Permit CITY OF TIGARD PLUMBING PERMIT
•1111111 Permit#: PLM2014-00176
COMMUNITY DEVELOPMENT
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/29/2014
TIGARD Parcel: 1 S 136CD00102
Jurisdiction: Tigard
Site address: 11681 SW PACIFIC HWY
Project: Jimmy John's Subdivision: 2006-016 PARTITION PLAT Lot: 3
Project Description: 100'of water service.
Contractor: VICON MECHANICAL CONTRACTOR INC Owner: WILSAL LLC
3651 KASHMIR WAY SE 834 SW ST CLAIR ST
SALEM, OR 97317 PORTLAND, OR 97205
PHONE: 503-507-7864 PHONE.
FAX: 503-540-5616
FEES
Quantity Description Date Amount
100 If Water Service 05/29/2014 $62.54
Specifics: 1 12%State Surcharge- 05/29/2014 $8.70
Plumbing
10 ea Minimum Fee Adjustment- 05/29/2014 $9.96
Type of Use COM Plumbing
Class of Work: OTR
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: ' "1 // Permittee Signature: / / /97°/'c_/ 4_77e/V_
Call 503.639.4175 by 7:00 a.m.for the next available inspect ion 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.
Plumbin Permit A. lica pC�l IFD
Site Utilities () / 1-(w 01•1.1(- - i SE ()\L\
City of Tigard MAY 29 2014 Received �r�/V --p�„itNoyoLnczoiY-eo/7 ,
13one SW Hall Blvd.,Tigard,
x: OR 9 r o�/yr DO/Pi
Phone: 503.7182439 Fax: 503. n1.f F tilUAii�i1
Date/By:vi`w Ochtrlbmtit
T i G A R.n Inspection Lane: 503.639.4175 '7����?711tlr�}!+t 111 l p t Ready/By,/nr rl�: ei Six P>ec 2 for
Internet: www.tigard.or_gov 1' . I, { Npty§ thoct: Supplemental lofonaltion
u' •'tl 2 l41} 1 F ! X j Y M 7' 1 t1:0 2 kyl'y •r rt�n ul'hUR'0 K =1.4^ 1 Hy H' N W .1'51 + ' /e Yn ii IM: i, C 1 1 Y{�'4
w,. .' ,. M411 £'.-cT" r .,1∎10}, "72,,1!lHi� y ,1. ;r ut 1. a 7, 1:.
tl 61.,..,.,... ,":.,-....":4•:-.--.r.� � f „�,,.......t..a�t;• J.�, x r�n�l'(' ..� n._ ..�., vrn m �. ,. - lyflw1 .
■ ®Ncw construction ❑Demolition For special information use checklist
Description I Qty. I Ea I Total
❑Addition/alteration/replacement ❑Ot1. . New 1-2-family dwellings(includes 100 ft_for each utility connection)
'!..9:Y7,1 �A'. t?'Fh M 1'!` 4,� ,{[.JFr-t gIt(r
n'.IlliW e)'�i'oefl'1t'e -tit ra� '- � 1114, a(�pi!3`), .07' � SFR(1)bath 312.70
.�.. $�;o v..,der �n�r,-•.l.: � -.� .. ���% r1� .., .., ,:� �{dll�,
❑ 1-and 2-family dwelling ®Commcrcial/indusirial SFR(2)bath 437.78
CI Accessory building ❑Multi-fwnity SFR(3)bath 50032
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
47';': ;∎14;52 liktt1Nl1Aittil,!!i3'TN ' Site utilities:
Job site address:11681 SW PACIFIC HWY Catch basin or area drain 18.76
City/State2IP:TIGARD OR Drywell.leach line,or trench drain 18.76
Footing drain(no.linear R: ) Page 2
SuitelbldgJapt no.: 1 Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft: ) Page 2
Water service(no.linear R:1ff I Page 2 62.54
Subdivision_ Lot no.: Future or item:
Tax map/parcel no.: Backflow preventer 31.27
Y 3�� -,74rS'FF.,:,t t 3'" T,, :- ,-.'•a• � re °° r Backwater valve 12.51
J ; trr y. ..■ . i _ ∎-;::i XZ6;A; , A;OW e t' _CJtf 1. Clothes waher 25.02
NEW WATER SERVICE
=:untiln 25.02
25.02
Ejedor&/sump 25.02 r
Ii e,&!.A nwroelgnn a��--;-d , `=.1-f _-------- � it 7i! -",r -1'' Expansion tank 12.51
1 '��-� � . n 11t 1 ;4*_I lnji
Fixture/sewer cap 25.02
Name:
- Floor drain/floor sink/hub 25.02
•
Address: Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
7l }2+ , y sFgg " Interceptor/grease trap 25.02
. ,.ail.4!rfj rtN{ ?,. fir 4.. i' �S:� ..r,.�^ yS�.V. ._.... W"
Business name:
.. Medical gas(value:$ ) Page 2
Primer 12.51
Contact name. Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar(nits(potable water) 62.54
Fax::( ) Tub/shower/shower pan 12,51
Phone:( ) 25.02
Urinal
E-mail: _ .
1.4 ,., „ r
Water Closet 25.42
e 1 . yS0 s,� kE 7;,AN iNaig Y d��fi = ig � t.
�. �.,,+W rt Y�+,. 1 n. :r,�`;r4 S �4 , . ._ ,�:a � .:Flab �.xr -� k+ �"�� 'fll;
Water heater 37.52
Business name:VICON MF;CHANICAI.INC Water piping/DWV 56.29
Address:3627 KASHMIR WAY SE Other: _ 25.02
ity/State/ZIP:SALEM OR 97317 Subtotal 62.54
Phone:(503)589-7101 Fax;(503)540-3616 Minimum permit fee: $72.54 72.50
, - Plan review (25%of permit fee) T
U" CCf3 Lic.:164217 Plumbing Lic.no.:24426PB S�surcharge(12%ofpermit fee) 8.70
-Authorized signature: TOTAL PERMIT FEE 81.20 t/dzyt
Print name:ROMAN BOYECHKO Date:05/29/2014 permit after it hhu been accepted�is not obtained as complete. �150
-Fan methodology set by Tti-County Sanding Industry Service Board.
tAsaildiaslaenairitPMU-YarmitAa0.0oc .dotA9 440-4616T(10/02/CAM/WES)
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Plumbing Permit Application - City of Tigard
Page 2-Supplemental Information
Fee Schedule:
. i Schedul e Residential
Fire
Suppression
upp� s IOl
Systems:
...
.te •••
�,s
' tE ���:� ' r x c ra4 { ow '3 1��c
Footing dram-la 100' 50.03 0 to 2,000 $121.90
Footing drain 2.001 to 3,600 $169.69 each additional 100' 37.52 3,601 to 7,200 $23320
Sewer-1st 100' 62.54 7,201 and greater $327.54
Scwcr-each additional 100' 37.52
Water Service-1st 100' 1 62.54 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52 ^ W e?1 4Y!
Storm&Rain Drain-1st 100' 62,54 $1.00t045.000.00
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
° 5 u�r - ""7:4074-0, each additional$1 .00 fraction thereof,in
3: _and including 00
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge—1t2 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 charge—2 hours) each additional$100.00 or fraction thereof,to
Reintpection Fees 90.00/Iv and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$120 for
(minimum charge-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. C
t { nlyT � • � • uw., ;. �1 U, s :.�..4: n i�e" '�•
�y.o�_P�,,:iF.B�fi;rt . Plan review is,required for any of the following. .x.i „• M
Baptistry/Fom
Please check all that apply.
Bath -Tub/Shower Q Any new commercial building with water service 2"and
-Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic . . ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Dave Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3"
-4 ti �_{• r a y tangy
Car Wash Drain
� � In Isometric or riser diagram is required for new buildings
Garbage Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach/Refrig.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-Clothes
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
waxr Close Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
http//www.tigard-or.gov/city_hall/deparuncnts/cd/docs/PLMU-PermitApiZdoc
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Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
11681 SW PACIFIC HWY, TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2014-00176
George Heimos
Violation Summary:
Inspector Contractor