Permit CITY OF TIGARD PLUMBING PERMIT
Permit#: PLM2015-00340
I COMMUNITY DEVELOPMENT
Date Issued: 10/07/2015
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S101 6601400
Jurisdiction: Tigard
Site address: 12178 SW GARDEN PL
Project: Park 217-Bldg 3 Subdivision: CROW PARK 217 Lot: 2
Project Description: Reset(2)water closets,(2)lays and add(1)break room sink(non-food related)
Contractor: WESTERN PLUMBING Owner: ICON OWNER POOL 1 WEST LLC
9460 SW TIGARD AVE SUITE 101 BY RYAN
TIGARD, OR 97223 PO BOX 460169
HOUSTON, TX 77056
PHONE: 503-639-5296 PHONE:
FAX: 503-684-9015
FEES
Quantity Description Date Amount
1 ea Sink 10/07/2015 $25.02
Specifics: 2
ea Lavatories 10/07/2015 $50.04
2 ea Water Closet 10/07/2015 $50.04
Type of Use: COM 1 12%State Surcharge- 10/07/2015 $15.01
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $140.11
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: O �W2. e9-770 /
,e,col .:?,, ,,,zz 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.
10/04/2015 07:31 5036849015 WESTERN PLUMBING INC PAGE 01/02
Plumbing Permit Application
Building Fixtures RECEIVED l (ti( !)till l 1 �1 O\1.):
lit...___ City of W Tigard �c T 5 2015 1.Received ii 7 a t1"VI tea"No/OL 3
13125 SW Hall Blvd.,Tigard,OR 97Y�1 Moto/ DO /D
I Phone: 503.718,2439 Fax: 503.598.1960 Ilan Review i 5 // /,
Inspection Line: 503.639.4175 CITY OF TIGARD I..' _x Other Femur �� f
Internet ReadyBy
www.tigard-or.gov gov - . ■ D •Iv I am
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❑New construction . ' ,N rww
El Demolition For . Mali °motion use checldirt
Desert. 'on Qty. Ea. Total
NI Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utili connection)
iii.. i('.1.'1t.. ..i11 ' ' rP ,.'.Y.�1':u I il'{ a„7 SFR(1)bath 312.70
CI I-and 2-family dwelling NJ Commercial/industrial SFR(2)bath 437,78 Mil
:1 Accessory building ID Multi-family I I SFR(3)bath 500.32
I Each additional bath/kitchen MI 2502
❑Master builder ❑Other:
Fire sprinkler( so ft.) Page 2 d' 1 l t r r t, a r r z ' grr i1 ,"l Site ut1litic#,' it�u4i„i2NN J4r , . ., ,., o.-r'cr {,..,.$,lt., �, 0..1,,a . 1 1 ` +r'k _
""-1
1111 Job site address:_ �tA+� t� e • Catch basin or area drain 18.76
III Drywall,leach line,o r t r e n c h drain 18.76
City/State/ZIPpi •i - `_ Qua 07
- Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt. m ,jectname:
L____ � ._ . �.h..` Manufactured home utilities 50.03 III
Cross street/di -.i.• . ... „• Manholes IIII1 18.76 -
Rain drain connector III 18.76
-
Sanitary sewer(no.linear R: ) Page 2
"'- Storm sewer(no.linear ft,,• __) Page 2
■ Water service(no.linear ft,:T) Milli Page 2
Subdivision: Lot no.: Fixture or item: _
Tax map/parcel no Backflow preventer 31.27
1 *� 1 �, . %4..(N.:-. . ,, °,i•,aoJ tn lt? Il l n ', j., Backwater valve e 12.51
,,. .4 f t,4,, .,: : u ,a. � .. ,, .. ,_ r,., 1.'! ,, alL.)gi! a t .!:.q',;', Clothes washer 25.02
t' I \C ( II• .I 1A∎^ Dishwasher 25.02 Q.. '- 1�) 1.1.1 tx--- 0\OP.\S 4-11__
U`.)( el,.\ (- ,3 Drinking fountain 25.02
• • t_ '. \i(--, Ejectors/sump 25.02
aaG r l•'[,A r,.. 4 .,. , ...1�...,-,1`„ . ... l,h n , ...t:ll ., .y,�• .e h i Expansion tank 12.51
Name: Fixture/sewer cap 25.02
�� "' ■ Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City/State/ZIP: - 502
Hose bib 25.02
, Phone ( ) Fax ( ) Ice maker 12.51
Sys" R'� h "' Interceptor/grease trap 25,02
Business name: Medical gas(value'.$_) Page 2
- Primer 12.51
Contact name: Roof drain(commercial) J, 12.51
Address: Sink/basin/lavatory 11l 25.02 `-I<c=,,(34,
City/State/ZIP Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
Urinal 25,02
E-mail: y 25.02 /+. 1
..i''VirP rr `'. ...;lri ;..•� �,. ,l. . :,, i„1..:-:.! , , x Water closet;1 25.02 .lJ�'Y.a
W
g" 'r Water heater 37.52
Business name:Western Plumbing,Inc.
Water piping/DWV 56.29
Address:9460 SW Tigard Street,Suite 101 . Other: 25.02
City/State/ZIP:Tigard,OR 97223 Subtotal jcZ i l0
0 2
$
f
i
inmum permit fee: 7 .5
Phone:(503)639-52% Fax:(503)684-9015 Minimum
CCB Lie.:2439 Plumbing Lic.no.:3429P6
Plan review (25%of permit fee)
State surcharge(12%of permit fee) 10
Authorized signature:. , ifiA f ,5 iA... ff ' TOTAL PERMIT FEE i(6 (I t�
I 7 x�v This permit application expires if• ,*ffl
Print name: * Date; I rp p+ peruait is cot obtained within ASO days
I •.♦t ♦ after it this been accepted as complete.
'Fee methodology get by To-County Building Industry Service Board.
I;,Bu,Idirts\Pmnit.WLMU•PrmitApp.doo 10/01/09 440-0616T(1 0,02,'C )
1 0/0 4/201 5 07: 31 5036849015 WESTERN PLUMBING INC PAGE 02/02
Plumbine Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su t r ression S stems:
f.'!t'r'ri,C1 :^&5 r., t'"M F , '."L�" ti ";ut',r+�'i,i'+ nrnf7"� `a'e„ �vnnp a},n Y.y ,;.7iv ry,)A i w't�nJf�wt:3� tt. "'. 71,;?Y•'.is
.. I ,r , : 1a 1T i' r pia r i;;;%;,,K� ) T 1 aV Y r r r .,
�'R' S�r�:..'-�•�.w�w�� `lrsll�t5�k ";'k� �` ,��'+5�,.�.;��.i�;:.#n"�r" �4,u�.�:�.,'r;`+��.r:tn`.� I�I :., r.•Ir rw.Jf..bx.n;n.vr :,�,.d�nrt,� ' ."..4$,•wF:.�..,vr.. 1M1�t�',�!'nn..it .31.MC'��W..
Footing drain-1'100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100 37.52 2.001 to 3,600 $169 69 -
3,601 to 7.200 5233.20
Sewet•1st 100' 62.54 7.201 and treater $32754
Sewer-each additional 100' 37.52
Water Service 1st 100' _ 62.54 Medical Gas Systems:
water Service-each additional 100' 37.52 wr"1"`"x∎57. 4177.3" + �^r}wt N '"+�m'"rzr r T v ,r , I,�V•
I it,'" ,;,; _4: .:..'4i,w:iS:l1"a:i..,r ,?..: :t�.�..r?,w. w'a�!SiaA r'�'lr- ,. a" Wt1,..
Storm&Rain Drain-1st 100' 62.54 $1.00 to$5',000.00 Minimum fee 572.50
Storm&Rain Dram-each additional 100' 37 52 $5,001.00 to$10,000.00 $72.50 for the first$5.000.00 and 51.52 for
, ^j761 r. .n- r1{V S *x; • each additional$I00.00 or fraction thereof;to
:l,-l.oa 3,,,„.,-. W .f4;;; 11. Ahilt„.
! and including$10.000.00.
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
1nunimurn charge-1/2 hour) and including 525.000.00.
Inspections outside of normal business 90.00/hr $25.001.00 to 550,000.00 5379.50 for the first 525.000.00 and$1.45 for
hours(minimum charge-2 hours) each additional 5100.00 or fraction thereof,to
Re inspection Fees 90.00/hr i _ __ and including 550,000.00.
Additional plan review for revisions 90 00/hr $50.001.00 and up 5742.00 for the first$50,000.00 and 51.20 for
(minimum charge-112 hour) ____._T each additional$100.00 or fraction thereof. '
Subtotal:
Commercial Fixture Work:
Arc you capping,adding or replacing fixtures? if"yes",
please indicate work performed by fixture. Failure to
accuratel re r .rt fixtures could result in increased sewer fees*.
r i i y� t... q" .. ,x µ •nrf�f¢n^r4•rim. a +:y::.,:s _ ow.: "-, 7 .. .'F;.. "'x";.' ' +,�-03�^a w, , ..
1 l �• `l , ! 4 It*1�_ei r:;%s 1 Y r...:,:A,'- e.A L.:,,i.a.� .,w }S�w Y . ..,": .: --. .
f /, �4� V �l `4, ? .� �Mi�1 Plan review is required for any of the following.
Baptistry/Font
Please check all that apply.
Baptist
Bath Tub/Shower ❑ 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 Q Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2 Submit 2 sets of'plans with any of the above.
Car Wash Drain i Isometric or riser diagram is required for new buildings l
• Garbage -Domestic-non-food
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 /C`7//S
-Stall
Sink/Lav -Non-food related 1 (-) 1 ,63./�--C19 L /2CC/1 -SINK. /101- ...MA/4
-Cy //e' - -
-Commercial-food related
-Service _• •
Swimming Pool Filter _ *Note: if the fixture work under this permit results in an
W NSher-Clnthe5
Water Extractor increase of sewer EldUs,a sewer permit will be issued and
Water Closet-Toilet __ fees assessed for the sewer increase must be paid before the
Urinal __ j plumbing permit can be issued.
Other Fixtures;
htnpJ/www.tigard-or.gov/city_hall/departmentslcd/docs/PLMF-Permit App2doe