Permit .. ., CITY OF TIGARD PLUMBING PERMIT
' . COMMUNITY DEVELOPMENT Permit #: PLM2010 00043
',TIGARD' 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 02/03/2010
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9483 SW WASHINGTON SQUARE DR AO6B
Subdivision: Lot: 0
Project: Pac Sun
Project Description: Install (1) drinking fountain, (1) 2" floor drain /sink, (1) bar /lav, (1) service sink, (1) w /c, (1) primer,
and (1) w /h. Install (6) caps for (5) 3" floor drains, (5) lays, (3) service sinks, and (2) w /c.
Owner: FEES
PPR WASHINGTON SQUARE LLC Quantity Description Date Amount
2235 FARADAY AVE STE #O
CARLSBAD, CA 92008 6 ea Fixture/Sewer Cap 02/03/2010 $150.12
PHONE: 1 ea Drinking Fountain 02/03/2010 $25.02
1 ea Floor Drain /Floor Sink/Hub 02/03/2010 $25.02
1 ea Primer 02/03/2010 $12.51
Contractor: 1 ea Sink 02/03/2010 $25.02
RECON INC 1 ea Lavatories 02/03/2010 $25.02
PO BOX 822964 1 ea Water Closet 02/03/2010 $25.02
VANCOUVER, WA 98682 1 ea Water Heater 02/03/2010 $37.52
PHONE: 360-772-8149 1 12% State Surcharge - 02/03/2010 $66.05
FAX Plumbing
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $391.30
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. • •ecialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if w. r 's not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to , Ilo the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0111. ou may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
n • b Issued By: I n U 1 ( �l'1 Prmittee Signature: — vJU1) Jv1 J� X \ 1 -
Call 503.639.4175 by 7:00 a.m. for an inspection that business . ay.
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
Building Fixtures -
ixtures E( - �EIVED .g ? °Y.i, &.`c'I .1.1 (l
"` ` , ,
It I
City of Tigard Received
Date/By: No.: pC
q 13125 SW Hall Blvd., Tigard, OR 97223 , t Q `� 2O Zo v..
i C Plan Review
Phone 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit No.:
I I c i� Inspection Line: 50 CITY OF TI Date Ready /By: Buis' ® See Page 2 for
Internet: www.tigard - or.gov BUILDING n � VISION Notified/Method: r� Supplemental Information
TYPE OF WORK l l ll 17 OSp�N FEE* SCHEDULE •
El New construction 0 Demolition For special information use check list
Description Qty. Ea. 1 Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
❑ I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi - family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: Q, l Catch basin or area drain 18.76
�� 3 1� �5 h' N�t� t �c 1 r`1, '�t' Drywell, leach line, or trench drain 18.76
City /State /ZIP: (/
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: 1 Project name: PAL 5/ y 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
Water service (no. linear ft.: _) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: \ S‘ ' Q Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Dishwasher 25.02
Drinking fountain ` 25.02
Ejectors /sump 25.02
❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: Fixture /sewer cap (a 0 25.02
Floor drain/floor sink/hub a't 1 25.02
Address:
Garbage disposal 25.02
City /State /ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON • Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Primer ( 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
Water closet 1 25.02
CONTRACTOR •
Water heater ( 37.52
Business name: V.e.,C6K) I (A t✓ Water piping/DWV 56.29
Address:
U (3. 2,9 G Other: 25.02
City /State /ZIP: ( (rYtCA . -/ /1/° te7 Subtotal
Phone: (%(.) ) 71 Z f3/ (( 6 Fax: (W) ) S sci 4151 Minimum permit fee: $72.50
CCB Lic.: )1,?/ / e Plumbing Lic. no.: P13 52 ; Plan review (25% of permit fee)
State surcharge (12% of permit fee) • I
� rrr---
Authorized sig ture: TOTAL PERMIT FEE ' ���in"''`"` 8
Print name: Date: C., �l� ja /U This permit ap expires if a permit is not obtained within 18
after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry M/ Service t �
I:\ Building \Permits\PLMU- PermitApp.doc 10/01/09 440- 46I6T(IO /02 /COWEB)
Plumbing Permit Application - City of Tigard -
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities • Qty. Fee (ea) Total Square Footage: Permit. Fee:
Footing drain - 1s 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' 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
Valuation: Permit Fee:
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
.Other Inspections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to
P 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 90.00/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 ", Plan Review;for Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees * . Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixture Type: Replace greater, except systems designed and stamped by licensed
Previous' Capped Added Existing engineer.
Baptistry/Font
Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure
Jacuzzi /Whirlpool as defined in OAR918- 780 -0040.
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive tall ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash Isometric or Riser Diagram
Floor Drain/sink - 2" I ❑ Isometric or riser diagram is required for new buildings
3 that meet the qualifications above.
Car Wash Drain
Garbage - Domestic
Disposal - Commercial
- Industrial Comments regarding fixture work:
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar /Lavatory ',- 5 1
- Bradley
- Commercial *Note: If the fixture work under this permit results in an
- Service 3- 3 1 increase of sewer EDUs, a sewer permit will be issued and
Swimming Pool Filter fees assessed for the sewer increase must be paid before the
washer - Clothes plumbing permit can be issued.
Water Extractor P g P
Water Closet - Toilet 0 'L l
Urinal
Other Fixtures:
1:\ Building \Permits\PLMF - PermitApp.doc 2