Permit CITY OF TIGARD I PLUMBING PERMIT
COMMUNITY DEVELOPMENT . Permit #: PLM2012 00223
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/07/2012
Parcel: 25101 BD00103
Jurisdiction: Tigard
Site address: 7835 SW HUNZIKER RD
Project: Madison Furniture Subdivision: 1994 -025 PARTITION PLAT Lot: 2
Project Description: Cap (1) toilet, (1) lay, (1) urinal & (1) floor drain. Add (1) breakroom sink. 8/8/12, reprinted to correct address from
7805 SW Hunziker to 7835 SW Hunziker.
Contractor: JAMES ROOD PLUMBING INC Owner: H G M CO •
125 S 1ST AVE #542 BY NORRIS BEGGS & SIMPSON
HILLSBORO, OR 97123 ATTN: BLAKE HERING
121 SW MORRISON #200
PORTLAND, OR 97204
PHONE: 503 - 648 -3907 PHONE:
FAX: 503 - 681 -2196
FEES
Quantity Description Date Amount
4 ea Fixture /Sewer Cap 08/07/2012 $100.08
Specifics: 1 ea Sink 08/07/2012 $25.02
1 12% State Surcharge - 08/07/2012 $15.01
Type of Use: COM Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total . $140.11
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 Notifi . enter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
Or direc • uestions to • _ NC b calling 503.232.1987 or 1.800.332.2344.
Issu d By: i / / Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available ins , : ion date.
This permit card shall be kept in a conspicuous place on the job sit= until completion of the project.
Approved plans are required on the job site at the time of each inspection.
•
•
! V CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00223
T [GA.RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/07/2012
Parcel: 2S 101 BD00103
Jurisdiction: Tigard
Site address: 7805 SW HUNZIKER RD
Project: Madison Furniture Subdivision: 1994 -025 PARTITION PLAT Lot: 2
Project Description: Cap (1) toilet, (1) lay, (1) urinal & (1) floor drain. Add (1) breakroom sink.
Contractor: JAMES ROOD PLUMBING INC Owner: H G M CO
125 S 1ST AVE #542 BY NORRIS BEGGS & SIMPSON
HILLSBORO, OR 97123 ATTN: BLAKE HERING
121 SW MORRISON #200
PORTLAND, OR 97204
PHONE: 503 - 648 -3907 PHONE:
FAX: 503 - 681 -2196
FEES
Quantity Description Date Amount
4 ea Fixture /Sewer Cap 08/07/2012 $100.08
Specifics: 1 ea Sink 08/07/2012 $25.02
• 1 12% State Surcharge - 08/07/2012 $15.01
Type of Use: COM Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
•
Total $140.11
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
issuan : , .r i wo - • . suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Uti' Notification Center. hose rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
direct questi ns to OUNC b - ing . !''.232.1987 or 1.800.332.2344.
Issued By: /1 A1A n 4D Permittee ignature:
/
Call 503.639.4175 by 7:00 a.m. for the next available inspection date. L/
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 Ann ilea
Building Fixtures .
Li) ,..,,i S ..,,,, .
FOR 011'Icr. 1 (
City of Tigard AUG 0 6 2012 ti. arerdnom per„. No.; , i ltiotra-olOAV-3
.74 13125 SW Hall Blvd., Tigard, OR 97223
Fla, Review
' • Phone: 503.718.2439 Fax 503.59t3,969, rsr, i 7 1 (;.: (in° llms/13y: Other Permit No.:
I I i : ■ : 7 , l I) Inspection Line: 503.639.4175 1 i :{ .....,! - 1 , .
ta , .i ,.'" rt ql:11%
Internet: www.tigard-or.gov pti J A., y , ..., .. , Date Ready/By;
NotifieWechod: alriS: El See Page 2 for
Supplancital Won:ndigo
:::::: ::.::-:::-.,',...`e.....q:'::i•.::::::..1:2::::,..:',:l. 3, .f......: g:.:..,..,:::,i .....
0 New eenstmetien CI Demolition For .Mal , , .,,, , n use checklist
st
Description Qty. Ea. Total
F4 Additiou/altea 0 Other: New 1- 2-family dweJlimo(includes 100 ft. for each utility connection)
_ .
: : ':. ';' ; :'..'.. ::'• : . • ; ': 7 : - •••;;..: :' ;':': : ,::: ! . : ". 1• :. : 4.... '-' 4**000:1 . 0.t 0.1 .:•:•:... :!:;';'•'[.:::::';': r ' : ;: : • . ‘ a "..:.:' ' sFR (I) bffili 312.70
El 1- and 2-family dwelling 91 Commorcialfuldustrial SFR (2) bath 437.78
•
. • SFR (3) bath 500.32
0 Accessory building 0 Multi
Enda additional bath/kitchen 25.02
0 Master builder 0 Other: Fire sprinkler (_ sq. It) Page 2
':•::,:,•,:!:::: • /if ,::#6*, ANii 10410N. :,1 .: .: Site utilities: _
Catch basin or area drain 18.76
Job Site address: , ., S ij n e.L.4 * i
• Drywell, leach line, or trench drain 18.76
City/State/ZW: - fi lain t 0 1 ,,
Footing drain (no. linear it: . ) Page 2
Suite/bldg/apt, no.: Project name: k , ,_: ._ __, 1 tare Manufactured home utilities 50.03
.. , . ,
Cross atreet/directions to job site: Manholes 18.76
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: 1 Lot no.: Fixture or item:
Tax map/parcel no.: A 5401 7 40 3 Backflow preventer 31.27
•:=:' ;:" :. ' :,•;:•:.... ' .., ..,:.. :::;'..' :.,.'. 6 : :,,!.. ,...,,,,;, .!,... , ,........:...? Backwater valve 12.51
Clothes washer 25.02
['op . aber twt I t- /ttu 1 (tyikr-I 1 Abv etvaik ,
Dishwasher 25.02
A.1-1, bpubobk cloc . Drinking fountain 25.02
Electors/sump 25.02 • 0?
• :'.:?.;.:'::::':',41:1::',115iitimfi..!:;'.::•:':::::-:.:.....;:. Expansion tank 1151 /0 '
Fixture/sewer cap 1 25.02
Name:
Address: ,
Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax: ( ) Ice maker 12.51
. • . . , „ . .. . • , „ . . • • • • . . . • .• , • .
• ,',:•::"..:,:':•••••:•. i'••. ::: El : 40.000E.: .:::::: . ; ':i '''.. :'::: ::, : ;.: f Lr:t 61 4,* . :i '... : Interceptor/grease trap 25.02
i
Business name: Primer Medical gas (value: $ ) . .' Page 2
Contact narne: • Pr 12.51
Roof drain (commercial) ' 12.51
_ ._._ .....-)
Address:
Sink/basin/lavatory I,' • • 25,02 aff,p1.„.
City/State/ZIP: Solar units (potable water) , • . . '62.54
Phone: ( ) Fax: : ( ) Tub/shower/shower pan • . 12.51
E.enail Urinal . 25.02 .
Watercloset :
25.02 •
- Water heater 37.52 .. • . I
Business name: lo ups , 00 te ID / titbit / 0 ; 4c 7:17j.„c
Winer Piping(DWY 56.29
Address: : : _ . " • • Other ' 25.02
_ . -
City/State/ZIP: Habbs kb cor- ? I 2-.1 - . Subtotal 'C
Phone ) 692- r ( 9 Fax: (S t* ) 6 -.- e gi94i . Minimum pemlit fee: $72.50 ' --;--_""
Plan review (25% of pennit fee) -----*
CCB Lic.: • le, 0.1 11 Plumbing Lic, no.: fig 559
State surcharge (12% of permit fee) /5; r9/
Authorized sip: . . iiir .:. ...- • TOTAL PERMIT FEB it/p •
Print name: P .4, Date #
This permit appliendon expire if a permit's ant obtained within 1 days
: . D • r This It bas been accepted as complete.
Ar.. rnmatnrinInnv gm. ins Trirnanintrrhs:leleAo Latin dr.. 'FArlyien lin.irrl
w , .
Plumbing Permit Application - City of Tigard
' Page 2-- Suer Information
Fee Schedule: .
Residential Fire Supp_ression Systems:
_ , . , .
_ .. .
; l'',.... z: , ::"4 . 4f: 1 !: . ! •' :..siiiiiiiie— ......,:::,?::•,.......;...,, .,,,- ,,,,... • ::: : ,.4_,......,..„ . .,
.....,. 004gF .!:'..N? !-I
Footing drain - P 100 50.03 • 0 to 2,000 $121.90 _
. 2,001 to 3.600 $169.69
Footing drain - each additional 100' 37.52
• 3,6or to 7,200 $233.20
Sewer - 1st 100' 62.54 7,201 and =eater
- $377.54 .
Sewer - each additional 100' . 37. ''''. .---. — •
Water Service - 1st 100' 62.54
• Medical Gas Systems:
Water Service - each additional 100' 37.52
.'.. ^,Ton see i
nit,,i:;;
• •• •••_ ... ••• . .••.• .••••••c•
Storm & Rain Drain -.1st 100' 62.54 , $1.00 to $5,000.00 Minimum fee S72.50
Storm & Rain rksin - each additional 100' 37.52 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for
.'.' . ' ' 1Fee en)•:'• ' '', Total ''
thOiljit, , .J.: ,.". '..::: 0 ,!'!'c:. ' .: ;...;(.,-.. i ::- ', :., :' each additional $100.00 or fraction thereog to
end including $10,000.00.
Inspection of existing plumbing or for . $10,001.00 to $25,000.00 $143.50 for. the first $10,000.00,and SL54 for
which no fee is specifically indicated 90.00/hr , each additional $100.00 or frac:lion thereog to
(minimum charge- 1/2 hour) .
and including $25,000.00.
Inspections outside of nomial 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 charge -2 bolas) ' each additional $100.00 or fraction thereof, to
Reinspection Foes 90.00/br and including $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 $120 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",
Opole indicate work overarmed bx fixture. Failure to
accurately report fixtures could result in increased sewer fees°. . -: •
• • - I: : ' - • :'' • • ' ..• korituniybillxIare.rfay.. .:T an ..... q:.0*.:,.i , . . Mg:TM .... ,.,
Pfau review is required for any of the following
' WorklerfOrsued:: - . .. ::. • • • • • .Pikilltett : 444ed : • ,.. *Ideate '
Please check all that apply.
Baptistry/Font •
_
Bath - TIM/Shower El My new commercial building with water service 2" and
- Jacuzzi/Whirlpool greater, except systems designed and stamped by licensed
-
Car Wash -Each Stall engineer,
,
- Drive mm - CI New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918
Dishwasher - Commercial • 0 Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain . 0 My complex structure as defined in OAR918-780-0040.
Eye Wath •
Floor Drain/sink - 2" I Submit 2 sets of plans with any of the above.
- 3"
- 4" , L ; ; :. ':• : ! . ...!..:: ..: initite. , , .. • ,- .03.0 5- 0 1 , 1 0 1 10411 1 .W.:1 . :7 . . 7 : ' ::'?: . ( : .'1 : 27 :7
Car Wash Drain
Garbage - Domestic - non-food 1-1 Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related — that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach/Raffia. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
,
Shower -Gang .
-Stall ,
Sink/Lay -Non-food related 1 1 —
-Bradley
-Cononercial-food related
-Service
Swimming Pool Filter
Washer- - *Note: lithe fixture work under this permit results in an
Water Extractor Increase of sewer EDUs, a sewer permit will be issued and
Water Closet. Toilet ' - I fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
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Other Fixtures: •
Accumulative Sewer Tally
a
Ill p , Tenant Name: Madison Furniture ** *CREDITS * ** SWR # N/A
TI G R Site Address: 3W Hunziker PLM # 2012 -00223
Parcel #: 1 S101 BD00103
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped #s value count added # added value total #s total 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 1 2 0 -1 -2
- 3 inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash 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 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
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:
- Lav /Bar - Non -Food Related 2 0 1 2 1 2 0 0
- Bradley 5 0 0 0 0 0
- Com /Serv/Util - Food Related 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 1 6 0 -1 -6
Urinal 6 0 1 6 0 -1 -6
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 4 16 1 2 -3 -14
Current Fixture Value -14 divided by 16 = -0.875 Current EDU 1 EDU = $4,665.00
Previous Fixture Value 0 divided by 16 = 0.000 Previous EDU
Change -14 divided by 16 = -0.875 over (under) $ (4,105.20)
Enter EDU Change Here -0.880
Notes: ***CREDITS***
Authorized Name /Signature: Debbie Adamski Date: 8/7/2012
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 \SewerTallySheet- 4665.xls 07/01/12
MO
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James Rood Plumbing Inc.
125 S 1Ave#542
Hillsboro, Or. 97123
Office 503-648-3907
Fax 503-661.2196
Email Floodi5aol .com
FAX TRANSMITTAL FORM
To City of Tigard Permits From: Jim
Name: Date Sent:8/6/12
CC:
Phone: Number of Pages: 3
Fax
Permit S. credit app for Madison furniture. Please fax back if possible.
Thanks, Jim
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