Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2010 -00300
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/14/2010
Parcel: 1S135BC00700
Jurisdiction: Tigard
Site address: 10795 SW CASCADE AVE
Subdivision: Lot: 0
Project: Spec Space
Project Description: Capping (18) fixtures.
Owner: FEES
ARDEN REALTY Quantity Description Date Amount
4510 EXECUTIVE DRIVE, SUITE 220
SAN DIEGO, CA 92121 18 ea Fixture /Sewer Cap 09/14/2010 $450.36
PHONE: 858 521 -4218 1 12% State Surcharge - 09/14/2010 $54.04
Plumbing
Contractor:
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 $504.40
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 503.246.6.! I ; �; 2.2344.
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 Sep. 13 2010 12:15PM P1
Plumbina Permit Apeication 5I ` . to
Building Fixtures RECEIVED i:t >li.c)1 FIC F USE ONLY
•
mut No.: �j /y�1-jt rf• dt
City of Tigard Ikue:/Oy: I Received et f v.fjJl_ Ik 44:2 00
n 13125 SW Hull Blvd., Tigard, r `�} Plun -Review Other Permit No.:
m Phone: 503.639.4 171 Fax: 5 C598.1 2010 Date illy V4O W - o0I �+ `
Inspect Line: 503.639.4175 ilea Ready /1)y nt7L�:d�.�_ [� See Page 2 for
f I G ? RD Internet: www.ligard.ur. �� O TIGARD Notified/Method: J ,J S upplemental Information
vPBLtL NG DIVISION .. FM" SCHEDULE
�1)emolition For speeid informaliion use checklist
❑ New construction
Description 1 Qty. I I 1 Tntal
❑ Addition/altcration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
SFR (2) bath 437.78
❑ 1- and 2- family dwelling VI Commercial/industrial SFR (3) bath 500.32
❑ Accessory building 0 Multi - family Each additional bath /kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft) Page 2 1
JOB SITE INFORMATION AND LOCATION Site utilities: .
Catch basin or area drain 18.76 IIM
lob site address_ 1 D 1 5 S e.1 Cell C et eta $r...tea /00 Drywall, leach line, or ucnch drain 18.76
Cityl3tateILIP . ? t>?! Footing drain (no. linear 1L: _.,) Page 2
Suite bldgJapt. no.: r '" Project name: C„ 50.03
Manufatxttred home trtilities
Cross street/directions to job site: - Manholes 18,76
Rain drain connector 18,76
Sanitary sewer (no. linear 11.: ) Page 2
Storm sewer (no. linear R: ) _ Page 2
Water service (no. linear fl.: _ Page 2
Subdivision: tot no.: Fixture or item:
Tax map /parcel no.: Backflow pry/toter 31.27
Backwater valve 12.51
DESCRfPT1ON OF WORK
r Clothes washer 25.02
` tt! f t� ' 1, .G;til 'S' � Y'I`La,l, --ei -. Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER ❑ TENANT Expansion tank 1251
Fixture/sewer cap i izt 25.02 a I.
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
0 APPI.IC:ANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (values $ ) Page 2
• Primer 12.51
Contact name: •
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/Statr/7..IP: Solar units (potable water) 62.54
Phone: ( ) Fax:: ( ) Tub /shower /shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
es 7 Watcr heater 37.52
CONTRACTOR
Business name: \ !cC yvte .s J fi i it nsz., Water piping/DWV 56.29
Address: . e S atm &Etta a eme rt .24 Other. • . 25.02
City/State/LiP: c, [ �(S'r
4.'. t S
Phone: ( 4�c�� ' �` •
Subtotal /
�h �?) -.4 17 - � Fax: f •r , Minimum permit fee: $72.50
M � . �',�r rt�.� (,CVO) feet`.- -�,: � '�'t�
CCB Lic.: .' `7' 1 Plumbing Lic. no.: 96 5 Plan review (25% of permit fee)
State surcharge (12% of permit fee) , 0 I
Authorized signature: �; le.., ^ �,v,: TOTAL PERMIT FEE 5 y
Pried mono; .0 i 1 Date: = n y ,a Th permit a pplication expire if a permit ix not obtained within lab day r
?,- ' �•. E after it has been accepted as complete:
BLS... nwr..a.an.w ... hv T.:J'n..M,. R.41,4;... t..A..ti... Cr. -.:r. IL.ar.l
J a PAP S
FROM : JAMES ROOD PLUMBING FAX NO. : 503 6483907 Sep. 13 2010 12:15PM P2
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee:__ .. _,
Footing drain -1' 1 W' 50 0 ut 2,000 $1 21.90 -
Pooling drain - each additional 100' 37.52 2.001 to 3,600 $169.69
3,601 to 7,200 _ $233.20
Sewer - 1st 100' 62.54 7201 and greater 5327.54 - -
Sewer - each additional 100' 37.52
Water Service - lst 100' 62.54 M edical Gas Systems:
Water Service - each additional 100' 37.52 Valuation: Permit Fee:.
Storm & Rain Drain - 1st 100' 62.54 $1.00 to 55,000.00 Minimum fee $72.50
Storm at Ram 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
Q ty. Fee (ea) Total each additional 5100.00 or fraction ther'cof, to
B
Other Inspections or Fees and including $10,000.00.
Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 for the first 810,000.00 and 51.54 for
which no fee is apacifically indicated 90.00/hr
each additional $100,00 or fraction thcrea to
(minimum charge - • 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 first S25,000.00 and $1.45 for
hours (minimum charge - 2 hours) each additional $100.00 or fraction thereof, to
Reinspection Fccs 90.00/hr and including $50.000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first 550,000.00 and $1,20 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 ", .. ' Plan Review for. P g Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following_
accurately report fixtures could result in increased sewer fees *. Please check all that apply.
Quantity by (Fixture) Work.Pcrformed ❑ Any new commercial building with water service 2" and
Fixture Type: Replace greater, except systems decd and stamped by licensed
• Previous Capped Added Eiisling
Baptistry/Font
Bath -rub /Shower ❑ New exterior plumbing site utilities for any complex structure
Jacum/Whirlpooi - as defined in OAR91 8-780 -0040.
Car Wash - Each Stall ❑ Medical gas and vacuum systems for health care facilities.
• tAivc That ❑ Any multipurpose fire sprinkler system
Cuspidoi/Water Aspirator ❑ Any complex stricture as defined in OAR918. 780-0040.
Dishwasher -Commercial i
-Domestic ( Submit 2 sets of plans with any of the above.
Drinking Fountain
-
Eye Wash ' 'Isometric or Riser Diagram..
Floor Draintsink - 2" 3 Isometric or riser diagram is required for new buildings
- - 4" _ that meet the qualifications above.
Car Wash Drain
Garbage - Domestic
Disposal - Commercial
- industrial Comments regarding fixture work: •
Ice MachJRefrig. f)raio
Ott Separator (Gas Station) '
Roc, Vehicle Dump S ration
Shower -Gang '
-Stall
Sink - Bar/Lavatory 6
- Bradley
- 00n1II1rc1al *Note: if the fixture work under this permit results in an
_ -Service increase of sewer )EDUs permit Pool Fillet , a sewer ermit will be issued and
Washer - Clothes fees assessed for the sewer increase must be paid before the
War cctor plumbing permit can be issued.
Water Closet - Toilet f
Urinal l
Other Fixtures:
•
Accumulative Sewer Tally Parcel # 1S135BC00700
Tenant Name: SPEC SPACE This SWR# NONE
Site Address: 10795 SW CASCADE This PLM# PLM2010 - 00300
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 1 2 0 -1 -2
Drinking Fountain 1 0 2 2 0 -2 -2
I?yc Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 • 3 6 0 -3 -6
- 3 inch 5 0 0 0 0 0
- 4 inch 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 HP) 32 0 0 0 0 0
- Industrial (over 5 L -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 1 2 0 -1 -2
Sink - Bar /Lavatory 2 0 6 12 0 -6 -12
- 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 4 24 0 -4 -24
Urinal 6 0 1 6 0 -1 -6
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 18 54 0 0 -18 -54
Current Fixture Value -54 divided by 16 = -3.4 Current EDU 1 EDU = $ 4,100
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -54 divided by 16 = -3.4 over (under) $ (13,940.00)
Enter EDU Change Here -3.4
Notes: ** *CREDIT * **
Authorized Name /Signature: BRANDENTAGGAR'I' Date: 9/14/2010
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.
1: \ Building \Sewer Tally \Sewer l'allyShcet- 3600.xls 06/25/08
Accumulative Sewer Tally Parcel # 1S135BC00700
Tenant Name: SPEC SPACE This SWR# NONE
Site Address: 10795 S \V CASCADE 'This PI.M# PLM2010 - 00300
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
Baptistry/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 1 2 0 -1 -2
Drinking Fountain 1 0 2 2 0 -2 -2
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 3 6 0 -3 -6
- 3 inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash Drn 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 I -IP) 16 0 0 0 0 0
- Commercial (to 5 I -IP) 32 0 0 0 0 0
- Industrial (over 5 I -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 1 2 0 -1 -2
Sink - Bar /Lavatory 2 0 6 12 0 -6 -12
- 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 4 24 0 -4 -24
Urinal 6 0 1 6 0 -1 -6
Previous EDU Count 0 0
Capped EDU Credit 0
'TOTALS _ 0 0 18 54 0 0 -18 -54
Current Fixture Value -54 divided by 16 = -3.4 Current EDU 1 EDU = S 4,100
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -54 divided by 16 = -3.4 over (under) $ (13,940.00)
Enter EDU Change Here -3.4
Notes: ** *CREDIT * **
Authorized Name /Signature: BRANDEN TAGGART Date: 9/14/2010
Building Division
Note: The property owner shall retain the ORIGINAL sewer tally record. 1 f 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.
1: \Building \Sewer Tally \Sewer TallyShcet- 3600.xls 06/25/08