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Permit Support Document (20) CITY OF TIGARD , �, PLUMBING PERMIT Ill .I-I COMMUNITY DEVELOPMENT Permit#: PLM2017-00321 Date Issued: 11/14/2017 TIGARD 13125 SW Hat Blvd.,Tigard OR 97223 503.718.2439 Parcel: 251136000600 Jurisdiction: Tigard Site address: 16580 SW 85TH AVE Project: Clean Water Services Subdivision: None Lot: None Project Description: O&M Building-Phase 2-Adding(1)dishwasher,(2)2"floor drains,(1)garbage disposal,(2)hose bibs,(1)ice maker,(1)lay,(1)break room sink,(1)service sink,(1)shower stall,(1)water closet&(1)water heater. 11/30/2017: REPRINT permit to correct address from 16060 to 16580. Contractor: WESTERN PLUMBING Owner: BURLINGTON NORTHERN INC 9460 SW TIGARD AVE SUITE 101 PROPERTY TAX DEPT TIGARD, OR 97223 PO BOX 961089 FORT WORTH,TX 76161 PHONE: 503-639-5296 PHONE: FAX: 503-684-9015 FEES Quantity Description Date Amount 1 ea Dishwasher 08/11/2017 $25.02 Specifics: 2 ea Floor Drain/Floor Sink/Hub 08/11/2017 $50.04 1 ea Garbage Disposal 08/11/2017 $25.02 Type of Use: COM 2 ea Hose Bib 08/11/2017 $50.04 Class of Work: ALT 1 ea Ice Maker 08/11/2017 $12.51 Type of Const: 2 ea Sink 08/11/2017 $50.04 Occupancy Grp: 1 ea Lavatories 08/11/2017 $25.02 Stories: 1 ea Tub/Shower/Shower Pan 08/11/2017 $12.51 1 ea Water Closet 08/11/2017 $25.02 1 ea Water Heater 08/11/2017 $37.52 1 12%State Surcharge- 08/11/2017 $37.53 Plumbing Total $350.27 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. a Issued By: G,� j` Permittee Signature: Q� �4� /eie 77 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. CITY OF TIGARD PLUMBING PERMIT , COMMUNITY DEVELOPMENT Permit U: PLM2017-00321 71 Date Issued: 11/14/2017 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 11 2S1136000600 000600 Jurisdiction: Tigard Site address: 16060 SW 85TH AVE Project: Clean Water Services Subdivision: None Lot: None Project Description: O&M Building-Adding(1)dishwasher,(2)2"floor drains,(1)garbage disposal,(2)hose bibs,(1)ice maker,(1) lay,(1)break room sink,(1)service sink,(1)shower stall,(1)water closet&(1)water heater. Contractor: WESTERN PLUMBING Owner: BURLINGTON NORTHERN INC 9460 SW TIGARD AVE SUITE 101 PROPERTY TAX DEPT TIGARD, OR 97223 PO BOX 961089 FORT WORTH,TX 76161 PHONE: 503-639-5296 PHONE: FAX: 503-684-9015 FEES Quantity Description Date Amount 1 ea Dishwasher 08/11/2017 $25.02 Specifics: 2 ea Floor Drain/Floor Sink/Hub 08/11/2017 $50.04 1 ea Garbage Disposal 08/11/2017 $25.02 Type of Use: COM 2 ea Hose Bib 08/11/2017 $50.04 • Class of Work: ALT 1 ea Ice Maker 08/11/2017 $12.51 Type of Const: 2 ea Sink 08/11/2017 $50.04 Occupancy Grp: 1 ea Lavatories 08/11/2017 $25.02 Stories: 1 ea Tub/Shower/Shower Pan 08/11/2017 $12.51 1 ea Water Closet 08/11/2017 $25.02 1 ea Water Heater 08/11/2017 $37.52 1 12%State Surcharge- 08/11/2017 $37.53 Plumbing Total $350.27 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: ( / �. Permittee Signature: cj "L9Z / j�0 Ait ,C,(5:47, Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Plumbing Permit Applicati sL, L ,EL Building Fixtures City of Tigard A U G 3 2017 lteoeiveti 1111111,111)111111'"1111111"11111111111111341111 13125 SW Hall Blvd.,Tigard,OR 9.? y� , ' Plan Review Phone: 503.7182439 Fax: 503.58 tg g DM y, Other Permit No.:, ,...0 . /7tC R5-7 Inspection Line: 503 639.4175 i r ,,i' Internet www tigard•or gov BUII,D1NG DrillS101 Date R JT let,: q /O i guru S See Page 2 for Notifiett/Method `6 / Su emental Information f� 4 n.i$t ir ``'e ��, 'yy .v. .k rxiawaY.t. .rsm..a, , '2 t 3Yn,. ., �...e•->.....,'>.._..w .:'<r.',wW._S�� a.t�e?`::;t "`.aca"�3i"�._°'»�':3i��G� .,.,..-�,�a :..;1k.,11-; .;;c4-', ,..<. rte ;, 1�s�+;:A ..PaK ',Ltvx 'mss s.. �.: n°..N' ua p. ❑New construction 0 Demolition For special Information use checklist -t) Description i Qty. I Ea ( Total til XAddition/alteration/replacement 0 Other: N1-2-family dwellings(includes 100 ft for eachty connection) ' .... k �4' �.. _ ` SFR(1)ewbath 312.70utili ❑ 1-and 2-family dwelling 11,1 Commercial/industrial SFR(2)bath 437.78 'J 0 Accessory building te 0 Multi-family SFR(3)bath 500.32 i Each additional bath/kitchen 25.02 jeMMal 0 Other: Fire sprinkler( sq.ft.) Page 2 Q r ' ¢ 1° �& ,s ;, p >' ,x i :. a. { „M� Site utilities: J Job site addres •• `�n� Catch basin or area drain 18.76 - •=� "S. ;11.�n i 11.1J Drywell,leach line,or trench drain 18.76 City/State/ZIPT , -CkAw4 &IAN) ft..L ,je_' Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: Project name:.1vg •,l tgrosIcaa.tymiro Manufactured home utilities 50.03 iCross street/directions to job site: ' i Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.:_•_) Page 2 1 Storm sewer(no.linear ft.: Page 2 Water service(no.linear ft.: Page 2 Subdivision: I Lot no.: Fixture or item: Tax map/parcel no.: S//3 6o p(0 00 Backflow preventer 31.27 a t° 2 i 'a.1 " ,'''',7,- ..'' lw 7 3 re,'y" 5�A6 Backwater valve 12.51 Y rr �;.. ., ,.`.44'444,.. ..10.*.<,E'iu-.. .•. ��p� z w�° . �_,,, �zz�� �� ��' �" Clothes washer 25.02 `' ``-" ` - t t• - 041 N * i i _ Dishwasher , 25.02 t l]2- o ! a- Drinking fountain 25.02 Ejectors/sump 25.02 t . . •:...,,•.„-, ...r' .z ,x. = " ' E..�..?" ,.4.,.0 i Expanson tank 12.51F, � c'nans•f4.w . �-„ ,,i. 5t .i� �st. 2 i • S Name: Fixture/sewer cap 25.02 i Floor drain/floor sink/hub fQ 25.02 ', )..\. Address: Garbage disposal ‘ 25.02 City/State/ZIP: Hose bib a 25.02 n04 , d Phone:( ) Fax ( ) Ice maker \ 12.51 s� „GJ t K r r:' .n,,,,,,,;..,'-,-,..,:;,,,,,,a4,....,; T,7�.^,,, r ...,r5.$ , ':7eae,,,,a&{eS'F` '.'at Interceptor/grease trap 25.02 : ?' ' `Fi . rYi...a`.'fai:Cu'�s`° '�a,r '4a�t f)3r'Zs` .fi '`• .� s Business name: • Medical gas(value:$ ) Page 2 4 �x. Ask _ . 4i6 0- &I I Primer 12.51 Contact name: \` X� g ge • Roof drain(commercial) 12.51 Address: C U, C SW 11 .,,, x-rk cNs&it l .-kt i O, Sink/basin/lavatory z 25.02 City/State/ZIP:� k l(0. a (potable water) 3 62.545 u� A--�] Solar units Phone: l(." l_ Fax::( ) Tub/shower/shower pan , 12.51 to F-3k r) E-mail: 0• r / . f Urinal 25.02 4 �� rn -„ v r-tr ,T , ,7,,,:,,,,,;,,. Water closet \ 25.02 (��. � Ar-,1,,,� ���y �'`a''v�','f t� ��� „ t`�,y'"?tsw. � b - CYas'.••••.. ,.a.uroe.:t..,:. :.'1,r.?i,...,,,.. >.-,;:.we1•:,. z»:t`.,.«th:« Ym.'`..,.,.1.:4:4.ht.. ...v. Water heater ‘ 37.52 '7)'�52 Business name:Western Plumbing,Inc. Water piping/DWV 56.29 Q- Address:9460 SW Tigard Street,Suite 101 Other: 25.02 r City/State/Z1P:Tigard,OR 97223 Subtotal .3. OM, .o Phone:(503)639-5296 Fax:(503)684-9015 Minimum permit fee: $72.50 CCB Lic.:2439 Plumbing Lic.no.:3429PB Plan review (23%of permit fee) o State surcharge(12%of permit fee) , Authorized signature: / 9 '^ m (1 k,, �(�� TOTAL PERMIT FEE 03 �� This permit application expires if a permit is not obtained within 180 days Print name: �\ t� g Date:�r31) � CUS./ it has been accepted as complete *Fee methodology set by Tri-County Building Industry Service Board. 1'\Building\Perm its\PLMU-PermitApp.doc 10/01/09 440.4616T(10/02/COM/WEB) lumbiaPermit Application - City of Tigard Page 2 -Supplemental Information Fee Schedule: Residential Fire Su i .ression S stems: E171,-- t..1„4_r .. ..,>-"r.���,a.�c.u..e�l+,,,:: .e-Z "nQ z...?! :::LT.; z�. l*.. Footing drain-I"100' 50.03 0 to 2 000 $121.90 Footing drain-each additional 100' � � 2 001 to 3 600 $169.69 Sewer-1st 100' 3601 to 7 200 $233.20 111 7 01 and ter S327.54 Sewer-each additional 100' 37.52 Mill Water Service-1st 100' 7Medical Gas S stems: 3 Water Service-each additional 100' Vin# '-;...:-=;,'27:,11, Storz&Rain Drain-1st 100' 62.54 IIIIII $1.00 to$5 000.00 Minimum fee$72.50 Storm&Rain Drain-each additional 100' 1111. 37.52 an $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for g y w £, ,.,,l....,..,:::,,2h each additional$100.00 or fraction thereof,to and includin:$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 III each additional$100.00 or fraction thereof,to minimum ch: :e-1/2 hour and ineludin•S25 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 char:e-2 hours each additional$100.00 or fraction thereof,to Reinspection Fees — 90.00/hr and includin:$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$1.20 for minimum char:e-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 „' �vtrl , 44th #ta� Plan review is required for any of the following. Please check all that apply. Baptistry/Font PP Y Bath -Tub/Shower 0 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 0 Medical gas and vacuum systems for health care facilities. -Domestic ❑ Any multipurpose fire sprinkler system. Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040. Eye Wash _ Floor Drain/sink -2" c / Submit a sets of plans with any of the above. -3" i: V:.-... T.r 'r te Car Wash Drain ;4-..4;.,?.-:,4,;L;° � ..... ..., ._ ..... . :s, �..,.�� .-.x.�-.A�� �. Garbage Domestic non-food - ' • Isometric or riser diagram is required for new buildings . Disposal -Domestic-food related \. / that meet the 'ualifications above. -Commercial-food related -Industrial-food related Ice Mach./Refrig.Drains 1 / Oil Separator(Gas Station) comments regarding fixture work: Rec.Vehicle Dump Station e 1.0 5 0,4,26,44,4_---r) 1 SPe t—S 1 Shower -Gang EH Pt.by� filo-' Gtr �I-RQ�C'o£� , S'�C1 -Stall �r`1 Sink/Lav -Non-food related ea. / F£f S -Bradley -Commercial-food related -Service \ Swimming Pool Filter Washer-Clothes *Note: If the fixture work under this permit results in an Water Extractor increase of sewer EDUs,a sewer permit will be issued and Water Closet-Toilet V ti r 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/departments/cd/docs/PLMF-PermitApp2doc DRECEtVED CiINty of Tigard • (:OMMuN1 EV T)1:rl;l,OPnii:NT Di'i'\RTMI:NT JUN 2 1 2018 '" CITY F'TIGARD Request for Permit Action q BUILDING DIVISION TIGARD 13125 SW Hall Blvd. • Tigard,Oregon 97223 • 503-718-2439 • www.tigard-or.gov TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPcrmits@tigard-or.gov FROM: n Owner 00 Applicant ❑ Contractor ❑ City Staff Check(✓),me REFUND OR Name: INVOICE TO: (l1ut..inCs Or Inftviduai) \1 W iI\v\c, Mailing Address: Up( 11 - , \.l�.lJf 101 City/State/Zip: 1 OZ qv. Phone No.: -(6)4-Z(p PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): 0 CANCEL/VOID PERMIT APPLICATION. REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CONTR\CTOKON PERMIT (do not cancel permit). Permit#: - tl - Site Address or Parcel #: WD'''‘' 1116, j,, , ,,Qnw Project Name: Odialst\) \3 .l 9Jr OM ci Subdivision Name: Lot#: EXPLANATION: A,; , 6,,, . •11. \'.1 ,i , &' ! •., • �, .►its► . �- ►C\ ImoXY* ,Aolisst_ �� �r.-k- Y'. • ' ' , , Signature: ,4 I ,/ .-1 Date: I_pl, L Ii g Print Name: V quT:j. I '�,Y1 Refund Policy - 1. 'Ilse city's Community Development Director,Building Official or(:ity I nginecr may authorize the refund of: • \nv fee which was erroneously paid or collected. • Not more than 80"i,of the application or plan review fee wici n an application is withdrawn or canceled before review effort has been expended. • Not more than 80"-"of the application or permit tee for issued permits prior to any inspection requests. 2. All refunds will be returned to the o,iyrinal pater in the hwm of a check via US postal service. 3. Please allow 3-4 weeks for processing refund requests. j €,s0 tem 17 3/.2. 7Y .37a 53 FOR OFFICE USE ONLY Route to ties Admin: Date By Route to Records: Date 3 2e/ /e, B,trj - Refund Processed: Dat4/Z2A --- By , Tnvoice Processed: Date By Permit Canceled: Date j,//z,/irf` B•9 Parcel Tag Added: Date By , I:\Ituilding\Forms\Rcyl crmci\etion J192314Aoc f11q-f r7i./o flit_.- /C-42 i?--,2 ,r7 A 147v$ Plumbing Permit Applicata 4`' ECEIVE1) /2 /e l�r, `.6 Building Fixtures t t llt ,till, 1 1 :I 0\1 1 ' City of Tigard AUG 3-2017 Received Date/By: 7 f' /7 / Permit No.: 4L1-04/7-061, J 13125 SW Hall Blvd.,Tigard,OR 9 • Plan Review Phone: 503.718.2439 Fax: 503.54 OF HEAR! y. other Permit No.: w,2gw/7trl 25-'? Inspection Line: 503.639 4175 �T � Internet: www ttgard ov BUILDING Reedy �10t+ 0 See Page •or g 1 }ply adSad/M r/ = do _ ALd1 N d �L /0 / for . 1 r t ti4 r i r a I laforma a !� ❑New construction _ ^"' -1..t.,---',..'1,-:',',''',.-..,..:- .. ..'- � ;!V"�T ,;p' 0 Demolition For sped.,170nm:fog ireeheeklkg ,^b Descriptionn_ lea ►i Addition/alteration/replacement 0 Other: I Q1Y.,f Fut I Total Y03 �� ,,_ � e.r ,_ New l-2-feral dwellings(includes 100 R for each ilial connection) e ) o % • } , ,AiN SFR(1)bath 312.70 'Mil ❑ 1-and 2-family dwelling 1:t Commercial industrial SFR(2)bath ' e 0 Accessory building 0 Multi-family SFR(3)bath 00.32 tri Oth Q � Each additional bath/kitchen25.02p Fin sprinkler( sq.ft.) a e _.. .. ? , -.,e;,:. -.,-.-,,•;1 {r Site utilities: NJ I? Job site ad. ��` 1116V„,411116 , _ Catch basin or arca drain 18.76 na 4 City/State2 �'"' � Drywell,leach line,or trench drain 18.76 cr � A _ 1 iv, K r r "' �� *• drain(no.lancer ft.: ) Page 2 Suite/bldgiapt.no.: �Projec ....7.41,....,...ecs�.aeieialku,mi .home utilities 50.03 1 Cross street/directions to job site: es 18.76 ...,. . ....... _ aim 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: I Lot no.: Fixture or item: � ' Tax map/parcel no.: a S//3 / 7Q(pct Backflow preventer 31.27 -,: Backwatcrvalve 12.51 � � b•., �� � Clothes washer , p Dishwasher , 2 It /0--72- L�4 A/9 /° .s Drinking fountain 25.02 _.i)/.� .© ATO l b 4.9 4/0 4 --- V�q /7' Ejectors/sump t Expansion tank •4R; d�'trd_+:�.`4.,r..�Pa ..a.. _�� ,.,' Yr ,. rev t -" 12.51 i • I Name: _ , t:-/7 ;l '._e0 -g-5---5 Fixturesewer cap Floor— Address: / •77 5 /L L)! Garbage disposaloor sulk/hub , City/State/ZIP: Garbage , N. OA Hose bib 25, ,i Phone: ) Fax:( ) Ice maker t ," inter(xptor/greaseaap ,s•'m --.-..,11.:;',...,•:-;','s . s , ° Business name: A?Q \` r\LA 1�i t` , Medical gas(value:$ ) Page 2 Iii Contact name:^;, xj I ,S03(-\ Primer12.51 Address: \ "� o i ` Roof drain(commercial) 12.51 q,14VCO SW r\ J"�-1 t SU 1 1 Sink/basin/lavatory , i City/State/ZIP �a s S t Solar units(potable water) III 62.54 Phone: 1!1 11 � /n Fax::( ) Tub/shower/shower pan 1 w E mall �1/ p 0 r Urinal 1 :,, a . r44, t' ,.1r1 // / 4'4 ,r r A �,�Ii, water closet , '� }3 .1J L �.k Yq...1. ,- ,,21'. .. n _.. c<.u..;.c.......,,.......; M..c.,,. •,.*.,;'.::. .,::,-.,..',' , } .,.::;':' Water heater 1 37.52 ?)-k 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 11 Phone:(503)639-5296 Fax:(503)684-9015 I Plan review (25%of pennit fee) , CCB Lic.:2439 - ' Plumbing Lic.no.:3429PB e(I 254 ofpermit fee) WA Authorized signature: � l� 1/n12TOTAL Print name: .if _ • .44; Plumbing Permit Application - City of Tigard Page 2-Supplemental Information Fee Schedule: Residential Fire Su. .ression stems:Footing drain-la 100' imig 50.03 0 to 2 000 $121.90~ _ Footing drain-each additional 100' c 2 00110 3 600 169.69 Sewer•1st 100' 3 dot to 7200 $233.20 7 01 and - $327.54 Sewer-each additional 100' in 37.52 Eno Water Service-1st 100' 11111111111=11 Medical Gas S stems: Water Service-each additional 100' 37.52 Storm&Rain Drain-1st 100' 62.54 IIIIII ' S 1.00 to SS 00000 Minimum fee$72.50 Storm&Rain Drain-each additional 100' MN 37.52 Ma 55,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for each additional$100.00 or fraction thereof,to :1, "41"..."7-4 ., "' . . .': "- and includin $10000.00. Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 -.r which no fee is specifically indicated ■ 90.00/hr each additional$100.00 or fraction thereof,to minimum ch, :e-1/2 hour and includin $25 000.00. Inspections outside of normal business - 90.00/hr $25,001.00 to$50,000.00 $379.50 for the rat$25,000.00 and$1.45 or hours minimum ch ; -2 hours each additional$100.00 or fraction thereof,to Reinspection Fees 90.00/1u and includin $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$1.20 for minimum chart -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*. 5 i' G 1S „> ^'r rf.,y�i'•J 4r '''''07,371.''''.r17;,', # W t �. ._ �. -. _ .: .W f � :. ` ,.., r '', , ,I#r e - =' ''4' Plan review is required for any of the following. Baptistry/Font ,. '... Please check all that apply. Bath -Tub/Shower 0 Any new commercial building with water service 2"and -.Iacuai/Whirlpool greater,except systems designed and stamped by licensed Car Wash -Each Stall engineer. -Drive Thru 0 New exterior plumbing site utilities for any complex structure Cuspidor/Water Aspirator as defined in OAR9I 8-780-0040, Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities. -Domestic , 1 0 Any multipurpose fire sprinkler system. Drinking Fountain0 Any complex structure as defined in OAR918-780-0040. yEye Wash - Floor Drain/sink -2" a . / Submit ain't/of piano with any of the above. -3" ' Car Wash Drain ✓ ' ; 'Garbage -Domestic-non-food 1 ■ Isometric or riser diagram is required for new buildings Disposal -Domestic-food related _ '. / that meet the .ualificatioris above. ' -Commercial-food related -Industrial-food related Ice Mach./Reftig.Drains 1 / Oil Separator(Gas Station) comments regarding fixture work: Rec.Shower Vehicle Dump Station e-Gan1.17 5 (�41-� �'� 1 SPO 1.6 io g £rfPc.oyi� Harr Corr C1+RQG£b SC_- stall , Sink/Lay -Non-food related a / l%££3 -Bradley -Commercial-food related -Service \ ,- Swimming Swimming Pool Filter Washer-Clothes *Note; If the fixture work under this permit results In an Water Extractor increase of sewer EDUs,a sewer permit will be issued and WaterCloset-Toilet t i 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_hal l/departments/cd/docs/PLMF-PermitApadoc ;� d TIGARD City of Tigard July 16, 2018 Western Plumbing Inc. Attn: Dana Jensen 9460 SW Tigard St, Suite 101 Tigard, OR 97223 Re: Permit No. PLM2017-00321 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 16060 SW 85th Ave. Project Name: Clean Water Services - O&M Job No.: Refund Method: ® Check#228992 in the amount of$350.27. ❑ Credit card "return"receipt in the amount of$ Note: Please allow 2-5 days for this refund transaction to be credited to your account by the company that issued your card. ❑ Trust account"deposit"receipt in the amount of$ Comment(s): Permit created in error at the wrong address. Refund 100% of permit fees paid. If you have any questions please contact me at 503.718.2430. Sincerely, 41,,;3;2)1-0-texa_e__.- Dianna Howse Building Division Services Supervisor Enc. 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard-or.gov iliii q City of Tigard TIGARD Accela Refund Request This form is used for refund requests of land use, development engineering and building permit application fees. Receipts, documentation and the Request for Permit Action form (if applicable) must be attached to this request form. Refund requests are due to Accela System Administrator by each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts Payable will route refund checks to Accela System Administrator for distribution to applicant. PAYABLE TO: Western Plumbing Inc. DATE: 6/22/2018 9460 SW Tigard St, Suite 101 Tigard, OR 97223 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt#: 412293 Case#: PLM2017-00321 Date: 8/11/2017 Address/Parcel: 16060 SW 85th Pay Method: CreditCard Project Name: Clean Water Services - O&M EXPLANATION: Permit created at wrong address in error by permit technician. Refund 100%of permit fees. :11.o.)s� » ���'I ,� -din' 4;'4544.4.3.,;,:. 4 £ '" t r t A °,. z gf0$mi ai e Plumbing Permit Fee 230-0000-43101 $312.74 12%State Surcharge 100-0000-24001 37.53 TOTAL REFUND: $350.27 APPROVALS: SIGNAT S/DATE: If under$5,000 Professional Staff If under$12,500 Division Manager If under$25,500 Department Manager If under$50,000 City Manager If over$50,000 Local +Contract Review Board . ,. ::'4-1'::". ' `FOS, jr' E r�,.4i�i'.� F .�.ITPts zia-t� T h43 k�'"' it .�; Case Refund Processed: Date: r 3/tee,�t y By: - Y yY ,"�..:,«k5�'� ' c 7 I:\Building\Refunds\RefundRequest.doc x 09/01/2010