Permit l
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2009 -00125
Date Issued: 05/19/2009
T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S 102A601901
Jurisdiction: Tigard
Site address: 9350 SW TIGARD ST
Subdivision: Lot: 0
Project: Kadel's
Project Description: Install w/c and lay.
Owner: FEES
DAVIDSON, WILLIAM G & DIXIE L Quantity Description Date Amount
8915 SW COMMERCIAL ST 1 ea Lavatories 05/19/2009 $16.60
TIGARD, OR 97223 1 ea Water Closet 05/19/2009 $16.60
PHONE: 1 12% State Surcharge - 05/19/2009 $8.70
Plumbing
Contractor: 39 ea Minimum Fee Adjustment 05/19/2009 $39.30
WESTERN PLUMBING - Plumbing
9460 SW TIGARD, AVE STE 101
TIGARD, OR 97223
PHONE: 503 - 639 -5296
FAX: 503 - 684 -9015
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
Issued By: Q A Permittee Signature: a jc 0 1/4. 43 (74.i ,
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
'05/13/,2009 13:38 5036849015 WESTERN PLUMBING INC PAGE 01/03
PIunI,_ bins Permit Applic i , C ED I,-.R orrlci, USE ONLY'
City of Tigard ,-, v xeeeived r s
+ 13125 S W Hall Blvd., Tigard, R 97223 Date/By: t ? • Permit No.: PL m �i T om. r s
a Phone: 503.639.4171 Fax 503.5 /0A 60 3 1
Plan y. °W Other Permit No U -/ ` �
1 . 1 c; A R D Inspection line: 503,639.4175
Internet �►nvw tlgard.or gov , . Bo rwu Id See P. 2 for
Date R
eady
/ C t / Notified/Method:
,r,-� . E � •--� - I e, S . lemtntal Information nti.��. .. 4 ri � - 37: . r ) 7 Q . _r t -T �j7a g`, r . . �} r 7. .r i -iq r - LA,
�.. ,.2 .. _4.: 7 . .:. ;: ..,. ,_,, r�M1 n �..i xs....:•� .,r cria".'f }i �",+•�,�,�rF� °?, {,�z,. + ✓ m �' a 7 �h ��Y�t. -. C
❑'New construction • �• ._ "`" - , -�t,r_ ,.r1rr. w�- -;`,,. �
- [ Demolition _ For spedal information use checklist
Addition /alteration/replacement El pthe. Description Qty, I Ea j Total
t -. u F, -� : New 1.2- family dwellings (includes 100 ft. for each utility connection)
'r r 'r ,$ r ,,, i F :17 : f :71 7.r r rc z'2 7" [ - ti1 r 7'f Vi t r 'i.�.. C twf :4 .:' �+��
i t . ,fiL s,i „, i A.... :&. er r', Y v: i,i3 ' wi �s {:`� c.. -5;�:a i � 'S1�R (1) ba th 249.20
❑ 1 - and 2- family dwelling lied Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
• ❑ Master builder ❑ Other; Each additional bath/kitchen 45.00
r ^r� L ,� �[ F x . "o ff - 9Y I[ �T'�'" f '. S _ ,`ra' �''J. i�f i' Fire sprinkler ( s ft)
.r.4;, ,,r„ . >' -', t . r v = ..A g- .'r..�,rM c Y {d ry I .27,!�. : '.r c
N, f S 4• ) Page
Job site address E ' , ► ; w \ t 1 Catch basin or area drain
City/StateJZ„IP: T 1 1 a - ry /lti 16.60
1 \C _Dmvell, leach line, or trench drain
Suite/bldgJapt. no.: 1 Project name: uo s pit A (1 ejfikl Footing drain (no. linear ft.: ) . Page 2
Cross street/directions to job site: Manufactured home utilities 110.00
- Manholes 16.60
Rain drain connector 16.60
-
l
Sanitary sewer (no. linear ft.: ___) Page 2
Storm sewer (no. linear ft-: ) Page 2
Subdivision: Lot no.: Water service (no. linear ft.: �) _ Pa 2
Tax map /parcel no.: Fixture or Item
fie- -^ ..� � J j -- -.. ^--T -. Abs va l v e
{ >'71= ', , ', tr ,r . � sa,.$ r _ ' p (fir 7 ,,�, 7.4 7fi 16.60
. _.. ,_�.,-...,u... , wti_ vC. , -_mot ...ar.�•1? ;,; � �R., ?�,. , - -,• c.. :+t' ', Rackflow preventer
Page 2
. • Backwater valve 16.60
e L1 r .. Aik +A11(t
Clothes washer 16.60
%ill Dishwasher • 16.60
, 7 D .. ra ! 4� Fr' t r'b 'r . "1. N Wr x ,r_ , . � � ..er r r� _ .',. � { 1 � ,f4,1 r+ Drinking ountain
_',.i ?r : , a ) �; t {� , e r r : cE� r .. u{{ l t " f 16.60
.
c _. h t s 4 . _ ._ ��,. 4 h- , � . _* 3 ,. te n,! ja Ejectors/sump 16.60
Name.
Address:
Expansion tank 16.60
Fixture/sewer cap 16.60
City /StamPZIP: Floor drain/floor sink /hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
K , . $ l r'-v Z 1 i M te e . 27. . rr-4- �tr'2 {{ •e f.,q C^ 7 y � 4,t7,1 a-r c hose bib
S ,,,-;.:4,,+.m--:: , _ ,, . e . { , r 16.60
�``vr •„y V � 3 ..a1..:. ,�1. •iw-a �' �.- R! � .� r_. � � fi � " ,yr. a4 •1� !i!
Business name: Ice maker 16.60
Contact name: .
Interceptor /grease trap 16.60
Medical gas (value: $ ) Page 2
Address:
Primer
_ _ 16.60
City/State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) I Fax :: ( ) _ SWdbasin/lavatory r 16.60 i f 0 6
E-mail: Tub /shower /shower pan 16.60
.ir a^ - Urinal
F, :7: ti� IJ? ` 4Y M. '
s � ti c 1� n e 7-7,: rr . 8.NVf;77� �{� r ry 1 _ 16.60
,._. �. . . - i :;, Water closet / 16.60 //F
Business name: Western Plumbing, Inc. Water heater 16.60
Address: 9460 SW Tigard Avenue, Suite 101 Other. .
City /State/z1P: Tigard, Oregon 97223 S '
Phone: (503) 639 - 5296 rax: (503) 684 9015 Minimum permit fee: $72.50
Residential backflow minimum permit fee: $36.25
CCD Lie.: 2439 Plumbing Lic. no.: 3429PB Plan review (25% of permit fee)
Authorized signature � . ► ' i i' State (12% of permit fee) 3r
TOTAL PERMIT FEE , t � (.)
Print name_ Dana Jensen T Date: 5_13.. This permit application expires if a permit Is not obtained within
180 days after it has been accepted as cv.nplcte.
*Fee methodology set by Tri-County Building Industry Service Board
1: souainswo 0402496 940 -na tyrt r°+avcokuwes)
05413/2009 13:38 5036849015 WESTERN PLUMBING INC PAGE 02/03
• Piumbingj ermit Application - City of Tigard
Page 2 - Supplemental Information
•
Fee Schedule: Residential Fire Sur • r
,.� r , ess><on S stems
q - - h .l, r 1 � ... ,�,� l _ 5 „`J 9i �.? .Y r a' �. ,.? 1 r y r' . , T r,...'ca" .-._- _ '- ' ,,,,: -..' 7-
_,F -'7y- --S i ., 7
-7�`" � »Y °.-
.. .... fir .- 5..'1 �. y« .-, :z. `dTTr,. .t-
- nJ,,r:J,, _t J,9?t:..-,„....: .,..:o " i��I.,441 , .T , �3'1lf i ni �L .,,-..- .tG0.-ti CF ^-1 . K ` w 7� ,
=-.1: �r��:,449 5
Footing drain - 1 100' 55.00 0 to 2 000 $115.
Footing drain - each additional 100' _ 46.40 2,001 to 3 600 $160.00
55 3 601 to 7 00
$220.00
Scwcr 1st 100'
_ � 7 01 and ater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00
Water Service - each additional 100' Medical Gas S stems:
46.40 i- a fe r- �" -, =,�- - ry �- ..
storm Rain Drain 1st 100' r 44:?Y_ 5 1.' r -17,A c . �� . - ~.� ...,
55.00 . ;a =.' .
$1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Dram each additional 100' 46.40
$5,001.00 to $10,000.00 .$72.50 additional for the first or fraction and $1.52 for each
t ` 5 va c 1 , . 2 fP . •1� Vi '- 13 _' additional $100.00 or fraction thereo to and
_,a., -. �...- - ..T ,._s ... ..�.,,,._ za!- ._ -:,� ,t... f. ,, including $10,000.00.
Commercial Back Plow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Backfiow Prevention Device each additional $100.00 or fraction thereof, to
minimum . rmit fee $36.25 27.55 and including $25,000.00.
Rain Drain, single family dwelling En 65.25 $25,001.00 to 550,000.00 $379.50 for the first $25,000.00 and $1.45 'for
Inspection of existing plumbing or each additional $ 100.00 or fraction thereof, to
s eoiall . nested in . ections - .er hour 72.50 _ and including $50
S ubtotal: 550 and up $742.00 for the first $50,000.00 and $120 for
each additional $100.00 or fraction thereof,
Fixture Work: �` „a� 7 �-
�:i36 ,. ._. n .. �� '' ..Y. _: '�.J. ✓.i,.. e a o E+•V "� y z � -!..,: � vin mew i f �1F t 7 A-..- -, �'
Are you capping, adding or replacing fixtures? If "yes", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all thai apply.
accurately re • urt fixtures could result in increased sewer fees*. ❑ Any new commercial building with water service 2" and
{" r te"" • 4 S ,, , , > f� '- ., - . ,£r iM, ; i:74- �:; greater, except systems designed and stamped by licensed
.4`� t r�� -�.p - 1 G fi r ., 44P14:W, engineer.
y + �'= ��' �' �. �. l. �r + .j��.._,'�.��.ut�1`>_ -t� ❑ Any new exterior plumbing site utilities.
B, ' tistry/Font
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirl .00l [] Any multipurpose fire sprinkler system.
Car Wash -Each Stall MEM -` ❑ My complex structure as defined in OAR918 780 0040.
-Drive Thru UMW
C •idor/Water • .irator MI= Submit 2 sets of plans with any of the above.
Dishwasher -Commercial
- DOmestiC FJF747.7 -Ift:. .;- -: -,... �7- - . cx7 --•..-
���- a.F.•; �"GY9�'ta. ,.011.2 k1 . 77. 11 P7 of " 1-
Drinkin_ Fountain �� �.,.�� l -� �.�
CI lie wash _��� Isometric or riser diagram is required for new buildings
FloorDrain/sink - 2" �� that meet the •ualificationsabove.
3 ..
-4" ME Comments regarding fixture work:
• Car Wash Drain MIN
Garbage •Domestic -��-
Disposal - Commercial NM/
- Industrial
Ice Macho ( Station
Oil io
Oil Se . arstator Gas Statio
Rea Vehicle Dum . Station
Shower -Gan
- stall . • *Note; If the fixture work under this permit results in an
Sink - Bar/Lavatory MUM increase of sewer EDUs, a sewer permit will be issued and
- Bradley 1111111 11111111 fees assessed for the sewer increase must be paid before the
- Commercial plumbing permit can be issued.
- Service ` -_-
Swilmnin_ Pool Filter
Washer - Clothes
Water Extractor
Water Closet . Toilet Milli
�
Urinal Other Fixtures:
leant7dinePer. 41.1.44J'mmitApp.d OWV17/O6 .