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Permit y n CITY OF TIGARD PLUMBING PERMIT 01 COMMUNITY DEVELOPMENT Permit #: PLM2013 -00183 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/19/2013 Parcel: 1 S135BD00100 Jurisdiction: Tigard Site address: 9600 SW OAK ST 570 Project: Houser & Allison Subdivision: ASHBROOK FARM Lot: PTS 5 & Project Description: Add (1) breakroom sink and (1) hub sink. Contractor: JAMES ROOD PLUMBING INC Owner: SUN LIFE ASSURANCE CO OF CANADA 125 S 1ST AVE #542 BY NORRIS BEGGS & SIMPSON HILLSBORO, OR 97123 121 SW MORRISON ST #200 PORTLAND, OR 97204 PHONE: 503 - 547 -0491 PHONE: FAX: 503 - 547 -0492 FEES Quantity Description Date Amount 1 ea Floor Drain/Floor Sink/Hub 06/17/2013 $25.02 Specifics: 1 ea Primer 06/17/2013 $12.51 1 ea Sink 06/17/2013 $25.02 Type of Use: COM 1 ea Water Heater 06/17/2013 $37.52 Class of Work: ALT 1 12% State Surcharge - 06/17/2013 $12.01 Type of Const: Plumbing Occupancy Grp: Stories: Total $112.08 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 Noti • . .ter. 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 ∎ uestions to OU . by cal ' • = 503.232.1987 or 1.800.332.2344. Issued By: '' � / — 1 % Permittee Signature: 400 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. Piuinbin2 Permit Application j , ,, _ Building Fixtures e. .. _ FOR O Fli::l- I_fbi. CNLI City Of Tigard Received 131 SW HagBlvd, Tigard, OR 972 S? 13 /]By 6 / • i PermttNo.: �'� ad 13 -v0/ IN Phone: 503,718.2439 Fax 503.598.1 "�i O , 1j DDateynew Other Permit No.: I _00 S • Inspection Line: 503.639.4175 I' i t r 1 K I) V Ready/BY; Jwia. - S Pa e Z ot � f°r �� ` ' fiMdhod c, su eroerml kntormation - Internet www ttgard or goy otted/ rf1 �Aa.3's r ,lu`. + t 11 .;), r r4 .r +r 7 F t iT -.113 r.li".`I 1...:, ..3 z �.+, i r o�r94 r yn j ° >1 , }r ff v + r. r / t 4 1 4 r 31f 4t1{ t1 t,f.'rlhl 5. )\ lr r1:�,� � � r .. r 'h t! 1I 1 . ^ 1 '1 r)i) ,F a ,..,... :_...i .., ........:.r....,.... -.-.. .G.`Ir..�� ..._ l . _.: _ ...t. `.., 4. d..! .._ .; a.rrr }M1tr .... .... �,.:. .b ..(ur nrt�: .._ _.. � xtr . "_. .._.. �r��J.,;, �}. El New construction ❑ Demo �,: �� \ For special in jormalion use checklist v. Description I Qryd Ea. I Total Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 It for each utility connection) C,r? r y iN rrMylr NJ ii t { (i•' N ti n � .h i. rr ,.7 �i.r �.. t 17 :43",f • { r P rlti 1 .n N::1 t t.1 1 i n f G i t r(o 4r QIi,c1<71 C , SFR(1)bath 312.70 .g0 :41:' .,.r: , :ivi 1 I. ...,�.i iY :lr. P.. ., ar a. k,,q- A�,'�k.Ca':. .,....c. e,, , ...,t7.,1. ,,,„_ i r ... ?_,,,.._,.„. ❑ 1- and 2- family dwelling R3 Commercial /industrial SFR (2) bath 437.78 ❑ Accessory building SFR (3) bath 50032 ❑ Multi- family Each additional bath/kitchen 25.02 ❑ Master builder ❑ Other Fire sprinkler (� sq. ft.) Page 2 r t rr , rlr r rr .ti 4r /si i �f �ti u: r rK ��ti t ir , . I r 1 '='::!'.':7.417.q ii I iN 1({.,.FI i : ,,k t l UT ! r�' 71' ,.- I i� ir A R r�� 1 ��f � � h { V � . q .Site utilities' r Job site address; NOD ` s b. f 0 (;L Catch basin or a rea dr ain 1 8.76 City/State/ZIP; Drywell, leach line, or trench drain 18.76 �' Footing drain (no. linear ft: _) Page 2 O'.Idg. /apt. no.; Project name: 5�r- �,n�l Jr 70 �' - � - Manufactured home utilities _ 50.03 Cross street/directions to job site: /qv itat vo- ,q L1_i se k) Manholes 18.76 F/&-2,.., W - T ,( s . " ; ; 1 , Rain drain connector 18.76 �" "] Sanitary sewer (no. linear ft.: _J Page 2 Storm sewer (no. linear ft.; Page 2 Water service (no. linear ft.: __,) Page 2 Subdivision: I Lot no.; Fixture or item: Backflow *venter 31.27 Tax map /parocl no.: l ra( r M! j 1 f 1`t BS I ) T r 1 � n 1{ r P 'r� T s r f r it t, r 4 s 1t,fm ,� 7 :,, z t 1 Backwater valve 12.51 i < t` 7 I i .r.'ieS t I 1 rU p , _ Clothes washer 25.02 -Af t i. .k.i - >ji:a : wits . .rx .. ,Zan c . ' ,�? 'i if , rrt r- ,.4 `!,,,,! s,!!) , -�+ • Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 41 - /Hit e c y r ; iG/ ( a n s al rt r } h" t g M /t' +a�� } r i1 " ')f r S �I t tz V t` It ri c i f} , l ) � nr l A R kr1 1 1 tL { 7 .} r Y r 5 . F ] 41 !1 ti ! F� F,Y+� 7 Expansion tank 12.51 a. .1w e.4 }r l`. , ,i i:.1 de inrx , ;; e, ,:„:.:V:1 .ra.,. :,.,, „.. V^,_.: „, ...ic.•.? Name: Fixturelsewer cap 25.02 Address: Floor drain/floor sinlc/bub , 25.02 J 5.0 Z Garbage disposal 25.02 City /State/ZIP: Hose bib 25.02 Phone: (pp ) Fax: ( ) Ice maker 12.51 io 7 ix ry.,r Z,� jr { ,Wi t f r'I ( f " '''. 7 }� .r P L. 11i7":; lr . it ri1 t t. 1 rJ } :f + �i1 1 '4 Y Interceptor /grease trap 25.02 „:F .1L_..1::>. 71` ..u_ {.TJ. ,x ...: �:Lx.i., :i .z -„ .; ..a,S ...._....r._r."? :.,1 E7 Li._r..... _. Medical gas (value: $ ) Page 2 Business name: Contact name: Primer / 12.51 /..2., 57 C if drain (commercial) 12.51 Address: Sinasin/lavatory 1 25.02 a5:412. City /State/ZIP: Solar units (potable water) 62.54 Phone: ( ) I Fax: : ( ) Tub /shower /shower pan 12.51 E-mail: Urinal 25.02 p ry 77. 1 7 +iiiilW C ,h p4 1 :14Vle� t ..77 /, 7 �..�, mzr,,9 : kA ; r �n'f - Water closet 2S.O2 rY 5, ;, r d ' ,c , 11 I l 7 r i ll i 1.' i i ! l o& � r y L a a i. / rJ e44:76.4i :l ,.. .t;..,;"..--,2; n ..,. i .rr L . - : r? , ^.__ .; �i. - .y- . `� .....:. .e , . :h., i�: .i, . . {.:,_ : .f_ ."!_C.� 1]C: ci.l -C i ; :1 _... �: ?:.. W ater heater 1 37.52 37. S•f._, Business name: _ /� .. � , 4 P A . ,A-5 c lea � Water piping/DWV 56.29 Address: /,5 s' )Ste. A� -# 3-5,2_, Other: 25.02 City /Statc/ZIP: /1/ /4 &ovD v' r -. 97/ 2- 3 . . Subtotal /00.07 Phone: ( 3o1) 59?- ) L. Fax: ( �3) 557 A 3 Z Minimum permit fee: $72.5 - CCB Lic.: /2):)01 //ie Plumbing Lic. no.: 16 55 Plan review (25 %o£ permit fee) State surcharge (12% of permit fee) /?..._..0 D Authorized signature: i jaf 0 TOTAL PERMIT FEE / j a * i; Print name: _' A.-Air Date: s © This permit application expires if a permit is not obtained within 180 days d fia after it hag been accepted as complete. r "Fee methodology set by Tri- County Building ndustry Service B l: lBuildinglPermits \PLMU- PermitApp.doo 10/01/09 440-4616T(10/02/COM/WEB) 3 Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: _ _ Residential Fire Su i r ression S stems: f 4. �y-i,,F. �. ' I -r. T7 y n .., - 45 i. rU rJ,, Y !y 9 .,. 7 Y ,., .. f 7) ib ' . 4:_i K i F i I r" I:::, w K h � i ' .� li c, , A 5 F"2 r5. �t �� S` 4 . t ; ' 1-5 ;' r t r n Id r, r' :. r .r j �{ irk. z F,, -qi. ,,,, ,; - 1 , -,..1.-z , ;.-: , "4�.3 �r7 t`� ,; :a. °fl .� n, {�!, �i .r .� e.rA ,�l:: r'�n n 3 ;lrl,.'.., _�i i• 7;5 1 e, 14..x. -vi e +r • I ] S t �. , � s 1 { f + 1.,,- e l r i t l q � : P.,, S +r ,.. .3 , , .,:.. , ... ,sjSe .g....;. i..�l: Mll Y,. ,_,: tL.Jk -r. a....5 .�. arnh,... .r na {��. r.n ,- <wn,Jut,,1 , -. ,.:. yr.r:,. Footing drain - I sa 100' 50.03 0 to 2 000 $121.90 Footing drain - each additional 100' 37.52 2001 to 3 600 $169.69 3.601 to 7.200 $23320 Sewer - 1st 100' 62.54 7,201 and :+ ater $327.54 Sewer - each additional 100' 37.52 MI Water Service - 1st 100' 62.54 Medical Gas S stems: Water Service - each additional 100' 37.52 ' c" r 1 ;,,; - -r-- r y .;� E,,q:, , a ■dirt. �:} P,._ r r, ;, Storm & Rain Drain - 1st 100' 62.54 'ai, . ;_.I ti ..2'. A':? :Ir : r .� { ;.J, .t .utt ra .x_ � r . rz ' ,i . r.z ' et,, _ $1.00 to $5 Minimum fee $72.50 y �� 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 rfr.M r rr r i f iiT ,' - ' , r r, ' r'ra I : r I i r , i 7 4 , : " } t 3'i��i { r�'" S; � � ' ! each additional $100.00 or fraction thereof to ?. { ti :SA-4 .Idl ir.{'..: 1 S",..... t,r `" V y :. .. rir:,r7 r 7-.. ir>,.,. .4.....r r• - and including $10,000.00. Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for which no fee is specifically indicated ■ 90.00/hr each additional $100.00 or fraction thereof, to minimum char :e -1/2 hour and including $25,000.00. Inspections outside of normal 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 hours) each additional $100.00 or fraction thereof, to Reinspection Fees _ 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 $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", please indicate work performed by fixture. Failure to accurately fixtures could result in increased sewer u urately report fi i,l b IC NI VE 1 n' R i'i f i '�f7.7.to . #``+'•'F ii f V �;fnF , t Y'�+ -�7"^ `..., 3l -TLl Z 1... t ,. _ r„g,�,.. ',. trz'7u,; , r r tr r rt w , t, r . ... I u nnp {-. u4 2 t } , Q i �, t B r 7."11f� 4 i i 775 . , r ;; ,t y r .-i w b w E : -, - : 2 ]� 7+ ` ,,.- -, S� , , ( t {� f .� '•1' �I �I "`.� � ., r 1 �, k.--.,,,-.. lt�i. Yi, { � r' ' r � j p� r .«n- �. y . r i . 6 F 8 � �. n 1 e..ut . t r + atC .. i 1� ! * a ryl k �r FIr YF Q i' ' I iir'�r # .:1� , ....... ..- .:.i.irc „:.:._. .. :,,,,e- :- • .4 . rs »<. n.... -.,,. - `.::c .. ', i t : r +r ,7,� � . , f t „ fi r," � .,....:11:47,- 1 f �`.; :,. ' r i 1 t 3 at I Plan review is required for any of the following - >1' r. v.l?;igri ii.L...i..,t .,", , ‘,4 ..� ..k.,' T,wl Sc y,.h .ti a •t r. h all Please check a that apply. Baptisuy/Font Bath . - Tub /Shower ❑ Any new commercial building with water service 2" and Jacuzzi/Whirlpool greater, except systems designed and stamped by licensed Car Wash -Each Stall engineer. - Drive Thm ❑ New exterior plumbing site utilities for any complex structure Cuspidor/Water Aspirator as defined in OAR918- 780 -0040, Dishwasher - Commercial ❑ Medical gas and vacuum systems for health care facilities. - Domestic ❑ Any multipurpose fire sprinkler system. Drinking Fountain ❑ Any complex structure as defined in OAR918 -780 -0040. Eye Wash Floor Drain/sink z) ] r =i ' i Submit 2 sets of plans with any of the abov per`.►■ 4 „ III y i 5 r 3r r1 iYiiir: ,6 �:: E l "' i rr' r. (:i, 373„ F+T :.:0 y=i ,4:" - M • Car Wash Drain 3 .�_ i t� ! 1.. 1, !,F:..,. of- :.."i 5.,f 0 Nx w I. l 4,. r i .,,ti - .., a -t n? ..= .3'rF :._ .t ... Vic.. ;tz Garbage - Domestic-non -food ❑ Isometric or riser diagram is required for new buildings Disposal - Domestic -food related - that meet the ' uaiifications above. - Commercial -food related - Industrial -food related Ice Mach./Refrig. Drains • Oil Separator (Gas Station) Comments regarding ixtur work: Rec. Vehicle Dump Station / s; , - t _ ! � � � Shower -Gang / c? /Tit I! d -stall W N l'+. i, a4 I t Kr Sink/Lav - Non -food related i - Bradley - Commercial -food related -Service Swimming Pool Filter y *Note: If the fixture work under this ernut results in an Washer - Clothes p 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 plumbing permit can be issued. Other Fixtures: C: \Users 1j im\Downloads\PI,MF -Permi App(I4).doc 2