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Permit CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit #: PLM2011 -00222 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/14/2011 Parcel: 2S112DD00300 Jurisdiction: Tigard Site address: 15900 SW 72ND AVE Project: Pacific Convenience & Fuels Subdivision: Lot: 0 Project Description: Add (2) 2" floor drains; replace (1) 2" floor drain and (1) lavatory. SWR2011 -00104 sewer fees must be paid prior to issuance of plumbing permit. Contractor: WESTERN PLUMBING Owner: PACIFIC CONVENIENCE & FUELS 9460 SW TIGARD, AVE STE 101 2603 CAMINO RAMON STE 350 TIGARD, OR 97223 SAN RAMON, CA 94583 PHONE: 503 - 639 -5296 PHONE: FAX: 503 -684 -9015 FEES Quantity Description Date Amount 3 ea Fixture /Sewer Cap 07/13/2011 $75.06 Specifics: 1 ea Primer 07/13/2011 $12.51 1 ea Lavatories 07/13/2011 $25.02 Type of Use: COM 1 12% State Surcharge - 07/13/2011 $13.51 Class of Work: ALT Plumbing Type of Const: Occupancy Grp: Stories: Total $126.10 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: 4,7n/ ,974,04/ e� / Ovkl 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. 07/12/2011 12:26 5036849015 WESTERN PLUMBING INC PAGE 01/03 Piumbin Permit A lira , cEivED Building Fixtures 111 City of Tigard J U L 12 2 011 ;received nawg� ?�3�// r 13123 SW Hall Blvd, Tigard, OR g7 4j ; r PermitNo. oa0/� (JQ ggz _ Phone: 503.639.4171 Pax: 50.3: �F TIGARD PlanRov%aw J p On e• 503 6 Y: Pemtit .' ... f3 0 4 75 � interact: C /r D I ot� n _ta DING D! i�I i v y Y : d' P attar r e i. ;11{1 ►arnfai ibrma �,r . l lion , Q New cons fiction © ]]erne]" ' _ .: ''.;'::***''r:***'..*::' . h use [t£On For , .. VA. Addition./alteration/replacement mewl w 1 2-family . align dwellings w eP� [Ti �] +fJthar r on (includes nuns .::,..' ..:... ..,.. :.:.:. :,1 TE *'. i uiii-61 :1: `` :: r ',': ; :; > .' oti) '' sFx(gbath utc 100 ft, for each utility C cti y • i- and 2- 312.70 family dwelling .. Commercial/industrial : - ID Accessory building ID Multi-family SFR (3) bath 500,32 0 Master builder Each additional bath/icitchan ❑ Other 25,02 MIMIN JOBt R V11t . 04 , ; I ATIO? Sit ( sq. lt.) � � lob site address. 1 ' „ `.i fe . �.. Catch basin area drain �'- •w�i:v,..c�.#Z..i. _ _ City /S ' teirZlP; E , A t 1JrY►oell leach line, or trench dram SuitcfbldglapR no.: I'm'ect nee M F cling drain (no_ #;near: 3 • •—• ' Iii 9 Maanh rod ]wane atilftie 3Q•03 Cross sCrvoNdirectinns to job site: - �4C /� .N(/EiView Manholes IMII 1R "76 Rain drain connector MINIMI IINIMIIIIIIMIIIIIIs Sanitary sewer (no, linear ft.: ___) S ter service bow. linear 111: —J Lot no.: ix Tax map/ Pierre's or to m / I no - P�'rti - B acldlow MON Clothes washer 25 02 it: 171 �� _ AI * ! Dwm..ber ME 25.02 Drinking feulga tl 23.02 Mill � O Eycctora/sump 25.02 , i'BiR.0 #' (1.'' 10*, .' Expansion ravk Name: Fixture/sewer ca � 25.02 � P + or drain/floor ...v Mg 25.02 City/State/ZIP: d' 25. Phone: ( ) ( ) 25 °2 NMI �;,,, ^� 12.51 NI „' 4'1�T Interceptor/grease trap 25.02 Business name: Medical as (value: S ) 1111MIEEDI WWII" Courant name: w ��! Roof drain (commercial) ME 12.51 City /State/ZIP: Siekibasin/lavatory i 25 - 02 MEW Solar units (potable water) 62.54 III Phone: ( ) - iabkhowcr /chewer paa 12.51 E-mail: i iy water cl aret 25.02 —. Business name: Western Plumbing; Inc Water Heatef IIIIIIIIIM 1 1111111011M Address: 9460 SW Tigard Avenue Suite 101 water Pipfpg/pWy City /State/ZIP: Tigard., OR 97223 e 25.02 Subtotal Mall P one; (503) 639-5296 Fax: (593) 684-9015 Minimum penult fee: $72.50 ' GCB Lie.: 2439 _ Plumbing Lie, no.: 34-29P13 �f / Plan review (25% of permit fee) MN is not Obtained within 180 days PE Authorized signature: ' �1,1 / !/ State surcharge(12%of fro i jmo . 1 1 / TOTA1, YtMiT FEE Print name: )Dana Janssen _ Dare: permit a /• • ' `r / ' . , pplication cp7,t if a }win t after it bas been accepted as compiste. *Are maM,nrinln.,,, err by Tri_`n. „m, RI,Otrlinn To / 51..,4,.. 111.,...•.7 07/12/2011 12:26 5036849015 WESTERN PLUMBING INC PAGE 02/03 Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information • Fee Schedule: F ,, , Residential Fire Suppression Systems: -, .,.. ;: drain i.'; l 100' r 1 y. , 1?it x -- ,: t , 1 `0 ? g .' t k" l't! 000: 50.03 MI O to 2,000 _ $121 -90 Footing drain - each additional 100' 2;001 to 3,600 $169.09 Sewer - 1st 100' ��� 3.641 to 7,200 $233.20 Sewer - each additional 100' �� 62-54 IM 7.201 and greater $327.54 Water Service -1st 200' IIIMSZIIIIIMI j1� s feTII18: Water Service -each additional 104' 11111=11 edicnl bra -each additional 100' y� Storm c & .Rain Drain -1st 100' " `$0tI " _ `ll u '',A*, , Stone: Run Drain $1.00 to $5 000.00 2blimmYrrn fee $7230 i $5,001 -00 to $10,000.00 $72.50 for the first $5,000.00 and $1 -52 for .' t :, i*Pl each additional $100.00 or fraction thereof, to Iuspe[2ia of existing plumbing or for and including $10,000.00. at which no Sec is spaaficatly indicated 90.00/ht $10,001.40 to $25,000.00 $14&.50 forthe f ust $10,000.00 and $1.54 for minimum e- F/2 bout additional $100 -00 or fraction thereof, to • Inspections outside of normal business 11111 90.00/hr _ and including $ r hours minimum e : , 1 . - 2 hours $25,002,00 to $50.000.00 $379 -54 for the first $25,000.00 and $1.45 for Reinsl�ectiotl Fees oo each additional $100.00 or fraction thereof, to Additional attdutolu in °00,000.00- plan review for Visions 1111 90,00/hr IIII $50,001.00 and up $742.00 for the Scat $50,000.00 and $1.20 for -1/2 hour each additional $100.00 or fraction thereof: • ; C ommercial Fixture Wor: - ,A.re you capping, adding or replacing fixtures? If "yes", review is please indicate WOirt performed by fixture. Failure to Plan t .` y o fthefollow . i ns. l# �o�irt§ .. • : , it all tha for any of the following. accurately report fixtures result increased fees*. cello could resell in - rexsed sealer f Please check alt that 0 Any n ew �: - ? ' �. ' ,; . y comma with water SerV1C¢ ,, building 2" and • Baptistry/Feat .: ; ? !. , ` n `• ' °e= d : ^' greater, designed and stamped by licensed Bath - Tub/Shower 0 New exterior plumbing site utilities for any complex structure -Jacuzzi/Whirlpool As de�ltied in 18- 7$oo44. 0 Cr s Wash -Each mall o .Medical gas OAR9 vactlunl systems o - for health care facilities. - Drive Thru Any multipurpose fire sprinkler system, Cuapidor/Vl/ater Aspirator 0 Any complex structure as sea ed in OA .9i8 -780 -0040. Dishwasher -Comm «cis! Domestic Submit 2 sets of plans with any of the above. • ' r Fountain • Eye Wash n . t y i. e.; :.i. S " , r ; : Floc' Drairo/sink . 2 . . 5 � ' � : � 1�, �. 1 :�� ■ that et ee qualifications r diagram is oud for new buildings 3" at that street t the qualzficatio»s abboveve. . Car Wash Drain IIIIIIIIIIIIII Garbage Domestic Po - Commercial -Industrial Comments regarding fixture work: Ice Mach./R.efrig, Drains Oil Separatorf(as Slater') Rec. Vehicle Dump Station Shower -Gang Ste}! — _ ' Sink - Bar/Lavatory —' - Bradley - Service 'Note: 11 the fixture work under this permit results in an Swimming Pool Filter — increase of server EDIls, a sewer permit will be issued and Washer -clods fees assessed for the sewer increase must be paid before the water Extractor plumbing permit can be issued. Wa Closet - Toilet = Urinal a] Other Fixtures; MEM MEM • •