Permit (44) CITY OF TIGARD PLUMBING PERMIT
71112 : - COMMUNITY DEVELOPMENT Permit#: PLM2017-00398
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/28/2017
Parcel: 25101 BB01400
Jurisdiction: Tigard
Site address: 12070 SW GARDEN PL
Project: Rokke Sports Subdivision: CROW PARK 217 Lot: 2
Project Description: ADD(1)clothes washer box.
Contractor: WESTERN PLUMBING Owner: ICON OWNER POOL 1 WEST LLC
9460 SW TIGARD AVE SUITE 101 BY RYAN
TIGARD, OR 97223 PO BOX 460169
HOUSTON,TX 77056
PHONE: 503-639-5296 PHONE:
FAX: 503-684-9015
FEES
Quantity Description Date Amount
1 ea Clothes Washer 09/28/2017 $25.02
Specifics: 1 12%State Surcharge- 09/28/2017 $8.70
Plumbing
Type of Use: COM 47 ea Minimum Fee Adjustment- 09/28/2017 $47.48
Class of Work: ALT Plumbing
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 952-001-0090. 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: G. �rt�_ Permittee Signature:
�6-C
611 77e/V
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.
Plumbing Permit Applica cL.i El
Building Fixtures i
City of Tigard SEP 2 7 Z 7 Received
13125 SW Hell Blvd.,Tigard,OR
Date/By: 9'e• /7 Permit N9°�, p/7 �OC)3
is_ Phone: 503.718.2439 Fax 5{13 f- l i i , f i t Plan Renew
Inspection Lino: 503.639.4175'' ) L ( rim a r-t Dare/BY:
Other Permit N �G/ �� ���
Internet: wont 5 rd-or gov I P § 4 ii;,...,,k,, i 1/i Duns. H See Page 2 for
Date ReadyBy, !7•�
Notified/Method 7 �� Si mb)Lformabon
_ �f�IXC,....
■ «. « , s - For spend informa ion use checklist
1 . ,. w, ent
Description � Qty. 1 Ea. I Total
s New 1-2-family dwellings(includes 100 ft.for each utility connection)
F. V2 '�, '-',ti''
',t '. SFR(1)bath _
�:.�..r ``
� �� "'' 312.70
l/tndttstrial SFR(2)bath 437.78
0 1-and 2-family dwelling 0 CommercraMIN
.32
0 Accessory 0 Multi-family SFR(3)bath e I
0 Master builder Each additional bathAdtchen 25.02
❑Other:
r�,r _¢ss a -_ Fire sprinkler( sq.R) Page 2
err Site utilides.•
Job site address: , QI ,I�'- ) Q� Catch basin or area drain 18.76
City/State/ZIP:, v Drywall,leach line,or trench drain 18.76
Suite/bldg./apt.no.:
Project name:
Footing drain(no.linear ft.: ) Page2
,,,,5',6•4,73- Manufactured home utilities 50.03 i
Cross street/directions tojob site: Manholes
18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ,__ J Page 2 t
Water service(no.linear It.:_) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
w Backwater valve
12.51..
attt , _ , s
(�(� Clothes washer t 25.02 0
\VS3 _a..)C x
Dishwasher 25.02
�C Drinking fountain 25.02
Ejectors/sump 25.02
k`�
n .� , Expansion tank 12.51
Name: Fixturdse mer cap 25.02
Address: Floor drain/floor sink/hub 25.02
City/State/ZIP:ress: Garbagedisposal 25.02
Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
._ •".. } x.. X Interceptor/grease trap
25.02
Business nacres: �'p S ' nC Medical gas(value:$ ) Page 2
Contact name r- 9.)(-•\_
} mer 12.51
n t� v Roof drain(commercial) 12.51
Address: `�tAt0C) .. I ` & (s0k,SkV 101 Sink/basin/lavatory 25.02
City/State/ZIPT '41, r :AC ht
Q 3 Solar units(potable water) 62.54
Phone:Ent," 4, _ _ 1 _ Fax::( ) Tub/shower/shower pan 12.51
�O
&mail• 111, t ,g o C 1L,aa 1 . ,ii 0 &• , , lel Urinal 25.02
water closet
25.02
r Water heater
Business name:Western Plumbing.Inc. 37.52
Water piping/DWV 56.29
Address:9460 SW Tigard Street,Suite 101 Other: 25.02 -
City/StaWZIP:Tigard,OR 97223 Subtotal ()_
1111111
i Minimum permit fee: $72.50Phone:(503)639-5296 1
CCEI Lie.:24,39 Plumbing Lic.no.:3429PB
Plan review (25%of permit fee)
State surcharge(12%of permit Rx)
Authorized signature: wr 11�./4 �1 At (I TOTAL PERMIT FEE
A.
Print name: Wilri `1 Date:R Oto (c? This permit application expires ire permit it not obtaiaeel within 180 days
' }f after k has been accepted as complete.
`Fee methodology set by Tri-County Building Industry Service Board.
1:1BuildinePemtitstPLMU-PermitApp.doe 10/01/09 440A616T(16/(32/COM W a)
Plumbine Permit Application - City of Tigard
Page 2-Supplemental Information
Fee Schedule: Residential Fire Su' cession S stems:
Footing drain-1°100' 50.03 1111111111 0 to 2 000 $121.90
Footing drain-each additional 100' 37.522,001 to 3,600 $169.69
_ 3,601 to 7 00 $233.20
Sewer-1st 100' 62.54 7 201 and,-- er $327.54
Sewer-each additional 100' ®_
Water Service-1st 100' 62.54 Medical Gas S stems:
Water Service-each additional 100' 37.524
Storm&Rain Drain-1st 100' 62.54
_ $100 to$5,000.00 Minimum fee 72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
each additional$100.00 or fraction thereof,to
. ..- and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,00000 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
minimum- -1R hour and including$25,000.00.
Inspections outside of normal business - 90.00/hr - $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours minimum ch: .-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 11.1 $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
minimum ch- _ -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*.
�•t - £ .,.`' .. .. . .. .. _..
-4 � ut"Y '' AP,p Plan review is required for any of the following.
' + ` Y r ,.., f• _. "'": Please check all that apply.
Baptistry/Font ❑ Any new commercial building with water service 2"and
Bath -Tub/Shower
-Jacuzzi/Whirlpool 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 OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit a sets of plans with any of the above.
h!"
-4p ,
Car wash Drain
■ Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food relateda that meet the .ualifications above.
Disposal -Domestic-food
-Commercial-food related
-Industrial-food related
Ice Mech./Rettig.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 *Note: If the fixture work under this permit results in an
Washer-Clotors increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet
Water Extractor - fees assessed for the sewer increase must be paid before the
s
Urinal plumbing permit can be issued.
Other Fixtures:
http://www.tigard-or.gov/city hall/depantments/cd/does/PLMF-PetmitApedoe
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12070 SW GARDEN PL, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2017-00398
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor