Permit y CITY'OF TIGARD , PLUMBING PERMIT
•
;r -- •`•• COMMUNITY DEVELOPMENT / Permit #: PLM201300060
TIGARD' 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/20/2013
Parcel: 2S102BA00800
Jurisdiction: Tigard
Site address: 12155 SW GRANT AVE B
Project: National Engravers Subdivision:RTH TIGARDVILLE ADDITION, AMENC Lot: 60
Project Description: Add (1) sink. 3/5/13, reprinted to add (1) water heater to scope of work.
Contractor: WESTERN PLUMBING Owner: SEE -ZER PROPERTIES
9460 SW TIGARD AVE SUITE 101 . PO BOX 965
TIGARD, OR 97223 NEWBERG, OR 97132
•
PHONE: 503 - 639 -5296 PHONE:
•
FAX: 503 - 684 -9015
FEES
Quantity. Description Date Amount
1 ea Sink 02/20/2013 $25.02
Specifics: 1 ea •Water Heater 02/20/2013 $37.52
10 Minimum Fee Adjustment - 02/20/2013 $9.96
Type of Use: COM Plumbing
Class of Work: ALT g 12% State Surcharge - 02/20/2013 $8.70
Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
• applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuan , r if work I spended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Ut" Notification Center. •ose rules are set forth in OAR 952 - 001 -0010 through OAR 952 -00 -0090. You may obtain a copy of the rules
direct questio s to OUNC by calling 503.232.1987 or 1.800.332.2344.
ssued By: /i .or . i / / Permittee - ? I 1
Call 503.639.4175 by 7:00 a.m. for the next available inspection date. r
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
•
03/05/2013 12:32 5036849015 WESTERN PLUMBING INC PAGE 01/01
Piumbine Permit. Application RECEIVED
Building Fixtures MAR 5 FOR OFFlCF. USE ONLY
City of Tigard 2013 R v d
DateByt P+ttrnitrre.S !,halo /3 e6og0
14 ,' 13125 8W Bau Blvd., Tigard, OR OF TIGARD Plan ts'°"' °W __ _
Phone: 503- 639.4171 Floc 503.39 Ott Permit No-;
T 3 (i A f: it an Datr/Sp
50 B DING DIVISION Deto Reedy/$y: > SI See Page 2 the
Internet www.tigard Noti6odRu
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❑ New construction ❑ Demolition • Fro. rpedmiinfarnstriiors we dbeeklinC
Addition/situation/replacement Other • I�scrlp4an _ 1 Qty ti Ea. ( Total
New 1 -2.fa� dwe)Bn ( ncludes 1008. for connection)
a r. +: ;,!A : r ri r SFR, 1 bath
4 " , y'. : : • : ( 312.70
13 1- and 2-family dwelling .1't ~ C om m e rei a l / indnsuial s R) bath - . 437.78
Q Accessory building ❑ Multi-family SFR (3) irnlli 500
Foch addiainnai bmhasitehem 25.02
El Master builder o Other
, :44. , ;x; r y::i� Stir ',4. 7 P ' ,: R • ` • ';• Yl'� b 9�t t " . ".• , E ' ' f O h __ .. ;' i SlEe ut !hiss
Jab site address: • C 3 , V r/ t 1 . r� 1 i - t . ,` # Cattoh'Uasut or area drain 18 76
GSty /3ta 1 1 s • ` , .- . • bell, leach Gan or trench drain 18.94
q rooting drain (no. linear ft..: __, Page 2
SuittdbldgJapt. no.: Project seam i i mom 1 ' / • o w , l , is Mao acmro4 homemiities 30.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
' Sanitary sewer (no. Uttar R: ___) Page 2
Sawa sower (m. Rum ft: ,�) Page 2 ` .
wrier service (so.. linear t3-: _ 1 Paso 2
Subdivision: /jut ao.: Fixture orttem:
Tax map/parcel aroel no.: Bat$finw prevetua 31.27
µ,. +'' :M- F :: :: Backwater valve
:t`• 7,:+ F'.r s ..:,, y , { �,� 12.51
.f ;.: :.•' %'� ..,. , '',.: °.. .,1, ,. • .,: '+f';; .;.., aothes washer 25.02
_ Dishwasher 25.02
A F. 1 k� '1111. i �a i
_ V 4 '� r ��• Drinking fountain 25.02
• 0 Ejeaers/svmp 25.02
4;743 6 1 - -: l7;r °' to :.'•� .i "r.". g-': •" _•; Oam lank 12.51
Nom: Fixture/sewer nap 25.02_
Floor d /floor sink/hub 25.02
Addtuss' - � Osubage disposal 25.02
City /State/ZIP: 13aaio hib' 25.02
Phone: ( ) Fmc ( ) Ion maker 12.51
-
r '' ;: 'ft . r 'iF _ 4 . �:(' .}::;:;; i'''',31:: ;; lntcrepdor/gnasetcaP 25_02 •
Business came: Medical gas (value: $ ) Page 2
- Contact name Pt�nar 1251
lined• dram (oottmzraeeont) 13.51
Address: 25-02
City/State/ZIP: Solar mini (potable water) 6234
•
Phone: ( ) I Fare : (. ) TubWshowreshowcrpan 12.51
&ramtL• Urinal 02
;` , .��, �u 'i?lFrfi1'i ?•f° S•r. 'r v.,'. , 1.y -� • p . n 1 ? ? o ' i ( wad closet 25 2 '
l uY Y ?SY; ,�F •` .' fi; � �v" S5 `''el;cd .4V •9 �(' •.:p ";r':; <�G. 2• "• ._,__ `' ..t,•�.: :.: ,, ( ,___ i , /�
`.� 41.r + .,u IG -...' :._ .K,, -"•D, C':';�'a .s:" ; ;M:i7 <. atf'�hCatal' 1 .J
Business name: Wei Se Inc- 37.32 s°„..
Water pipi°g/DW V 56.29
Address: 9460 SW Tigard Avenue Suite 101 Other: _ 25.02
City/State/ZIP: Tigard, OR 97223 - Subtotal
Phone: (503) 639.6296 Pax (503) 684 -9015 - Misaat = pmt fce: $723
Plaza review (25% of permit fee)
CCB Lie.: 2439 Plumbing bias, no.: 34 -29P'B --
St ( ��
Authorized signenue: . .1� I.
toTAI, rlxMrr FSE
if a permit la not obtained within 180
! This permit application enpbof days
`'1'rimt name Demist Jensen + -'` `/ ?, after It has bent ercapeed as compete.
■F.. ,:.0....44...... ...4. tn, 74.4`.wmn, A,,itA.... T.uin.hv lt.....'. Anise
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2013 -00060
-T IGARD. 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/20/2013
Parcel: 2S 102BA00800
Jurisdiction: Tigard
Site address: 12155 SW GRANT AVE B
Project: National Engravers Subdivision:RTH TIGARDVILLE ADDITION, AMENC Lot: 60
Project Description: Add (1) sink
Contractor: WESTERN PLUMBING Owner: SEE -ZER PROPERTIES
9460 SW TIGARD AVE SUITE 101 PO BOX 965 -
TIGARD, OR 97223 NEWBERG, OR 97132
PHONE: 503 - 639 -5296 PHONE:
FAX: 503 - 684 -9015
FEES
Quantity Description Date Amount
1 ea Sink 02/20/2013 $25.02
Specifics: 1 12% State Surcharge - 02/20/2013 $8.70
Plumbing
Type of Use COM 47 ea Minimum Fee Adjustment - 02/20/2013 $47.48
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 Noti - - -nter. 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 • uestions to O by - ' • 503.232.1987 or 1.800.332.2344.
Issu d By: , � _ - Permittee Sig ( ' G` � r
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.
WESTERN PLUMBING INC PAGE 01 / 03
02/18/2013 13:16 5036849015
p lum bli L____A•41,0 CEIVED .
Building Fixtures
FOR OFFICE USE ONLY
City of rigard FEB 1 9 2013 Received
Daren3y: g_l ao 13 s_r P-rdiNa: gig iv) 3.6fek)
N„..,.
13125 SW Hall !Ilya, rtgard. OR nacy O nGARD Plea Review
2 . Phan= 503.639.4171 Fins 503,5_9
Other Permit No:AA) a go/ 3-tx:010
.4 - m --------
TIGARD inspection Line: 103.63eA175 BUILDING DIVISION Dam Re WY. .. sec Page 2 for
/BY:
/aremet ww2tard-or.gov
Nati6edMettu:
I RV So . . mental Inrerreatien
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0 New commuction 0 Demolition :
Dined . 'en
WM. EA. Told
Ilii Addition/alteration/replacement 0 Other • New 1.2 - , , 1 I, , , itt,2 (includes 1001 for each utility connection
Fe 041,#0 ::;; spit (i) bath
1111.11 312.70
0 1- and 2-fmatly dwelling 1:, Conamemial/industrial SFR (2) bath Mil 437.78
SFR (3) bath 500.32 - 0 Accessory butlding 0 hialti-facoily
Earth adcfnional bath/kitchen UM 25.02
0 Master builder 0 Other
. , Fre quirkier ti.) 1112!El
g;:fgt ":Y.•:::';',::' sitrufnittex
Job she aches= . - l Is fel l .i _ - l .0 -0 .6' Catch basin or area drain 1111.11ECE3
.
Dry%vell leach lineosr teach drain Millitan
awstaltraPf 4 kt 1,.... cat. . 114 P - Itfaill . linear ft.: -..) En Page 2
Suite/bldg./apt no.: Pa name: ming (n° eat •
-, A ilk Mannfactured home uhlrbes MI 50.03
Cross stred/directions to job site i
Manholes
18.76
Itein drain connector • MINI 18.76
• Sanitary sewer Om linear H.: ___) Page 2
---
Storm sewer (no linear ft: __) moimmil.
Water service (ne. linear II; ) MI NM
Subdis;ision:
Lot no.: Fixture Mite=
&drib* provenfer NMI 31.27 • g - '-,•; . '''''''."" ' • '''. r ' :•••••''''' 1 •' :', :-::' ':. t: :: ,:, .1?,; Backwater valve RIM 12.51
Clothes wardacr NM 23.02
Dishwasher IIMI 2542 IMO
IllarantilM,„ Al it,_.-A L 4 Drinking fountain . 1E11 23-02 Milli
4
Ejectors/sump
25.02
91: z; tl' ,t :i ' • • • , 3 , ::; : . :z .: 4;T, )4 s,,IsitAf.Aft3.:F. Expansion tank MOWN
Fiatare/sewar cap
N 23.02 =IN
ame:
Floor chain/floor siok/Itub NM 2502
Address:
Garbage disposal 2102 MEI
City/Stale/ZIP:
1103e bib 1..11 25.02
-
Phone: ( ) Far ( ) Ice maker IIKEEINIMIll
..,.,..!..*.:.....Ev:;.,.E.1*- NAtc,-;..,..i.-..:'-i:,,,:::i.;-:',!.??.?.. intireePlOriffeaac traP 25.02
Medical gas (ookie: ft) EMB
Business nal=
Prang% IIEEMI
Contact name:
..: drain (commercial) • MEI
Address:
rr.: ........„ I . 25.02 0.5 •
City/State/ZIP:
1113:1111=111
Solar Unite (potable water)
Phone: ( ) Fax • ( ) Tub/shower/shower pan .111111031
Urinal 111111 25.02
E-mail:
MI 25 OM.
itA'k s i , :•,%r!Williegig:F;ii";;;:: ;' i ■i..:::;ftipnR!5t,F,•;.i,;:•M'if .; :,::::, .iil'i,;': watniater
III 37.52 1.111
Business mime: Western Plumbing, In.
Water piping/DWV 56.29
-
Address: 9460 SW Itsgerd Avenue. Suite MO
Other: 25.02
. Subtotal
City/State/ZIP: llgard, OR 97223
•
Minimum permit fee: 87250 ERFAM
Phone (503) 639.5296 Far (S03)684-9015
Plan review (25% of permit fee) MEM
CCB Lie.: 249 Pituabitts Lic, ao.: 34,79PB
Mato surcharge (12% of permit fee) MAW
Authorized signature! If , , 4 ,, , /I
TOTAL, PERMIT FEE MB
Print name: Dam Jensen mg.& g -1 This permit amnesties erpase if a paean te not obtained vdtbla 180 days • atter it bus been =opted as complete.
•go.......-ewi.e...ev ....e h.r.4.r Ritilrlina !warms.. R.....L.. ri.--;
(k 'a
WESTERN PLUMBING INC PAGE 02/03
02/18/2013 13:16 5036949015 — — ----
Plumbing Permit Application - City of Tigard
rage 2- Supplemental Information
Fee Schedule: Residential Fire Su 1 . ression S 'stems:
1 , .‘„ , ,I.
Footing drain - 1 100' 50.03 o to 000 $121.90
Footing drain - cads additional 100' , 3732 001 to 3 600 5169.69
Mos to 7 00 $233-20
Smug( - Id 100' 62.54 7,201 and l• - - $327.54
Sewer - each additional 100' 1752
Water Service- 14100' , 62.54 •
— Medical Gas 5 • 'tans:
Water Service - each additional 100' 3752
i...,
Storm & Rain Drain - 1st 100' 62.54 SOO to $5,000.00 misimiva fee $72.50
Storm & Rain Drain - each additional 100' 37.52 $5,00100 to $10,000.00 $72.50 foram first $5,000.00 and $1.52 for
each additional $100.00 or election thareot to
r. : l ."71 a ' t k_00**' •0■.:,,' ••.: es.3(• ..,. i:§4 :,-:,191:1:-.., sod inch' ' . StO 000.00.
Inspectionefexisting plumbing or for $10,001.00 to $25,000.00 $14830 forthe Brat $10,000.00 and $1.54 for
which DO fee is specifically indicated 90.00/hi each additional $100.00 or *action thercog to
I nspections outside of normal business 90.00/hr 525,001.00 to $50,000.00 $379.50 ferr the first $25,000.00 and $1.45 for
hours minimum ,, . : --.2 hours each additional 5100.00 or eaction thereat to
Reinspection Pees 90.00/hr and indudins
Additional plan review for revisions 90203r S50.0131.00 and rm $742.00 for the first $50,000.00 and $1.20 far
minimum • - •,- ,1J2 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 Plan teview is gequired for any of the following.
accurately report fixtures could result in increased sewer fees*. Please check all that apply.
ritv:,:.. af....:-,...=4; - e 3V
, '''' ' ',`'• • ' — ":11t," - -- . ''' . ' s 'n 0 Any new commercial building with %vater service 2" and
' ''. v
..' • _ t:Li•!•;:-: ':::Pt'A';'.. . greater, except systems designed and stamped by licensed
'; ;',Y iz '4 l'.; '''.-- .. ,''•' ::
ei.' b . ;?. -:', - =: ''4' ''',k ;-. :: engineer.
.. Baptistry/Font — 0 New exterior plumbing site utilities for any complex structure
Bath - ThhiShowar - as defmed in OAR918-780-0040.
-Jacuzzi/Whiripool, 0 Medical gas and vacuum systems for health care facilities.
Car Wash - Each Stall
Ei Any multipurpose fire sprinkler system.
- Drive 'Bun
compidocrw irstor 0 Any complex structure as defined in OAR.918-780.0040.
at
Dishwasher -C.osomercial -
- Domestic _, Submit 2 sets of plans with any of the above.
Drinking Fountain - ' I •
Eye Wash ,t..Zaa;!Vit;,••:.4.I•ri. i'.; ''' . 9 ;''''' I, '7": "r; 1z:ViMT,'T,t!i::Th:
" .14.1vAr ." .1 -z^ f.... '''-- ;41. h '' ! - ''''' .24 -'1,W.IY.
Floor Drain/sink -2" ' IN 'somatic or riser diagram is required for new buildings
- 3"
- 4" .. that meet the i : ',, cations above.
Car Wash Main ..
Garbage , -Domestic
Disposal -Commercial
-Indastrial Comments regarding fixture work:
_Ica Mach./Refrig. Drains . .. —
_
Oil Separator (Gas Station) - - -----
Roc. Vehicle Dump Station _ ____
Shower -Gang —
-Stall -
- —
' Si* -Bar/Lavatory —
-Bradley
' -Commervial a *Not If tbe fixture wmic under this permit results bi an
-Service increase of sewer EDUs, a sewer permit will be issued and
S'WS Pool Filter fees assessed for the sewer increase must be paid before the
Washer - Clothes -
Water Bxuactor plumbing permit can he issued.
Water Closet-
Urinal
Other Fixtures':
Accumulative Sewer Tally
C 'Tenant Name: National Engravers S\XTR # 2013 -00040
Site Address: 12155 SW Grant B,Tigard, OR 97223 PI ,M # 2013 -00060
T,tc3n.Itn Parcel #: .2S102BA00800 - . '
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped #s value count added # added value total #s total values `
Baptisery /Font 4 0 0 0 0 0
Bath: - Tub /Shower 4 0 0 0 0 0
- Jacuzzi /Whirlpool 4 0 0 0 0 0 . .
Car Wash: - Lach Stall 6 0 0 0 0 0
- Drive through 16 0 0 0 0 0
Cuspidor /Water Aspirator 1 0 0 0 0 0
Dishwasher: - Commercial 4 0 0 0 0 0
- Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink: - 2 inch • 2 0 0 0 0 - 0
- 3 inch 5 0 0 0 0 0
- 4 inch , 6 0 0 0 0 0
- Car Wash 6 0 0 0 0 0
Garbage Disposal:
- Domestic (to 3/4 HP) 16 0 0 0 0 0
- Commercial (to 5 1-IP) 32 0 . 0 ' 0 ' 0 0
- Industrial (over 5 1 -IP) 42 0 ,. 0 0 0 0
Ice Machine /Refrigerator Drain 1 0 0 0 0 0
Oil Sep (Gas Station) 6 0 0 0 0 0
Rec. Vehicle Dump station 16 0 0 0 0 0
Shower: - Gang (per head) 1 0 0 0 0 0
- Stall 2 0 0 0 0 0
Sink:
.. - Lay /Bar - Non -Food Related 2 0 0 1 2 1 2
- Bradley 5 0 0 0 0 0
- Com /Scrv/Util - Food Related 3 0 0 0 0 0
Swimming Pool Filter 1 0 0 ' 0 0 0
Washer - Clothes ' 6 0 0 0 0 0
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 0 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
'IO'I'AI 0 0 _ 0 0 1 2 1 _ 2
Current Fixture Value 2 divided by 16 = 0.125 Current !MU 1 EDU = $4,665.00
Previous Fixture Value 0 divided by 16 = 0.000 Previous I {DU
Change 2 divided by 16 = 0.125 over (under) S 606.45
Enter EDU Change Here 0.130
Notes:
Authorized Name /Signature: Shirley Treat Date: 02/20/2013
Building Division
Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher which must be
submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
I: \ Building \ Sewer Tally \Sewer l'allyShect- 4665.xls 07/01/12