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Permit CITY OF TIGARD PLUMBING PERMIT _ COMMUNITY DEVELOPMENT Permit#: PLM2021-00194 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 6/21/2021 Parcel: 1 S 1260000300 Jurisdiction: Tigard Site address: 9640 SW WASHINGTON SQUARE RD G11 Project: Jand Subdivision: None Lot: None Project Description: Interior plumbing for TI:Capping(1)sink and(1)water closet;Adding(1)3"floor drain/sink and(3)sinks;Installing (1)backflow preventer,(1)primer,(1)water heater,and water piping/DWV;50 ft.of sanitary sewer and 61 ft.of water service. Contractor: MODERN PLUMBING Owner: PPR WASHINGTON SQUARE LLC 11120 SW INDUSTRIAL WAY BY MACERICH RET TUALATIN, OR 97062 PO BOX 4085 SANTA MONICA, CA 90411 PHONE: 503-691-6166 PHONE: FAX: 503-691-6771 FEES Quantity Description Date Amount 50 If Sanitary Sewer 06/21/2021 $62.54 Specifics: 61 If Water Service 06/21/2021 $62.54 1 ea Backflow Preventer 06/21/2021 $31.27 Type of Use: COM 1 ea Floor Drain/Floor Sink/Hub 06/21/2021 $25.02 Class of Work: ALT 1 ea Primer 06/21/2021 $12.51 Type of Const: 1 ea Water Piping/DWV 06/21/2021 $56.29 Occupancy Grp: 1 ea Water Heater 06/21/2021 $37.52 Stories: 2 ea Fixture/Sewer Cap 06/21/2021 $50.04 3 ea Sink 06/21/2021 $75.06 1 12%State Surcharge- 06/21/2021 $49.53 Plumbing Total $462.32 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: Vaw e/Wege Permittee Signature: 0rvAppl CCAti,Qn 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. 'lumbiag a to t Application Building Fixtures ix uyps RECEIVE ��� ry Fit��fi # '�� r ', ,ti rar Y �;1 4tr ';,r1;s fi a ! � 1� ` S 1rtN '�i City of Tigard Received 5g 13125 SW Hall Blvd..Tigard.OR 97223 APR 15 2021 Dale/BY. S/(,,,/_ / �� Pei„ut?vo: , Ai/AO )'-0()/q �t a yi Phone 503.718.2439 Fax: 503.598.1960 Plan Review r Elate/ny. Other Peltier No. Inspection Line: 503.639.4175 /, .6 i Internet: wr�m.tigtrrd-or.gov CITY OF TIGAR pare R¢atlyJtt,: iar,K: See'age 2 for BUiLDiNG-BIVIS t'.°oficd/Slethod supplemental lnflrmalion nil'. OF M ORK FEE' SCHEDULE i ULE 0 New construction 0Demolitiou w � For special inj'ornat1on use checklist. Description i Qty. i f a I Total >WY Additiot rat Nplacement 0 Other: New 1-2-tiunlly dwellings(includes 100 1.for each utiht connection) ('1 I OORV OF CONSTRUCTION SFR(1)bath 312.70 Q 1-and 2-family dwelling ,otnmerc�'�Jjjldustrial- SFR(2)bath 437./8 - ❑Accessory building��� 0 Multi-family SFR(3)bath 500.3 ❑Master builder �� Each additional bath/kitchen25.02 ( Other: Fire sprinkler( sq.tl.) Page oR AN p �� J SITE INFORMATION D LOCATION Site utilities: Job site address:9 SW Washington Sq Rd. ^ Catch basin or area drain 18.716 City/Statc/L1P:TIgelyd, g/ 23 � '_ Dryweli.leach line.or trench drain 18.76 Footing drain(no.linear ft.: ) Page h Suite/bldg./apt.no.: 1_Project. '� M �, Manufactured home utilities 50.0 Cross street/directions to,job site: Manholes __ 18.76 J t,.t`.t.e-l. NS �� �~ Rain-drain connector _ 18.76 --- Sanitary sewer(no.linear 11.: 50 ) '1 Page h $62.54 Storm sewer(no.linear ft: ) Page Subdivision:�1, K Water service(no.linear II,, 61 ) 1 Page $62.54 ,,re �\ , C"Clh3 r LAst:4.Ji;t; 1 Lot no., , Fixture or item: ! I fax nap/parcel no.: ' e7.9 /2 is_- 4� Backtlow preventel i 1 31.2>7 $31.27 DES('Rl.PTlO` OF WORKY _ _ _ Backwater valve 12.5L New tenant fit out of an existing retail space. Scope� 'othcs,vasher zs.o includes new partitions, fixtures, finishes, lighting, Dishwasher 25.0 Drinking fountain 25.0 plumbing, HVAC Ejectors/sump 23•0 L PROPERTY OM'\FR 0 TENANT f''xpansion tank 12.51 Name: _' Fixture/sewer cap _____25.0 sa.e'i_l Address: Floor drain/floor sink/hub 1 25.0 $25.02J 1, ,1 ��� 1v ----- Garbage disposal 25,0 City/state/""/,,11: tic@i:9�t`� �aC� �__ Hose bib 25.0 Phone:(Or 1 �S .6 Fax:( ) _ _� .M _ ._._ 12.5 _ __ Ice maker © .�� \PP1.1C AN1 l]+`CON'CA( i' t'E115ON Interceptor/grease trap 25.0 Business name: Medical gas(value:S Page. Corset name: �7 ••- i '4j Primer 1 12 5 $12.51 Roof drain(commercial) 12.5 Sink/basin/lavatory 3,e 25.0 yspQt7 °) „it., 3_0,,-,,c4,), ,:',t..3 A Os, '1 \ \Ci \ Solar units(potable water) 62.54 + Phone:( ,y) ' ` C �,. _ , (p�(, �:J� ,� �. ��`� � f•'ax::( ) 'i'ublshowarfshowerpun _ 32.51 I:;•mttil; ��3" sS� '�"s1�CTIL`S Q. c q� , °�6��n,� Urinal 25.0Z CONTRA(TOR _ --.� Water closet �' 25.02 ,;:',i; -- _ r....." •---- Water heater I 37.52 $37.52 Business name.: -._.. - Water piping!DWV 1 56.29 $56.29 ' Address: _ Other: 25.02 City/state/7._IP: ` I _ Subtotak $412.79 I Phone: �__ Minimum permit fee: 72.50 __ __.. Plan review (25%of permit tee)t COB Lie.: Plumbing Lic.no.: -7. Plumbing --- State surcharge(12%ofpermitfee 5-1 Authorized signature: _._ 3 . _ 111 TOTAL.PERMIT Ft r'� a(,.33. 1 Print name: r-j z a-•�� 1�s, �� I Date:/_-....{j'7 2 ,�!'I f Ios permit applteatl0n expires If a permit a not obtained]Violin ISO days \J (v..J.I after It Iran been accepted as complete. ^Fee methodology set by Tit-County Building industry Sete ce Board. I'\BitJiI i rrnira\PLIVILI.Vermi,App.doe 10,01,09 440-4b16'f(Ie;(12/COMAr9:n) 1 Plumbiin2 Permit Application - City of Tigard Page 2 -Supplemental Information Fee Schedule;ule Residential Fire Suppression Systems: =Sits Utilities` Q Fee(ea) rtOl t rl + Oa + , t , , 1 ±e; Footing drain-t'I00' 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 7,200 $233.20 Sewer-1st 100' 1 62,54 $62.54 7,201 and greater $327.54 Sewer-each additional 100' 37.52 Water Service-1st 100' 1 62.54 $82.54 Medical Gas Systems: Water Service-each additional 100' 37.52 'lraltllatiprl ; Permit Fee: 3 r ' Storm&Rain Drain-1st 100' 62.54 . $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 .atlt7- -*i-re�Ctis►.e n,,,,Fee e ,1 otai each additional$100.00 or fraction rereof,to �, e.rr>, 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 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 90,007hr and including$50,000.00. Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$59,000.00 and$1.20 for (minimum charge-1/2 hour) each additional$100.00 or fraction hereof, Subtotal: Commercial Fixture Work: Are you capping,adding or replacing fixtures? If"yes", please indicate work performed by fixture. Failure to accurately re ort fixturei,could result in increased sewer fees*. Plan Reviev for Plumbing Instals t ons Quantity h Fixture T :y y pe -, Plan review is required for any of the following. Fixture"Type for Replace/ Please check all that apply. Work Performed: Capped Added Relocate Ba,>tisuy/ront ❑ Any new commercial building with water service Ti and greater,except systems designed and stamped by licensed Bath: -Tub/Shower -Jacuzzi/Whirlpool engineer. Car Wash: Each Stall 0 New exterior plumbing site utilities for any complex structure Drive Thru as defined in OAR918-780-0040. Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care fae lities. Dishwasher: -Commercial ' 0 Any multipurpose fine sprinkler system. Domestic CIAny complex structure as defined in OAR918-780-0040. Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: -2" 3" t .ts tn.etrie or Riser Diagram 4 - Isometric or riser diagram is required for new buildings -Car Wash Drain Garbage Domestic non-food that meet the qualifications above. Disposal: -Domestic food related -Commercial food related //. a -Industrial food related lee MachiRefrig.Drains Comments regarding fixture work: Oil Separator(Gas Station) `'. Rec.Vehicle Dump Station ` Shower: -Gang -Stall Sink: -Lav/Bar non-fop'related a -Bradley -Com/Seryi{Jtil food related t -Service' *Note: If the fixture work under this permit results in an Swimming PTA-Filter increase of sewer EDUs,a sewer permit will be issued and Washer-Clothes fees assessed for the sewer increase must be paid before the Water Enactor Water loset-Toilet ' 1 plumbing permit can be issued. u- al Cher Fixtures: 4 L1Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 • Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: rtincrwixer :'t*:TrriVqiiirr!4 lotit .; , szarnr 11.44U. 4,41, Footing drain-1 10r., (1 to 2,000 $121.90 Footing drain-each additional IOU' 37.52 2,001 to 3,600 $169.69 3..601 to 7,200 $233.20 Sewer- 1st 100' 62.54 7,201 and greater $327,54 Sewer-each additional 100' 37.52 Water Service-1st 100" 62.54 Medical Gas Systems: Water Service-each additional 100" 37.52 A . Storm 8:Rain Drain- 1st 100' 62 54 $1.00 to$5,000 00 Minimum fee$72:I. Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to S 1 0,000.1X) $72.50 for the first$5,000.00 and$1.52 for each additional$1(8).00 or fraction thereof:to and including$10,000 00, Inspection of existing plumbing or for $10,001.(X)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 for the first$25,()00.00 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 90.0()/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 accuratel resort fixtures could result in increased sewer fees*. riT,W114W loot P i;''';17.71,44 Plan review is required for any of the following. - • ; • Please check all that apply. f Any new commercial building with water service 2"and Baptistry/Font greater,except systems designed and stamped by licensed Bath, -Tub/Shower engineer. -Jacuzzi/Whirlpool t] New exterior plumbing site utilities for any complex structure Car Wash: -Each Stall as defined in OAR9 18-780-0040. -Drive Thru Medical gas and vacuum systems for health care facilities. Cuspidor/Water Aspirator CI Any multipurpose tire sprinkler system. Dishwasher: -Commercial Any complex structure as defined in OAR918-780-0040. -Domestic Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: -2" *In% sow if,* LSO or riser diagram is required for new buildings -Car Wash Drain that meet the qualifications above. Garbage -Domestic non-food Disposal. -Domestic food related -Commercial food related -Industrial food related Ice Mach./Refrig.Drains Comments regarding fixture work: Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower: -Gang -Stall Sink -LaviLiar non-food related 2 -Bradley -Com/Serv/Util food related -Service *Note: If the fixture work under this permit results in an Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and Washer-Clothes fees assessed for the sewer increase must be paid before the Water Extractor Water Closet-Toilet plumbing permit can be issued. Urinal Other Fixtures. 1:\BuildinglPermits\PLMF_PemtitApp,doc 08/04/2011 Accumulative Sewer Tally i Tenant Namc: !AND SWR# 2021-00117 TIGARD Site Address: 9640 SW WASHING1ON SQUARE;RD PLM# 2021-00194 Parcel#. 1 S 1260000300 Fixture \',clue Previous Previous Credits Capped Fixture Fixture New New # value count capped#s value count added# added value total#s total values Baptisery/I ont 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 1 5 1 5 -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 2 4 1 2 -Bradley 5 0 0 0 0 0 -Com/Serv/Util-Food Related 3 0 0 1 3 1 3 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 0 0 0 0 Previous EDU Count 0 0 Capped EDU Credit 0 TOTALS 0 0 2 8 4 12 2 4 Current Fixture Value 4 divided by 16= 0.250 Current 1?DU 1 EDU= $5,800.00 Previous Fixture Value 0 divided by 16= 0.000 Previous EDU Change 4 divided by 16= 0.250 over (under) S 1,450.00 Enter EDU Change Here 0.250 * *Round EDUs to the nearest 1/100th: a count ending in.005 shall be rounded up to.01,and a count ending in.014 or less shall be rounded down to.01. Notes: Authorized Name/Signature: BRANDEN TAGGART X2449 Date: 5/6/2021 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_5800_070119.xlsx