Permit (7) I� CITY OF TIGARD PLUMBING PERMIT
��11 i , COMMUNITY DEVELOPMENT Permit PLM2023-00376
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 8/24/2023
Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9355 SW WASHINGTON SQUARE RD T19
Project: Yeti Subdivision: None Lot: None
Project Description: Relocating and adding 38 ft.of water service, relocating 10 ft.of venting,and installing(1)new water chiller.
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
38 If Water Service 08/23/2023 $62.54
Specifics: 1 ea Water Piping/DWV 08/23/2023 $56.29
Type of Use: COM 25 Misc Other Fee 08/23/2023 $25.02
1 12%State Surcharge- 08/23/2023 $17.26
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $161.11
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 sus ded for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center ose 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: a 14I I(i041 M
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. ( 1
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 ApplicatiovI EC E IVE D
Building Fixtures FOR OFFICE USE ONLY
City of Tigard AUG 2 1 2023 Le:471 b 1
% 13125 SW Hall Blvd.,Tigard,OR 97223 1)ateBy: W�/J 't 1p Permit No.: �Ll�libli O�'(��I
Phone: 503.718.2439 Fax: SD3.598.1g0,,� Nan Review L 3 W 1
Inspection Linc: 503.639.4175 UI I Y OF TIGARD DateRes / Other Permit No.:
TIGARD te 1 ��r rein..-:, Note eeadyetbo kris I la See Page for
Internet www.tigard-or.gov R ' "' """ J
Nalified/Melhod: Supplemental Information
TYPE OF WORK FEE* .SCHEDULE
❑New construction ❑Demolition For special information use checklist.-. Description
Addition/alteration/replacemcnt 0 Other; I Qh• I Ea. I Total
New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
❑ 1-and 2-family dwelling CommerciaVindustrial SFR(2)bath 437.78
❑Accessory building CI Multi-familySFR(3)bath 500.32
Each additional bath/kitchen 25.02❑Master builder ❑Other:
/)j � Fire sprinkler( ,sq.ft.) Page 2
`�1.. qJOB SITE;INFORMATION AND LOCATION Site utilities:
Jobsiteaddress: 15�j S� WG �k v>. k0� Catch basin or area drain 18.76
City/State/ZIP: i 0l Y 6 O 01�.!J 2 J l prywell,leach line,or trench drain I8.76
Suite/bldg./apt no.:1-"- t Project name: t' J Footing drain(no.linear R: ) Page 2
IC) I "1e�C I&Y SkO(C., Manufactured home utilities 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 ft.: ) Page 2
Subdivision: Water service(no,linear ft.:4t7r)tR Page 2 101, .rg‘
I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRLPTION OF WORK Backwater valve 12.51
MWUR� 3Piln`40.krliAC- 1Ok&c adekin92.oG ek o kof-
Clothes washer 25.tn
t ova r1 V2.Vo-ktiV ti'p 6*( __,,ss t�p, Dishwasher fountain 25.02
011�L� J`� \j NIWin!�iU4�r 0('Vc,vlti�q'irt Drinking
INC
-J 11'" 25.02
NC I VI sliTO.Wt'()tLW0.• Oil \tY 1 Ejectors/sump 25.02
0 PROPERTY OWNER 1 0 TENANT Ex panaron teak 12.51
Name: Fixture/sewer cap 25.02
Address: Floor drain/floor siltklhub 25.02
City/State/ZIP: Garbage disposal 25.02
Hose bib 25.02
Phone:( ) Fax:( ) Ice maker
,. 12.51
C,,/�APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: , `�CQ rS Medical gas(value:S
�Q.�kcY� _) Page 2
Contact name: A ,V')VI nWh l Primer 12,51
Q,v L _�TrY.'V
Address: 0 q 1 ,0 N 6 �1112 n AA p.„,, Roof drain(commercial) 12 51
Sink/basin/lavatory 25.02
City/State/ZIP: Pov yv O q vz,,4 Solar units(potable water) 62.54
Phone:(Vt{7) 952 - 2Arj Fax::( O ) Tub/shower/shower pan 12.51
E-mail: dyr) 14ve•'tt'Sty Vi Uitioal
.C.OYYI 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: L pv C--)E V V t C.C.S
Address: W I ZO 1\1 ., 42nd I�vvt. Other Water P1l10tVox � 2502 Sid 1,4..
City/State/ZIP: j � oX l/t1i11QJY • 1 total bS.Q�
�i)Y�\t�.f�G 0� ���1 � Subtotal
Phone:( 131- - 34 Z3 I Fax;( ) Minimum permit fee: S72.50
CCB Lie.: (2 ��]- Plumbing Lie,no.: 2.to -1-l8p�i Plan review (25%ofpermit fee)
Authorizedsi e: I State surcharge(12%ofpemiltfee) tl Aka
�q� � 1 TOTAL PERMIT FEE 11b1. 11
I Print name: 'lN hG Yt a/�r `^�I Date:$/Z. This penult application expires if a permit h not obtained within 180 days
r ✓W 1 7 otter It has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:1BuildieglPermiisTIMU-PermaApp.dec 10N1N9 440.4616T(10/02ICOMMEB)
i
1
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Q'Y. Fes(ea) Total _Square Footage: Permit Fee:Footing drain-1"100' 50.03 0 to 2,000 g $121.90
Footing drain-each additional 100' 97•32 2,001 to 3,600 $169.69
3,601 to 7,200
Sewer-1st 100' 62.54 $327.20
Sewer-each additional 100' 37.52 7,201 and greater 327.54
I
Water Service-1st 100' l 62.54 1,01 SA
Water Service 37.52
-eachadditiona110D' Medical Gas Systems:
Storm St Rain Drain-1st 100' 62 Valuation: Permit Fee:
.54
Storm&Rain Drain-each additional 100' $1.00 to$5,000.00 Minimum fee$72.50
37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Other Inspections or Fees Q13• Fee(ea) ' Total each additional$100.00 or fraction thereof,to
Inspection of existing plumbing or for and including the first$.00.
which no fee is specifically indicated yo��r $10,001.00 to$25,000.00 each a 0 for first$10,000.00 and$1.54 for
(minimum charge-1/2 hour) each additional$100.00 or faction thereof,to
Inspections outside of normal business 90.00/hrand including the first 0.00.
hours(minimum charge-2 hours) $25,001.00 to$50,000.00 each a 0 for first$25,00 fraction and$l eo.45 for
Reinspection Fees 90.00/hr each additional$100.00 or thereof,to
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: VI
C A
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*. Plan Review for Plumbing Installations
Fixture T e for Quantity by Fixture Type - Plan review is required for any of the following,
Replare(r Please check all that 1
Work Performed: Capped. Added Relocate aPP Y•
Baptistry/Font 0 Any new commercial building with water service 2"and
Bath: Tub/Slmwer greater,except systems designed and stamped by licensed
-lacum/Whirlpool engineer.
Car Wash: Each Stall El New exterior plumbing site utilities for any complex structure
Drive tall as defined in OAR918-780-0040,
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher Commer l ❑ Any multipurpose fire sprinkler system.
Domestic El Any 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"
Isometric or Riser Diagram
4,.
Car Wash Dra n 0 Isometric or riser diagram is required for new buildings
Garbage Domestic non-food that meet the qualifications above,
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice MachiRefrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related
-Bradley
-Com/Serv/Util food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothesincrease of sewer EDUs,a sewer permit will be Issued and
Water Extractorfees assessed for the sewer increase must be paid before the
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures: &kgY I,h\l\pX
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