Permit CITY OF TIGARD PLUMBING PERMIT
111
' COMMUNITY DEVELOPMENT Permit#: PLM2015-00414
I GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/08/2015
T
Parcel: 2S 101 BA00101
Jurisdiction: TIGARD
Site address: 7500 SW DARTMOUTH ST
Project: Walmart Subdivision: WEST PORTLAND HEIGHTS Lot:
Project Description: Installing 400 ft.of sanitary sewer.
Contractor: WESTERN PLUMBING Owner: WAL-MART REAL ESTATE BUSINESS TR
9460 SW TIGARD AVE SUITE 101 2001 SE 10TH ST
TIGARD, OR 97223 BENTONVILLE,AR 72716
PHONE: 503-639-5296 PHONE:
FAX: 503-684-9015
FEES
Quantity Description Date Amount
400 If Sanitary Sewer 12/08/2015 $175.10
Specifics: 1 12%State Surcharge- 12/08/2015 $21.01
Plumbing
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $196.11
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:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. �G
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.
12/02/2015 05:10 5036849015 WESTERN PLUMBING INC PAGE 01/02
Plumbinj Permit Application
Building Fixtures RECEIVED 1(111 0 1 i'li i I ,1 t,'\l._'
City of Tigard Received /�
:� ■ 13125 SW Hall Blvd.,Tigard,OR RE* 3 2015 Aata/ffiy: -7 Permit No,: 5�iL)�C,'//
15 l.�-i- � l vlJ 1
Phone; 503.718.2439 Fat: 503.598.1960 plan Review
r [,!_ Inspection Line: 503.639.417`
Date/By:
Other Permit No
Internet www ngard or gt t1 OF TIGARD Date Ready/By runs RI See Page 2 for
tWa �.�p,-f�,r11 irt.(,{{.i w • \ a `,. a,► , Notified/Method i�a 'SappleMllltal Information
alt .M',y+>ii�4i''.'t: ,1�. , i .: i4g;,hl''i:t,is;!jK.11i .. .r:! ,.,t.,'.f fi , ...:7::. :!:!';';'; . 1i itO
❑New construction 0 DemolitionIIII For dal in on,sarion rise checklist
Description •
74 Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
.03' � ia "fEa •, , t� pp t!-. ,f7 ill w J,
l "fSFR(I)bah 312.70� � C1 , ! oa: m �A,, a .,. EWii(t?Si�.gkiM ;,a ,l
0 1-and 2-family dwelling (X Commercial/industrial SFR(2)bath 437,78
-
SFR(3)bath 500.32
❑Accessory building 0 Multi-family _
0 Master builder •
Each additional bath/kitchen 25,02
❑Other Fire sprinkler( sq.ft.) Mira
x' Flat r 7, e 4 T , ' . e wP �t +r i +m;i"7, N`r r, "+ 9ytl e";-
1
e h 1 1 "n,, c 'I �, v
+LGu�.'+vtreat ri...,w�•[ *.,,r1..4 r w _r „ .. ......n^....film..;...,",'`_..„$....,..i i.ulr{ Site UHlitiea:
Job site address: , Ell
Catch basin or area drain 18.76
�t „�A r Drywell,leach lime,or trench drain 18.76
City/State/ZIPS" y .k �9
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt,no.: Project name: i* 11111 Manufactured home utilities 50.03
Cross street/directions to job site: Nil Manholes 111111111111
.,� _ w /-
;
. 5 Rain drain connector
` t ice. Sanitary sewer(no,linear ft.:� MICE (
)� .� 1`� • Storm sewer(no.trocar ft.: ) Page 2 !
ko ,v14 n'f• Water service(no.linear ft.: ) Page 2
Subdivision: l o Lot no.: Fixture or Item:
Tax map/parcel no Backflow preventcr 31.27
"A4410.40);',.
4. '1 � �nirl/,,1 r Irl .`, "'• ,..aril 1L5t�t i iSk{ y ,,, on^-rs r,,,,O; Backwatci valve 12.51
'Int lPdAiic \iiliA,ti-,cc 1 ,,,,s1..,e,..., <. ;: ,; ,; .ur,„.xc,,;i 1>„?1.fan!,....!i j,t 1,1,2«r:,,in 1!r'aL':,a f,
Clothes washer 25,02
Dishwasher 1
mo
mmommuminumnion1 . &. l R Drinking fountain 25.02
Ejectors/surnp 25,02
ill
{ h 'r flin r 19 ,7 t.' ,,,F, ? r htw „;{i,x1V "d 71t 1 h xl � t p Expansion tank
I2.5]eitla.r . , .,,n.;�:ampc4a�i/1,:..,.',:i,',..,.,..,::!.:",.:: ,,,yV�:,{.S du.;.},��.y6 ,a,,35 +'�[Ir&r,.uer urd , I
Name: (-4,1V ' Fixture/sewer cep 25.02
Address: Floor drain/floor sink/hub 25.02
1Sc� cA`Q lcc S�=.
City/State/ZIP:{�� ,; �A Garbage disposal 25,02 �
C:X\:(2N- `hcxk t 1�� J b a Hose bib 25.02
Phone:(/of0 C3 Fax (C )„ - / ice maker 12.51
:It-,,,,.1 S a,' .r!k :sA g. ,1:7,,,t,,,-t;Fi 1 , '� l .t + xk � °:fi, rxr hi "w .±4 )l y it, 1
i Interceptor/gcase trap 25.02tI . ,. ,,4, ,;,...h# , ,t;i 4N w , w.''!;',.,Q,:,',,{I lflr1..li. j s ,.•,. ..GY.; ;;uixi,., t l',.!li ,7,a.ti',;r.5 ,181h,
-
Business name: Medical gas(value:S ) Page 2
Contact name: Primer 12.51
T
- Roof drain(commercial) 12.51
Address.
Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) _j Fax;:( ) - Tub/shower/shower pan 12.51
'f"----1E-mail:
'f"----1'-- Urinal 25.02
.."
,..c..,-,,,,, ° Water closet
.171(4 1 � l , ,it . S � '.'''''f;:::; nt4)�x1x1 �°% , 25.02
:K ♦ rl4 Ri , t .. __',::'.. , n1 ..!.i.,:9, .1a�wltl,..J,.. . .�r � ,-
Wats heater 37.52
Business name:Western Plumbing,Inc. Wates piping/DWV 56.29
Address:9460 SW Tigard Street,Suite 101 Others --r 25.02
City/State/ZIP:Tigard,OR 97223 Subtotal � aAC'')
Phone:(503)639-52% Fax:(503)684-9015 Minimum permit fee: S72.50
Plan review (25%of permit fee)
CCS Lic.:2439 , lambing Lie.no.:3429PB State surcharge(12%of permit flee) a 6 E
Authorized signature: /d �f `'"
4 A TOTALPERMIT FEE 1,9(.01
Print san��(� .' `4C r, Date./Q/2/J This permit application expire*if s permit is not obtained within iso days
ids /` after It has been atceptcd as complete.
4Fee methodology set by Tri-County Building Industry Service Board.
1.tDu)1diogTermm1Pl.MV-Pl mitApp.doc 10/01/09 440.4616T(10/02/COM/wSB)
12/02/2015 05:10 5036849015 WESTERN PLUMBING INC -- _PAGE 02/02
Plumbing Permit Application - City of Tigar#
Page 2 - Supplemental Information
Fee Schedule: Reskiental Fire Su. .cession S stems:
AF{ � IPf,I, 'U�a 3C� Pt I
r,pd>V( ,., ,U rr.f T:ufi}c}} iri \ ,�} ,�C^:,r}li} ilif±7 irr Tiq mu: i i'^' } L)hi4
7 � �.' ��5,]�U.„v>+�3,� ; t��}f,,;,i r,%'�'�h 1�u.. t,; 11,1,.,�v..1�r.��,,�„„,,A,��;. ,rytl,�,r1.�.�u�"�'ick H '� . airs if..a ,"'eta����;,f xi-- �sxet Jl;✓'I`TiE"'tt,'I�Z~aJf'tsJa�-��"°Rjr;�
u ; , ..,..nM St w.;1;0i 7 #11144.7.ww,+1?t rA, t t.lik�r.,(0y a.3.Marr,',l}I n S751;1F iii wlii f 1T= 4: i,rn Via... .ch,, .i:cn4>Fi r. 1Y't,?)f ,1•t ,,.1i-1: r1a'«Y�J�a.�x Y?K,�il%:C �
Footing drain-1f`100' EMI 50.03 IIIIIIII 0 to 2,000 $121.90
Footing drain-each additional 100' 1.111 37,52 NM 2,001 to 3.600 $169.69
3,601 to 7,200
Sewer-1st 100' $233.20
Sewer-each additional 100' SZMINEI 7,201 and greater $327.54
37-52
Water Service-1st 100' EXIIIIIIIII
Medical Gas S stems:
Water Service•each additional 100'
�,t,..L �cC" `y ;h �7� 7r' RW� ) P'Y 7Storm&Rain Drain-1st 100' �� v < � il Vrr , �A;' .'ii..,. "k?wItlYAl' } t4lt 4dtl ,;'
$1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain each additional 100' 55,00100 to 510,000.00 $72,50 for the first$5,000.00 and$1.52 for
-��qql���'y�'.'!�'r"iy��il ".7r"1M1R„ r�ynt�«m,rots�'�lrpLt a�y 4,r t.(��{'yn•,4t
INilitt 14,4.40 .)A.�,n ..74-ie,) :,...,)ice,wn..._,�lY^`4�ii, �GPI,S`li.'z4y�t}f4�}i.,,}�,k,um ltsg,,}}h1+^ each additional$100.00 or fraction thereof,to
and including$10,000.00.
inspection of existing plumbing or for
which no fee is specifically indicated 90.00/hr
$10,001.00 to$25,000.00 $148.50 for the first 0 0orfra 0 and for
(minimum char.c-1/2 hour) each additional$100.00 or fraction thereof,to
Inspections outside ofnormal business 90.00/hr and includin_$25 000.00.
hours(minimum charge-2 hours) $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr . and including$50,000.00.
Additional plan review for revisions 90.00/hr 550,001 00 and up $742.00 for the first$50,000.00 and$1.20 for
minimum char:e-1/2 hour each additional$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please Indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer
p „ sewer fees*.
ees*' q , S^ rt ) �
rr'lp �} ',r� L 'L�a�"` 1cm t ew^1
)Y
n,,:,;• ,'i„ yi ? s, > t t '1'''''
. Lk F „ V S {tS"A 1L„ arte.+.M. f ! l r. . iS«r, ; i
M
.”'.,�.� �'M�'c 11M j„ l?J�i1C ll 'ti 174,,l. :,''
n'� .,., �Ta„ ii "�` '` Plan review is required for any of the following k ,'�1,..La.„.s .rirA. w+I; j n Mr;"6 sehawili YxPlease check all that apply.
Baptistry/Font
Bath -Tub/Shower 0 My new commercial building with water service 2”and
Jacuzzi/Whirlpool 'r greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
- -Drive Thru _ 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator — as defined in OAR918-780-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic . 0 Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR9I 8-780-0040.
Eve Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above,
-3”
4,. 7 4,4�y�p1,�7,1.11 r mw?axr..„7 yYy-y>st:!,;illm,i07 T, t e.nrr^ , fn
�Ia iritiz. r5dn,.; '::, '.-5x..,.it.a,,i.. ,f 4 ,ar,•::.''Y''� )IliVfli't .}'
Car Wash Drain u' ,1t,t
Garbage -Domestic-non-food — Isometric or riser diagam is required for new buildings
Disposal -Domestic-food related that meet the qualitions above.
-Commercial-food related
-
-Industrial-food related
Ice Mach./R.efrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter
Washer-Clothes '. *Note: If the fixture work under this permit results in an
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
http://www.tigard-or.gov/city hal l/departments/cd/docs/PUMF-PermitApp2doc