Permit } 4 CITY OF TIGARD PLUMBING PERMIT
' ® ': COMMUNITY DEVELOPMENT Permit #: PLM2009 -00274
=`- Date Issued: 10/01 /2009
T IGAAD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S113AC01201
Jurisdiction: Tigard
Site address: 7319 SW BRIDGEPORT RD
Subdivision: BRIDGEPORT VILLAGE Lot: 0
Project: Leonida's Fresh Belgian Chocolate
Project Description: Water line for expresso machine, no drain No change in EDU's
Owner: FEES
BV CENTERCAL LLC Quantity Description Date Amount
ATTN: FRED W BRUNING, 7455 SW
BRIDGEPORT RD #205 25 da Misc Other Fee 10/01/2009 $25.02
PHONE 1 12% State Surcharge - 10/01/2009 $8.70
Plumbing
47 ea Minimum Fee Adjustment - 10/01/2009 $47 48
Contractor
WESTERN 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 • - • will be done in accordance with approved plans This permit will expire if work is not started within 180 days of
issu. • e, or if work is susp- •ded for more the 180 days. ATTENTION Oregon law requires you to follow the rules adopted by the Oregon
ity Notification Center. Tho- - rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct questions to OUNC b . lin• 503.246 6699 or 1 800 332.2344.
Issued By: I A / Permitt• a Signature: /
Call 503.639.4175 by 7:00 a.m. for an inspection that b 1 siness 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.
' - 10/01/2009 07:54 5036849015 WESTERN PLUMBING INC PAGE 01/03
Plumbing Permit Applicati i CE v ED 1 1112 Ol i' lc l: USE ONLY
City of Tig received
M 13125 SW Hall BWd. Tigard, OR 9722 1 0' 1 2009 Dates : / o p9 y Permit No.: ',. , 4 _ 7
_' - • Phone: 503.639.4171 Fax; 503.598.1 Plan Rev 1N'
Tic, lx j Ikon Line 503 639 4175 DateeRR strait No.,
Internet www tigard -or gov CI' ' TIG AR C Nate R Fro ead,/�
:, °V \ SIO� NohE'ied/MetUod ®See Pa 2 for
i ;`: �, " � y y , , 3uppreroenmllntormat,on • ,a1i,.��. - 1.,f , r�. f wl + I ,-' k n Z ,.. 1 e Cr W, �l r IMF ; I '` + ,G �.xS a r ...,,;':,%:;".:::11.i ; i ' 4 ''' ,ate
,.. 7 . , :: , L .. i. Z, .., ■,... ... r, t . stn _,. " f +"' A
0 New cgtlstruction - ❑ Demolition For spedal Information use ckeckUst
Other: Descnption Qty. Ea Total
1 Addition /alteration/replacement ❑
n) ''.:q/':":;:,.- New 1- 2- family dwellings includes 100
" ._' ° ' <' h 4� ', 1 ) + i k 71 �' r �. , Ot he r [ r +C' i `. + :C,. s � ,.4 � n u8 ( ft for each utility connection)
.f.. 1,, . .r... •l ).u. ,.d`_ a;_ r:P , . s,; S , . ''� - '� ' ` , , -, y , ., ,i - SFR (I) bath 49.20
w xl
❑ 1- and 2- family dwelling I"� Commercial/industrial SFR (2) bath 3 0.0
1:1 Accessory building - ❑ Multi-family SFR (3) bath 3 _
Each additional bath/kitchen 4 ,
❑ Master builder a Other
f a <) 1 w^'r ,, - M s , r Fire sprinkler
:R t � a r -uy:.p.. ? r V "r 1 h� it : 0, + -- C .t. r l' , 'r } :4."'Ct�"'t.4 'lr kl
1t � SQ. ft.) �eZ
{ • � t::,, > •� -.. r- ..,...; 5 a: Site utilities
Job site address: t tut 4 ? . �i tt ` Catch basin or area drain _ •
City / State/ZIP: r'• f f 1 1 0 0 : 1 Drywcll, leach line, or trench drain - K.60 ,
Suite /bldg. /apt. no,; Project name: , 1/1 /.l4 / `v�l`"/L• ie Footing drain (no. linear ft.: _) e .�. I� , L 7 fJ.I� Cross street/directions to job s1e: !1 _a_ �4 7 1 Manufactured home utilities , r t
GYM Manholes _ , .0
Rain drain connector 6.: 0
Sanitary sewer (no. linear ft.' _,__) • age ,
Storm sewer (no. linear ft.: _) Page .
Subdivision: ! Lot no.: Water service (no. linear ft: _ J Page 2
Tax map /parcel no.: Fixture or item
itP�' C Yi } � �I, ,r ,,. .r ^4 ;i4 1 . - 1 Y4 ', , ...e 4 +y)gla .absorption valve 16.60
: �
.. _ ?G
- c.
,'.u`a . 7, ..:.r. ,. un ,,,.+, 'r ,.. fir: ; Backflow prevents[ e2
_ _ Backwater valve 16.61
1 1 = )
___ .ir i Clothes washer 16.60
�� % Dishwasher
- 6.60
4ii, ; ^a + 5. .; Drinking founwin 6.60
ayi ,c_ ,a P i hl 7l , + lE ' $
nL:�' >.3. ,, ,. °,;., r ....:o2•?S � -�z �_U�: - -.ir `t'..,.: =�'
r# l r., ,.�I , Ej ectors / sump
6.61 ..
Address: \ , Expansion tank 6.61
I cr) „ 7 1, 1, +.1 du & .1 , ► _4 Fixix ture/sewer cap 6.6.
City/ State/ZIP: kill t f. � i � Floor -.
ifl � Vc JV •_./ 1� 6.61
Phone: V lip w _ a 44 Fax: ( ) Garbage disposal 6.64
1 i t+llt k f ,`s7 j , , r - Hose bib 6:i
i 1 -.f v . ,,. M1,,. �. r-. 4r:5 . ,, K J 1 cn a „r, a 4Lv'3 y r,.'.� „k.a 7, U .G , I4 ` 4` i a::,
Ice maker
Business name: 1 +. •0
Contact name: - T lntereeptor /grease trap 1 . .0
Medical gds (value; $ ) P 2
Address: Primer 1:, 60
City /State/ZIP: Roof drain (commercial) 1: 60
Phone: ( ) �.. Fax:: ( ) Sink/basin/lavatory : 60
E-mail: —
Tub/shower /shower pan 6 60
1 ,,, , r xs Urinal 16 60
u : `LL: r f�, i_ We s G } =, 3� a x + ';r� •r �� r "�i ` :;:
w.. �, „1 !!z';' Water closet 16
Business name: Western Plumbing, Inc. Water heater 16.0
Address: 9460 SW Tigard Avenue, Suite 101 Other e - { I aA�t),
City / State/ZIP: Tigard, Oregon 97223 Gt7a J �e.(, Subtotal k
Phone: (503) 639 -5296 Fax: (503) 684 -9015 Minimum permit fee; $72.50
( ) Residential backflow minimum permit fee: $36.25 ,
CCB Lic.: 2439 _ Plumbing Lic. no.: 3429PB Plan review (25% of permit fee)
•
Authorized signature () T State surcharge (12% of permit fee) i •
.IJt/ _ . �1, !ii _ TOTAL PERMIT FEE
Print name: Dana Jensen Date: ir e This permit application expires if a permit is not obtains within
180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
1 \au06111Uwermwwu t- P.rm,AApp deo 06/26,06 740.4616rp0ro21COrnnvasl
'10/01/2009 07:54 5036849015 WESTERN PLUMBING INC PAGE 02/03
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule
Residential Fire Su ■ t ression S stems:
, a Vw ti, G r�
Footing drain - 1 100' 55.00 r 0 to 2 000 $115.00
Footing dram - each additional 100' 46.40 _ 2,001 to 3 600 $160.00
Sewer - let 100' 55 00 3 601 to 200 $220.00
7,201 and : er $309.00
Sewer - each additional 100' 46.40
Water Service -1st 100' 55.00 r
Medical Gas S stems:
Water Service - each additional 100'
46,40 T '. , , - , r =r n r
c , ran�! ' . t 1.:::z - ,- 1-;oL,- Y d t - ?�; rt c . :- . 1:G.c... , r .. ,f,,,, ,�
Storm &Rain Dram 1st l0U 55 UO
$1,00 to $5 000.00 Minimum fee $72.50
Storm & Rain Drain each additional 100' 46,40 $5,001.00 to 10,000.00 $72,50 for the first $5,000.00 and $1 52 for each
:: - }� � ,. . , 7, -. fir.... i t I� r.,
4 S o J � if '14,:,'"::,?,.. a,� r ,� u additional $100.00 or fraction thereof, to and
•' " ` " "` i " 1 ` �' " - { . includin: $10 000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000 00 and $1.54 for
Residential Backflow Prevention Device ME- each additional $100.00 or fraction thereof, to
minimum i ermit fee $36 25 and includin: $25 000.00,
Rain Drain, single family dwelling 65.25 $25,001,00 to $50,000,00 $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
specially .nested ins. ions .er hour 72.50 and inch', .. $50 000.00
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $120 for
each additional $100.00 or fraction thereof.
Fixture Work: _ , r , ' --� ' �-r , i
Y .w� , , , =f - r4',• 'r • 1 -' -- A ' r=',.:',51 G4 4,. - .0 » 1 �: e. , :,-� I, :;
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 that apply.
accuratel re . ort fixtures could result in increased sewer fees''. ❑ Any new commercial building with water service 2" and
j' .. t y� ;I 3 F- f l EiT } _J i "1 ' r,r7 ,7 greater, except systems designed and stamped by licensed
l � �3W 0 =Ir-j ..! . \ i # i `- r n . 'fit ,.E en w`s'r ` yy y } 1.�- 2 C r �`" .: u �� I- j) 3./ �i4 1 ,.. : . j .. ❑ Any eer.
r new exterior plumbing site utilities.
Bath l Font Shower El Medical gas and vacuum systems for health care facilities.
-Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cuspidor /Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial -
- Domestic y , i ^ , rw r , Y z�-
i
Drinking Fountain WF:ej._ .. n r e..P: •, ' 1�� N e_ 1 ..:, u,_1, ^ae7- I,e,., c� , ,1 :' , "
_
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain/sink - z °° ik that meet the • ualifxcations above.
- 3„ _11__IA
-4" .1111111EMialla Comments regarding fixture work:
Car Wash Drain MIMIllgr-i
Garbage -Domestic ���,
Disposal -Commercial
,
-industrial ��,lt
Ice Mach./Refrig, g. Drains —
Oil separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang •
_ - Stall *Note: If the fixture work under this permit results in an
Sink - - Bar/Lavatory increase of sewer EDtrs, a sewer permit will be issued and
- Bradley fees assessed for the sewer Increase must be paid before the
- Commercial plumbing permit can be issued.
- Service
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
. WBaldirmArermtm \PLA}PcnyitApp.doc 09/7.2106