Permit CITY OF TIGARD PLUMBING PERMIT
` COMMUNITY DEVELOPMENT Permit #: PLM2011 -00327
Date Issued: 11/01/2011
:TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718,2439 parcel: 1 S1356D00100
Jurisdiction: Tigard
Site address: 9600 SW OAK ST 330
Project: Parsons Subdivision: ASHBROOK FARM Lot: PTS 5 &
Project Description: Interior plumbing: Relocating breakroom sink
Contractor: JAMES ROOD PLUMBING INC Owner: SUN LIFE ASSURANCE CO OF CANADA
880 NE 25TH AVE, STE 2, PMB #129 BY NORRIS BEGGS & SIMPSON
HILLSBORO, OR 97124 121 SW MORRISON ST #200
PORTLAND, OR 97204
PHONE 503 - 648 -3907 PHONE.
FAX 503 - 681 -2196
FEES
Quantity Description Date Amount
1 ea Sink 11/01/2011 $25 02
Specifics: 1 12% State Surcharge - 11/01/2011 $8.70
Plumbing
Type of Use:
47 ea Minimum Fee Adjustment - 11/01/2011 $47.48
Class of Work: Plumbing
1 ea Fixture /Sewer Cap 11/01/2011 $25.02
Type of Const:
Occupancy Grp:
Stories:
Total $106 22
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: / ///J�
/ t
40. _
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.
FROM : JAMES ROOD PLUMBING FAX NO. : 503 6483907 Nov. 01 2011 08: 47AM P1
Plumbine Permit Application
. . •
. .
Building Fixtures
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1,1( . i. k $1
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- ' ' ' City of Tigard -.$, 4 1: s '
iteuived . i -,11M1111.1.111
13125 SW all Blvd , Tigard, OR 972 1
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P 1318 : 63 R:v 121 SiMilirialffil
I Phone: 503 2439 other Permit No : i t , h --
' 718, Fa x: 503. 'I,!' ', t N dc) Dr/By ,_._.
Inspection Linc: 503,639.4175
cs,,, ( ..,:i?s.V . :Adlate Ready/By, torts Ef See Page Z for
T I- A I P Internet: www,tigarci-orgov \.11,.\\ ..i ,i,,."-',....\\"7: Notifted/Method ... 7 Supplemental Information
,,"'*;,..,, " •., , ,, Ili__ rrE,-,oF NIT•: .... c . R.K 6
”FEE*„'SeiltDElLE ' ,,, :' ,' , •,,.....,„, , ,:1!.,-,
For sLeeial infornuilion us k checklist
0 New construction 0 Democit/p -
— Descri .tion • . Ea, Total
ttl Addition/alteration/replacement 0 Othcr'' New 1- 2-family dwellings (includes 100 ft for each utility uonnection)
SFR (1) bath 312.70
" . ,. .
0 1- and 2-famdly dwelling it Commercial/industial SFR (2) bath 437.78
_
SFR (3) bath 500.32
D Accessory building 0 Multi-ftunily ._
— Each additional bath/kitchen 25,02
0 Master builder 0 Other: Fire sprinkler (__ sq- ft ) Page 2
_ .
C93,::$;KEt e:,' .,TION LOCATION ", ' ' , , ; , Site utilities:
, Catch basin or area drain 18.76
Job site address: 76, c 5 f. „) ; ,- .)c ,„ . ;.-,,-
Drywall, leach line, or trench drain 18.76
City/Statc/ZW: 7T,,crco-c„1 C, Footing drain (no. linear ft,: __) Page 2
—
Suite/bldg:/apt. no.: *0 I Project name: PcK)i 'TX manufactured borne utilities 50.03
Cross street/directions to job site: pj ct,e.a.. W T3 Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no, linear ft.: _) Page 2
Storm sewer (no. linear 11.: •__) Page 2
Water service (no. linear ft : _.) Pagc 2
Subdivision: Lot no.: Fixture or Item:
- .
Tax map/parcol -
Baclorlow preventer 31.27
no.:
• Backwater valve 12.51
4' ., ' .,.: . -.' : , ','' ' ;.• • '. ..' ' • '' ' .' ' '''
Clothes washer 25 02
bee/Ora-re, ibie ..c Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25,02
—
p Ev-sic. wrik 12_51
sTi) ,::: :‘,,,,,,,,-
Fixture/sewer utp i 25.02
Name:
- Floor drain/floor sink/hub 25.02 -
Address:
. Garbage disposal 25,02
City/StatcJZIP:
Hose bib 25.02
Phone: ( ) Fax ( ) Ice maker
P ,-,!':,, s ,.-, Q, 9D.I.gg Intcrc trap 25.02
Busin&-ss name: Medical gas (value: $ _ ) 'Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 12.51
AddMs:
Sink/basin/lavatory 1 25.02
City/State/ZIP: Solar units (potable water) III 62,54
Phone: ( ) Fax: : ( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02 Mil
Water cloact II 25 02
P"2/-4Ift.it ;..C. 9R
Watrbeater 37.52
Business name; i ie pit4,; .7.7"
, Winer piping/DWV 56_29
' ad.
Address: sl me, c ;..9 at ,„ s -,.., 1 2. p pi ig 'A' /.22, • Other, 25,02
City/Statc/ZEP: Sabbot, 01r c 121y Subtotal QS pa_
—,
_ Minimum pcimit fee: 872.50 -7
_
Phone: ( 563 ) Aig-36 Fax: (5 t,3 ) - c 2.194
CC1=1 Lic.: ran ' ,, /1_ Plumbing Lic. no.: re 55, 7 t — 7, Plan review (25% of pornait fee)
4
Authorized State surcharge (12% a permit ice) , 7o
signatti — -
TOTAL PERMIT FEE 8 1, a,c)
Print name: 5/ Date: j , 41 This peniat application alpint'
e; ill permit is not obtain h
obtained within IN days
after it has been accepted as complete.
'TAP anorkevIntr,aau art ha Tei.Onlirow lailnAmP Tnrinstrw qPrvirr rtnuni
FROM : JAMES ROOD PLUMBING FAX NO. : 503 6483907 Nov. 01 2011 08:48RM P2
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su • ression 5 steins:
.; t0' tit�'es, 1,.• , Qty, t:ee'(ca) Total Sgeiare.FOOtagc.., - . il' F
Footing drain - I" 100' ' 50.03 0 to 2,000 5121,90 �
Footing drain -each additional 100' 37.52 2,001 to 3.600 $169.69 mm -�
3,601 to 7,200 5233.20
Sewer 1st 100' 62.54 7,2o] and grr atcr . $32254
Sewer - each additional 100' 37.52 -
Water Service 1st 100' 62.54
i o additional waters 1 1 Medical Gas Systems:
cry sc - ca h add z r$ Q0' ' 37.52
Storm & Rain - Drain -1st 100' 62.54 "- Vid t tied:. • '' P, tnia(; C,:1,' M „ '' ,.1 : , - '3', ^'r x
$1,00 to $5,000.00 Minimum fee 572.50
Storm & Rain 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
' i QtYr t •(ca) 3 o al each additional $100.00 or fraction thereof, to
•1 _ ' . ligl „ , ,q, Sic,,{ - t� eiss , ; .., and including $14 •
Inspection of existing plumbing or for $10,001.00 to $25,000.00 $14R.50 for the first $10,000,00 and $I.54 for
which no fee is specifically indicated 90.00/hr each additional $100.00 or fraction thereof to
(minimum charge -1 /2 hour) , including $25,000-00 -
Inspections outside of normal business 90. DO/hr $25,001,00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
hours (minimum charge - 2 hours) _,•_- _ each additional $100 00 or fraction thereof, to
Rcinspeetion Fees 90,00/hr and including $50,000-00 -
- Additional plan review for revisions 90.00/hr $50,001.00 and up $722.40 for the first $50,000.00 and $1.20 for
(minimum charge 1/2 hour each additional $100,00 or fraction thereof.
Subtotal;
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? if "yes ",
nleace indicAte work nertormed by fixture. Failure to
accurate report fixtures could result in increased sewer fees *.
,
a. n.' a , cr . r
FI>rt trG 1 ::; o '; iteplacel :':. 1 14= fSS ?'ft17� ,_... a:a'e''' 'a
'ottkl`'P- +ref -.' :, c$trp�' , A adts(' ,,2ielocate Plan review is required for arty of the following,
Baptistry/Font Please check all that apply.
Bath _ -Tub/Shower 1:1 Any aew commercial building with water service 2" and
- jacuni/Whirlpoot greater, except systems designed and stamped by licensed ,
Car Wash -Each Stall - engineer.
-Drive -Drive flint ❑ New exterior plumbing site utilities for any complex structure
Cus.idor/Waier As.irator — as defined in 0.4129I8- 780.0040,
Dishwasher - Commercial WWII ❑ Medical gas and vacuum systems for health care facilities.
- Domestic CI Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex Structure as defined in 0AI2918 -780 -0040,
Eye Wash
Floor Drain/sink - 2" Submit 2 sets of plans with any of the above.
-3" .
- 4"
Car wash Drain SO,I o ', ), e , _,a,.,
Garbage Domestio -food — 0 Isometric or riser diagram is required for new buildings
Disposal - Domcstio-food related �""' that meet the qualifications above,
- Commercial -food related -
- Industrial -food related
Ice MachJRefrig, Drains --
oil Separator (Gas Station) - - Comments regarding fixture work:
Rec. Vehicle Dump Station j
.
Shower .fig Fc? lC,P��ry ( 11 ) bvA:. ' ;- trww.,, x. .' o =C
-Stall
Sink/Lav - Non -food related _ 1
- Bradley
- Commercial -food related
-
- Service
• _Swimmer Pool 1�ilter �- "
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 fees assessed for the sewer increase must be paid before the
Urinal
" Other Fixtures. plumbing permit can be issued.