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CITY OF IGAR® PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2010 -00202
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/22/2010
TIC�
g Parcel: 1 S135BA00100
Jurisdiction: Tigard
Site address: 10205 SW WASHINGTON SQUARE RD
Subdivision: WASHINGTON SQUARE TOO Lot: 0
Project: Thirsty Lion
Project Description: Interior demo of fixtures to prep for TI. 8/11/10, revised demo fixture count.
Owner: FEES
PPR SQUARE TOO LLC Quantity Description Date Amount
BY THOMSON PROPERTY TAX SERVICES,
2235 FARADAY AVE STE #0 1 ea Backflow Preventer 06/22/2010 $31.27
PHONE: 1 ea Dishwasher 06/22/2010 $25.02
2 ea Floor Drain /Floor Sink/Hub 06/22/2010 $50.04
6 ea Sink 06/22/2010 $150.12
Contractor: 3 ea Urinal 06/22/2010 $75.06
SHORE CONSTRUCTION INC 2 ea Water Closet 06/22/2010 $50.04
2206 SE WASHINGTON 1 12% State Surcharge - 06/22/2010 $45.79
MILWAUKIE, OR 97222 Plumbing
PHONE: 503 - 314 -7380
FAX:
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $427.34
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
issua , or if work is . - .ended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Uf ' Notification Center. .se rule -re set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the ules
direct questions to OUNC b c. ng 503.246.6699 or 1.800.332.2344.
ssued By: / /e r / , Permittee Signatu r-
CaII 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.
�i17n CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2010 -00202
Date Issued: 06/22/2010
TiGARD, 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1S135BA00100
Jurisdiction: Tigard
Site address: 10205 SW WASHINGTON SQUARE RD
Subdivision: WASHINGTON SQUARE TOO Lot: 0
Project: Thirsty Lion
Project Description: Interior demo of fixtures to prep for TI.
Owner: FEES
PPR SQUARE TOO LLC Quantity Description Date Amount
BY THOMSON PROPERTY TAX SERVICES,
2235 FARADAY AVE STE #0 1 ea Backflow Preventer 06/22/2010 $31.27
1 ea Dishwasher 06/22/2010 $25.02
PHONE: 2 ea Floor Drain/Floor Sink/Hub 06/22/2010 $50.04
6 ea Sink 06/22/2010 $150.12
Contractor: 3 ea Urinal 06/22/2010 $75.06
SHORE CONSTRUCTION INC 2 ea Water Closet 06/22/2010 $50.04
2206 SE WASHINGTON 1 12% State Surcharge - 06/22/2010 $45.79
MILWAUKIE, OR 97222 Plumbing
PHONE: 503 - 314 -7380
FAX:
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $427.34
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct q - ions firOUNC by calling 503.246.6699 or 1.800.332.2344.
Issued k Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures RECEIVE „ t +,« ; al OR () I I I(I T liSl 1() 1 \I 1 c 4 )G* i . l
+ ' l " 4hi�?�':" .6,J;'i +C , 44";. tit .:a. :r 8': tCrttl� u:., aMa4, "-$:, . r u b .. tiut d �3i
City of Tigard Received /� n' 411 7 /O 2.
IN
Date/By: c 4" h �U Permit No.: ^
a 131 25 SW Hall Blvd., Tigard, OR 97223 JUN 2 2 2010 010 Plan Review
:. Phone: 503.639.4171 Fax: 503.598.1960 Date/By:
C !•
Other Permit No.:
1 Inspection Line: 503.639.417
T 6 NIL 1) CITY OF TIGARD Date Ready/By: Juris: ® See Page 2 for
_ .,. ,.. Internet: www.tigard- or.gov BUILDING DIVISI ®g otified/Method: Supplemental Information
TYPE OF WORK • FEE* 'SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description 1 Qty. 1 Ea. 1 Total
❑ Addition/alteration/replacement ❑ Other: New I- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
❑ 1- 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: 102.0 [A)} t BTU l0 °� Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City /State /ZIP: tG.,D
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: '1 4- 1t25 ---r L1 - N 1 Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
6 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: Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 1 31.27
DESCRIPTION OF • WORK Backwater valve 12.51
Clothes washer 25.02
( N+ O 01 Dishwasher Dr�o Ea- CvvM( 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
■ PROPERTY OWNER I ❑ TENANT • Expansion tank 12.51
'-i, Fixture /sewer cap 25.02
Name: M A C. - € e1 (.44 Floor drain/floor sink/hub 'Z 25.02
ddress:
J � Garbage disposal 25.02
City /State /ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
4. ❑ . APPLICANT 0 CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Primer 12.51
‘,42)ontact name: Roof drain (commercial) 12.51
q Address: Sink/basin/lavatory 49 25.02
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 3 25.02
Water closet Z 25.02
j CONTRACTOR ' Water heater 37.52
Business name: S � Q- C s 2. _r 1oti11� I IJC Water piping/DWV . 56.29
Address: 2 Z0(o S 6_ W t/A5 t-fl ►-•7 17 Other: 25.02
City /State /ZIP: n/1 L,,�,,., k_t lam, t Subtotal
000((( Phone: (Z) 31 c{ -I/ Fax: ( ) Minimum permit fee: $72.50
CCB Lic.: ( -Z(D 3 21 Plumbing Lic. no.: Plan review (25% of permit fee) ---(9
State surcharge (12% of permit fee) $/#,2 "A; 7T
Authorized signature: cc = -/ l� l 1 TOTAL PERMIT FEE 7.5T
Print name: � lJ S' 1 (ZFL Date: G'Z izei o This permit application expires if a permit is not obtained within 180 days
iii after it has been accepted as complete.
"Fee methodology set by Tri- County Building Industry Service Board.
1:\ Building \Permits\PLMU- PermitApp.doc 10 /01/09 440- 4616T(l0 /02/COM/WEB)
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 - 1' 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
Storm &Rain Drain - 1st 100' 62.54 Valuation: Permit ,Fee:
$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 Ins ections or Fees Qty Fee (ea) Total each additional $100.00 or fraction thereof, to
I� 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
Tub /Showr ❑ New exterior plumbing site utilities for any complex structure
Bath - ower
Tub /S erlpool 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" ❑ Isometric or riser diagram is required for new buildings
•
that meet the qualifications above.
-4 „
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
- Bradley
- Commercial Lo * N ote: If the fixture 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:\ Building \Permits\PLMF - PermitApp.doc 2
Accumulative Sewer Tally Parcel # 1S135BA00100
Tenant Name: Thirsty Lion * *RFV ISl D ** This SWR# N/A
Site Address: 10205 SW Washington Sq This PLM# PLM2010 - 00202
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off #s count # value #s values
Baptisery/Font 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 1 4 0 -1 -4
- 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 4 20 0 -4 -20
- 4 inch 6 0 0 0 0 0
- Car Wash Drn 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 I -IP) 16 0 0 0 0 0
- Commercial (to 5 HP) 32 0 0 0 0 0
- Industrial (over 5 I -IP) 42 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 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 - Bar /Lavatory 2 0 6 12 0 -6 -12
- Bradley 5 0 0 0 0 0
- Commercial 3 0 • 0 0 0 0
- Service 3 0 0 0 0 0
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 2 12 0 -2 -12
Urinal 6 0 3 18 0 -3 -18
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 16 66 0 0 -16 -66
Current Fixture Value -66 divided by 16 = -4.1 Current EDU 1 EDU = $ 3,600
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -66 divided by 16 -4.1 over (under) $ (14,760.00)
Enter EDU Change Here -4.1
Notes: ** *Credits * ** 8/11/10, corrected capped fixture count, from 3.1 to 4.1 credits.
Authorized Name /Signature: Debbie Adamski Date: 6/22/2010
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 \Sewerl'allySheet- 3600.xls 06/25/08
Accumulative Sewer Tally Parcel #
Tenant Name: Thirsty Lion This SWR# N/A •
Site Address: 10205 SW Washington Sy This P1,M# PLM2010 - 00202
i:ixturc Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off #s count # value #s values
Raptisery/Pont 4 0 0 0 0 0
Rath - Tub /Shower 4 0 0 0 0 0
- Jacuzzi /Whirlpool 4 0 0 0 0 0
Czar 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 1 4 0 -1 -4
- Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 0 0 0
1?yc Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 2 4 0 -2 -4
- 3 inch 5 0 0 0 0 0
- 4inch 6 0 0 0 0 0
- Car Wash Drn 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 HP) 16 0 0 0 0 0
- Commercial (to 5 1-IP) 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
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 - Bar /Lavatory 2 0 6 12 0 -6 -12
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 0 0 0
- Service 3 0 0- 0 0 0
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 2 12 0 -2 -12
Urinal 6 0 3 18 0 -3 -18
Previous EDU Count 0 0
Capped EDU Credit 0
"1'O'1'A1.,S 0 0 _ 14 50 0 _ 0 -14 -50
Current fixture Value -50 divided by 16 = -3.1 Current EDU 1 EDU = S 3,600
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -50 divided by 16 = -3.1 over (under) S (11,160.00)
Enter EDU Change Here -3.1
Notes: ** *Credits * **
Authorized Name /Signature: Debbie Adamski Date: 6/22/2010
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.
1: \ Building \Sewer Tally \Sewcrl'allyShcet- 3600.xls 06/25/08