Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00172
T t G A RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/18/2012
Parcel: 2S102CB02700
Jurisdiction: Tigard
Site address: 13050 SW PACIFIC HWY
Project: Sanchez Taqueria Subdivision: FREWING'S ORCHARD TRACTS Lot: 7
Project Description: 70 linear ft of water service
Contractor: WESTERN PLUMBING Owner: WALTER, TOM & ANGELA
9460 SW TIGARD AVE SUITE 101 2863 RIVERWALK LP
TIGARD, OR 97223 EUGENE, OR 97401
PHONE: 541 - 729 -5432
HONE: 503 - 639 -5296
FAX: 503 - 684 -9015
FEES
Quantity Description Date Amount
70 If Water Service 06/18/2012 $62.54
Specifics: 1 12% State Surcharge - 06/18/2012 $8.70
Plumbing
Type of Use: COM 10 ea Minimum Fee Adjustment - 06/18/2012 $9.96
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 64 Permittee Signature: OBI- f /1 - �j �„ ,^ 1 /Ok ,CbtlithAt "r cal c—I�i" ) '
Call 503.639.4175 by 7:00 a.m. for the next available Inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
06/18/2012 12:08 5036849015
WESTERN PLUMBING INC PAGE 01/03
Plumbins Permit Annlication RECEIVED
Building Fixtures JUN 18 201 FOR OFFICE USL ONLY
City of Tigard CITY OFTSGAF,i�
11,11 = q 13125 SW Hall /31vd.. Tigard, OR 97223 Y y Permit No.
Phone: 503.639.4171 Fax: 503.598.1 � 1II.DIi'��J I�IVIS 12k W 1Q (i A Po ) a - On ? Y
I I<sAF.T? Inspection Line: 503.639.4175
Other Pemfit No.:
aw' ,'1t1'' . t. ..., ed/Met6
blame See P
mww +ae By. �
SiT' : h;�' `^ : , K'• N R p$�rW larormatloa
1 ;.
❑New COnShnCdarl .: •'_ +, . ' ' ' • ' . ,,., ..., . `:,: " .
. ..For • eclat infpr>tlelion the daarklilk •.
tli
Addition/ ❑ (hher Description °.a Ea. Total
New 1- 2- family dwellings (includes 100 ft- for each utilit c )
' • .., 2r.•:!:? :, 51 lI0!F ; '` °` () bath at
` ''= �.. SFR 312.70
❑ 1- and 2 -family dwelling Commercial/industrial SFR C2) bath 437.78
- -
❑ Accessary building ❑ Multi -family SPR (3) bath 500.32
Each additional bstbJkrtehen 25.02
Q Master builder 0 other
Fire sprinkler ( s t- S) Page 2 -
, , , ;;JO$,S.E.' .[ 1_ O a 0C ilob:. - Site atarii •
Job site address:
P Ti I 18.76
City /State/ZIP: T o`t (]`7 s (` � `(-r^' �� , � J Catch basin or area drain
Drywdt leach line, or trench drain 18 -76
Suite/bldg./apt no.: name: Footing drain (no. linear ft.: _ ) Page 2
Crum street/directions to job site: • �1 G�Q ��' .- IVlanufactared home utilities 50.03 N P . !! Manholes 15.76
Rain drain connector 18.76
. Sanitary sewer (no. linear ft.: `, Page 2
Storm aOwne (n6 linear.: ) {� Page 2
subdivision: Water service (no. linear 1t.: _ a ) ' Page 2
Lot 110.: Figure or Rem:
Tax map /parcel no.: -
-
BacicRow premier 31.27
, ...... .: , .:•: > l3adcwatervalve • 12.51
clothe was 25.02
° Dishwasher 25.02
Drinking fountain 25.02 -�
« pf , .. .. Ejectors/sump 25.02
... ' .r. :... :a ,. } ',. ... „ . ''3:i1'04 ;,. ..' ExPansien tank
Nttme 12.51
`� , 1 i+ i ` ► Fixture/sewer cap 25.02
Addtes9: y Floor drain/floor sinddhub 25.02
e 14. a . ` ♦ .\ . . fat
City /5`tatelzlP: t / ► • `� �'° 25.02
1J0a0 bib
Phone: ) 25.02
I
( 1 643 q Fax: ( ) Ice maker 12.51
. : _tivor .... ... ` cf . * Interceptor gr
*tits* / easetrap 25.02
Business mane: Medical gas (value: $ ' ) . Page 2 '
Contact name: Pliroer 12.51
Address: Roof drain (commercial) C 12.51 -
City/State/ZIP: Sink/basin/lavatory 25.02
Solar units (potable Water) 62.54
Phone: ( ) Fag : ( ) Tub/shower /shower pap 12.51
E- mail:
',: =;
Urinal •
25.02
-
' r' >.....; _ .'':r' °.... ;i;i`, i:'It;` : :; y , WateC t3oset 25.02
Busine W ester n Plunal sus In
WatEx !maw 37.52
Address: 9460 SW '( Water P DW V 56.29 •
Tigard Avenue Suite 101
c
Other: 25.02
ity /State/ZIP: Tigard, OR 97223
Subtotal .. .5t 1
Phone: (503) 6 3 9 , 5 2 9 6 F a x : ( 5 0 3 ) 684 -9015 Mifltt an permit f e $72.50
CCB Lic.: 2439 t l Plumbing Lic. no.: 34 -29PB 01W\k Plan review (25% ofpermait fee)
Authorized signature: rinr/� f I \1 1. 1
Stale surcharge (12% of permit fee) � �� ■ - �� 1 ! _ Al. �. > . TOTAL. FERMif FEE , ql l , 6
Print name: Dana Jensen . ► Date :� _ l - I a� °p'
X'bk peemm ca
a ltlon gybes if o permit is oat obtained within 150 clays
otter tt has been accepted as complete.
et .,.,...owt,a•,.. nit i.v n:r,...w a..aah.,, i..,a,...., ce..:.,. z:,,...4
PLUMBING INC PAGE 02/03
06/18/2012 12:08 5036849015 WESTERN
•
PlunALfiv Permit Application - City of Tigard
Page 2- Supplemental Information
Fee Schedule: Residential Fire Su . , ression S • stems:
le . i''' iP(e)r '! .'.::::::;;..,,,; : ,,...- r *I:: ,,, -. mi yew: :.: , ..::: :'. :.
, ..-,...
Footing drain - 1 100' 50.03 0 to 2,000 $121.90
Footing drain - each additional 100' 1 , 37.52 2,001 to 3,600 $169.69 ---
_ 3,601 to 7,200 $233.20
Ses " - r - 1St 100' ----- 62.54
7,201 and greater $327.54
...
Sewer - each additional 100' 37:52
Water Service - 1st 100' ‘ 62.54 (42 5.‘ Medical Gas Systems:
Water Service - each additional 100' 3752
:
Storm & Rain Drain - let 100' 62.54
' $1.00 to $ Minimum fee $72.50
Storm & Rain Drain - each additional 100' --37.52 $ to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for
i '. k.0***1.-::::‘.:'. !..: ; `r.4:1,1',..' each additional $100.00 or fradion thereot to
■ and includ io Roo .00 .
tutpectiOn of ezisting plumbing ar for '
$10,00i.00 to $25,000.00 ' $14.50 for the First $10,000.00 and $1.54 for
which no fee is specifically indicated 90.00/br
each additional $100.00 or fraction thereof, to
(minimum charge -11/2 hoar)
and ineludi $25 00000 .
tospectious outside of normal business 90.00/hi $25,001.00 to $50,000.00 $ for t t----7- ba first $25,000.0and for
hours (mum charge - 2 hours)
each additional $100.00 or Raction 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 fatthe first $50,000.00 and $1.20 for
(minimum charge -1/2hour) 4 each additional $100.00 or fraction thereof
Subtotal: t 4
.-..„,_,,,,...,,,,,,...................
Commercial Fixture Work:
Axe you capping, adding or replacing fixtures? If "yes", ;','F:.,.:11iiiiitiitiewlqi,stlikifi tn$ta11
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could retult in increased sewer fees*. . Please check all that apply.
. .--,. ::.....!::::::::: ... ciiiitt'' 0 Any new commercial building with water service 2" and
1 10#47.0.1!:;'.:: : ::' j': ,' ,' • ''': : z •,. .:.: .4. ifolo,(,i.#::,j greater, except systems designed and stamped by licensed
S'
engineer.
)....:,_
0 New exterior plumbing site utilities for any complex structure
Bath - Tub/Shower
' as defined in °ARM-780-0040.
-raciectimbisipoot
Cl Medical gas and vacuum systems for health care facilities.
Car Wash -Each Stall
-__.,.,_,I CI Any multipurpose rue sptioklet system.
-Driven:1i ,
Cuspidor/Wa 0 Any complex structure as defined in OAR918
ter Aspirator
Dishwasher -Commercial
-Domestic ___,
Submit 2 sets of plans with any of the above.
Drinkirjg Fountain
Eye Wash
Hoar Drain/sink - 2"
___ ISOmetric or riser diagram, is required for new buildings
_
. 3"
that meet the qualifications above.
-4" : .
Car Wait Drain
Garbage -Domestic
Disposal -Commercial
- Industrial Comments regarding future work:
Ice Maciilltefrig. Drains
___
-____
, ,_
Oil Separator (Gas Station)
Rec. Vehicle Dump Station __
Shower -Gang .
----
..--
-Stall
---....
Sink -Bar/Lavatory
, . ___....,
-Bradley
-Commercial
*Note If the fixture work under this permit results in an
r
-Service .
• --____._____ increase of sewer EDUs, a sewer permit will be issued and
SwintrainZ Pool Filter .
. fees assessed for the sewer increase must be paid before the
washer - Clothes
Water Extractor plumbing permit can be issued.
,
Water Closet - Toilet
Urinal a -
, Otlier Fixtutae: