Permit CITY OF TIGARD PLUMBING PERMIT
n
111 COMMUNITY DEVELOPMENT Permit #: PLM2009 -00147
TICAg D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/12/2009
Parcel: 25101 DB00103
Jurisdiction: Tigard
Site address: 7360 SW HUNZIKER RD 207
Subdivision: Lot: 0
Project: Counseling Services
Project Description: Add (1) sink.
Owner: FEES
HILLTOP BUSINESS CENTER LLC & Quantity Description Date Amount
HUNZIKER LLC, 9430 NW KAISER RD
PORTLAND, OR 97231 1 ea Sink 06/12/2009 $16.60
PHONE: 1 12% State Surcharge - 06/12/2009 $8.70
Plumbing
56 ea Minimum Fee Adjustment - 06/12/2009 $55.90
Contractor: Plumbing
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 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 -0100. You may obtain a copy of the rules
or direct stions to OUNC by calling 503.246.6699 or 1.800.332.2344.
1
Issue By: I\ � // t . Permittee Signatur ` V; J �
Call 503.639.4175 by 7:00 a.m. for an inspection that business 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.
« 4 ,. /11/2009 14:49 5036849015 WESTERN PLUMBING INC PAGE 04/06
Plumbiqg Permit A licatio r ' Eon ole Iclr. USE ONLY i,
",, f • Received ,
City of Tigard
�_ t/1
Ili Da II w 13125 SW Hall Blvd., Tigard, OR 97223 �o Plan Review
teJB : A 7�! Peoria No.. l_1+ i. emu/ 7
JU • Phone: 503,639.4171 Fax: 503.598.1960 9 Date/By: Other Permit No,: ,e V i
TIGARD Internet Line: 503.639.4175 crry rr � Date Ready /By; ruin: ' 0 See Page 2 for
t: www tigard ot.gov �r 7�(-1 /4i r 1 ir ° I Notified/Method: Supplemental Information
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El 0 New construction For s r eclat in ormatlon use checklist. • Dosed .tion 0 . EMI Total
Vi Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
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0 1- and 2- family dwelling 1l Commercial/industrial SFR (2) bath 350.00
El Accessory building [] Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45,00
❑ Master builder ❑ Other:
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ri"1F� +?:4',.1.,,,,ifle" a ".. , v„ zx„ a a,- t.•t, $ ; "r „au,:a,ar > {iail3' Site utilities
Job site address: , 1 1 ` �1 �1 U� act name: %, l � � Catch basin or area drain 16.60
City /State /ZIP; � ' ) Drywall, leach lino, or trench drain 16.60
Suite /bld ./a t. no.: ^ U A i Project l /� Q� 43L p Footing drain (no, linear ft.: ) Page 2
S p ,' r� �X.
Cross street/directions to job see: Manufactured home utilities 110,00
Manholes 16.60
Rain drain connector 16 ----
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Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: n Lot no.:. Water service (no. linear 8.: �) Page 2
/� / Fixture or item
Tax map/parcel no.: - •- • -••• - -
PP
DD
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Absorption lion valve
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Backwater valve 16.60
= „11 j �` Clothes washer 16.60
,. ", .. ,. t.. ; , .. ,..,., ...... ,.. " ter•^^ ^:�` � _ Drinkin lr fountain 16.60
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(,.,.,, _�;,::;:= ,..:.;:.:. ,J.: ., Ejactors /sump 16,60
w.,,.:...,,..,. v ".44.44., ,� .a ... .;
Name: ,_ Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /State /ZIP: Floor drain /floor sink/hub 16:60
Fax: ( ) Garbage disposal 16.60
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......... ", .44..4...4.tit ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: • Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State /ZIP: Roof drain (commercial) 16,60
"" "'" Sink/basin /lavatory i 16.60 Had D
Phone: ( ) Fax:: ( ) -- -- w-- . -.Y_
Tub /shower /shower pan 16.60
E -mail: -
w n -i. Urinal
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S 1 3I p , S f i Ni a S eft Yfs h wIY3 : king 1,t, ( 1 'r�"lv'�t ` ;; F . ii.:g Water closet 16.60 }i
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Business name: Western Plumbing, Inc. Water heater 16.60
mm
Address: 9460 SW Tigard Avenue, Suite 101 Other:
City/State/ZIP: Tigard, Oregon 97223 ,
Subtotal
Minimum permit fee: $72.50
Phone: (503) 639 -5296 Fax: (503) 6$4 -9015 Residential baccktlow minimum Perrnit fee: 536.25 • ,
CCB Plan review fee)
Lic -: 2439 Plumbing Lic, no.: 3429PB riew (25% of pei f
' State surcharge (12% of permit fee) Wall
Authorized signature ✓ � A dinu9AL1 TOTAL PERMIT FEE 11
Print name: Dana Jensen 47,J /JIM This permit application expires if a permit is not obtained within
1$0 days after it has beep accepted as complete.
"Fee methodology set by Trl- County Building Industry Service Board.
r: nuudrngnor ,nrrnPLM- rorn,l.ppp.doc oa/aa/oe ora-oe 167.0 0/0VCOM/WL0) 4 6,910 Pe) 67,
II " - /11/2009 14:49 5036849015 WESTERN PLUMBING INC PAGE 05/06
Plumb Per mApplication - City of Tigard
•
Page 2 - Supplemental Information •
Fee Schedule: Residential Fire Su . . ression S stems:
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... . ." ..`Cz e. . v.v. • .. ,.,:v. w� , TVi., t ..........x . w , 4. w . h. Y d'.wY r'. v.....,::,. .w, .w .:w...vn ww-
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.... ... ..... .. ... ....i"Y,,..... :2.x ,,...,..:.a..v. n._a.,._........: ...... ..,...a,._ ....:1'�,` �,�"'let..... .. . , •, ...,1.. a. �,,. , , ,. f,,,n :: �.- ."`�.a.i .�',.�_
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} p } .t .:.. ,d . ,..1,_,.... ...R ....),. ..,��;�.,.c -, I .< ............... r. . .;., I ,: 1 � ... . ,. 1 .. i .: r +
lt 111, } 611 1 { 1'.2 : i^t.i: b :. ia'.,w44 t o 13 r' . . }.Fz..).:. + t✓V : teFF.'" a.n aiQ n �ls_S.k� -@ `1 �� �. ,, .., ^r:. 9. Ar!". .Z -.. , d1 )r ,. ... ._V Y . .e:..
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Footing drain -1 : 100' 55.00 M. 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2.001 to 3,600 $160.00
3,601 to 7,200 S220.00
Sewer • 1st 100' N . 55.00 7 201 and greater $309.00 -
Sewer - each additional 100' s 1111111 46.40 M
Water Service -t 100' 55.00 Medical Gas S stems:
Water Service each additional 46.4 w,..w.wr. M �s: r". w :.- ,,, -
-,-
Otla1l ' � p ^ ...; 1 : l r.. 2 m. :!t5::�::Yi:;�rc::...:.- s - ::n.r .._..... .,,..a....Ci`." u� �-a.....,, ,.. _.....'^•^�•.�.r...... =rer^., ..:r.;Go-y""�: -+
. } f'w` Y � y" h „ 1 3, � l.41' ^z ,"E' 54114, t3 Y.d �}� �xr1e� „� tS..(.e.� x-.. M,P , , 1tw" RZR
Storm & Rain Drain - 1st 100' 55.00 . "' ' 46 """ `
$100 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
,:::. �...,.,:: -. ,;� „' „',' >:':. • ,, ,�, �"1, ` 'r. "::;7;. .: i"" :�;;ir '1 additional 100.00 or fraction thereof, to and
,1 y u � t * r 3 cfn q } rl , � a irr
,, :.ttf.;2 ':;li !i c 3 i ,11lii ranFw , r s Z i r.lr!Sill rtt „!., a .��. 2sCl rtl
inchtdin_ $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 each additional $100,00 or fraction thereof, to
minimum . ermit fee $36.25 and including $25,000.00. .
Rain Drain, single family dwelling 65.25. $25,001,00 to $50,000.00 $37950 for the first $25,000.00 and $1.45 for
Inspection of existing plumbing or each additional $ 100.00 or fraction thereof, to
s eciall re • nested ins actions - r er hour 72.50 and including first 50,
Subtotal; -_� IIII
$50,001.00 and up $742.00 for the first and ereo for
each additional $100.00 .00 or or fraction ion thereof.
F Work: . ...,...., c',^ :;::P"w5.:; rr : : ; ^.17,r.":"";�c:':�';5;;1; "�y"n�u�+:7 :> , 2Jrc .:..,-'""'.'..pF"1=s"3::...': ..
Fixture VY QX C. '; :!:, ^^; .
A , lr�'�� <i,'p'dT \4;: 19`9,�f • 441. g ro ; , �y4 �f�'''wr' l}I„�Ce., :i 4. #'G,4 � ,,,� }]�
:,:w.W.(w.,,.:.. awn' J" w' ric. t, Snw, anhtf�:+ 4.' PwX: �IYmYm� ,w.4h•K�µR.dM'+1�v3AM:,.w^,�W�. .•✓M��f 1' .._Y:,W"tl. M1.. _. ..- �R... _:f'..
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. .
accurately re • ort fixtures could result In increased sewer fees * . ❑ Any new commercial building with water service 2" and
---� mmm � 3�><, E + �, � caer, except systems designed and stamped licensed
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„ky4p4lsd.ar`wkr j r i t`.11012` 1'vF < `I i£ { > ,Ai .,E, x$1.1,1 ~.�'d 1 t r t t r c e � p Y 8 P
1 h�l CS r ) 4 i 4 ?i N t r. engineer.
t :r `i. ::A:Y � S },R Aiw,.., ..:... a., ):,. :}t/vikki:.$,\f t'',�'Mvl�A.4: i ) akskv,.9.b.M:d t EW�..�:.f� a5 a1 ❑ Any new exterior plumbing site utilities.
flartistr /font - -_ ❑ Medical gas and vacuum systems for health care facilities.
Bath - Tub/Shower ❑ Any multipurpose fire sprinkler system.
-Jacuzzi/Whirl •ool - -- ❑ Any complex structure as defined in OARS)] 8-780-0040.
Car Wash -Each Stall - - --
-DriVe Dun MOM � -- Submit 2 sets of plans with an
Cut • idor/Water As • irator -� -- P any of the above.
Dishwasher -Commercial - u.:::_::. rr. •.rte r: ,,:., r .; M :. .- w : :,:::' -
-Domestic - � r.�9r,a'f!,i,,:.It ..r {i� 4 ", i• �., 3 !t : :: uti.,41t 1, ;)-4I 4,
Drinkine Fountain - --
- IIIMIII -_ ❑ Isometric or riser diagram is required for new buildings
Floor Drain /sink - 2" 1111111111111 that meet the • notifications above_
- Comments regarding fixture work:
Car Wash Drain - -_-
Garbage - Domestic 11111111111111 - _ __
Disposal - Commercial -_IIIIIII
- Industrial -� .
Ice Mach. /Refri;. Drains MO
Oil Se arator Gas Station)
Rec. Vehicle Dom. Station
Shower -Gang
_Stall 11111111 - *Note: If the fixture work under this permit results in an
Sink - Bar/Lavatory - =NM increase of sewer FDUJs, a sewer permit will be issued and
- Bradley -- fees assessed for the sewer Increase must be paid before the
- Commercial MINIIIIIR11111111111 plumbing permit can be issued.
- Service IIIIIIIIII --
Swimmin. Pool Filter --
Washer - Clothes MIN .
Water Extractor 111111111111111 ��
Water Closet - Toilet -- IIMMINIIIIIIIM
WIZI1111101.111 MINIM
Other Fixtures; MIIIIII - -MINIM
,..,,.: /d;r.ly -IP «.»I pp.aoc o,ro,,
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