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Permit CITY OF TIGARD PLUMBING PERMIT f ii '` COMMUNITY DEVELOPMENT Permit #: PL.M2010 00352 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/27/2010 Parcel: 1S1260000300 Jurisdiction: TIGARD Site address: 9524 SW WASHINGTON SQUARE RD H08 Project: H & M Subdivision: WASHINGTON SQUARE MALL Lot: 0 Project Description: Interior plumbing: adding (2) 2" floor drains, (3) sinks, (2) water closets, and (1) water heater. 11/19/10, per contractor, all fixtures are replacements, no change to EDU's. Contractor: CASCADE PLUMBING CO Owner: PPR WASHINGTON SQUARE LLC 2630 N HAYDEN ISLAND DR #3 2235 FARADAY AVE STE #O PORTLAND, OR 97217 CARLSBAD, CA 92008 PHONE: 503 - 289 -7095 PHONE: FAX: 503 - 283 -9514 FEES Quantity Description Date Amount 2 ea Floor Drain /Floor Sink/Hub 10/27/2010 $50.04 Specifics: 3 ea Sink 10/27/2010 $75.06 2 ea Water Closet 10/27/2010 $50.04 Type of Use: COM 1 ea Water Heater 10/27/2010 $37.52 Class of Work: ALT 1 12% State Surcharge - 10/27/2010 $25.52 Type of Const: Plumbing Occupancy Grp: Stories: Total $238.18 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, r-- is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility tification Center. • - ules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or dir ct questions to OUNC .. , ailing It .232.1987 or 1.800.332.2344. - - - -- _ Issu d By: i 4 �� Permittee ignature: / r, - Call 503.639.4175 by 7:00 a.m. for the next available inspection date. 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 REC t - /I� -1c7- .t ...I 1 , Building Fixtures Ion OFFICE 1.S1 °NIA' • Cl of Ti and 0 C T 2 6 2 O 1 1 Received A mit per No.: / i� - r- III � ie 13125 SW Hall Blvd., Tigard, OR 97223 natcl8 : p ` si - Phone: 503.639.4171 Fax: 503,598,1960 CITY OF TIGAR��;::. othcrPenmitNo.: ` LA 4, _0 1 4t 5 - Inspection Line: 503.639.4175 BUILDING DIVISIv .'Ready/BY, BJ See Page 2 for TiCiAltll Internet: www.tigard- or.gov Notified/Method: Su. elemental Information TYPE O Woi ❑ New construction ❑ Demolition For special ig/ormram'on use checklist -- Dcscripiion J Qty. 1 Ea. 1 Total Olt: ddi tion/alteration/replacement ❑ Other; New 1- 2- family dwellings (includes 100 ft. for each utility connection) •. ..:-.: ; ,..... <.r:. CATEGORY; O)B ty,Uh1* x'105. -: i..... > . :'! S ,. FR (1) bath ❑ 1- and 2- family dwelling !ir ommercia /induct iat SFR (2) bath 437.78 SFR (3) bath 50032 - 0 Accessory building ❑ Multi-family Each additional bath/kitchcn 25.02 ❑ Mac a' , ❑ Ofhc : Fire sprinkler L.._ sq. ft) Page 2 Jt : ��� - S TI'E' - *04:4MA, ION ANA,,LOCA1'YON Site utilities: - Catch basin or area drain 18.76 ess: `1L .. 1 // Dtywell, leach line, or trench drain 18.76 City/State/ZIP: / ` 4' Footing drain (no. linear ft.: ___) Page 2 Suite/bldg. /apt no.: Project name. 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: Lot no.: Fixture or item: Tax map /parcel no.: Backtlow prcventer 31.27 Backwater valve 12.51 ' li SCItikTON'OF' "..WORK,.' • 25.02 I Clothes washer I h d 11L ! 1 lit 11 [.t / Dishwasher 25.02 .. 1 ' :i Drinking fountain 25.02 Ejectors/sump 25.02 ❑ PTtoPERTX. owAiii, :_ .. .. ; .':a lIgNA ri Expansion tank 12.51 Fixture/sewer cap 25.02 Name: _5 25.02 _ Floor drain/floor sink/hub Address: Garbage disposal 25.02 City/State/ZIP; Hose bib 25.02 Piton: ( ) Fax: ( ) Ice maker 12.51 C� ° ,APPIxe4N'f ❑ :COIVT P>?ItSON .. lntcreeptor /Breast trap 25.02 Medical gas (value: $ ___) Page 2 Business name: . 1251 Primer 12,51 Contact name: Roof drain (commercial) 12.51 Address: Sinklbasinnavatory 3 25.02 7 5- Q City/State/ZIP: Solar units (potable water) 62.54 Phone: ( ) Fax:: ( ) Tub /shower /shower pan 12.51 Urinal 25.02 lrnrail: Pc 25.02 SD, Water closet CQN[ ltACIOR' ::: 3 Water heater _ - I 37,52 "-]. �i _ .1 ' • 2 II a r Water piping/DW'V 56,29 Address: '‘,kpt e - Other: - 25.02 _ • City /State/ZIP 1 . 71 Subtot 0A. � I. Minimum permit fee: $72.50 I `on (5 e: ) 3 �°) 7g dS' Fax: i56 3) - c / plan review (25% of pennic fee) E' t CCB Lie.: 1 � Plumbing Lie. no.: L� -. 1■, State surcharge (12% of permit fbc) r 2 j . I Authorized signature: � TOTAL PERMIT FEE z 9 3 O ' 6 Hate: ✓ Is permit application expires if a permit Is not obtained within 180 days Print name: r t.:e ®� n , /� ,� � after it has been ateepted as complete. ?� l �t/w / j ltor . � - bee isi� -.-, "pee methodology set by Tri- County Building Industry Service Board - I:\Batdln �ermiti PLMU- PcnnitApp.doa 10101 / 440 -16 I6T(10/o21COM/WEB) £O /TO 3Edd 3G JS D bt56£8Z£OS tit:tit OIOZ /5Z /Ot Plumbing lermit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Su r . ression S stems: � ;:v r;,0 • �aat Y :4077 $n -' rTT ■;,;r�,: ,) ;t' ":, rr ` 76∎ .) -, . t � ''::',;: a" r +r5� r , �� t s � r , :,,: p - .., .. ,: rr• -r s:'„�.� °,.v ;as�;"t 1(; " 55 .00 0 to 2 00 $115.00 Footing drain -1° 100' 2 001 to 3 600 $160.00 Footing drain -each additional 100' 46.40 MIN 3 601 to 7 200 5220.00 Sewer -1st 100' 55.00 - 7.201 and : eater $309.00 Sewer - each additional 100' 46.40 MN -1st 100' 1M 55.00 M edical Gas S stems: Water Service .. •�"'sR�',3i"�tk„ ,. • ;t - , tib? , r.t�r' v� % ( ,;1;? `. ` • Water Service - caoh additional 100' � 46.40 NM ; ''t.7� ;' ; ,�,;�' �i:�'.�.,�, ?ru:ay�_, ' aei• .�.. t.l� 4 c•. Storm &Rain Drain -1st 100' SS.00 $1.00 to $5,000.00 Minimum fee $72.50 Stoma & Rain Drain - each additional 100' 111.1 46.40 NM $701.00 to 510,000.00 $72.50 for the first 55,000.00 and $ 1.52 for each � x .I additional 5100.00 or fraction thereof, to and i �,: :,pry ■•T.; , .' . v. e , 46^ 'rs'' %° T.fr,g irm includin 510000.00. . . :. 'k:.':;' P_ ; e . tin D a6 ' �' ` � " 46.40 � $10,001.00 to $20 5,00.00 $148.50 for the first 510,000.00 and 51.54 for • Commercial Back Flow Prevention Devitt each additional $100.00 or ftaction thereof, to Residential . it tee 536.25 Device -�� and including 525,000.00. Rain Drain, n, singl It ffe e family $25,001.00 to $50,000.00 $379.50 for the first 525,000.00 and 51.45 for (fain family d welling 65.25 dwelling each additional 5100.00 or fraction thereof, to Inspection of existing plumbing or and includin 550 000.00. s.cciall re,uested ins .ect1ons- •erhour IIII 72.50 $50,001.00 and up $ 742.00 for tho first $50,000.00 and $1.20for Subtotal: 11.111.111111111= p oach additional 5100.00 or fraction thereof. sc1nq .WAG'2•�7, � 3. ", "z;: G �l'f' � nhm,. ' eitl re Work: ; N. � Rt,; .: , 1, -!, r Y !;< n,. _;, _; ; s_ , ,.,. „ . .rs,:4 _ . ., Are , u capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following. please indicate work performed by fixture. Failure to Please check all that apply. ❑ Any new commercial building with water service 2" and accuratel re tort fixtures could result in increased sewer fees*. eater, except systems designed and stamped by licensed r"� ' 'rc�'':,'r :- -i ,i t'y. 'W' i'� ('��} �l "l� i i l`, ,,': • ',f _ 'xiy:'.l}u l�,, , {! ��P:Sj� ". ^i %;. l .�s ?? ineer. :i tr ry F,� 4 J� i i .� ', r'' 4't�' ! r >'�i a. eng it < < i ° n� r s , s i l t , � o ,. , � a `4_ , ' 4 i _ ❑ Any ne exterior plumbing site utilities. i 13,: i ts i !, ., ' -rs tt'? .,,S.i ks.- ..1..1.1 -i. w.. f 1 z..s�i; B: +•ts /Font IMO! IIM.M1111.1 © Medicsl gas and vacuum systems for health taro facilities. Bath - Tub/Shower 1111111111~0.1111.1111.1 0 Any multipurpose fire sprinkler system. - Jacuzzi/rlvhirl...t EMI WleIC11 » r M 11= I ❑ Any complex structure as defined in OAR918-780 -0040. Car Wash -Each Stall -- UE!'! Submit 2 sets of plans with any of the above. -Drive 71atu Cus,idor/WaterAs.iratOr EIMIIMIN " � _ r � -._ � �. ,J ,s 1C - � 'G �: %'f{ -; ';` � "l�h�� : � .,. ) .\lr • k � l h ' i . p� • her -Commercial �V �.�` :.1 2`, ; ,. . '';., i � %" ;' > ; +:: , .: ; ^' a Dishwasher i aA,:rw-. .:�-: - Domestic ►"1M! ❑ Isometric or riser diagram is required for new buildings Drinkin: Fountain R��ldAl�,lirj -' that meet the qualifications above. _-1 Floor Drain /sink - 2" Mitiallirnali W -3" !'1�^.ilIIIIMINIIIIIIII Comments regarding fixture work: Car Wash Drain ai_1111111111111 11 MIE -- -- Garbage - Domestic WIIIJrMIIIMMIIMIIIII ._ Disposal - Commercial t �� - industrial ��� Doe Mach./Refri _, Drains _ Oil Se. arator Gas Station Rec. vchicleDum Station *Note: If the fixture work under this permit results in an liallS1111111=1111111111.1 increase of sewer VDUs, a sewer permit will be Issued and Sink B��avatofy fees assessed for the sewer increase must be paid before the - Bradley ��� plumbing permit can be issued. - Commercial MM - Service MOM Was her c _ Pool Filter r Water Extractor tors �� Water xtr guommommillommumlImm Other Fixtures: MIIIIMMIIMINIIIIIIIIINIM ee /ze - s a d sadssds tii56EszEe5 OT :VT OZldz /5z /8't Accumulative Sewer Tally Parcel # 1S1260000300 Tenant Name: I - &- M ***REVISi D1.1 /19/°1.0 * *, *" This SWR# "SVVR2010 001.54 Site Address: 9524 WASIHINGTON' SQUARE' RD " _ ° This PLM# 'PLM2010 =00352 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 0 0 0 0 - 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 2 :. 4 2" 4 0 0 - 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 HP) 16 0 0 0 0 0 - Commercial (to 5 HP) 32 0 0 0 0 0 - Industrial (over 5 FIP) 42 " 0 0 0 0 0 Ice Machine /Refrigerator Dram 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 3 6 3: 6 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 2 12 0 0 Urinal 6 0 0 0 0 0 Previous EDU Count 0 0 Capped EDU Credit 0 TOTALS 0 0 7 22 7 22 0 0 Current Fixture Value 0 divided by 16 = 0.0 Current EDU 1 EDU = $ 4,100 Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU Change 0 divided by 16 = 0.0 over (under) $ Enter EDU Change Here 0 Notes: 11/19/10, per contractor, all fixtures arc replacement fixtures. No change in EDU's. D.Adamski Authorized Name /Signature: BRANDEN TAGGAWI' Date: 10/27/2010 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:A Building \Sewer Tally \SewerTallyShcet- 3600.xls 06/25/08