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Permit
q CITY OF TIGARD PLUMBING PERMIT : COMMUNITY DEVELOPMENT Permit#: PLM2013 00317 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/12/2013 Parcel: 25101 BB01500 Jurisdiction: Tigard Site address: 12250 SW GARDEN PL, BLDG#1 Project: Northwest Occupational Medicine Subdivision: CROW PARK 217 Lot: 3 Project Description: Cap(3)lays Contractor: JAMES ROOD PLUMBING INC Owner: WALTON CWOR PARK BC 8 LLC 125 S 1ST AVE#542 BY CTMT-WALTON RE TAX HILLSBORO, OR 97123 4678 WORLD PARKWAY CIR ST LOUIS, MO 63134 PHONE: 503-547-0491 PHONE: FAX: 503-547-0492 FEES Quantity Description Date Amount 3 ea Fixture/Sewer Cap 09/12/2013 $75.06 Specifics: 1 12%State Surcharge- 09/12/2013 $9.01 Plumbing Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Stories: Total $84.07 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direc :l es io - • OUNC by calling 503.232.1987 or 1.800.332.2344. Issu=d By: Permittee Signa ure:� Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Plumbin�Permit Application BB � �Building Futures l {';,::; :, ,',c ,.. i ,.'_ ;,•:, , City of Tigard D 9 is /3 , PexmitIsle.: 1e.f4ao/3--103/7 13125 SW Hall Blvd,Tigard,OR 97713 S E P 1 2 2 013 � JJ Plan Phone: 503.7182439 Fax 503.598.1960 /By: w Other Permit No.: _ NQ j Inspection Line: 503.639.4175 CITY OF TIGARD Da c Re /Br. rugs' >a See Page 2 liar t'!t Internet www.ti l °d•7'.3'hb�,•..v: 4 ' H g/M�ad : nVi�DI yC': . ' . Supplemental•AAA Information •: n ,y7^ ' ii f 'eti L i -. 2t,•.sn�, ,v!b .,+.t-•,, y�B Jh..g.tw��°LC i e •.�2 �1' r‘.'°'l iy.w V': `q; .'-•f,;, '•r 7.y . r •�,i « -1 4 tiex��,;5i/ M �1 �n f .F�v.k.�. :� �"_( ntitN lJ.'S ,..". . .• : ..f 0 New construction ©Demolition For'pedal i moor+we ehattklist ` El Addition/alteration/replacement 0 Other: : New 1-2-ihmily dwellings otal llm$s(,inchides 100 ft.for each utility connection) ti .y : ,i:, q :,--.:-.:c.4.,, r e.:r!s-a $;' a:ar; SR(1)bah 312.70 :...::+.k' ,°•S.C'^ r)` ,:,SA.tr9,. '+� ! �„y,tX''�s�''S!R., • ; . .:it4:'t5.,:' ':::.a :;'d `,; 4 G.7, . S.,.:;ei:c. o ::*Vs,�r�., :rv�•;k" O .d�C�t�'l.,:t:ti... ia ;F�iii? r .n.,. �`�' a„ .a•.:c`�!:� :r.yr:157;`-:h7�n;':�;��, . fl 1-and 2-fbmily dwelling 0 Commescialfmdustrial SFR(2)bath 437.78 , SFR 0 y building 0 Multi-family Each ad itio 520.32 Fran adelitioaal bath/kitchen • 25.02 • 0 Masten builder 0 Other 'The sprinkler i-sq.R) Page 2 , .'r',:;D�.i 1: :;r:;1:':,�2:':;..:..;j.'.ti ao.:ctiti.. f,r•.;...k,6 ,; '�:ga47. :�33y`t.;a,: '1 e8'. '::. :v' 7.'':%':'.':-4�j .,,, ,,,.n}�'f 1Q,,, K ✓ .:1• '.JY....!• t,i'...0%.6.%.44',F '/:5:'.1- : ..,'��•�.�r''t':'4:•,.1^E'�..J�. r' :1 3: .l Il M J:. \.�,vn^.� Job site address; /��.5 0 s� /76,1rI2 pi...., Catch basis or area drain 18.76 : _ - i City/State/ZIP: 77 Qy 0 i.--. leach line,linear drain Page 2 U '" a Footing drain(no.linear ft:_) Page 2 Suit bldg apt.no.: i Project name: etared home utilities 50.03 Cross�Vstreet/directions to job site: ND/Lr/•/ &.E',T 5Ce4'R97/u 1' ' Manholes 1576 . H*,,, >e./,J 1- • Rain drain co>mector 1576 ' Sanitary sewer(no.linear ft: Page 2 • Storm sewer(no.linear ft:____,) Page 2 Water service paw linear ft.: ) ' , Page 2 Subdivision: 1 Lot no.: Figure or item FT5Pce10.: (g S/D 4$Q/500 BaclsHow Pte' 31.27 =' ,1.;, , t;; Backwater valve 7. isk.s. �'.:c�:; �,:xSaS'�::�`'=::f1i��A i �.",R;f`:2 Y J)�!t:.,. .1,37',3';�i., `piy•��'€�Z! tt:Lri ,�X '!i9'f�g�.. 12.51 .'. ii: .. ,.hi8E,c t ,l).,.�!.rf 1%y_._....�I u.sre•f .," 34 .,.f'1.i il:tr r'..,z,G.Mfd�i,` C10tl1.eS W8$hCl �' 3 L C V S ,6YJ� 25.02 Drinking fountain _ - 25.02 • . Ejectors/snap 25.02 %.�7..?k.,tAp i 1� 'W;4r" sy� ��"aM1`it!. � M :�`1 EPanalOO teak 1/51 . .,..... .:. ,...i•../ : �� ye , .:f: :,+r t,ra.!i ,:%.. r.. . y.:1'�V.., ..r. : . { ..$i.i V Name: , Fixture/sewer cap 3 25.02 : 51).6 Floor drain/floor siolrntub 25.02 .Address: • Garbage 25.02 City/State/ZIP; , Hose bra 25.02 • Plume:( ) Fax:( • ) Ice maker . ...�.:.i'.�t.:':;.•. 12511 .'i :1 ;:A.� � i�l5Y: :44,.r'�ti I i.4: -e.4{,f ( 5,., V. :;`i: C' inte /Pc^pe/ Y 255.02 Bneinrce name. Medical gas(value:$ ) • Page 2 • Contact name: Primer 12.51 Roof drain(commercial) 12.51 Address: gory 25.02 City/State/ZIP: • : Solar units(potable water) I 62.54 Phone:( ) I Fax.:( ' ) . Tub/showei'/sboaer pan 12.51 E-mail,: ' Urinal 25.02 .w.?:.;;..,:.4,...q-,;,,;;:,.:-:,'r,s ,: -ad- 5`3n" ,�. t f :;;::i' M:iii N4,§'C:. ;'rte;,_ r:,. Water el oset • 25.02 �. ;: •. c,"r- .g.:r^.`.s 1.r..t .f�.•,��.:: z.tk:.^q, k.,•?. "1"'.A.wM 3752 Business name: V a1 {S l Ph ,.l_i ti -z-hoc., , w a pipiog/D wv 56.29 „4 V / A.ddress: ) S. )A`" 1194.-, �' 2,... Other: 25.02 . 1 City/StateJZIP: /" ��l1J,.Oho O $ 114 Subtotal "s,04 Phone:(Jr`aj) W?--0 vet/ FaX (So)) 3-97-o V9 7.-1 1,rmimom Punt fee: $72.50 _ CCB Lie.: f S''D--'70) Plumbing Lic.no.: .pg 5f'1 Plan review (25%of permit fee) Authorized si State smcha (12% permit fee) 4 9 ,O f ■ TOTAL PERMIT FEE F5e,,O Print name: £/i4 , /�4�a te? Da 9/2 4 p aPP�allm+eviles tea permit to not obt fined within 180 days f after ft has beet accepted as compism +Am moo.cvinino..¢M 1w Tl:l`.uwn o.:oe.Tevi.tetra.G,..irw 1lna,�i ii, 4.0 1 , 4.rf't.1-- * C •54° Plumbing Permit Application - City of Tigard Page 2 -Supplemental Information Fee Schedule: Residential Fire Su+ +ression Systems: '.+ ;t .,-,..x:::".-•cutx r 1;4.,1d•e,. xy ,t7 i,an,iwsi' F s ,.,tx,- :II:d;. +' "f�Y1n� Rc x.:, ; � - yi ,. -a: n �14.:{ ?e7+i oh".i...-•i,.-'t.-7 61.- +.'iL- i._t. iv4.c's, _,q s�:•s.-f. .-.:,,% .SSa r 1n% Fooling drain-1'100' 50.03 0 rot 000 $32t 90 Footing drain-each additional 100' .3752 2,001 to 3500 $169:59 3,601 to 7.200 '$23320 Sauter-lit 100' 62.54 7•)a I and_'-:— $32754 Sewer-each additional 1130' 37.52 • ' Water Service-1st 100' 62.54 . Medical Gas Systems: Water Service-each additional 100' 37.52 ; c ;.i _`-r_n Frs n d ,°_s Mi' Swan+dt'Rain Drain-1st 1110' 62.54 , $1.00 to 1:5.000:00 ' Itdinmam 6x.$3.2.59 Stalin&Rain Drain-each additional 100' ' 37.32 $5,001:00 to$10,000.00 $7230 for be that$5,000.00 and$1.53 for • each additional$100.00 or fraction thereof;to sold' $10000.00. aspeczion dexisting plumbing or for , $10,001.00 to$2500:00 ' $148.50 far the fast$10,000:80 and$1.54 for which no fee is specifically indicated 90.00/hr • each additional$100.00 or*action there£to , (j inimttm charge-1/2 hour) and including$25,000.00. Inspections outside of normal business 90,1 tr ' ' $25,401.00 to$50,000.00 $37950 forest T St.'$23,'000.00 and 5145 for hours(taihtimunacharge-2 boars) each additional$100.00 or fraction thereof';to ReinspeetionFees . 90.00/hr ' and incArding$50i000.00. Additional plan review for revisions 90.0ttihr $50,6000 and up . $742.00 for the first350,000,00 and S1.20 for•(minimum chi-112 sou each additional 5100.00 or fraction thereof Suboetal- 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*. rF. .y.. ,,;.,,.. ,:a: svJrss�....,�.5S -,y.... .w�. a.'•Trn•' .a:•1......;:,. ;.4.:i1,,,..1,2,.-1 r:' + ! ; �' :''= Plan review is for any of the following. ` '' `'' •;;; Please check all that • B _ 0 Any new commercial building with water service 2"and Bath -Tab/Shower -Jacuzzi/Whirlpool , greater acuzzi/Whirlpool gamer,exert systems designed and stamped by licensed Car Wash -Each Stall engmtxr. -Drive T7tnt 0 New exterior plumbing site utilities for any complex structure Aspirator as defined in OAR918-7800040. . .Cuspidor/Water Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities. -Domestic 0 • ny multipurpose fire sprinkler system. Drialciat Fountain 0 Any complex strucar a as defined in OAR918-780-0040. EE eWash . Floor Drain/sink -2" Submit 2 sets of plans with any of the above. -3" -4" '1 yt g.e,sC n''t7a ,f` or` 4 T' t.tion fi "d•Jr�4.,..7.i.o rrg,:.: Car Wash Drain f„• i-._., �� trY.., .,: ';14.'- Ce bage -3Donsesae-non-food I7 Isometric or riser diagram is required for new buildings Disposal -Dotaestic•fbod related that meet the qualifications above. -Commercial-food related -Industrial-food related 4 . ice Mach.Rgcfrig.Drains Oil Separator(Gas Station) Comments regarding fixture work: Rec.Vehicle TAump tm l• Shower -Gang -Stall Sink/Lav -Non-food related 3 -Bradley , -Conaamcrcial-food related -Service . Washer loihes Filter *Note: If the fixture work under this permit results in an I. wee afluhcs increase of sewer EDUs,a sewer permit will be issued and Water Extractor Weser Closet-Toilet fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. Other Fixtures: 1 Accumulative Sewer Tally :: p a Tenant Name: Northwest Occupational Medicine **CREDI IS*-' SWR# N/A TIGARD Site Address:,12250-5\\'Garden P1 PIA # 2013-00317 Parcel#: 2S101 BB01500 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: - Bach 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 I3ye 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 4 inch 6 0 0 0 0 0 -Car Wash 6 0 0 0 0 0 Garbage Disposal: -Domestic(to 3/4 1-1P) 16 0 0 0 0 0 -Commercial(to 5 1-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 0 0 0 0 Sink: -Lav/Bar-Non-Food Related 2 0 3 6 0 -3 -6 -Bradley 5 0 0 0 0 0 -Com/Scry/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 G:xtractor 6 0 0 0 0 0 Water Closet-Toilet 6 0 0 0 0 0 Urinal 6 0 0 0 0 0 Previous[DU Count 0 0 Capped [?DU Credit 0 I O 1`\LS 0 0 3 6 0 0 -3 -6 Current Fixture Value -6 divided by 16= -0.375 Current[?DU 1 EDU= $4,800.00 Previous Fixture Value 0 divided by 16= 0.000 Previous[DU Change -6 divided by 16= -0.375 over (under) S (1,824.00) Enter EDU Change Here -0.380 Notes: ****CRLDITS*** Authorized Name/Signature: Debbie Adamski Date: 9/12/2013 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;\Seiner Tally