Permit •
• y ;, CITY OF TIGARD PLUMBING PERMIT
C COMMUNITY DEVELOPMENT Permit #: PLM2010 -00224
13125 S W Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/16/2010
T 1GARD g Parcel: 151260000300
Jurisdiction: TIGARD
Site address: 9524 SW WASHINGTON SQUARE RD H08
Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project: Spec Space
Project Description: Relocate 30' storm sewer and 200' water line
Owner: FEES
PPR WASHINGTON SQUARE LLC Quantity Description Date Amount
2235 FARADAY AVE STE #O
CARLSBAD, CA 92008 30 If Storm and Rain Drain 07/16/2010 $62.54
200 If Water Service 07/16/2010 $100.06
PHONE. 1 12% State Surcharge - 07/16/2010 $19.51
Plumbing
Contractor:
MODERN PLUMBING
11120 SW INDUSTRIAL WAY
TUALATIN, OR 97062
PHONE: 503 -691 -6166
FAX: 503 - 691 -6771
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
•
Total $182.11
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 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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: _'�, Permittee Signature: /
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
Jul. 14. 2010 1 :02PM Modern Plumbing o, 2317 P. 2
Plumbing Permit Application */" tva /,� Pz , 'A/MIN p/O /OD /3"
Building Fixtures 1 (IR 1)1 1 1(1 t tit O \l 1
,Y; City of Tigard J I i 1 1 4 21,00 Received 7 / 6 w t Nn.f
Hall gar, J '" Date/B " J/� �z" / °?a f0 - 00��
~ plan Review
® ; L3125 SW HIE Blvd., OR 9722
Phone: 503.639.4171 Fax: 503.598. p other Permit Nelij�a0/�!
Inspection Line: 503.639,4175 C1 a OF DatecRea n3 ��� �
...
i i ';''.r..9::,),, Internet; www.tigard- or.gov D y �f"�� ® [or
RIIILDING Nmified/Mmhnd: / L Supplememallnformation
TYPE OF WORK . , FEE* SCHEDULE
[] New construction ❑ Demolition For special infor»mfion use checklist
Description 1 Qty. 1 Ea. 1 Total
Addition/alteration/replacement ❑ Other: New 1- Z- family dwellings (includes 100 ft. for each utility connection)
' CATEGORY OF CONSTRUCTION . SFR (1) bath 312.70
❑ 1- and 2- family dwelling ',Comercial/industrial SFR (2) bath 437.78
m
SFR (3) bath 500.32
❑ Accessory building ❑ Multi - family
Each additional bath /kitchen 25.02
❑ Master builder , ❑ Other: Fire sprinkler (_____ sq. ft.) Page 2
q,Sa' / JOB STT INFORMATION AND LOCATION ' , Site utilities:
Job site address: �t W 1, k srl a Catch basin or arca drain 18.76
City /State/ZIP: 1 G ��� Drywcll, leach lino, or trench drain 18.76
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: /--/-..., 9 Project name: - 1 - 4 e' ILA t re,,_, Manufactured home utilities 50.03
Cross street/directions to job site: ARMr L y /�C( (// L Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no, linear R: J Page 2
Storm sewer (no. linear ft.:3) Page 2 (;2. sq
- Water service (no. linear ft.: Page 2 /QQ,(ab
Subdivision: I Lot no.: Fixture or Item:
Tax map /parcel no.: Backflow preventer 31.27
-
DESCRIPTION OF WORK Backwater valve 12.51
f Clothes washer 25.02
R e,: (� L-0. 4 e 3 0 J C V n .S c u r Dishwasher 25,02
9 -\ E' t Cl L.O- k- '2_06 LJJ 0. r 1 1 n Q,> Drinking fountain 25.02
Ejectors/sump 25,02
' ❑ PROPERTY OWNER • 1:1 TENANT Expansion tank 12,51
Name: Fixture /sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City /State/ZIP: Hosc bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT ' I ❑ • CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Primcr 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: ( ) 1 Fax:: ( ) Tub /shower /shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
CONTRACTOR •
Water heater 37,52
Business name: Ode L
t.1 �' 1!1 ' (� Y� �J ■ A Q Water piping/bWV 56.29
Address: 1 l \ Z `x , ) 11 c( 0 5 \ Y \ tJ 1,)(:),;,1 Other: 25.02
City /State/ZIP: T 1 ( ii,, ) c),/1_ 9 7 6 te 'Z Subtotal 1(p ?, (
(9/5 Minimum permit fee: $72.50
Phone: ? ) (4 l CP ((A c Fax: ) (fl 9 ( (," 7 -
0/e CCB Lic.. 7 7 O J Plumbing Lic. no.: 3 4- Z,sO� Pla review (25% of permit fee) )
State surcharge (12% of permit fcc) 19.5 (
Authorized signature: TOTAL PERMIT FEE 1, $Z, 1 1 V
Print name: i.� K a 41 6 e c. :_A� 1 Dat 7 f /` / This permit application expires if a permit is not obtained within 180 days
after it bas been accepted as complete.
i°Fee methodology set by Tri- County Building Industry Service Board.
I:\Bu i) utng '?ermltu\PLMIJ- PermitApp.doc 10/01/09 440- 4616T(10 /02/COM/WEB)
Jul. 14. 2010 1:02PM Modern Plumbing . No. 2317 P. 3
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire. Suppression Systems: • .. •
Qty. fee (ea). , : Total .. .,_ . ... .., •.
Site Utilities ._: quare`Footage P+eruit'e
Footing drain - I" 100' 50.03 0 to 2,000 5121,90 _
Fooling drain - each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 9 200 $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
I b2V Medical Gas Systems:
Water Service - each additional 100' ( . . 37.52 . s c• ti , -.= .
3 -1,9,-- ahYattiou: ,erml<tFee � .T, � - -• - „
Storm & Rain Drain - 1st 100' i • 62.54 (02,41 $1.00 to $5,000.00 Minimum fee $72.50
Storm et 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
r.. ;�aF i. v,,: w:_...: w
�iliP ; IIap: UB:QIt'.a T '.._ ;: ,?: • :..: .e: each additional $100.00 or fraction thereof, to
and including $10,000.00.
Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 for tho first $10,000.00 and 51.54 for
which no fee is specifically indicated 90.00/hr . each additional 5100.00 or fraction thereof, to
(t minimum chnr�e - I/2 hour . and including $25,000.00,
Inspections outside of normal business 90.00/hr $25,001.00 to $50,000.00 5379.50 for the fast $25,000.00 and $1.45 for
hours (minimum charge - 2 hours) each additional $100.00 or haction thereof, to
Reinspection Fees 90.00/hr and including 550,000.00. _
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
(mina charge -1/2 hour) • _ each additional $100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
g P g ... . Pla11ot.R i: 106 �furTItiiri binglirsfallations_:
Ace.yQU.sapping�llEddin or. re .lacin fixtures ?, tf "yes ",
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.
Anent* by.(Fixturey 111 Any new commercial building with water service 2" and
• • • - F'lttture 4 ype .. .•. , , Replace' :. greater, except systems designed and stamped by licensed
Prevtons Capped A dded Eiciiijn engineer.
Baptistry/Font
Bath Font hoover ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918- 780 -0040.
- Jacuzzi/Whirlpool ❑ Medical gas and vacuum systems for health care facilities.
Car Wash -Each Stall •
Drive 'Duo ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator ❑ Any complex structure as defined in 0AR918- 780 -0040.
Dishwasher - Commercial
- Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain �,
Eyc Wash �, 1' `' :i \ S • ol O c O roL Ths ej' : Diag Ani i ......
Floor Drain/sink - 2" _
- - that meet the qualifications above. ❑ Isometric or riser diagram is required for new buildings
- 3» ' .
4 ,. _
Car Wash Drain
Garbage - Domestic
Disposal Commercial Comments regarding fixture work:
- Industrial _ - Ice Mach./Rcfri • . Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang -. -
_ -Stall
Sink - Bar/Lavatory
- Bradley _
- Commercial *Note: 11 the flxture work under this permit results in an
- Service 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 .
Water Extractor plumbing permit can be issued.
Water Closet - Toilet
Urinal
Other Fixtures:
I :1 Building \Permits\PLMF - PermitApp.doc 2