PLM2012 00229
T [ GAR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/13/2012
Parcel: 1 S134CB05200
Jurisdiction: Tigard
Site address: 12560 SW SUMMER CREST DR
Project: Lopez Subdivision: ANTON PARK Lot: 14
Project Description: (1) water heater installation 100' of water service
Contractor: WESTERN PLUMBING Owner: LOPEZ, FRANCISCO E
9460 SW TIGARD AVE SUITE 101 12560 SW SUMMERCREST DR
TIGARD, OR 97223 TIGARD, OR 97223
PHONE 503 - 639 -5296
PHONE: 503 - 709 -3484
FAX: 503 - 684 -9015
•
FEES
Quantity Description Date Amount
1 ea Water Heater 08/13/2012 $37.52
Specifics: 1 12% State Surcharge - 08/13/2012 $12.01
Plumbing
Type of Use: SF 100 If Water Service 08/13/2012 $62.54
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 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: . 4 % 014.1.4,/ Permittee Signature: • D i A p � .
Call 503.639.4175 by 7:00 a.m. for the next available inspection date. r C• /lL
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.
08/10/2012 10:31 5036849015 WESTERN PLUMBING INC PAGE 01/03
Plumbi Pe rmit A licatio EIvED
Building Fixtures
II City of Tigard A, VG G 1 3 2012 0 1 a- sr . Pariah No.: Nil dio, a- U01a.q
a 13125 SW lull Blvd., Tigard, OR 972233 T � / . D� _ Databy, Q Pane: 503.639.4171 Fax 503.59M of IGARD 1 Review Other Pamuk No.:
Inspection Line: i ! C: 4 P, T)
Interact www 2
r e`• ah£i�/Method Supplemental iafb umatiou
DIVISION BUILDING IT IVI I N
www.tigard-or.gov � S
_
... ,. .p, .2,r , :::.:'.;.::::':-.7:.',32,,,:::,;;:1:1:::;,,'‘,; ..... o � ?�.;
Y.1 .• .! :'•Rf?!'a7r'���r�.�;; � . . •
❑ New construction ❑ Demolition em �., i sb nna g !� ra: s s:r,'
For speemt:�urnr�(are use tfieelhliaK
❑ Other l Q.V
Addition/alteration/replacement N �� ( !001 cow 'em
:Yt': OY� *+ ►N ems. : ;; :'?' >.r .< : .. ;:; y ,, - )
'. -:,: �,;, ".:' �`:� .. .* S'i',>t�JChri�[ . , . ' < .
sFR(I)bath 312.70
1- and 2- family dwelling 0 Commeretalfrodusttisl OR ( bath ! 437.78
Q Y building 13 mufti-Emily (3) bath 50032
❑Master builder Each additional bath /kitchen 25.02
,:�V�kB1('<" Ot het .. Fire aprintie' s4. R.) Page 2
-
•
!
Job situ ed � � A > c"I I IV (� 1f'�5,1(Q } (` i s
Catch basin or area drain
�v,_ 18.76
City /State/ZIP: , > �, leach line, or trench drain 18.76
Swte /btelgiapt. no.: Pr game: Footing drain (no. linear R: ) Page 2
o�ect , ■ Manufactured hone utilities ies 50.03
Cross street/directions to job site / 18.76
. Rain dram connector 18.76
Sanitary sewer (no. linear ft: „____) Page 2
Storm sewer (no. Sneer 1t:. ) Page 2
Subdivision: Water service (no. linear iL :13) ! _ Page 2
1 Lot no.: • FBtwe or ltrm. S
Tax map /pareel no.: l Uuw premier 3127
i4 M: - I
"' D 1 A 1c % i OF 1VO yX 12.51
on j u a.48 Dis Clothes washer 25.02
� � Drdewesher zs.o2
lhal__\_1,zava-Woeker4
I 1 C5L. .. Dri Drinking fountain 25.02
Ejectors/sump 25.02
M: :6444.0.. `o'' ii Es ansion;a&
:'' 1'.':.:::.'•' _ .. 12.51
Name: 4t4. 0.1�,! . Fix are /sewer cap 25.02
Floor draia/ftoor siolk/ineb 25.02
Address: I ce c`i ►) 1 A 0 'more A i:4 \ k cftaposal / 25.02
City /StatolZlP :7Vor ' +` Nose bib 25.02
Phone: (5y3) "1 ' '�k Fax ( ) -
Ite maker 12.51
S.` "° '. 11" l '.,` '' I 1rA Interceptor /greaseta
;;..' . �:°,- ... ,.: P 25.02
Business name: . Medical gas (value: $ ) Page 2
Contact name:
12.51
Address:
Roof drain (commercial) 12.51
Sb l basin/iavalory 25.02
City/State/ZIP: Solar u (potable water) 62.54 •
Phone: ( ) _ I Fax : ( ) Tub(shower/ahower pan 12.51
Urinal 25.02
.. .......
a F 4 .::.? Water rdoset
:;r:' :;�''.•: ``J. : ; _ 25.02
Business Hama: Western Plumbing, Inc.. water heater i 37.52 5.-1,
Water piping/DW V 56.29
Address: 9460 SW Tigard Avenge Suite 101
Other 25.02
City/State/DP: Tigard, OR 97223
bbhtptel i0744
Phone: (503) 639 -5296 Fax: (503) 684 -9015 Minimums permit fee: $72.50
CCB Lic.: 2439 Plumbing 1rc. no.: 34.29PB - l � ( of permit fee)
State a
" �� I, surcharge 1295 of
Authorized si 6 ( P fee) II . 01 l x.0
•a , _di /. TOTAL PERMIT FEE •
I Print acme: Dana Jensen �� Dater This Permit app expires Ito permit is not obtained within 180 days
II b sRa It has beau accephxf as complete
•r...,Mh,r4n4y.v ..• h , Tri-rrawkr11046e, Tr. file,. Qsnr... Anon! / �
C)'* v l s�
� I
08/10/2012 10:31 5036849015 WESTERN PLUMBING INC PAGE 02/03
•
Plumbinz Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: itesiden . Fiir, Systems:
Suppression S stems:
g.M#;,...:445t:-.A7.,.',.',. gtijfAi'dthite"'"iifltf;2
Footin than - I 100' 50.03 0 to 2,000 $121.90
Footing drain - each additional 100' 37.52 2,001 to 3,6430 $169.69
_ 3.601 to 7,200 $233.20
Server - lst 100' 62.54
7,201 ander eider $327.54 ,
Sewer 'each adti
drons1100' 37.52
Water Service - 1st 100' ' 62.54
Mediad Gas Sems:
Water Servc c - each additionai 100' / , 37,52 - e..n_.... ,,,., rs.....4......,.. , :...:...:.,..,,,..., ,,,,. . , 4 , .. ...,,„,!,,,,„„
Storm & Rain Drain - 1st 100 62,54
$1.00 to $3,000.00 Minion fee $72.
Storm & Rain Drain - each additional 100' 37.52 $5,001.00 to $10,000.00 $72.50 forthe fast $5,000.00 and $1.52 for
, --- 1 , _ z : ..:.,, • ....?„,, e. .... ,..t. : vi,gr,(49 4.
:74givr ,,'":.. ;':. , t'. each additional $100.00 or fraction thereo4 to
and including $10,000.00.
.
Inspeaion of existing plumbing or for '
$10,001.00 to $25,000.00 $144.50 frethe first 310,000.00 and $1.54 for
which no fee is specifically indicated 9O.00/by
each additional $100.00 or fluxion thereog to
(ain/maw charge - 112 hour)
and including $25,000.00.
Inspections outside of normal business 90.004n --- $25,001.00 to 550,000-00 $379.50 for the Brat $25,000.00 and $1.45 for
bows (minimum charge -2 bows)
each additional $100.00 or fraction therno4 to
Reinspectiosi Fees 90.00/br
and including $50,000.00.
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
(minimum charge -1/2 boar)
- each additional 5100.00 or fraction thereof
sc,btoiai_ _____________
.,..-........„,____
Commercial Fixture Work:
, -
Are you capping, adding or replacing fixtures? If "yes",
please indicate work performed by fixture. 1i'ailure to Plea review is required for any of the following.
accurately . report fixtures could result in increased sewer fees*. Please the all that apply.
0 Any new commercial budding with water service 2" and
:Phiti:014ict.:.:- .:,,., .: :..F.: ' ., . 5 ;: , • ::,, '..'''''' ''' ',...-. greater, except systems designed and stamped by licensed
,..:-.:7 ,;!:: ,,,,,,ii.44‘.. r: L:Aiisiiiiit; engineer.
Baptistry/Font
O New (Pallier plumbing site utilities fo r any complex structure
Bath -Tub/Shower
as defined in OAR9l 2480
- Jacuzzi/Whirlpoc4
O Medical pa and vacuum systems for health care facilities.
Car Waala - Each Stall
O Any multipurpose lire sprinkler system.
- Drive 'Dare
Qught/Wrda Aspirator . D Any complex structure as defined in OARM
or
Dishwasher --Commercial ,
Submit 2 sets of plans with any of the above.
Domestic
Drinking Fountain
, •
-
Eye Wet* : 1.....,1.,L,i„...' lig;:ii,;.. y ieZp, 4,1 ,...... ..:iili.% -,,,.
IPAPPVI4/1•:,4412F r ': - ' *
Floor Drain/sink -2"
III Isometric or riser diagram is required for new buildings
that meet the %ratifications above.
Car Wash Drain -
Garbage -Domestic •
Disposal -Commercial .. Comments regarding fixture work:
-Industrial
Ice Afach./Reltig. Drains
011separatorscraa Station)
Rae. Vehicle Dump Station
Shower -Gang ,
-St en
Sink -Bar/Lavatory
__
-Bradley
-Commercial
*Note: if the fixture work under this permit results in an
-Service
i i increase of sewer ENDS, a sewer permit will be issued and
swmmng Pool Filter-- - fees assessed for the sewer increase must be paid before the
Washer - Clothes .____,
Water Extractor plumbing pennit can be issued.
. .
Water Closet - Toilet
Urinal
Other Fixtures: up 14- i -