Permit CITY OF TIGARD PLUMBING PERMIT
1111 COMMUNITY DEVELOPMENT F8117/1111 Permit #: PLM2011 -00122
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/15/2011
Parcel: 151260000300
Jurisdiction: TIGARD
Site address: 9591 SW WASHINGTON SQUARE RD B10
Project: Victoria's Secret Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project Description: Plumbing modifications for new tenant, capping (16) fixtures and replacing (8) fixtures, installing backflow preventer
and (1) water heater. 6/17/11, reprinted to add (1) drinking fountain, (3) floor drains, (2) primers, (1) mop sink & (1)
hose bib for Dream Steamer.
Contractor: HAWKS PLUMBING Owner: PPR WASHINGTON SQUARE LLC
947 S R ST 2235 FARADAY AVE STE #0
COTTAGE GROVE, OR 97424 CARLSBAD, CA 92008
PHONE: 541 - 767 -0398 PHONE:
FAX: 541 - 767 -0421
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 04/15/2011 $31.27
Specifics: 1 ea Drinking Fountain 04/15/2011 $25.02
16 ea Fixture /Sewer Cap 04/15/2011 $400.32
Type of Use: COM 3 ea Lavatories 04/15/2011 $75.06
Class of Work: ALT 2 ea Water Closet 04/15/2011 $50.04
Type of Const: 1 ea Water Heater 04/15/2011 $37.52
Occupancy Grp: 1 12% State Surcharge - 04/15/2011 $74.31
Stories: Plumbing
1 ea Drinking Fountain 06/17/2011 $25.02
3 ea Floor Drain /Floor Sink/Hub 06/17/2011 $75.06
1 ea Hose Bib 06/17/2011 $25.02
2 ea Primer 06/17/2011 $25.02
1 ea Sink 06/17/2011 $25.02
0 12% State Surcharge - 06/17/2011 $21.01
Plumbing
Total $889.69
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 Notificatiort_Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952-111-0090. You may obtain a copy of the rules
or direct que ons to O ' , by ca • g 03.232.1987 or 1.800.332.2344.
Issued By: / 1 Permit S•a 4 . /
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.
a CITY OF TIGARD PLUMBING PERMIT
' '1 1 •• COMMUNITY DEVELOPMENT Permit #: PLM2011 -00122
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/15/2011
Parcel: 151260000300
Jurisdiction: TIGARD
Site address: 9591 SW WASHINGTON SQUARE RD B10
Project: Victoria's Secret Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project Description: Plumbing modifications for new tenant, capping (16) fixtures and replacing (8) fixtures, installing backflow preventer
and (1) water heater.
Contractor: HAWKS PLUMBING Owner: PPR WASHINGTON SQUARE LLC
947 S R ST 2235 FARADAY AVE STE #0
COTTAGE GROVE, OR 97424 CARLSBAD, CA 92008
PHONE: 541 - 767 -0398 PHONE:
FAX: 541 - 767 -0421
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 04/15/2011 $31.27
Specifics: 1 ea Drinking Fountain 04/15/2011 $25.02
16 ea Fixture /Sewer Cap 04/15/2011 $400.32
Type of Use: COM 3 ea Lavatories 04/15/2011 $75.06
Class of Work: ALT 2 ea Water Closet 04/15/2011 $50.04
Type of Const: 1 ea Water Heater 04/15/2011 $37.52
Occupancy Grp: 1 12% State Surcharge - 04/15/2011 $74.31
Stories: Plumbing
Total $693.54
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. T • e rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct • . - ions • UNC . ca l ing 503.232.1987 or 1.800.332.2344.
Issue. By: � $ Permittee Signature: 6
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 Applicat' CE
Building Fixtures
IV--
City of Tigard Received i/ 1W 15 2011 DateBy: / I5� / Perm � 9/J// /�A
n 13125 SW Hall Blvd., Tigard, OR 97 Plan Review v
I Phone: 503.718.2439 Fax: 503.5 DateBy: Other Permit No.:
Inspection Line: 503.639.4175 O F TIG> i I Date Ready/By: 7u ris: ®S Page 2 for
Internet: www.ti
T I G A K D ardor. ov + y o g
g g BUILDING nlv�l Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I 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 ❑ 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:
557 �j / , 1 , // - (z/ r , 1 �j„ Catch basin or area drain 18.76
Job site address: Ot w prt JUCV N Of.�, -
City /State /ZIP: /¢ - ,2b U2 q 7 a- 7- 3 Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: () t C_f,2_0 1 5 g 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: 0O1 3d 0 I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer / 31.27 ? 2- 7
DESCRIPTION OF WORK Backwater valve 12.51
0 , Clothes washer 25.02
',) / Dishwasher 25.02
Drinking fountain / 25.02 25, O 7
Ejectors /sump 25.02
❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51 L
Name:
/ M t/ n uL I Clf- Fixture /sewer cap 46 25.02 aco. 3u.
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
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
Primer 12.51
Contact name: Roof drain (commercial) 12.51
Address: , 06
Sink/basin/lavatory 25.02 75
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 '7-- 25.02 j - d •° i f
Water heater / 37.52 ?,') • 6 2--
Business name: ai • i A " � � 0 t , �(/L Wate piping/DWV 56.29
Address: ? 9 / I Other: 25.02
City /State /ZIP: �� �� �. i t a Subtotal ( ( q , .23
Phone: ( ) 7 O • ' Minimum permit fee: $72.50
CCB Lic.: , • • $ . 3 .. Plumbing Lic. no.: 1 i3 Plan review (25% of permit fee)
State surcharge (12% of permit fee) 1q.51
1 /
Authorized signature: A , � A { - - ' l TOTAL PERMIT FEE tpq 3'6`f
Print name: ..� S Date: / / / This permit application expires if a permit is not obtained within 180 days
C't 11 C+ �� after it has been accepted as complete.
*Fee methodology set by Tti- County Building Industry Service Board.
I:\ Building \Permits\PLMU- PermitApp.doc 10 /01/09 440- 4616T(10 /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
Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' 62.54
$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
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 ",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees * .
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/
Work Performed Capped Added Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath - Tub /Shower ❑ Any new commercial building with water service 2" and
- Jacuzzi/Whirlpool greater, except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918- 780 -0040.
Dishwasher - Commercial ❑ Medical gas and vacuum systems for health care facilities.
- Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain I / ❑ Any complex structure as defined in OAR918- 780 -0040.
Eye Wash
Floor Drain/sink - 2" -(� x Submit 2 sets of plans with any of the above.
Isometric or Riser Diagram
Car Wash Drain
Garbage Domestic ❑ Isometric or riser diagram is required for new buildings
Disposal - Domestic related that meet the qualifications above.
- Commercial -food related
- Industrial -food related
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav - Non -food related
- Bradley
- Commercial -food related
- Service
Swimming Pool Filer *Note: If the fixture work under this ermit results in an
Washer - Clothes increase of sewer EDUs, a sewer permit will be issued and
Water Extractor P
Water Closet - Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures: Cow
I:\ Building \Permits\PLMF - PermitApp.do 02/24/2011 2
Accumulative Sewer Tally Parcel # 1S1260000300
Tenant Name: Victoria's Secret ** *CREDITS * ** This SWR# N/A
Site Address: 9591 Sw Washington Sq Rd This PLM# 2011 - 00122
Pixture 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 1 1 0 -1 -1
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 4 8 0 -4 -8
- 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 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 5 10 0 -5 -10
- 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 3 18 0 -3 -18
Urinal 6 0 1 6 0 -1 -6
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 14 43 0 0 -14 -43
Current Fixture Value -43 divided by 16 = -2.7 Current EDU 1 EDU = $ 4,100
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -43 divided by 16 = -2.7 over (under) $ (11,070.00)
Enter EDU Change Here -2.7
Notes: ** *CREDITS * **
Authorized Name /Signature: Debbie Adamski Date: 4/15/2011
Building Division
r ote: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher which must be
bmitted to the City of Tigard Building Division to redeem credits towards future system development charges.
1: \ Building \Sewer Tally \Sewer I'allySheet- 4100.xls 07/01/10
Plumbine Permit Applicat-,
io , // 7/1/
2, .
Building Fixtures ,... .., L,A.
i L I 1' ' [(Hz ou Hu L I SE ONE\
City of Tigard Received II
1 . 1 13125 SW Ha Blvd Tigard, OR 97
1 ..--. Phone: 503.718.2439 Fax. 503.
1111 A * R 1 5 2011 DateiBy: , Permit No.: , ,,,, / --0 / 4 2 ...
Plan Review
Date/By: Other Permit No .
• Inspection Line: 50311394175 ttloF 11Gi.:',i.
Date Ready/By: Jun el See Page 2 for
Internet: www.tigard-or.gov Elt)ILDINC; niVISI Notitied/Melhod: Supplemental Information
,
TYPE OF WORK FEE* SCHEDULE
0 New construction 0 Demolition For sprcial Information use checklist
- Description I Qty. I Ea. I Total
0 Addition/altention/replacement 0 Other: New I- 2-family dwellings (includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
0 1- and 2-family dwelling 0 Commercial/industrial SFR (2) bath 437.78
' SFR (3) bath 500.32
0 Accessory building 0 Multi-family
Each additional bathikitchen 25.02
0 Master builder 0 Other:
Fire sprinkler ( sq. II) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: cis A 6(.1$60/Aildrz:)x) sg?.., Catch basin or area dram 18 . .76
Drywell, leach line, or trench dram 18.76
City/State/ZIP: i C„,/+- a - b 01 2 - 9 7 9. ; 5
Footing drain (no. linear ft.: __) Page 2
Suite/bldg./apt. no.: I Project name: ,c ) 5 ■.f 0 ,k... r- Manufactured home utilities - 50.03
_____
Cross street/directions to job site: Manholes 18.76
--
Rain drain connector 18.76
Sanitary sewer (no. linear It.: ......_) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear It.: ) Page 2
Subdivision: / 5 I 21 0 Lot no.: Fixture or item: ---
Tax map/parcel no.:
Backflow preventer / 31.27 g,/T2. 7
' -- Backwater valve 12.51
. DESCRIPTION OF WORK
R -4\---A -,,.
„ ., i ,, - , - t-T i) ,,, . t/(I t".) v 5 ......._ •
Dishwasher Clothes washer
, , \ .. Drinking fountain 25.02
25.02
/lc, 4,.
25.02 - ■0
(A Pr15 1. - 001 i Ka-f
ru5 -k )6/1/
Ejectors/sump 25.02
b PROPERTY OWNER 0 TENANT
/ Expansion tank .
12.51 L
Name: tPr-e_ttiof Fixture/sewer cap ; (6 25.02
Floor drain/floor siric/hub 6) 25.
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 064 (1) 25.02 a i
-- •
Phone: ( ) Fax: ( ) Ice maker 12.51
........
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:
Medical gas (value: $__,,.) Page 2
03-
Primer (i• ) 12.51 eg '•
Contact name:
Roof drain (commercialA 12.51
AL ....0%
Address: Siniubasialavatory tiOji‘.0 ) "'5 25.02 '75. A
City/State/Z1P: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub/shower/shower pan 12.51
E-mail: ___
Urinal 25.02
Water closet "2-- 25.02
CONTRACTOR 62--
Water heater c 37.52 .;7•
Business name:
4; P IP ' ' '''''- ik . piping/DWV . ^4e 5629
Address: /(7\21,;?1, Other: 25.02
---....
City/State/ZIP: A sy , e .„ , ()rewe b
Phone; (5t..) 1) 76 ? O9 9 f< Fax: ( 5 -- / .0 et,y i Minimum permit fee $7250 11"
et
Plan review (25% of permit fee)
CCE1 Lie.: /1#?07 5 3/4,4 Plumbing Lic. no.: pi, A9,5
Authorived signature:7 /
- State surchar (T12:0_ PERMIT FEE
i gt*
This permit application expires if a permit is not obtained within ISO days
after it has been accepted as complete.
LPrint name: ITh j ..., „ 6----------- 5 Date: V70/ I .. .1
*Fee methodology set by TB-County Building Industry Service Board. # I R
PetoldingTormiu\PLNIU-Petmiclipp doe 10101/09 440-46161(10/02/COMPA1tB)
04 C l e r:"S .-....'''''''''....
lifijIs
Accumulative Sewer Tally Parcel # 1S 1260000300
Tenant Name: Victoria's Secret ** *CREDITS ** *REVISED 6/17/11 This SWR# N/A
Site Address: 9591 Sw Washington Sq Rd This PLM# 2011 -00122
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
. value capped off value added added total total
count off #s count It value #s values
Baptisery/F'ont 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 1 1 2 2 1 1
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 4 8 3 6 -1 -2
- 3 inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash Dm 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 5 10 3 6 -2 -4
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 0 0 0
- Service 3 0 0 1 3 1 3
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 3 18 2 12 -1 -6
Urinal 6 0 1 6 0 -1 -6
Previous EDU Count 0 0
Capped EDU Credit 0
i TOTALS 0 0 14 43 11 29 -3 -14
Current Fixture Value -14 divided by 16 = -0.9 Current EDU 1 EDU = $ 4,100
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -14 divided by 16 = -0.9 over (under) $ (3,690.00)
Enter EDU Change Here - 0.9
Notes: ** *CREDITS ** *REVISED 6/17/11, adding fixtures per plumber.
Authorized Name /Signature: Debbie Adamski Date: 4 /15/2011
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 \SewerTallySheet- 4100.xls 07/01/10