Permit CITY OF TIGARD PLUMBING PERMIT
:. COMMUNITY DEVELOPMENT Permit#: PLM2022-00490
T[GAF.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/6/2022
Parcel: 1 S1260000300
Jurisdiction: Tigard
Site address: 9619 SW WASHINGTON SQUARE RD M06
Project: Pottery Barn Subdivision: None Lot: None
Project Description: Replacing 100'of sanitary sewer line.
Contractor: LOVETT INC Owner: PPR WASHINGTON SQUARE LLC
6920 NE 42ND AVE BY MACERICH RET
PORTLAND, OR 97218 PO BOX 4085
SANTA MONICA, CA 90411
PHONE: 503-737-8423 PHONE:
FAX: 503-288-1630
FEES
Quantity Description Date Amount
100 If Sanitary Sewer 12/06/2022 $62.54
Specifics: 1 12%State Surcharge- 12/06/2022 $8.70
Plumbing
Type of Use: COM 10 es Minimum Fee Adjustment- 12/06/2022 $9.96
Class of Work: ALT Plumbing
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
Issued By: .,. /= - � Permittee Signature:
)
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 Application RECEIVED
Site Utilities FOR OFFICE usr ONLY
NO 1 5 202,
Received 0 'Jci A )I mO
`iii City of Tigard �nnitNo•: �� r�l T I
a 13125 SW Hall Blvd.,Tigard,OR 97223 nreBy ro%(�
CITY OF TIGARi nRevew
Phone: 503.718.2439 Fax: 503.598.196 Q Other Permit No.:
Inspection Line: 503.639.4175 BUILDING MIS! y:
1 k G A R D Date Ready/By: lurk: ® See Page 2 for
... Internet: www.tigarrl-anger Notified/Method: Supplemental la(ormanon
:: _ "TYPE OF WORK FEE* SCHEDULE.
0 New construction ❑Demolition For special information use checklist.
---- --- Description I Qty. 1 Ea. I Total
Addition/alteration/replacement D Other: New I-2-family dwellings(includes 100 ft.for each utility connection)
,'. „,, ' i c - //.1�Up /�tt.+(04� 'A�,, r'�ing" �l SFR(I)bath 312,70
`.31i. -, .�s... I .a.a�ATYTMreR ���M.S•Y V3•^(,"t�1 U�:r �A ''�p3,. �;�i.--; '� r ?#
❑ 1-and 2-family dwelling Commercial/industrial
SFR(2)bath 437.78
El Accessory buildingSFR(3)bath 500.32
0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler(_sq.R.) Page 2
p j b: Y *H 'Y q+4
F ( C r ' _, () ' X '1A�x tAVR S Ill "5 > ' Site utilities:
(� � r t_ Catch basin or area drain 18.76
Job site address: -k � c51,) (Dct' Y�,h Cvv, s,A,0Jr c c
CitylStatc/ZIP: 1 Drywall,leach line,or trench drain 18.76
T J�8 Jog. /91-2Z-� Footing drain(no.linear ft.: ) Page 2
SuiteJbldg./apt.no.: i(y1d0, Project name: Manufactured home utilities 50,03
Cross street/directions to job site: Manholes 18.76
, .1 }l
to �)f IC- \-0��;>1 e) p I�Ce iv, Pa I.i eci VI Rain drain connector 18.76
i v` fk� C)"L V"�` 1 i Sanitary sewer(no.linear ft.:la) 1 Page 2
Storm sewer(no.linear R.: ) Page 2
- - Water service(no.linear ft.: ) Page 2 t
Subdivision: I Lot uo.: Fixture or item:
1 Backflowpreventer 31.27
Tax map/parcel no.: P
D' r° Eackwatervalve 12.51
S(R(PTION-:OF WORK
�7
Clothes washer 25.02
' V-ep 1 ek.C.C. I0 6 Oe tYST-e:f'or _3C a- )11/t a Dishwasher 25.02
Drinking fountain 25.02 I
- Ejectors/sump 25.02
Ati PROPE1tTY OWNER ?ry O g i ` ' Expansion tank 12.51
Name: Fixture/sewer cap 2502
Floor diain/floor sink/hub 25.02
Address: ,
Garbage disposal 25.02 ,
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
Ti.';',. ,., APPLICANT [I CONTACT PERSON -� Interceptodgreasehnp 25.02
Business name: Lp„e.T }- . ,&t t Medical gas(value:$ ) Page 2
Pruner 12.51
Contact name: `,CUrl Ce, Cafl'100. ,
�r/ � Roofdhain(cmmeanial) 12.51 q
Address: (0 l 0 Q, 142_, AU L Sink/basin/lavatory 25.02
City/State/ZIP: o,(�-10,v5 d 'o t.III-2 I Q Solar units(potable water) 62.54
Phone:(SON)1•' .-. g (I, Fax::( ) Tub/shower/shower pan 12.51
E-mail: Pe.r w)4'5 I bk.yvr1 SI(u i C es. ,c 2q/eN Urinal 25.02
COI'TRA OFt=` r ...f :f Waterheaet 25.02
Water heater 37.52
Business name: Lo' (;Lt '(VI Cos Waterpiping/DWV 56.29
Address:go Ne I. 2 Other: 25.02
City/State/ZIP: Q C IQ0,,,6 a 2 q-1'21g Subtotal
Phone:(So3)734._ 842,3 Fax:( ) Minimum permit fee: $72.50
{�Q Plan review (25%of permit fee)
CCB Lie.: i Lc 5()' -• Plumbing Lic.no.: rL(p-1--3.-3P..B
.."......, /' p State surcharge(12%of permit fee)
Authorized signature: ( L x k{t{r TOTAL PERMIT FEE
Print name: ( ,Cs (.a,f w)(2k+. Date: (1 2/(c This permit application expires if a permit is not obtained withhs 180 days
( �.e� after it ban been accepted as complete.
Fee methodology set by Tri-County Building Industry Service Board.
l:VBuildimgWaraits\PLMU-PermiaApp.doc 10/01009 440.4616T(10/09/COMAYEB)
7
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities • QEy. Fee(ea) Total - ,:7 -.:., _;, ,'s. � -
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 7,200 $233.20
Sewer-1st 100' r 001 62.54 7,201 and greater S327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52 a� � y + """" "r
'�f 1}tl fla " r '.= P.Ir�tk. -i i a: s} h
Storm&Rain Drain-1st]00' 62.54 iR
$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
Qty " Tee(ea) >Total.€ each additional$100.00 or fraction thereof,to
Od[ir��Spe6titSl�l3;a�v�`�t?$._ : 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 S100.00 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 90.00/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 S 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 sewet_fees*.
Quantity byFixture type ,PIaiL Revie 4OF'YIumbmgttttall4 i 1
Fixture Typefor Replace/
Capped Added RelocatePlan review is required for any of the following.
m
WorkPerfor edcPlease 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 Thm ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/WaterAspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit a sets of plans with any of the above.
-3"
-4" '-Isolnetric or Riser Diagram
Car Wash Drain
Garbage Domestic-non-food a❑ 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 MacbiRefrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
increase of sewer EDUs,a sewer permit will be issued and
Water Extractor
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
I:\Building\Permits\PLMU_PernutApp.doc 2