Permit Ihi CITY OF TIGARD PLUMBING PERMIT
0 • COMMUNITY DEVELOPMENT Permit #: PLM2010 -00331
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/20/2010
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9416 SW WASHINGTON SQUARE RD K08
Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project: GNC
Project Description: Interior plumbing: Adding (1) sink and relocating (1) water heater.
Owner: FEES
PPR WASHINGTON SQUARE LLC Quantity Description Date Amount
2235 FARADAY AVE STE #O
CARLSBAD, CA 92008 1 ea Fixture /Sewer Cap 10/14/2010 $25.02
PHONE: 1 ea Sink 10/14/2010 $25.02
1 ea Water Heater 10/14/2010 $37.52
1 12% State Surcharge - 10/14/2010 $10.51
Contractor: Plumbing
MP PLUMBING CO
PO BOX 393
CLACKAMAS, OR 97015
PHONE: 503 - 655 -9161
FAX: 503 - 655 -1726
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $98.07
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 33 .2344. /-�
Issued By Permittee Signature: / v //
i
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.
gs. Pogo 2 for
siandkmeiW Information
437.78
500.32
25.02
Page 2
❑ New constriction
Addition /altcration/replacernent ❑ Other
❑ 1- and 2- tkmily dwelling I Commercial/industrial
❑ Aecessoty building ❑ Multi- family
0 Master builder 0 Other:
Job site address: •
City/State/ZIP:'
Suite/bldg./apt no.:
Cross street/directions to job site:
Subdivision:
,•t1. t >
• e
Name:
Address:
City /State/ZIP:
Phone: ( )
Business name:
Contact name:
Address:
City/State/ZIP:
Phone: (
E -mail: -.
Authorized signature:
Project name: ay aI
j 7:1 v mb In
Address: -- PC) . 7-97)
City/State/ZIP: ( Q Ccm . l YR c 10 1 IA
L9
( SDI) S. I r Fax: (C3) iD F7 1
CCB Lic.: S130 / a Plumbing Lic. no.' /�
Al
New 1- 2-fondly dwellings (includes
SFR (1) bath
SFR (2) bath
SFR (3) bath
Each additional bath/kitchen
Fire sprinkler (, sq. ft.)
Site utilities;
Catch basin or arca drain
Drywell, leach line, or trench dram
Footing drain (no. linear fl.:
Manufactured home utilities
Manholes
Rain drain conmoctor
Sanitary sewer (no. linear R: _)
Fiatore or hem:
Backwater valve
Clothes washer
Dishwasher
Expansion tank
Floor drain/floor sink/huh
Interceptor/grease trap
Medical gas (value: $
Roof drain (commmeial)
Solar units (potable water)
Water closet
Water piping/DWV
Other:
100 it_ for each utility connection)
312.70
18.76
1 11.76
Page 2
50.03
18.76
18.76
Page 2
Page 2
Page 2
31.27
12.51
( 25.02
25.02
25.02
25.02
12.51
25.02
25.02
25.02
25.02
12.51
25.02
Page 2
12.51
12.51
25.02
62.54
12,51
25.02
25.02
37.52
56.29
25.02
Subtotal
la 2,S
r
Plumbing Permit Application
Site Utilities
City of Tigard
13125 SW Hall Blvd,. Tigard. OR
Phone 503.639.4171 Fax: 501.5
Inspection Line: 503.639.4175
Internet: www.tigard- or.gov
Print name:
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Date 10
/3
440.46167(10102 >CC» ,vW r:>t)
Z d s9 8Z8008' °N /VC :S1'1S /tC:SI. 0102 01 100(03M)
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Minimum permit fee: $72.50
Plan review (25% of permit fee)
State burcharge (12% of permit fee)
TOTAL. PERMrT FEE
k)- (`t
Thb permit application expires If a permit le cot obtained within 180 days
after a na been accepted o complete.
*Fee methudoIoey set by Tri ttuilding Indmlry Service Board.
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Plumbing Permit Application - City of Tigard � ) 1 ( .
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su ression S stems:
,: i ; , , , I{ ,� 17 „ t ! 't } i i 1 71 ,l1 4II' b, I' { � G '. � I
H X171„ + r xx, �
, 1,1 , r lRa +l ? F fd
Footing drain - L" 100' 50.03 0 to 2,000 5121.90
Footing drain - each additional 100' IiiiEll 2 001 to 3 tiW 5169.69
S 601 to 7 00 $233.20
Sewer - 1st 100' 62.54 7,201 and : cater 5327.54
Sewer - each additional 100' 37.52 MI
Water Service - 1st 100' 62.54 Medical Gas S stems:
Water service •oath additional Loo'
rr c ,rt
1. ! „� , IC f t ._ r �:�, F �lf,
_ . .m , . • .. . ..',i° P.
Storm & Rain Drain -1st 100' 62.54 51,00 to 55,000.00 Mmmrum foe $72.50
Storm & Rain Drain - each additional 100' 37.52 55,001,00 to 510,000.00 57250 for the first 55,000.00 and $1.52 for
each additional $100 00 M fraction thereof, to
and includm • $10 000.00.
Inspection of existing plumbing or for 510,001.00 to 525,000.00 5148.50 for the first 510,000.00 and 51.54 for
which no fcc is specifically indicated III 90.00Ru' ■ wet additional 5100.00 or fraction thereof, to
minimum _e -1/2 Lour and includin: S25 000.00.
90.00/lur - $25,001.00 to $50,000.00 $379.50 for the Iir% $25,000,00 and $1,45 for
Rei l an additional 5100.00 or fraction thereof, W of,
n� oon Fees 90.00/hr and d d
includm: 5500,, 000.00.
Additional plan review for revisions 90.00/hr - 550,001.00 and up 5742.00 for the first $50,000.00 and 51.20 for
minimum a -1/2 hour each additional 5100.00 or fraction thereof.
Subtotal: ___
Commercial Fixture Work:
pP, ,, R�tlt +1.3 +fl
Are you capping, adding or replacing fixtures If "yes", {i r . I " f, ,'6 y ++ , ,, ,,t,1,
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accuratel r ; ' rt fixtures could result in increased sewer fees *. Please check all that apply,
n r{. , ,
4 �yf „ i; ,,, , + ,,�� +'.V l , + ,,, ,r I , , x Any new commercial building with water service 2" and
++ ` , ry , , . 34 , ;�, greater, except systems 7 h S fi4 t+S i } ,} L+ stems di � 7 � ed and s b stamped by licensed
c ,.; /Font engineer,
Both - - -- ❑ New exterior plumbing site utilities for any complex structure
�
- lac 1 �� �� as defined in OAR918- 780-0040.
Car wash -Each Stall ❑ Medical gas and vacuum systems for health care facilities.
- Drive Thtu MMINII -- ❑ Any multipurpose fire sprinkler system.
❑ Any complex structure as defined in OAR918- 780 -004D.
Dishwasher -Commercial - - --
- Domestic �
Submit? sets of plans with any of the above.
MINIM
inhin • Fountain -_ -- _
1 {�f >d4fh { I{ If >i iifl ,±is frt tt ns + l3iu , pht'1 ,ut:r s' t
E e Wash i {
*t i I�' r. ' S
Floor Drain/sink - 2" - - -- • Isometric or riser diagram is required for new buildings
- 3" that meet the • ualifications above.
-
Car Wash Drain 11111111111111111111
Garbage - Domestic - - --
Diylxrsal commercial Comments regarding fixture work:
Ice MachiRcfri: Drains - - --
Oil -.., . • Gas Station - - --
Rec. Vehicle ► Station - - --
Shower -Gang
-Stall -�_-
Sink -Bar/Lavatory - - --
- Bradley -��-
-Commercial *Note: If the fixture work under this permit results in an
- Ser11e increase of sewer EDUs, a sewer permit will be issued and
Swimmin Pool Filter IMIIIIIMIIIIION1111011111111 fees assessed for the sewer increase must be paid before the
Washer - Clothes - - --
Water Extractor plumbing permit can be issued.
Water Closet - Toilet -In=
Urinal -MIME
Other Fixtures: V[j M",►fM !
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