Permit (3) CITY OF TIGARD PLUMBING PERMIT
.74
COMMUNITY DEVELOPMENT Permit# PLM2010 -00338
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/20/2010
Parcel: 2S101 BB01400
Jurisdiction: TIGARD
Site address: 12060 SW GARDEN PL, BLDG# 5
Subdivision: PARK 217 Lot: 0
Project: Expressions Printing
Project Description: Interior plumbing: Capping (1) sink.
Owner: FEES
GVA KIDDER MATHEWS Quantity Description Date Amount
ONE COLUMBIA STREET SUITE 950
PORTLAND, OR 97258 1 ea Fixture /Sewer Cap 10/20/2010 $25.02
PHONE: 503 221 -9900 1 12% State Surcharge - 10/20/2010 $8.70
Plumbing
47 ea Minimum Fee Adjustment - 10/20/2010 $47.48
Contractor: Plumbing
JAMES ROOD PLUMBING INC
880 NE 25TH AVE, STE 2, PMB #129
HILLSBORO, OR 97124
PHONE: 503 - 648 -3907
FAX: 503 - 681 -2196
Type of Use: COM
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 Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. ti
i c r
Issued By: Permittee Signature: -
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
FROM : JAMES ROOD PLUMBING FAX NO. : 503 6483907 Oct 19 2010 10:08AM P1
4 r ) ' 4 i)
Plumbing Permit Application
. H I 4 A
Building Fixtures eb 41- 1(w (,1.1( L. i SI 0\1 1
- \ \
City of Tigard 'RP ' • 0 / 7 M.
permit No.: plink ic) - 01
1 Phone; 503.639.4171 Fax: 503.598.1960
‘11. 'N.
13125 SW Hall Blvd., Tigard, OR 97223 o i . 4i111 ■ pat eni Review Other Permit No.! tp i i -0.2.2o
'Inspection Line: 503.639.4175 C t %' 1 Date Resdy/By: 01 see Page 2 for
1 1 ti ,\ Kt) intancr www.tigard.or.gov ‘S' Noed/Meaux,: FArig Supplemental laformatioo
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,, , , .. , _ ■ : ,: ,:,' : 1...,1! :,...: :: 1:.... '.. t.::, :.'. 4,:.‘.:4.,:,::?•.10:*:idkask0u,wVAT:;',.-'0., e; :i,r.f.%.',7.?:..:.,.,:.
=-.-4 . -,.,.. .. ...- •
For spacial infamterflon use checklist
ID New construction in Dmnolition
Description _ 4 . Ea. Total
0 Addition/alteration/replacement 0 Other. New 1- 2 dwellings (includes 100 ft. for each utility connection)
, • . • .. ,... •• w• ...• • . ,• .. -, '• n.:,. :.:::.!--:::::: ' :1 SFR (1) bath 312.70
gii44.rr".Y#"gl40.1,*Jg***19910. °` . CAPgt::::::':J. '.(,:.;;,.:;',.... --, _ iiil (2) bath
111.11 437.78
El 1- and 2-family dwelling Fr Corrunercial/industrial
, SFR (3) bath 500.32
CI ACcessory building D Multi-family
Each additional batik/kitchen III. 25.02
1:1 Master builder .,
0 Other: Fire sprinkler (____ sq. ft) Page 2
m
' - * I44ii builder . 'fAi.iii7iteiiii614-.;;;W::-:4W site u tiliti es;
- 4. 1 ,010 - gitaktP§ogi,,,,,,,,, , ---.-.---------‘.------ - Catch basin or area drain 18.76 MO
Job -
site address: 1 2_040 sw 6c-velx,A- el- .... Drywc11, leach line, or trench drain 18.76
City/State/Z1P: -r; _ , . • I,-- . - Footing drain (no. linear ft.: .......J Pagc 11111111
Suite/bldgJapt. no.: ot 5 Project mune: e, i r3 ; „, ; Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Kant drain camector 18.76
Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no. linear ft.: _.) Page 2
Water service (no. linear ft.: ___) 1 Page 2
Subdivision: Lot no.: Fixtum or item: ,
Tax map/parcel no.: Backflow preventcr 31.27
WOR 12.51
•A" '''•:: : !::‘ 5'..' ::
i• , 4 - .-, ••••,,‘: • -,,,-- ••%•• !••'• • ' ''•••••'' -"''''' ' • • ' ' ' :". Clothes washer 25.02
r.
£ 1. /at. Dishwasher 25,02
thinking fountain 25.02
Ejectors/sump 25.02 £xpanszon tank 12.51
, ::,.k ....., •:.'..;1= .. ..,.1.. ,. -'
Name: Fi .
xturcisewer alp / 25.02
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
(:),t <ii*thyi
ts 6 1 4,: .. ,:,::? intaccptow blip 25
s'%'.: '.'• : ' '''' '-:::. .02
usiness name: .--a
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 units (potable water) 62.54
Phone: ( ) Fax: : ( ) , Tub/shower/shower pan 12.51
.
E-mail: Urinal 25.02
..„ ..• . ; Water closet 25.02
. ; . 4•g:g ; t : 7 3 4kii .; ; :: ikZ;gi . :S . ; ; i :; 0000t1.* -. . :::.: !, ::::-;: ,•'::•:,.:',:. ........,• ;.. war= hcatcr
37.52
Business mule: 4c )14 , i a,, ph,,...4,24,,4. ...i...c Water piping/DWV 5629
Address: ppo 'le zri afr Sk.zt 1: Plve # k+)"? Other 25.02
City/State/ZIP: 1 PI. Subtotal
...
Phone: ( y(>3 ) &cep- 2%) Fax: (S ) 1a/-214%),4: Minimum permit fcc: $72.50 7).
Plan review (25% of permit fee)
CCB 1..ic.: / ,.).,_") 0 i 4 Plumbing Lic. no.: 1243 SS5
State surcharge (12% of permit fee) jr. 7c)
Authorized signature: ..,. • - -:"....„..„„voteL,Z-;,_t_ TOTAL PERMIT FEE 81 )--0
Date: / o if - t - i v i 1 This permit application expires if a permit b not obtained within 180 days
PI -- mune: t : ",/ •t/...:14.1. ./
after it has be accepted as complete.
....thetrInInent c* hv Tri-rnmov Thvilelh, a Intim:Iry P.Arvirv. Pro ni
FROM : JAMES ROOD PLUMBING FAX NO. : 503 6483907 Oct. 19 2010 10:08RM P2
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residen Supp ression Systems:
Site Utilities . Qt Fee (e a) Total Square Footage: Permit Fee:
Footing drain • 1" 100' 50.03 0 to 2,000 5121.90
Footing drain - each additional 100' 37.52 - 2,001 to 3,600 .69
3,601 to 7.200 $233 $233.20 T
Sewer - 1st 100' 62.54 7,201 and greater 5327.54
Sewer - each additional 100' 37.52
Water Service - 1st 100' 62.54 Medical Gas stems:
Water Service - each additional 100' 37.52 Valuation: Permit Fee:
Storm & Rain Drain -1st 100' 62.54 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 37,52 • 55,001.00 to 510,000.00 J $72.50 for the first $5,000.00 and $1.52 for
Other Inspections or Fees qt Fee (ea) Total - a including h additional 5100,00 r fraction thereof to
Inspection of existing plumbing or for $10,001.00 to 525,000.00 5148.50 for the first 510,000.00 and $1.54 for
which no fcc is specifically indicated 90.00/hr each additional 5100.00 or fraction thereof to
(minimum charge - l2 hour) and including $25,000.00.
Inspections outside of normal business 90.00/hr 525,001.00 to 550,000.00 5379.50 for the first $25,000.00 and 51.45 for
hours (minimum charge - 2 hours) each additional 5100.00 or fraction thereof to
' Reinspection Fccs 90.00/hr and inaludin _ 550.000.00.
Additional plan review for revisions 90.00/hr 550,001.00 and up 5742.00 for the first 550,000.00 and 51.20 for
1minimum charms 1 2 ho ur) i each additional 5100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes ", Plan Review for Plumbing Installations
please indicate work performed by fixture. Failure to plan review is required for any ofthc following.
accurately report fixtures could result in increased sewer fees * . Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixture Type: Replace greater, except systcms designed and stamped by licensed
Previous Capped Added Existing engineer.
Baptistry/Font
Bath - Tub /Shower 0 New exterior plumbing site utilities for any complex structure
as defined in UAR918- 780 -0040.
-Jacuzzi/Whirlpool
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive Tall ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash Isometric or Riser Diagram
Floor Drain/sink - 2" 0 Isometric or riser diagram is required for new buildings
3» that meet the qualifications above.
-4"
Car Wash Drain
Garbage - Domestic
Disposal -Commercial al Comments regarding fixture work:
Ice MachiRefrig. Drams
Oil Separ ( Gas Station
/tee, Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar /i..avatory 1
-Bradley •
-Commcrcial *Note: If the fixture work under this permit results in an
Seri1Cr increase of sewer EDUs, a sewer permit will be issued and
Swimming, Pool Filter f a ssessed f or the sewer increase must be aid before the
wa.4her - ctowK, P
Water Extractor plumbing permit can be issued.
Water Closet - Toils
Urinal
Other Fixtures: ,
Accumulative Sewer Tally Parcel # 2S101 BB01400
Tenant Name: EXPRESSIONS PRINTING This SWR#
Site Address: 12060 SW GARDEN PL BLDG 5 'This PLM# PLM2010 - 00338
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off #s count # value #s 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 - Each 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
-4inch 6 0 0 0 0 0
- Car Wash Drn 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 - Bar /Lavatory 2 0 1 2 0 -1 -2
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 0 0 0
- Service 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
"TOTALS 0 0 1 2 0 0 -1 -2
Current Fixture Value -2 divided by 16 = -0.1 Current EDU 1 EDU = $ 4,100
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -2 divided by 16 = -0.1 over (under) $ (410.00)
Enter EDU Change Here -0.1
Notes: * * *CREDI"1'* **
Authorized Name /Signature: BRANDEN TAGGART X2449 Date: 10/20/2010
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 1'allyShcct- 3600.xls 06 /25/08
Accumulative Sewer Tally Parcel # 2S1018601400
Tenant Name: EXPRESSIONS PRINTING (REVISED) This SWR# N/A
Site Address: 12060 SW GARDEN PL BLDG 5 This PLM# PLM2010 - 00338
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off #s count # value #s 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 - Each 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
- 4inch 6 0 0 0 0 0
- Car Wash Drn 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 IIP) 16 0 0 0 0 0
- Commercial (to 5 HP) 32 0 0 0 0 0
- Industrial (over 5 HP) 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
Rcc. 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 - Bar /Lavatory 2 0 1 2 0 -1 -2
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 0 0 0
- Service 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
TOTALS 0 0 1 2 0 0 -1 -2
Current Fixture Value -2 divided by 16 = -0.1 Current EDU 1 EDU = $ 4,100
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -2 divided by 16 = -0.1 over (under) $ (410.00)
Enter EDU Change Here -0.1
Notes: * * *CREDTI' * ** CREDIT APPLIED TO PERMIT SWR2011 -00157 IN FULL. NO ADDITIONAL CREDITS AVAILABLE AS OF
11/17/2011.
Authorized Name /Signature: BRANDEN TAGGART X2449 Date: 10/20/2010
Building Division
IN 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 I'allySheet- 3600.xls 06/25/08