Permit CITY OF TIGARD PLUMBING PERMIT
�' COMMUNITY DEVELOPMENT Permit #: PLM2011 -00038
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/01/2011
Parcel: 151260000300
Jurisdiction: TIGARD
Site address: 9355 SW WASHINGTON SQUARE RD T19
Project: Verizon Wireless Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project Description: Add breakroom sink, water heater & condensate drain.
Contractor: LEED CORP Owner: PPR WASHINGTON SQUARE LLC
12606 NE 95TH ST SUITE C160 2235 FARADAY AVE STE #0
VANCOUVER, WA 98682 CARLSBAD, CA 92008
PHONE: 360 - 213 -0969 PHONE:
FAX: 360 - 213 -0967
FEES
Quantity Description Date Amount
1 ea Floor Drain /Floor Sink/Hub 02/01/2011 $25.02
Specifics: 1 ea Sink 02/01/2011 $25.02
1 ea Water Heater 02/01/2011 $37.52
Type of Use: COM 1 12% State Surcharge - 02/01/2011 $10.51
Class of Work: ALT Plumbing
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
issuan - • ' • •s suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utilit otification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or dl ect questions to OUNC b • g • • .232.1987 or 1.800.332.2344.
Issu •d By: / • Permittee Signat 4111111.1Pbil A#
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.
Accumulative Sewer Tally Parcel # 1 S1 260000300
Tenant Name: Verizon Wifeless This SWR# 201 1 -00025
Site Address: 9385 SW Washington Sq Rd This PLM# 201 1 -00038
Fixture Value Previous 'Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count oft #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 0 1 2 1 2
- 3inch 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 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 0 1 2 1 2
- 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 0 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 2 4 2 4
Current Fixture Value 4 divided by 16 = 0.3 Current EDU 1 EDU = S 4,100
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 4 divided by 16 = 0.3 over (under) $ 1,230.00
Enter EDU Change Here 0.3
Notes:
Authorized Name /Signature: Debbie Adamski Date: 2/1 /2011
Building Division
N ote: 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 \SewerTallySheet- 3600.xls 06/25/08
FROM (TUE >FEB 1 2011 7:45 /ST. 7: 45 /No. 7500000000 P 7
)F'f a ''',' - DC:, ?& z-E . /T.6,5 - 7/P- )y5
Plumbing Permit Applic .
CEIVED �.t 70441 - sar- tat 4.t,te<t4
Site Utilities 1 FO R 011 1( I. l tit. 0\ 1.1
City of Tigard r C D 0 1 Received ❑erv� tNo: .
71111 M 13125 SW Hall Blvd., Tigard, QR. 7 Date/B : ��� �etmt o.: �,��` 038
Plan Review t5W n n oif _ l _ n�
Phone: 503.639.4171 Fax: Sbr1- GARD Other Permit No.: �( �.�
Date /By:
Inspection Line: 503.639.41 VjJLDf NG DIVISION Date Ready /By: Anis: S5 See Page 2 for
I `' 1 l Internet: www.ti and -or. ov
g g Notified/Method: Su . , lemental Information
a: * a+i cx ,, , .y. :., y „ i � „ r , f �. 1 �s, � s,x a� n o ,A,
H� t , t t1, . l y r q , q t {I dS,S 3 4 ( t p i . ,.� t g r t6 .: t ' 1 1 :i ;t t ; jl .
it Ud y' t .r' NI . t i '. i i liill:LA ;I ".:NO • •• �e. I 'ii ,I . � utut an :l. :, ;m:r tl kia ` .a ant: t it NI'
` t,:,t„t t. t
❑ New construction ❑ Demolition For special information use checklist.
Description ( Qty. I Ea. ( Total
pi<ddi tion/alterationJreplacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
I I ' I i t f h� 41 ill T t ii ' '&iF.t:� `, I tiNri3 ,i • lt• W ' N ill , p�
f ! 'H {h 1 at I i miry t, s i � v r at i J a ti ¢ t t 3 x$a1I x, l q' SFR (I) bath 312.70
. l a���iiA3..biUi yt. ! tt?, L�f� tai.n� lRE.k'e,iLttluitttit�a(�8t i t:i;117 a. �.nr�*.'t'nA!�4;.a Sio
p 1- and 2- family dwelling % ommercial /industrial SFR (2) bath 437.78
building SFR (3) bath 500.32
❑ Accessory g ❑ Multi- family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Pagc 2
vtm, a t r" r w,ntui Y ` � �' • a t ' ', 4 ' o as Gati IL r.= '.,.: r +1� a �. 'fl y ( . Site utilities:
Job site address: tl J ''�4,, p.,..#. - ' c' ied # 7 19 Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City/State /ZIP: A /} d ig 1 ?.t.-2 ? Footing drain (no. linear ft.: _) Page 2
Suite/bldg. /apt. no.: I Project name: //Lie ,/ (xi52 -4 r Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18. /6
Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: Page 2
Subdivision: I Lot no.: Fixture or item: `
Tax map /parcel no.: / 6 / / . 6 boo 03a, Backflow preventer 31.27
, ,y Backwater valve 12,51
a , ,i nitt t 7
70 furai n ^a t +1 - , iliu 11 :
61 I tiiilllllliE : " t . l ,,. NIo , , .t -, 3�m Ea � t>l
Clothes washer 25.02
c-4711-k..., _�
#0 '� � 're - 6 � Dishwasher 25.02
AirP 4--,,,c) oa...t.v "Ilk 04.0 0 +-A) /&. Drinking fountain 25,02
Ejectors/sump 25.02
•fiI j
1 ' . fiaFI i �i I`F. git !'{ � 1 i�t ,t ` I t ` t i y'�il� II+ z3) l,tiltr I I I 1• g . t 6 Expansion i3s , y . i< .,ilu... iiairi uirj , Ex ansion tank 12.51
lad,. iia.�s.es^=x. i t su, ii R
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub ,4 / 25.02
Address: Garbage disposal 25.02
City /State/ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
t ,,,�. .�+1y5 I 7 �a [TYf I g, t k64 i "RIC. pF,
( i!i I i1 eir { j Ii i;t' - 11 "1 ate. #'m, I i i I ff i r1 Interceptor/grease ' . ' , .I i ! i=:,, , e -v , ' ∎ il 9. - 'fir ( liv es,,, tlla «$ ,kaa4 4t t4kia I `tiE.Il iii II. ep tor/ rease trap P 25.02
Business name: Medical gas (value: $ ) • Page 2
Primer 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: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
tIKM, un` s A r,O x ; o % ' qbi i ;:il , ,e z t, Water closet 25.02
I:JC: tti k r 'i r l , J[i :}ti :' k , ; t ..:- r t4 Ofi lulls a� x... ,iµ: l i f. , t li; oP ,[, Water heater ' 37.52
Business name: Lear-12 6-. / Water piping/DWV 56.29
Address: /M Q 6 tic= 9 , 3-/- . e,-,,q d Other; 25.02
City /State/ZIP: (/01,1.-"C e--x - s ,r6/--•Z Subtotal 77 Sb
Fax: Minimum permit fee: $72.50
Phone: (..No ) .2/7 •- d 2 a S (360) JrT- �s 7
CCB Lie.: /P /°/ Plumbing Lic. no.: le s' /,Z Plan review (25% of permit fee)
/ State surcharge (12% of permit fee) ! d , St
Authorized signature: -/�- -___ TOTAL PERMIT FEE ?? Q
Print name: E7'7.,�Pt� Date:/r/ /7 This permit application expires It a permit is not obtained within 180 da
after it has been accepted as complete.
'Fes methodology set by Tri -County Building Industry Service Board.
I:\ Building \Permits 1 PLMU•RxmitApp.doc 10/01/09 440- 4616T(10 /02/COM/WEB)
FROM (TUE)FEB 1 2011 7:55 /ST. 7: 54 /No. 7500000e87 F 3
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su r r ression S stems:
i . , .:4 t t r'' £ i T i (c e , �, 7 "3 s r i* r p, �it s il3 7 t _ . -, R s
p u: , ,ir f � .'ll �f
,,}} ` " ,� rtkf� :.•,;�, "'` txa sr�t II f t t� N,4 a. I , i , i r ,r r f 4. ;t ryy �� t(;i
t E, -i 5 a , I i I i _ mi rt ti ll, a. ii;'.uG. {1Ot atilit l tizA: r. ;a1: L r.. a #. k t1t i i ili s;.. i t,i.' i,; .15,, MW ,rk!:.,,., -,0 1;i • iitii -11,, 11 u.. ., „ +fir b r1. esa. li �il ;{ , :ill
Footing drain - I" 100' 50.03 0 to 2000 $121.90
Footing drain - each additional 100' 37.52 2 001 to 3 600 $169.69
3 601 to 7 2
Sewer - 1st 100' 62.54 re $233.20
7 201 and !miter $327.54
Sewer - each additional 100' S 37.52
Water Service - 1st 100' 62.54
Medical Gas S stems:
Water Service - each additional 100' 37.52 fi , {'' '�I, n � n iy } ; i r tH s y } f14 . , 1119111 3 G11 r 1114R1� ss , {i�
Storm & Rain Drain - 1st 100' 62.54 ''�i Ply I?r.k i s a� .N
$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
' Y'� # i:11 rig ' PII K'� t. ` q,; i a r nJa l!,1114il ,a liti 7 , j , i n , x „ 4 " r , each additional $100.00 or fraction thereof, to
Ii1.1',.�t,,. {,!
.;, 14 '.,1 .,.ih
.,,,. ..,1;i4 an ..t ,a!_!,I,il{1,I ki•tatilaiRnitE and including $l 0,000.00
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 cha :e - 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 cha :e - 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 S $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
minimum cha :e - 1/2 hour each additional $100.00 or fraction thereof.
Ft.t..,.
I - I I I I
Commercial Fixture Work:
Are ,, capping, addin or replacing fixtures If "yes", es r bs'' ` i 1H; �'' t �"" ' ' 4 ij s
tll
Y adding P g Y i `g.. 1 I i „! ', , , Lit, ,t . A', ,i., ±r, . , ' 1,,,,14,1,,:,,:" ' ! ,. • ,'t1 nigtO
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accuratel re • ort fixtures could result in increased sewer fees *. Please check all that apply.
T . �t I t s , i , i , ; ../ p A , x ; r Any new commercial building with water service 2" and
.. ') uoiti - -# 1 1 irgat r ,ur pp1 II '@,' � 3 °mtl greater, except systems designed and stamped by licensed
1liIlis iititi la a h,_..- .�:.: II E engineer.
Baptistry/Font
-Tub/Shower ❑ New exterior plumbing site utilities for any complex structure
Bath hower
Tub/S
-Jacuzzi/Whirlpool , as defined in OAR918- 780 -0040.
Car Wash -Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive The, ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator - ❑ Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial Submit 2 sets of plans with any of the above.
- Domestic
Drinking Fountain f
Eye Wash U •. �t1 v i_it h` ' . . ".l, >n G:F 4 ; ,,. 1 t it
.: . 1 , ,, I , 4 t l it
Floor Drain/sink - 2" X • Isometric or riser diagram is required for new buildings
3 that meet the • ualifications above.
- 4"
Car Wash Drain
Garbage - Domestic
Disposal -Industrial ommercial Comments regarding fixture work:
Ice Mach. /Refrig. Drains Rt'i)(I.6 67'L3 i (,NC ta- L /TV / ,4 ZZ-)
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar /Lavatory X )(
- 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 - Clothes
Water Extractor plumbing permit can be issued.
Water Closet - Toilet X
Urinal '
Other Fixtures:
http : / /www.tigard - or.gov /city_hal l /departments /cd/docs/PLM F- PermitApIdoc