Permit CITY OF TIGARD PLUMBING PERMIT
I COMMUNITY DEVELOPMENT Permit #: PLM2010 -00304
T [CARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/16/2010
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9669 SW WASHINGTON SQUARE DR CO3
Subdivision: WASHINGTON SQUARE MALL Lot 0
Project: Express
Project Description: Interior plumbing for TI: adding (2) 2" floor drains, (2) sinks and (1) water closet. Capping (2)
water closets and (2) sinks. Other fixtures: (1) primer, (1) water heater.
Owner: FEES
PPR WASHINGTON SQUARE LLC Quantity Description Date Amount
2235 FARADAY AVE STE #O
CARLSBAD, CA 92008 4 ea Fixture /Sewer Cap 09/16/2010 $100.08
PHONE: 2 ea Floor Drain/Floor Sink/Hub 09/16/2010 $50.04
1 ea Primer 09/16/2010 $12.51
2 ea Sink 09/16/2010 $50.04
Contractor: 1 ea Water Closet 09/16/2010 $25.02
JACK CORMAN PLUMBING INC 1 ea Water Heater 09/16/2010 $37.52
7483 SE JOHNSON CREEK BLVD 1 12% State Surcharge - 09/16/2010 $33.03
PORTLAND, OR 97206 Plumbing
PHONE: 503 - 788 -6947
FAX: 503 - 788 -6949
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $308.24
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 ma obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 • . :.332.2344.
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Issued By: Permittee Signature:
∎Li/�
Call 50 . • 9.4175 by 7:00 a.m. for an inspection that Xss day.
This permit card shall be kept in a conspicuous place on the job sit until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application 1l�® d. oc)00 0
g Fixtures ck Buildin FOR OFFIC .: IESE'. ONI.1
City of Tigard .. 16 V Received
S Date/By: '7 1!o i 0 O•' Permit No.: a mew - a33i9
a 13125 SW Hall Blvd., Tigard, OR 97223 v 1
Plan Review
0 ' Phone: 503.639.4171 Fax: 503.598.1960 nc \1G C ' Other Permit No.: R�P � _ 300
1 1;1> Inspection Line: 503.639.4175 f� G D1v1S1 Date/By: C1
Date Ready/By: kris: ® See Page 2 for
Internet: www.tigard or.gov 1 111 D1N1 Notified/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 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
❑ 1- and 2- family dwelling ., ommercial/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: 9 (P6 y' SG,) t S oft c a? Catch basin or area drain 18.76
City /State /ZIP: � ` G 4-a.1) �� �, 6 Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: 1'7( 2 CL O.% i Sat.- Manufactured home utilities 50.03
Cross street/directions to job site: 4-5-4S 7 $',r, g--- 0°r Manholes 18.76
f/7S /1/ 0 J 6 iip _S' 0 (//}t o Ur2/ GI Rain drain connector 18.76
-gar Ua / %- - Y Q� C Sanitary sewer (no. linear ft.: 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.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
//4S./ 6L- UG P(/° ' Dishwasher 25.02
6�l f, Drinking fountain 25.02
Ejectors /sump 25.02
❑ PROPERTY OWNER 1 ❑ TENANT Expansion tank 12.51
Name: I a 25.02
Fixture /sewer cap a 25.02 1 OJ, 01
Address: Floor drain/floor sink/hub 5"0) ut.I
Garbage disposal t 25.02 1
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
Contact name: Primer 12.51 1 ).-., 5"
1' •
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory j in dec. /14 a 25.02 ,j .0 4
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
CONTRACTOR Water closet _ / -. 25.02 '�S tJa-
Water heater i 37.52 `3 s�,
Business name: J - 6 1 0 : ( rGAmei P(14,71,, Aj 1/" Water piping/DWV 56.29
Address: ?LI ccd SIC ,70 /NSOisl eab -zs_7 ,L// Other: 25.02
City /State /ZIP: 7a'?7 zAA4) o 972 G(� Subtotal
S o;) - 7‘,.-c - 6 (.Se/3 ) 7 kS -- 6 Minimum permit fee: $72.50 2.-7 5"-.J( Phone: Fax:
Plan review (25% of permit fee)
CCB Lic.: 3 /J
4 ,8,4_ Phunbing Lic. no.: p 4 9 a ,
� J , -1 State surcharge (12% of permit fee) •'3 6?
Authorized signature: ���Li TOTAL PERMIT FEE 3 permit t
Print name: �/ � e �� /y�/f/11 Date 9 =�G / , Tpermit application expires if a permit is not obtained within 180 days
v after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
L\ Building \Permits\PLMU- PermitApp.doc 10/01/09 440-4616T(10 /02ICOM/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 - lst 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 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
e Thr ❑ 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 - 27 ,Z ❑ Isometric or riser diagram is required for new buildings
3 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 Z• 7-
- Bradley -
- Commercial *Note: 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 - r Clothes
plumbing Extractor P g P ermit can be issued.
Water Closet - Toilet 1
Urinal
• Other Fixtures:
I: \Building\Permits\PLMF- PermitApp.doc 2
Accumulative Sewer Tally Parcel # 1S1260000300
Tenant Name: EXPRESS This SWR# NONE
Site Address: 9669 SW WASI-IINGTON SQUARE DR. CO3 This PI,M# PLM2010 - 00304
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
Baptistry/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 0 0 0 0
- Domestic 2 0 • 0 0 0 0
Drinking Fountain 1 0 0 0 0 0
Eyc Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 2 4 2 4
- 3 inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash Drn 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 1-IP) 16 0 0 0 0 0
- Commercial (to 5 I-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 2 4 2 4 0 0
- 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 1 6 -1 -6
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 4 16 5 14 1 -2
Current Fixture Value -2 divided by 16 = -0.1 Current EDU 1 EDU = $ 4,100
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -2 divided by 16 = -0.1 over (under) $ (410.00)
Enter EDU Change Here -0.1
Notes: ** *CREDIT * **
Authorized Name /Signature: BRANDEN TAGGART X2449 Date: 9/16/2010
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 \ScwcrTallySheet- 3600.xls 06 /25/08