Permit CITY OF TIGARD PLUMBING PERMIT
i ' ,. COMMUNITY DEVELOPMENT
II
Permit#: PLM2016-00320
TEGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/23/2016
Parcel: 25101 BB01500
Jurisdiction: Tigard
Site address: 12250 SW GARDEN PL
Project: MedFocus Subdivision: CROW PARK 217 Lot: 3
Project Description: Replace existing(1)dishwasher,(1)garbage disposal&(1)sink.
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 Dishwasher 06/23/2016 $25.02
Specifics: 1 ea Garbage Disposal 06/23/2016 $25.02
1 ea Sink 06/23/2016 $25.02
Type of Use: COM 1 12%State Surcharge- 06/23/2016 $9.01
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $84.07
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 q ions to 6 N calling 503.232.1987 or 1.800.332.2344.
re �
Issuecj By: �,�� /
/ , Permittee Signat : ,, A fi r/ , /��
Call 503.639.4175 by 7:00 a.m.for the next available inspe 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.
06/20/2016 11:06 5036849015 WESTERN PLUMBING INC PAGE 01/02
Plumbinn Permit A lice
Building Fixtures i , It ,:„ ri< i 1 `l i t\l:1
Received111 if As ko Nil zo/!e-OD 3 Po
City of Tigard 2 1 2 016 Waterer: / Permit No.: .,
_r 13125 SW HaIi Blvd.,Tigard,OR 97 Pion Review Other Permit No,;Phone: 503.718.2439 Fax: 50 60 I Date/g ; p,t.( .'a/(0�I
Inspection Line 503 639 4175 1.-$1 (jal 1 I t'9 ri t Date Ready/By; ��� see Page 2 for
{`` Internet: www ttgard or gov $ ; I k 1 Not1Cied'Mefhod supplemental information
l 5w(,2.. mn�,ita1} 1, + ,re rS•-,-','4,,,'.'77,71';,;1.,,,`,,,,",:4':,1,:;1',„t,,74,„s. :;. {t�r i ;.91.1,-,1:;,:;:l.:,,„,,, ':',1.11;1',.., a 1,
,h':.1''',-,::
{ t 7'77: ,•.,t ,•.h
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4uit1 L ia.',. i. . ,,. ,, :: / „ji13o .aiJr.-4, ,+,t,, 1,4' ,; ,. . . {4'' , ,`,L' . ie,, + checklist
iff ri. 't{?,n3 , 1i a
❑Newconstruction Demolition Ftl lbRlSC CJEC
Description 1Qty. 1 �
Mt Addition/alteration//replacement 0 Other: New 1-2-family dwellirt�s(includes 100 ft.for each utility connection)
ticii-gee i,, l 111 °c±x r. ':7..k..6,- .{r . N t„1 's,,.,'...Et"s'a.ih i' i�r° 4141 SI�t�1gMtt jit�;',1,t11r�f SFt7(1)bath — 312.70
N Commercial/industrial r SFR(2)bath 437.78
(] 1 and 2-family dwelling SFR(3)bath 500.32 1111
❑Accessory building 0 Multi-family Each additional bath/kitchen 25,02
Q Master builder 0 Other: Fire sprinkler(� sq.ft.) Page 2
1'' f (‘ y 4r " i ;u , ,— ''. a 1 F ^r- ::7 ft r " 'Tnyiti ,t♦<4tti�F,,f t,' Site rt$itie8:
i u ¢°YwKta:<if iw,.,,,,,';;,t ,1 ,, ro, . ,t. aN i.,u,,,),,y.. .1.,,,,,',, ,i.,!
Catch basin or area drain 18.76
Job site address. 1 gQc 5w Clo.rL ass, .
bryw�ell,leach line,or trench drain 18.76
City/StatciZIP:;\(jp�y let Footing drain(no.linear R-:_� Page 2
Suite/bldg./apt.no.: c3_ — 17`Project name: Manufactured home utilities 50,03
Cross street/directions to job site: Manholes I8-76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
„_. - - • Storm sewer(no.linear ft: ) Page 2
Water service(no,linear ft.:_-) Page 2
Subdivision: Lot no,: _Fixture or item:m
Tax map/parcel no 11111 Backflow preventer 111.11 3L27
y --c i u''',rr}1J '%111, t,'-to l 'p T r L',(,'- Backwater valve 12.51
� ,� i{InT*64K1�,tit nr.+,,,1%,,,,,.,,
,,1,,,i.,t,1„i.,1,�(+1.150,1;10 W.,,,i,t ::.:u„4 ........ t: 4 roll,-.,,(/.1.. ti»fit,}, �tsll�ufhFr.e
Clothes washer III 25.02
Dishwasher 25,02 444,
illn=lia
` %. i .I I Ili 11{ .. Drinking fountain 25.02
, Ejectors/sump 25.02
• 1=t117,@''T'l ltm { , t t a7-P t' VS, i 'a, Ninq se +r' :+ , expansion tank 12.5l
'' , i....
- apoK�ran'om,:t d,i?; 1„R1.. +{, r,,4;,,-„.:.;,:,,1",.., 1j:' `?„ , .11,01 ,„ ,R'1+.41n idt y• ,'Aotia,4, .1ii _
MI Fixture/sewer
cap 25.02
Name:
— — Floor drain/floor sink/hub 25.02
Address: 11111 Garbage disposal ‘ 25.02 _a
City/State/ZIP: Hose bib 25,02 11111
1:111.1111111111111111ice maker 12.51
Phone: 25.02
q ( )
I! I,
`-yt ki f�,z r�^L7 AI i f ten err is F •,.' t:,'FI'nx,, i,',, ''1}q.,,,,,,..»..1r.::-:-:f,77,4,,,,„,”, i + i III. ierr'i 4 ' Interceptor/grease trap
.e� P y'11i6 4..1�.a,,,,,u i f, 1 i :4.,I1.',;1,,11,,,-:'-'11,,`.!,‘I.'4:. ,,:::r r,t,rJ a it:,`:,:.1',d.,?..K"'d.a l,.n•,`„ Medical gas(value:$ ) III Page 2
Business name: 12,51
Primer
Contact name: 12.51
Roof drain(commercial) III
Address: 1111 Sink/basin/lavatory 25,02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) I Fax::( ) Tub/shower/shower pm 12.51
Urinal 25.02
E-mail . ,a; ` ' rt..kik
A tt, eL 't
•4y1n n1t, •nT' r o, 1 ,+ r , t ,''1 t{V i mo d .„37,i il+pIe Water closet
25,02
t , 1 ,kt,,,rN,1 i ',`,',,,,:,;•,':':: 1, , r , ,-0.,::-: 4..',M.1 >AlI:::1,t t{r:sknr14. '` VatCleStei 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
( )
Phone:(503)639-5296 Fax: 684-9015 Minimum permit fee; $72.50
Plan review (25%of permit fee)
CCB Lie.;2439 (l4 I Plumbing Lie.no,:34291P1f3 State surcharge(12%of permit Fee) is,r 1
Authorized signature: :r i� - TOTAL PERMIT FEE
r This permit appCrcadon expires ii s permlit is aot obis"teed within 180 days
�. $.41M1911111.1111,
t., Date: ► a�L ,.Fee methodology t by Tri-County uuildinB dustry Service Board.
I:Isuilding1Perminn.MmU-PernniAna.doc 10/01109 440-4616'r(O0/02/ DMAWEn)
06/20!2016 11:06 5036849015
WESTERN PLUMBING INC PAGE 02/02
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Su. .ression S stems
a '
s-s
1r I ,1 rt I t ,4;,j;-',14,,,,h,t: 1
'' I d., a CJI ':,,,'•:'-
F v n I l�, .:1,,.0.r
H r ,1 $121.90
"' 50.03 4 to 2,000
Footing drain-101 100' � 2 001 to 3 600 $169.69
Footing drain-each additional 100' 2 001 to 700 $233.20
Sewer-1st 100' 11
62,54
7,201 and, ,ter $327.54
Sewer-each additional 100' iiiiYY11��
water Service-1st 100' _ �
62.54 _ Medical Gas S stems:
Water Service-each additional 100' ,, I,'"-;T"-,, ,'•, .';, I r,":1:71.-P1';';','ifi
Storm&Rain Drain-1st 100' 111111111=11111111
$1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 111111111Kall $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
each additional$100.00 or fraction thereof,to
ti„!',`;"""., w ,.. ,,i 1... :l! ,.a.'.,-lf,'� d."> t4,.,if and including$10,000.00.
nsp ,,,n.fe, ,ing pl.
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 III 90.00/hr 1111 each additional$100.00 or fraction thereof,to
minimum chi —1/2 hour and including$25,000.00.
Inspections outside of normal business 111111 90.00/hr IIIII $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours minimum ch: =-—2 hours each additional$100.00 or fraction thereof,to
Rcinspeotion Fees 1111111 90.00/hr MI and includln_$50 000.00.
90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
minimum
Additional plan review for revisionsillIl
each additional$100.00 or fraction thereof.
m
minichar: —1/2 hour
Subtotal; _IIIIIIIIIIIII
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*. J x$,1
° 1,r, ' till 4 h!$°no`�u ,Ali iii v�ti 'f`%kj 0 1 ' , v1n,, Urnr:^ r ,^ II,^ ,t { .r .i. :r.'r, ,, ;, ..., ,, r .,,I t.',I.,Tr�;!,
�i' I -4 F„;g riLIS:1454, 14 v ` ,0 i 7, 7a+ t f, a lar Plan review is required for any of the following.
1 ,nl11l,,m�d>":;fii., . t-rrwi Please check all that apply.
Baptistry/Font 0 Any new commercial building with water service 2"and
Bath -Jacuzzi/whirlpool
greater,except systems designed and stamped by licensed
,lacu2zi/whirlpool � engineer.
Car Wash -Each Stall ❑ New exterior plumbing site utilities for any complex structure
-Drivepohru _ as defined in OAR918-780-0040.
Cu
Dishwasher
her Comma ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher -Commercial 0 Arty multlpurpose fire sprinkler system.
-Domestic
0 Any complex structure as defined in OAR918-780-0040.
13finlcing Fountain, •
EF e Wash Submit a sets of plans with any of the above.
FloorDrain/sink -2" ,. �
3" itI ",P.r J i J mr., 1 yY
,�„�, ,lllat�2tE.1.,",, �:.. ,, A ,, ,;:,1::,,;,,,,,,,....'1,„, , i;:;,YI ale, s '.
Car Wash Drain ❑ isometric or riser diagram is required for new buildings
Dispose -Domestic-food r ea - that meet the •ualifications above.
Disposal -Aon�esri�food related � _
-Commercial—food related
-Industrial-food related
Ice Mach./Refrici Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dutn,Station
Shower -Gang
-Stall i
Sink/Lav -Non-food related
-Bradley -
Cornmercial-food related
-Service
Swimming Pool Filter *Note; If the fixture work under this permit results in an
Washer-Clothes increase of sewer EDUs,a sewer permit will be issued and
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet 1 oikt
Urinal _. plumbing permit can be issued.
Other Fixtures:
http://www_tigard-or.govlcity_hall/departments/ed/does/PLMF-PermitAp oe
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
12250 SW GARDEN PL, TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2016-00320
Don Sylvester
Note: dishwasher door did not close completely .
Violation Summary:
Inspector Contractor