Permit (143) CITY OF TIGARD PLUMBING PERMIT
: I` COMMUNITY DEVELOPMENT Permit#: PLM2016-00583
and OR 97223 503.718.2439
13125 SW Hall Blvd.,Ti Date Issued: 11/30/2016
TIC;;11,f) 9
Parcel: 2S 101 AA07600
Jurisdiction: Tigard
Site address: 12540 SW 68TH AVE B
Project: Integrative NW Subdivision: WEST PORTLAND HEIGHTS Lot: 18
Project Description: Replace/relocate(1)sink&(1)water heater.
Contractor: WESTERN PLUMBING Owner: BGG PROPERTIES, LLC&AGF PROPERTIES, LL
9460 SW TIGARD AVE SUITE 101 11255 SW CHICKADEE TERRACE
TIGARD, OR 97223 BEAVERTON, OR 97007
PHONE: 503-639-5296 PHONE:
FAX: 503-684-9015
FEES
Quantity Description Date Amount
1 ea Sink 11/30/2016 $25.02
Specifics: 1 ea Water Heater 11/30/2016 $37.52
1 12%State Surcharge- 11/30/2016 $8.70
Type of Use: COM Plumbing
Class of Work: ALT 10 ea Minimum Fee Adjustment- 11/30/2016 $9.96
Type of Const: Plumbing
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 N. ' . . enter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or dire questions to •, NC b fling 503.232.1987 or 1.800.332.2344.
Issue. By: l , 4 Permittee Signatur :
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.
11/29/2016 10:00 5036849015 WESTERN PLUMBING INC PAGE 01/02
Plumbing Permit Application ,'
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City of Tigard I ecaived I I 3° // ,` ; !1, Permit No.: fLI-0'o/67-O6 dj$3
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.,x 13125 SW Hall Blvd.,Tigard,OR 97� 9 (4 n;F
Phone: 503.718.2439 Fax: 303 59 ' t '`- Ian Review ��
Inspection Line: 503.639.4175 Qa �y. - cow Permit No.; �ps(Q-�a Q
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❑New construction ❑Demolition Forsreciallnformadonas checklist
" Description i Qty. Ea. Total
r,� Addition/alteration/replacement 0 Other New 1-2-family dwellings(includes 100 It.for each utility connection)
i;�,�1t `� '�l'd jX ,�..(�1*'§.i' ....,, .... ` _..
v x. +" r.`:�E rrr.1, ,,:A:,w,r,t.. v...i,,.a.. ..', ;r,.. ?raa�ie. •01,m,,,,..„,,,,i �,t�f� SFR(1)bath 312.70
El 1-and 2-family dwelling 1�4 Commercial/industrial I SFR(2)bath 437.78
SER(3)bath 500.32
❑Accessory building ❑Multi-family � --
Bach additional bathikitchen 25.02
❑Master builder 0 Other
Fire sprinkler(�_sq.ft.) Page 2
t � �r e n f { r a r f,F� a�N+r °7R �1l�
"�¢f� r ,1 Gn9w`'. qqE rf'� a a�r,r a s .'i w
O -f i(41�, '44f � r�Edi i r l 'i '.R 1.f"ai y� ti^ +`', 6f„.,,l Site utlbtie9: �.
h'w„7�:C i.}�;+! ,..ri�alF Ci.•,rs:k,tr'-,,ii,-4,,;„,,',, �u�:.$M'z•,^R,F�1�`�,PiEu ��� ..,,�S X.°`, .
j� 1 ) `HCl i) 1Vki Catch basin or area drain 18.76
Job site address:' ill d1TC�
Drywell,leach line,or trench drain 18,7b
City/State/ZIP: 'X()(\)cC\
1 ' Footing drain(no.linear St.:_,) Page 2
Suite/bldg./apt.no, Project name:- Viv.k.,A� �� ! _Manufactured home utilities 50.03
Cross street/directions to job site: 1 Manholes 18.76 mm T
Rain drain connector _ 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.:_,•„_) Page 2
water service(no.linear ft.: ) Page 2 r
Subdivision: Lot no.: I Fixture or Item:
Tax map/parcel no.; j Backflow preventer 31.27
..4,771:17:7,r-v.7
-
x f r,,'l.4 11:1 ,r- !;, f �1 ;Arii Backwater Valve 12.51q1•f "� g?AirAmyo-,„ .;,f ",.. ;-a. f, ,•,;,..„°;"111frr ,rl;;;;;.Ntin:.9,,. Wi iii! frhiit�1t.•9;f1.i' ; (r ,
---
III
Clothes washer 25.02
1
Dishwasher 25.02
Drinking tbumain 25,02
Ejectors/sump 25.02
.+ 'p „ 7t Yr?a na 7ra >� �f 'tV",9'`,7rz . r171 r t n ,, ? Expansiontank
12.51:;1,i 4Aittll , 4,`,,- . �E°.a ,, .,r., r'�l� a" fil :.l..rtookri:4-s i.,7•:^ 4 , ,:,;t#, Fixturciscwcr cap 25.02
rFame: - "- Flor drain/floor sink/hub 25,02 Address:
Garbage disposal 25.02
City/State/ZIP: w
_ Hose bib 25.02
Phone:( ) Fax:( ) i Ice maker 12,51
7l�l, terrSw e 34ii ; e; ?Yta. f.! C ;;7 ; nP '',';5:r4' 'r lrPl.-'Pta f interceptor/grease trap
22f 77. ..' ,r'u"b" �r?441.'i:1Mda1''4il''d''' 0 "inrrr'?lli';;d!)1 'drqu%'411'."Li1,ki Medical gas(value:$ ) Page2 name:
Contact named Primer 12.51
Roof drain(commercial) 12.51
Address: _. I Sink/basin/lavatory 25.02
City/State/ZIP:
Solar units(potable water} 62,54
Phone;( ) Fax::( ) j Tub/shower/shower pan 12.51
E-Mail:
Urinal_ 25.02
^'fn,ru., , �Y -,i5.{1'yfi•„^r-- ^ , :'..-,,-.7''''',"'''''''''irr ;FF./ 1 7rc !rn Water closet 25,02 it,ii! :I'i�or r •-;"• ••-';',;,'''''
• ''.,-,-;•:,-;:. :F µ a 'is,''Y' tii4. tP rf L Mf r.ii,.,4,'fd Water heater X 37.52
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Business name:Western Plumbing,Inc.
Water pipinWDWV 56.29
Address:9460 SW Tigard Street,Suite 101 I Other 25.02
-
Subtotal 100,4iCit /State/ZIP:Tigard,OR 97223
Phone:(503)639-5296 Fax:(503)684-9015 Minimum permit frc; $72.50
r
CCB 1,ic.:2439 Plumbing Lie.no.:3429P9 Plan review (25%of permit 1te) _
State surcharge(120 of permit fee)
Authorized signature ; - 'S
.�Alt 1111,/, TOTAL PERMIT FEE �,g( )
Print risme: / "' t. This permit application expires if a permit is not obtained within 180 days
+ 1 �1 I •• atter it has been accepted as complete.
1 *Fee methodology set by Tri-County Building Industry Service Board.
1:livildIng1Persiia\PFNIU-PenmirApodoc 10/01/09 440-4616T(lo/b22COM/WeB)
11/29/2016 10:00 5036849015 WESTERN PLUMBING INC PAGE 02/02
1
Plumbing Permjt Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: ' Residential Fire Su i i ression S stems:
"R,,,tt „rx�,, f n T 1, ^^i'ror o I Y ,, j 1, m. 5' v ,,,,-;;;4: ,,,,,77,-,--.477:,,,,,,,.,;,,,,,,,..
r
I MNWfrt;,(,,, ...',1,;',7,4,',;
nsV a''.itfl1'1a:, ?i t"v:u.N ,,.1..t! ar.h=ji:ar ~ - .., ,..,.. ., I. I .., 1l � x, .Footing drain-1g100 50.03 DtP2000 $12190
Footing drain-each additional 100'
37.52 _ I 2,001 to 3,600 $169.69
Sewer-1st 100' 62.54 3,601 to 7,200 $233.20
1111111111 1 7 01 and_+-ater $327.54
Sewer-each additional 100' 37,52
Water Service-1st 100' IS62.54 Medical Gas S stems:
Water Service-each additional 100' iiiiiistaamm ,2,:,,:,-,. .-X , 3 x '''.'f,:-:'`,°,''''''''',"'1'',
N r .;'; !:T:Ni
Storm&Rain Drain-1st 100' 62.54 �,,MiuM : .;.y; !u
$1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain each additional 100' 17.52 IIIIIII $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
^ 7 0 + `v" 14 , 11r' 2EYfa each additional$100.00 or fraction thereof,to
14b .,.; ;1 .,,a.: .. .. , . Ne, -.,'.'4,.'',.;:r.':,-,:7.',-':': _.r,r :Ar. .,::mecaa?1daln.; and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 fir the first$10,000,00 and$1,54 for
which no fee is specifically indicated ■ 90.00/hr each additional$100.00 or fraction thereof,to
minintvni cher_ -112 hour j and including$25,000,00.
Inspections outside of normal business 1111 90.00/hr $25,001.00 to$50,000.00 5379.50 for the first$25,000-00 and$1.45 for
hours(minimum ch e-2 hours 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 $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
minimum charge 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 fees*
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i y " ',,a 1 `� °• Plan review is required for any of the following.
.4,,r ak-at,ts.A ' 14 , I t-:4",',"'-'', dr�a rot,-
Baotistry/Font Please check all that apply.
Bath -Tub/Shower ❑ My new commercial building with water service 2"and
-Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru Q New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial . - ❑ Medical gas and vacuum systems for health care facilities.
-Domestic - 0 Any multipurpose fire sprinkler system.
Drinking Fountain 0 My complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" ! Submit 2 sets of plans with any of the above.
-3"
-4..
�N*'ic,"`�. 7 ` i.' r 1'''. .�w7r7: rw'r1mn,7.. 1TY11,1 p7f I
yl�l1l'&:;. 4wu:lx„�'te.w;,r, r r ,,r,.a n.,WMw�au M,«,Mi: s�nn, s"a� a� 1Car Wash Drain
Garbage -Domestic-non-food ❑ Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related - that meet the 'ualifications above.
-Commercial--food related
-industrial-food related
lee Mach./Reflig,Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station -W
Shower -Gang
-Stall
Sink/Lav -Non-food related k
-Bradley
-Commercial-food related
...
-Service 1
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 i plumbing permit can be issued.
Other Fixtures:
http://www.tigard-or.gov/city halt/departrnents/cd/docs/PLMF-Pet riitAptdic