Permit W CITY OF TIGARD PLUMBING PERMIT
' "� COMMUNITY DEVELOPMENT Permit #: PLM2011 -00127
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/21/2011
Parcel: 151260000300
Jurisdiction: TIGARD
Site address: 9633 SW WASHINGTON SQUARE RD FC04
Project: Braganza Tea !� Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project Description: Set fixtures on existing rough -in.
Contractor: WEST COAST CENTRAL PLUMBING LLC Owner: PPR WASHINGTON SQUARE LLC
12714 SE MAJESTIC LN 2235 FARADAY AVE STE #0
HAPPY VALLEY, OR 97086 CARLSBAD, CA 92008
PHONE: 503 - 298 -0435 PHONE:
FAX: 503 - 855 -3264
FEES
Quantity Description Date Amount
1 ea Ice Maker 04/21/2011 $12.51
Specifics: 3 ea Sink 04/21/2011 $75.06
1 12% State Surcharge - 04/21/2011 $10.51
Type of Use: COM Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $98.08
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
appli • e law. Al work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
is •ante, or if work is sus.: -. ; • for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
- tility Notification Center Those - are set forth in OAR 952 - 001 -0010 through OAR 95 ! : -:: e0. You may obtain a copy of the rules
or direct qu-stions to O C by . alli i 503.232.1987 or 1.800.332.2344.
Issued By: Permittee S !nature: of
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.
04/21/2011 06:53 5035981960 CITY OF TIGARD C 01/03}
PlumbinE Permit Application„
Building Fixtures ' C , ^r'� I OA( 1 1 1 1 If < I , 4 ■NI ■
City of �Igard t c�� �' $ Received d/ a/ A 1 i'em►ir xo.: °(, few- Cv' /•?
13125 SW Hall Blvd., Tigard, OR 97223 Y`` \G� C* Fl ew
Phone; 503.718.2439 Fax: 503.598.1969 O� �lv�' Da R rr Other Permit No.:
i , , 1� Inspection f ins: 5{L1.634.4175 Cl l � G Date Rcadyaly: lama[ g See Pew 2 Ihr
Internet: www.tigard - er,gov V ) Notiled/Mcthod: Sappieaeatallatarmrhea
. . T YPE OF w p m, 4) :. . -
❑ New construction ❑ Derllelitirm For special information irreekmktia
Description I Qty. I Ea. 1 Total
J Addition/alteration/ placement ❑ Other: New 1- 2- family dwc1Engo (includes 100 fl. for each ctil iiy cnanection)
• • . - CATEGORY OF COi.VSTRLIC . SFR (1) bath 312.70
❑ 1- and 2- family dwelling ,Cnmencialrmduatria] SFR (2) bath 437.78
m
0 Accessory building 0 Multi- family SFR (3) bath 500.32
Each additional bath/kitchen 23.02 02
❑ Master buttder ❑ Other' 966.5 Fire sprinkler ( _ sq. ft.) Page 2
• - JOIE ter iivroxidAnctig ANb LOCATION' Stle utilities:
Job site address �� ` t� % 4)t . W TC�°, ��asin or arra arai r 18, 76
- ..�...na.aa�i l / r 1(4 t Y1. Dryw foe,
CItylSlatt ILIP 11, latch li or trench drain 19,76
.ate.:. / � . Footing drain (no. hoar fL: ) Page 2
Suite o,: iYLiits r, la MsnufaUUrcd home utilities 50.03
Cro- sreet/dire• Manholes 18.76
•
• i a ii[q, r : /, 1 .._ Rein drain connector 1$.76
in ' n Sanitary sewer (no. linty ft: ___-..) Page 2
V V10, -re■ `6 4 • Storm sewer (no. line R: . ) Page 2
Water service (no. linear ti: _) Page 2
Subdivision' l Lot no.: Fixture or teem: -
Tax map/parcel no.; Bscldlon prewenter 31.27
DE5CRlFT1ON OF WORK Backwater valve 12.51
� j . Clothes washer 25.02
k -- - (EX`1 - ilt �� e it4 rll )# II 1.- - . I73shwashcr 25.02
1 ( Drinking fountain 25.02
Ftors/surnp 25.02
0 1f1(o?ERrtr owi g I • O' =urn r Expansion tank 1251
Name: Fixture/sewer sap 25.02
Floor drain/floor sirkihub 25.02
Address: - Garbage disposal 25.02
City/Sfnte/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker I 12.51 1,0.�j
.51
I .0 Arrurca T Pli CONTACT MOON irtcrccpmegrcasc trap 25.02
Business namt: I e . *La !t Medical gas (value: S) Page 2
Contact name: /� ?Printer 1251
C
7 C eat 14 r rn Roof drain (commercial) 12.51
Address: 1 221 I LI f - / • . a4.j c . l / h.. Sinbhavin/la•atory , 5 25.02 75 .04.„
City /State/ZIP: d b,l► / ` . lt
Q1 , Solar ;Mi (potable water) 62.54
Phone. ( +. ) ' _ "�'c Fax:: ( •/ ) 15 - r 3 Tub /shower/ehowerpan 12.51
Urinal 25.02
' E -mail: a
L. ► . i•b• a i i / '.40 - Y1 Pled )'1P Water closet 25.02
Cswi Water heater 37.52
Business name \)& e / (Ph d J I" ��1 t V U) I)i Waterpiping/DW 56.29
Address: 12_1 1 E C Other: . 25.02
C4y/Statc/ZIP: r ( \' fts4:-Le___Le
y i r LTW Subto < . fl
Phone: (�`�) i .1 n 61,1 Miniature permit Lee: $72.50
F AX, (50i � ��
CCI3 Lic.: t 'g 0 _ Plumbing Lie. raw.: T L ?5R 1 Plan review (2594 of permit fee)
State surcharge (12% ofpersnit fee) ( . 5t
Authorized signat: V (.-(i Q,L 0 y i r
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l 1 nn i� This pemrrtapplluhesespir ifa permit wweto btalnel
Prim name: / _. _ in RatE. i()).1 .0 i
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04!21/2011 05:53 5035981%0 CITY OF TIGARD PAGE @2/03
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities: Qty. Fee Todd Square Footage: Permit Fee:
Footing drain -1' 100' - 50.03 0 m•,000 $121.90
Footing drain each additional 100' 37.52 2,Q01 b 3,600 5169.69 t
Sevxr - 1st 100' -- . 3,601. to 7 .200 $233.20
7,201 and greater $327.54
Sewer - eseh additional 100' 37.52
Water Service -1st 100' 62.54 Medical Gas Systems:
! Water Service - each additional 100' 37 i2 Valuation: Permit Fee:
Storm Q Rein Dram -lot 100' 62.54 51.00 to $5,000.00 Minimum fee $72.50
Storm Be Ram Drain -euch additional 100' 3752 55.001.00 to 510,000.00 572.50 for the first $5,000.00 and $1.32 for
Other inspections or Fees Qty. • Fes (es) • Tool each additional $100.00 or fraction thereof, to
p and including $10,000.00.
Inspection ofcxisti plumbing or for 510.001.00 to 525.000,00 $141.30 far the first 510.000.00 and 51.54 foe
which no fee is specifically indicated 90.00/M each additional 5100.00 or faction cheroot to
(minimum cherpc- 1/2 hour) and including 525,000.00
Inspections outside of normal bonne** 90.00/17, 525,001.00 to $50,000.00 $379.50 fns the first $25,000.00 and $1.45 for
hours (minimum chime- 2 hours) each additional 5100.00 or fraction tiered. to
Reinspeetien Foes 90.00/hr and including $50,000 00.
Additional plan review for revisions 90.00bhr $50,001.00 and up $742.00 for the first $50,000.00 and 51.20 for
(minimum charge - 112 hour) , each additional $ 100.00 or fraction thereof,
Subtotal:
Commercial Fixture Work:
Are you capping adding or replacing fixtures? IT"yes ",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer tees *.
Qa..t1 s by Fixture Type , Plan Review for Plumbing Installations
Fhtnre r for Replace, ■
k Plant rcv;ew is required for any of the following.
Work rerfortb rtted: 1 - g
Copped
Brptistry/Fant Please check all that apply.
Bath Tub/Shower rcr 0 Any new commecinl building with water service 2" and
- MeaeziNVdlrlpool greater. except systems designed and stamped by licensed 1
Car Wash -Each Stall cn ec'
-Drive Thru ❑ blew exterior plumbing Site utilities for any complex structure
Cuspidor/Water Aspirator 1 as defined in OAR918480 - 0040.
Dishwasher - Commercial ❑ Medical gas and vacuum systems for health care facilities.
- Domestic ❑ Any multipurpose fire_ sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918 780
Eye Wash _
Floor Draia/sink - 2 Submit 2 sets of Omar with any of the above.
- 3' r
- 4° Isometric or Riser Diagram
Car Wash Drain
Garbage Dermestio-non -Caod CF Isometric or riser diagram is required for new buildings
Disposal - Domestic - food related that meet the gu.alifications above.
- Commcrvial -food related
ndustrici -food related __„
Ice Mach./Refriig. Drins `I
Oil Separator (Gassurion)
) com11)�enta regardin fixtulre
� Rec. vehicle Dump Station - a < 214 t 1 XiLtre-C it Y ',
Shower -Gang l
-"tall ' ti a - a A h
Si nk Sink- Non -Food related
-Commercial rrlsted �`vJ 3\ �1 ow ; •
- Serv j J
Swimming Pool Filler
Wetter •Clothes *Note_ If the fixture work under this permit results in an
Water Extractor increase of sewer EDIJs, a sewer permit will be issued and
water closet- toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures: l
0.Bui1ding \Pcrmifc\PLLMF- PermitApp.doe 02/24/2011 2
d 179Z£998 209 @ulgt.unld O3M uZ9:90 l. l 1. add