Permit CITY OF TIGARD PLUMBING PERMIT
C COMMUNITY DEVELOPMENT Permit #: PLM2012 -00235
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/15/2012
Parcel: 1 S136CB02400
Jurisdiction: Tigard
Site address: 11160 SW 82ND AVE
Project: Coolman Subdivision: RANCH VALLEY Lot: 5
Project Description: (1) water service 35'
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Contractor: WESTERN PLUMBING Owner: COOLMAN, HERBERT R
9460 SW TIGARD AVE SUITE 101 11160 SW 82ND AVE
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 503 - 639 -5296 PHONE:
FAX: 503 - 684 -9015
FEES
Quantity Description • Date Amount
35 If Water Service 08/15/2012 $62.54
Specifics: 1 12% State Surcharge - 08/15/2012 $8.70
Plumbing
Type of Use SF 10 ea Minimum Fee Adjustment - 08/15/2012 $9.96
Plumbing
Class of Work: OTR
Type of Const:
Occupancy Grp:
Stories:
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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 wit 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: I/ Permittee Signature: . \ APP`/ VD ti
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.
0 8/14/2012 14:14 5036849015 WESTERN PLUMBING INC PAGE 01/03
!iumb Permit An»b cation RECEIVED '
Building Fixtures
AUG 14 2012 FOR OFFICE USE ONLY
City of Tigard iced
13125 sw hall Boa., Tigard, OR 97223 IT OFTIGAR i reW I PemitxgpLH Ava- as
Phone: .3.639.4171 Far 503.598.
1 / - lCiA 50
1 D W 503 - 639.4175 , BIJ ILDIT\GDIVIS I • i - - -
Deb Otter Permit No.:
mod,
2 for
L 4 ' •r,. % . i;' , y../ .h, ra.; Iuf°.mIIHOtl
New construction E] Demolition : f `
L Additiom/altetatt dteplaoCm De sca �i pt i oa
wfo sl�roliea at c r. ' . '•:
° ❑ Other: l each connection)
- at. : w 1- a fami� dwellings (=lades
`;; ..: 1#44*. u >, Ne 1 100 R for escb utility connection) ��1 -and2 '' FR( 312.701
-family dwelliing ❑ Commercial/industrial SFR (2) Rath
El Accessory building 0 Multi -family SFR be) 437.78
500.32
El Master builder ❑ Other:
Each additional bath/Idtchon 25_02
y . :2: ..1...:.', ,: w .. Fire sprinkler ( it) p
: •: ... ,. : :1 uv, F Oiii v r� 1p. .�y Rader
2
. J .:: L:,- 3
dress: � i
Job
Site ad t � .•, • l„Jo . : r1 . , L . . _
Catc bas O T A rta dra in - -
18.76
City/sis g O , .• , : ` larywefl leach li e, o! trench dra 18.76 • • SttitrJbldgJapt no.- Ptvject name: /1,� rn�� } FOog (no. linearl : ; Page 2
Cross street/di 1 •; � ,� �� YLCSL Manufactured home utilities r
uecsioas to job site
Manholes
•
-�_. stain drain connector
_ Sanitary sewer (no. linear R: —, Page 2
Storm sewer (no. linear It; ) Page 2
Subdivision: Lot no.: Water service (nn. Hofer tt: T:.) i P� 2 5
Tax oaalt✓Paccel no.: nature or ham -
•. =• •,,., _ ,,. wp�ve� 31.27
i:'" "'P °` ' tali '.,OY►;'.'. Ba water v alve
r
Clothta washy 25.02
- _" - Dishwasher
- 25.02
Drinking fountain 25.02
{ !� � ; , , Ejatam/sv� 25.02r
•. ...........:. Pxpacuueiemtantc
Neme: ...MIL ! , -s, . : ` Fixture/sewer cup 25.02
Address: Floor drain/floor siaklhub '
25.02
Oarbsge disposal City /Slatd�p: �1. h l � 1 25.02
Phone: (53) y •`s ; ` a _ F ar ( ) I Ice es: maker 25.02
. . .. G ` 1 4"r' grease trap r
Business came: Medical gas (value $ ) 2
Contact name: Primer 12,51
Address:
Roof chain ( 12.51
City /Spttel�lF --- Sink/basin/lavatory 25-02
Solar its a water) 62.54
Phone: ( ) Fax : ( ) Tatilahowedshower pan 12.51
�„� ';a:: . +.; Tjrt 25.02
: , •f:�. S : P. : t � n'y:. j f i I.+r Iii it.� _ a ii5 ,t, i 1ra�i� . •
Business name: Western Phunbin& Inc. K Wager hem 3T 52
Address: 9460 SW Tigard Avenue Suite 101 Water pt g/pWlr 56 02
City/State/ZIP: Tigard, OR 97223
+ fie ' 25,02
Phone: (503)639 -5296 Far (503)684-9015 Mrnimtan remora the: $72.50
�C13 Lic.: 2439 bing l ic. no.: 34-291'B Pfau review (25% of permit fee) i
Authorized signature; a State surcharge (12% of permit fee) 8.10 /it , TOTAL PERIM' FEE /
Print name Dana Jenson • Ante: -1 _ This t » no va goo exprras v. ,u m eoe m.a wee*, iso da otter tt bw beta iweeptM ai com
' ee....,...A,n w,,,, v, rtv 'M 111,11.4. 7 7., cm...: �r s:.....r
WESTERN PLUMBING INC PAGE 02/03
08/14/2012 14:14 5036849015
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Plumbing lApitt Application - City of Tigard
Page 2 - Supplanenhd Information
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Fee Schedule:
giZZ Residential Fire Suppression Systems:
7.
.. n> n -:.. ,. , ... ,,.::,-..::•?,.? .. .•,-; Thal !.":
•••• ' L. ' " t ' ' '1 in '.'‘'st.::1:. :•-•/...J.:-....%: 1.-:.!;!;:•••• .;,!: .; ••••,--,--r I
Footing drain -1 100' 30.03 III 0 to 2,000 $121.90
37.52 to3 •
___,
Footing drain - aub additional 100' 200111 $169.69
3 601 to 7 00 $233.20
Sewer - let 100° 62.54 IIII
7,201 and greater $327.54
Sewer - each additional 100' 37.52
Water Service - 1st 100' 1 62.54 preATI
.,6*,, Medical Gas Systems!_
Water Service - each additional 100' 37.52 is:,Y,:i•V•:.?,:,'•::::;•;;•1
, , 2 1 5. ' i .1 .!'.'...---.::,!.::11WWW•awc;i7:•• ::.: - :• . .....'.:"''''s . :
Siam &Rain Drain - 1st 100' 62.54
Storm $1.00 to $5,000.00 Minimum fee $72.50
& Rain ain - each additional 100' 37.52 $3,001.00 to $10,000.00 $72.50 for tl and $1.52 far
each additional S100.00 or fraction thereo4 to
: • • ' ' rl v A.Irlfe0f:. ••.; •::'!: ,,,•••,:::;,
and including $10,000.00.
Inspection of esistiag plumbing or far
$10,001.00 to $25,000.00 $148.50 for the inn $10,000.00 end $1.54 for
which no fee ia spxifically Indicated 90.00/hr
each additional $100.00 or fraction thereot to
(minimum charge - 1/2 hour)
and includine $25,000.00.
Inspections outside of normal business 90.00/hr
$25,001.00 to $50,000.00 $379.50 for **feet $25,000.00 and $1.45 for
hours (minimum charge -2 hours)
each additional $100.00 or &action ° to
Reinspection Fees 90.00/hr
and including 550,000.00.
Additional plan review for revisions 90.00/1w 1 $50,001.00 sod up $742.00 for the fest $50,000.00 and 51.20 for
/minimum cline - 1/2 hour)
each additional $100.00 or fraction thereof
Subtotal- 111.11.M1
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Commercial Fixture Work: ,
Are you capping, adding or replacing fixtures? J1"1, :::..::::Iiiiiiitt$0:
please indicate work perforated by fixture. Failure to • Plan review is required for any of the following.
accurately report fixtures could result in increased L' .wer fees*. Please check all that apply.
'•:::::::, .ic - : cL%i:'...;.4 Vir ' '.11‘1 Z :i.:: CI Any new commercial building with water service 2" and
iistipii-o7typii:.,4 :', z .... .:?,.,‘..: :. .: s .. . ' .: greater, except systems designed and stamped by licensed
. ..., .., 1•;;•.., ::i • , %. ,2 : , :. '... 7 : •.1RiL.,, '.. *.• ','...- ' ' '',.., . . ' Z. ,''' .4..;=- engineer.
Bntistri/Pont
. 0 New exterior pbanbiog site utilities for any complex structure
Bath - 11th/ShoWer
as defined in OAR912
-racuazi/whiripool -__ 13 Medical gas and vacuum systems for health care facilities.
Car Wash -Edell Stan
O Any multipurpose flre sprinkkr systeta.
-Drive Um 7
O Any complex structure as defined in OAR918-780-0040.
Cuspidor/water gupi
Dishwa.sher - C - ommareial
Submit 2 sets of plans with any of the above.
-Domestic
, rcluttait1 J _ __
-
Eye Wash
';'.•'). C “. •': ...';...: : .-.% Itil ':' 01rill... it : :`!"
Floor Drain/sink -2" "
- I Isometric or riser diagram is required for new buildings
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that meet the onalificatico3s above.
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-
Cm Wash Drain
Garbage -Domestic •
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Disposal -Commercial I .
-Induatria - '
. Comments regarding fixture work:
Ice Mack/Refrig. Drain : .
--.... -
Oil scPorator Was Station)
Rec. Vehicle Dump Station
Shower -Gang
___ _
--_-
-Stall
Sink -B/Lavatory
-Bradley
-Commercial
*Note: If the fixture work under this permit results in an
-Service
increase of sewer MTh, a sewer permit will be issued and
swimrdioa Pool Rex
fees assessed for the sewer increase most be paid before the
Washer - Clothes
plumbing permit can be issued.
water Extractor
-
Water Closet - Toilet
Urinal
Other Fixtures:
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