Permit CITY OF TIGARD PLUMBING PERMIT
1,1
a COMMUNITY DEVELOPMENT Permit#: PLM2014-00094
-f t G A R O 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/03/2014
Parcel: 1 S135BD00100
Jurisdiction: Tigard
Site address: 9600 SW OAK ST 570
Project: Houser&Allison Subdivision: ASHBROOK FARM Lot: PTS 5&
Project Description: Capping(1)sink for TI.
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 Fixture/Sewer Cap 04/03/2014 $25.02
Specifics:, 1 12%State Surcharge- 04/03/2014 $8.70
Plumbing
Type of Use COM 47 ea Minimum Fee Adjustment- 04/03/2014 $47.48
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
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: *ir--11717Y-1-
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.
Plumbing Permit,A.pplicatifiEc ovED 0I fI / t•Building Fixture I OR OFI I( I t SI- O\1.1
City of Tigard A PR� 1' Received ��.r� -- 'it No.��/�,D/L -_ir
1111 ' 13125 SW Hail Blvd.,Tigard,OR 97223 plan Aavie v
Phone: 503.718.2439 Fax: 503.59)tim 1r r .- a n Date/By: Other Permit No.:, �p, 0/7 ,, 4p 747f
Inspection Line: 503.639.4175 (�� pate Ready/By: Juri9: H See age 2 for
T■t,n k 0 lntemet: www.tigard-or.gov 'e 1
B'� $�' a. � I k I �ti I Notifsed/Metltod: mow- ,:kmentat Information
i- t: K1`r:71 d af,11F. ,1(7,iir i t„ ,;i'l�l `:U�•_7..`"ttl�'il F V:. `.7m • r ire'ig' •�x. ) j,1..''. �'l IH Fr.St•w.`^I•�t�x.1 a r.:Yu _".•,'off ,,l I1 X11; 1t -
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,L .•�.• _. .w r r�. :t,(u,o. i�:,r ;c, r,J.�'3,3�.,. .,.u.u,u ,,. . . .Jr. I`t�.�+.. _ t�,••:-�. .t., a.. .cti_ ,: .i: sm i.�. �:F,e.,
❑New construction ❑Demolition For special information ase ckecklist
Descri•lion a Ea. Total
P Addition/alteration/replacement ❑Other: New 1-2-family dwelli,,_:(includes 100 ft.for each utility connection)
f 1 , ..4,, :i; a TJt .f� l t ,,;,„..,,.1.1-0:::cr SFR(1)bath 312.70
El I-and 2-family dwelling is m
Comercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building d Multi-family
. Each additional bath/tdechen 25.02
❑Master builder 0 Other: Fire sprinkler(__sq.It) Page 2
�{� {- ,+l _ aJt e.a ulFt rci r .�1�1tJ r 'ttltEf rc *t
I�} l�wii c ( I. i 1 + J ;' . �°I 1 p11 r1 dr , 1 SIte ublltles:
it,3.�,t'ikl.ltl.t., ..�:.,;d r.. .....A4 t r., .,iP:VP:. ,,.or .t`, .,,,'.>s r•:+,:t,-w.,_e.-.∎
Job site address: ,ot, icy' • 3 Catch basin or area drain 18.76
City/State/ZIP: �,
- Drywell,leach line,or trench drain 18.76
5 -. Footing drain(no.linear ft,: ) Page 2
Suite/bldg,/apt,no.:$70_ s-Project name: /jL4BV Manufactured home utilities MI 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no,linear ft,; ) Page 2
Storm sewer(no.linear R: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: 1 Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
j tl = ,l •t' t.t _ �i 7 't 1 ., t }..: :':-�I t.r4'1 t 1 Backwater valve 12.51
-el 1'.. : , ....4,t. . . .lt? -,i..., '�;1, a� .. rr` ... a r - "Jlf'. . . .
r �Q ,i.;1:0:: Clothes washer 25.02
` ' L d/ ry� 'I- ,gyp. , y• Dishwasher 25.02
,J b I . Drinking fountain 25.02
o, ��1
f� d t EjLfctors/Sump 25.02
e4 :*--:',..'1:,',!'.':!;,-- Itl l u" I ,. i:`1 -: 1 I F�tpansion tank 12.51
+
Name: a j~ 1i sewer cap Milli 25.02 O2...
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
$ : , �7:;q i1 ui 1 a- ', ,t ;a B J 113l ,L ., . 1,Il+ � a ,-it
Interceptor/grease trap 25.02
Lt....,, ',,..1vru,1i 1M.n,� .;; A.. , .a. . ;a!i,;,: ,.i:,.7lg.6 . tw.NrLLlE �-`.„r
z.nr''i
Business name: Medical gas(value:$ ) Page 2
14imer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12,51
E-mail: Urinal 25.02
i „i. fitter" -- r r Water closet 25.02
� ::_ Water heater 37.52
Business name: + `` /
_ I / _. bat_ 1P.�6i� �� Water piping/DWV � 56.29
Address: S v 4'5/.1.. Other 25.02
City/State/ZIP: f`k i, . I - 1 .1.?-.-3 Subtotal ,as.,,,
Phone:(jb) ) cj?- ow/ Fax;(,Sal) S97.r o942- Minimum permit fee: $72.50 MIMI
CCB Lie.; .>� Plumbing Lic.no.: '>'s Plan review (25%of permit fee)
State surcharge(12%of permit fee) , .
Authorized signatur • TOTAL PERMIT PEE r ,7(1 I
Print name: D a t e; / This permit applica tion expires if a p e r m i t mot obtained within 180 days
_ ! after it has been accepted as anoniete.
"Fee methodology set by Tri-County Building Industry S&'+rvice Board
t:l Build'mippomitreLsru-ParmhApp.Gce I010r1oo 440-4516T(10/02/COM/WE8)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su' .ression S stems:
a:;47i r = 7 I i'4 rt . '1 Fla. i r , ri a f`rl E M"1.� i 1 3 r r 4 t+ Hld F•L ,..,,&, tle. a r, .o-.. ..A,w.G!....�...rw,�. .,p.:,.:-..i._±.,:,.,':.,:. : . , ltlfi tlr.n. :,.;.,,,..,4•m ' �
Footing drain I"100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2 001 to 3 600 $169.69
_ 3 601 to 7200 $233.20
Sewer 1st 100' 62.54 7 201 and,-.ter $327.54
Sewer-each additional 100'
Water Service-1st 100' 62,54 Medical Gas S stems:
Water Service-each additional 100' 37.52 777.77,7-77-, `•- ;*r r" n §, p'"r r "'.---7547:::": rg17«-,n„r
Storm&Rain Drain-l st 100' e.. t'.:.. v
�� $1.00 to$5,000 00 • • Minimum fee$72.50
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
g } -..,77,77.77.:':-.717_ r w ,ryry „; r each additional$100.00 or fraction thereof,to
_t ;,!, : _5GW .,.... --. .x.rk 9
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 charge-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 fbr the first$25,000.00 and$1.45 for
hours minimum char_c-2 hours each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00. r
Additional plan review for revisions 1111 90,00/hr - $50,001.00 and up $742,00 for the first$50,000.00 and$1.20 for
minimum -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 report fixtures could result in increased sewer fees*.
1,:-.:,; , ''.' 9f ' fit Po ^ ,,�,y Tight �"',7 .. t� , rr A 11)11 ".r, r c T 1 pi11,,I,.'-t1Fo.rtt
.n� ,4�,C� 1} 'y„rr --Ttinv 0.` �9adi '1' ,g..�' � 5 t��f CL r.!}'f .4z;;:‘,.::".4.. .:...` ',::.:7,\.::,� -:-!.a.... .... ...,,i ! ., ., .,.,.., .I t,. m,•.. 4.7.7
iii i r+ 1.13:- c�'t ,r1 * t : "Mtr� ": w'6, . v�� :14p41:4- Plan review is required for any of the following.
, L a .r.u�»:s '`tf.l ,u',1{t,.a0" ?` ... ..�.a:., xr.._.i.4.�.,.u:-r, � Please check all that apply_
Baptistry/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 Thru ❑ 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 ❑ My complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3"
-4
Car Wash Drain :N.a
Garbage -Domestic-ton-food ❑ Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the .ualifications above.
-Commercial-food related
-Industrial-food related _ _
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regardin fixture work:
Vehicle Dum,Station �r'�p I Z it . _
Shower -Gang - (0
-Stall
Sink/Lav -Non-food related i 1
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
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:1Users\jim\Downloads\PLMF-PermitApp(34).doc 2
Accumulative Sewer Tally
-- Tenant Name: HOUSER&ALLISON SWR# N/A
Site Address: 9600 SW OAK ST SUITE 570 PLM# PLM2014-00094
i ic.\RI) Parcel#: 1S135BD00100
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 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 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
Living Unit 16 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 0 -1 -2
-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 0 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 1 2 0 0 _ -1 -2
Current Fixture Value -2 divided by 16= -0.125 Current EDU 1 EDU= $4,800.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -2 divided by 16= -0.125 over (under) $ (624.00)
Enter EDU Change Here -0.130
Notes: ***CREDIT***
Authorized Name/Signature: BRANDEN TAGGART X2449 Date: 4/3/2014
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.
t:\Building\Sewer T ally\SewerTallySheet_4800._070113.xlsx
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
9600 SW OAK ST 570, TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
2014-04-07 (null)
PLM2014-00094
PASS - No C of O
Cap-off pass
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
9600 SW OAK ST 570, TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
2014-04-04 (null)
PLM2014-00094
FAIL
1. access for inspection is required, no inspection was made 102.2.2/1035.4
CCI won't work as access code, need four numbers.
Violation Summary:
Inspector Contractor