Permit CITY OF TIGARD PLUMBING PERMIT
1 14
COMMUNITY DEVELOPMENT Permit #: PLM2011 -00174
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/16/2011
Parcel: 151260000300
Jurisdiction: TIGARD
Site address: 9502 SW WASHINGTON SQUARE RD J03
Project: Wetzels Pretzels Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project Description: Relocate and add fixtures for new tenant. Capping of fixures done by others under PLM2011- 00065.
Contractor: BEAVERTON PLUMBING INC Owner: PPR WASHINGTON SQUARE LLC
13980 SW TV HWY 2235 FARADAY AVE STE #0
BEAVERTON, OR 97005 CARLSBAD, CA 92008
PHONE: 503 - 643 -7619 PHONE:
FAX: 503 - 643 -7620
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 06/16/2011 $31.27
Specifics: 1 ea Expansion Tank 06/16/2011 $12.51
3 ea Floor Drain /Floor Sink/Hub 06/16/2011 $75.06
Type of Use: COM 1 ea Ice Maker 06/16/2011 $12.51
Class of Work: ALT 1 ea Interceptor /Grease Trap 06/16/2011 $25.02
Type of Const: 1 ea Primer 06/16/2011 $12.51
Occupancy Grp: 4 ea Sink 06/16/2011 $100.08
Stories: 1 ea Water Closet 06/16/2011 $25 02
1 ea Water Heater 06/16/2011 $37.52
1 12% State Surcharge - 06/16/2011 $39.78
Plumbing
Total $371.28
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 Notifica '. - - - • -r. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct • - stions to OU • b -fling 503.232.1987 or 1.800.332.2344.
Issued : y: / I / , / I, Perm ittee Signatu • � J /aL
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 '
Building Fixtures 1 c►1z urflc: L t ;l: I1�I_.1
City of Tigard JUN 3 2011 Received Dat�Ar , �ed (Q � NrmitNo.: , � / 7y
_ _ - w 1312 SW Hall Blvd., Tigard, OR 97223 .J, �
Phone: 503.7182439 Fax; 503.598.1960 : OF rl"" Review
Ins extionLine: 503 -. Q T= � � ' Date Readyy
+ bale/By: other Pcrmil.Nu.: 4/04( -0��D
�.�.�c. P ,. . r , 1 SIC.' brit. ,^'
Internet: www.tigard-ur.gov
r - trfic See Page 2 tor
Y
No d/mettiod:
'silt - +yo,.' , �,. • . „� Supplemental information
:, , ,i ,. '1 YPE y.w i , ; t pi,i M 4 1 FEE* entr JLE
❑ New construction ❑ Demoliticm For cia - or mallon use checklist.
Description TOte
® Addtt ❑ Other. �' �
,,m ,I .1 ,. New ] - 2 -fxm ell ales 100 ft. for each utility ouectt )
:. ". A COR ' k >u, ipi , . O N.' : V li�` " ,i ' SFR (I) bath r aeh 20 connection)
dwellings inCl
d lq 1 : G :
0 I - and 2- family dwelling _ ® Commercial/industriai SFR (2) bath 437.78
0 Accessory building SFR (3) bath
❑ Multi - family 5
[J Master builder - Faach additional bath/kitchen 25.02
❑ Other:
" Fire sprinkler ( sq, to P age 2
J+',TT STJE TINii'e : TIION`I' ' I L4ll Site utilities: _ .
Job site address: ' ', W WASHINGTON SQUARE RD. Catch basin or area drain 18,76
City /State/ZIP: PORTLAND, OREGON 97223 Dry�+Cll, leach line, or trench dram 18.76
Suite/bidg. /apt no.: J-03 Project name: WE1'ZE:L'S PRETZEL'S Fooling drain (no. linear R.: i ) Page 2
Manufactured home utilities 50.03
Cross strect/directions to job site:
Manholes
^" 18.76
» _Rain drain connector 18.76
Sanitary sewer (no. linear ft.:. ) P age 2
" w Storm sewer (no. linear ft-: _) Pagc 2
Water service (no. linear It,: -_) I Page 2
Subdivision: I Lox no.; Fixture or Item:
Tax map /parcel no.: Backfuw preventer 1 31.27 31.27
it'�'P'�p" "��»iO}i}��Iiy'b Ay : M I k Hackwater valve 12.51
„ e .,,
RELOCATE BATHROOM, AND KITCHEN EQUIPMENT. Clothes washer 25 -02
- Dishwasher_ 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
". tOT R l OWN ; t ' A r't fA Expansion tank 1
rNN
�u. Ex 12.51 12.51
Name: MCJ INVESTMENTS, LT.0 Fixturc/sewer cap 25.02
A,ddi s; Floor druin/tloor sink/huh 2 tr 3 25.02 75.06
die
Garbage osal 25.02
City /Statc/L1P: p
lime hih 25.02
Ice maker 1 12.51 12.51
;. 1
� . *!iiti, ❑ '0Ol414GT P080118 Interceptor /grease trap 1 25.02 25.02
Business name: BEA VERTON PLUMBING, INC. Medical gas (valuc; $ �) Page 2
Contact name: JOE RANDALL Primer 1 12.51 12.51
Address: 13980 SW '1'UALATTN VALLEY HWY Roof drain (commercial) 12,51
• Sink/basinnavatory 4 25.02 100.08
City /State/ZIP: BEAVERTON, OREGON 97005 Solar units (potable water) 62.54
Phone: (503)643,7619 - Fax: : (503) 643.7620 Tub /shower /shower pun 12.51
E-mail: SucObeavertonplumbing.eom ti Utinal 25.02
"' Walercinget 1 25.02 25.02
1'��L . r'IQ Milli Water heater -- _.
1 37.52 37.52
Business name: BFAVERTON PLUMBING, INC
Water piping/DWV 56.29
Address: 13980 SW 'I'UALATIN VALLEY HWY Other:
25.02
City /State/ZIP: BEAVERTON, OREGON 97005 Subtotal 331.50
Phone: (503) 6.7619 Fax: (503) 643,7620 T
43 Minimum permit fee: $72.50
(:CB Lk... 012889 Plumbing Lic. no.: 34-4PB
Plan review (25% of permit fee)
Authch izCd signatur "` State surcharge (12% of permit fee) 39.78
�E 70'1'AL PERMIT FEE 371.28
Print name; SUSAN DEAN Date: 6/3/2011 ' - This permit application expires if a permit is net obtained Within lair days
II afhv it hes been accepted as [(MOW.
"Fee mothodefu8y set by Tri- County Gadding Industry Service Board.
I.\ Bui ldiag4PermitpVtmu- PefmuApp.doc 10/O1/09 410.4d161•'l0
utrllCUiW WE1r)
Plumbing Permit A _lit - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Supres S stems
^�— W r • ww � i '— ..
, iiTtil !1�t!« �1 n ' ' 7 tty k q : (e5) INI 11, atgl .
,,��� Sy re :Foote N� � P elr i �`i F+� � ,�
Footing drain 50,03 0 to 2,000 $121.90
Footing drain - each additional 100' 37.52 2,001 to 3,600 _ $169.69
Sewer - 1st 100' 62,54 3,601 to 7200 $233.20
7,201 and greater $327.54
Sewer - each additional 100' 37.52
Water Service - 1st 100' 62.54
water Service 37.52
each additional — Medical Gas S stems:
Storm & Rain Drain - I st 100' 62.54
- ' ''';!h: :,1>u ? l). PC , t
Storm & Rain Drain - each additional 100' 37,52 $1.00 to $5 Minimum fcc $72.50
$5,001.00 to $10,000.00 572.50 for the first $5,000.00 and $1.52 fur
ier 111 pe ctins 0'0>�' ' :. `Sat i each additional $100.00 or fraction thereof; to
and includi1 _ $10,000,00.
Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 for the first $10,000.()0 and $1.54 for
which no fcc is specifically indicated 90,00/hr
(minimum charge -1/2 hour) each additional $100.00 or fraction thereof to
Inspections outside of normal husincss — and includm r $25,000.00.
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
Rcinspection Fees 90.00/hr
and imludin• $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 $120 for
minimum charge -1/2 hour) each additional $100.00 or fraction thereof.
Subtotal:
' w
Commercial Fixture Work:
Arc 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 *.
ture y e ;
Work Performed; med: > C unn Added r , . Retocare fee :Plumbing 111]l1tl I .I1.Star1O4
Ieare Plan review is required for any of the following.
sPPe e
Baptistry/Font y/Funt Please check all that apply,
Rath - Tub/Shower El 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 ❑ Ncw exterior plumbing site utilities for any complex structure
Ct idor /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 owntain ❑ Any complex structure as defined in ()AR918- 780 - (1040
Eye Wash
—
Floor Drain /sink - 2" 3 Submit 2 sets of plans with any of the above.
3 ., —
Car Wash Drain 11Y yI4ti ;11et Or ir1i
Garbage 12omesticrnon -food — — Isometric or riser diagram is required for new buildings
Disposal - Domestic related — that meet the qualifications above.
-C:onnnercial -food related
- Industrial -food related
Ice Mach./Refrig. Drains 1 ..}.
Oil Separator (Gas Station) Comments regarding fixture work:
Roo. Vehicle DuniEStation
Shower -Gang — -
-Stall
Sink /1,av - Non- tood related (uij) 1 1 -
- Bradley
-Commercial-food related 1
-Service 1
Swimming Pool Filter
Washer - Cluthes *Note: If the fixture work under this permit results in an
Water Extractor Increase of sewer EDUs, a sewer permit will be issued and
Water Closet - Toiicr 1 fees assessed for the sewer Increase must be paid before the
Urinal lumbin
Other Fixtures; P g permit can be issued.
http: / /www.tigurd- or.gov /city hall / departments /cd/docs/PLMF- I'ermitApedoc
06/03f2011 09 :54 5035981950 CITY OF TIGARD PAGE 92102
Accunialsttive Sewer Tally
TenSat Name: W1 rz,E7 I > Parcel ## 1512600003Qp
.�.�. � PRETZELS
Site Address: 9502 SW 17NGTON This SWR# NONE
U ARi; RID This P1 M# PLM p11 0
F Value I > tc vi ous s �`
! revious Credits Capped Fixture t
x[urc I.lcu, New
# value capped off value added added
count off #P total total
B. time /Font count' # value
0 #s values
Rath - Tub /Shower 0 0 0
� � 0 NM 0 � a
- acur�xi Whirl not WM 0 0 0
Ca* Wash - .Each Stall 0 0 0 0 0 MI D MIN
- Drive thmu :h 0 0 0
C u .idar /Water Ae tot 0 0 0 0 0
1.7ishwashcr - Commercial � NM 0 0 0 0 0
0 Mill 0
- Domestic 0 0 0 MN Dnnkif• Fountain 0 0
- 0 0 � Inn v 0
l; - Wash 1 ME 0 0
0
0 0 0
Floor Drain /Sink - 2 inch 0 0
- 3 inch 0 NM 0 0 0 0
- 4 inch � 0 0
0 0
-Car Wash Dtn 6 0 0 0
Gar - phi • nsal � 0 0
0 0 0
- IDomcselt to 3/4
HP
- Commercial to 5 II IIMMIIIII 0 0 ME
0 0 0 0
- Industrial over 5 Hr 0 0 0
0 0 0
Ice Machine /Re , tar Efrain 0 0 � 0 0 0
Oil Sc. (l►ts Station 0 0
6 0 0
Rec. Vehicle Dum station MI 0 0 0
Shower - CrRn r head 0 0 .11.11 0 0 0 0 Sink • Still IIMMINE 0 0 0 0 0
Hat /I,arato 0 0 0 0
- ,BYadlc MINIMIll 0 �� 0 NM 0 0 Mg -2
- Cnmrnercial =11.1.1 0 0 0
0
- Service 0 � D 0
0 0 0
iw477mir7_ Pool litter � 0 0
0 0 � NM 0
K•asher - Clothes 0
0 0 0
Uatcr 1?xtractnr 11M11111111 0 0 0
0 0 0
'inter C:laect - Toilet 111111 111.11111 0 0 0
rival 6 0
6 0 0 0
Previous 1:;130 C� 0 0
Count 0 0 0
Capped EDU Credit
1AIS 0
0 0 2 g 0
Current 1' Ikturt Value g 0 0 -2
Previous Fixture V;tlue divided by 16 = `0.5 Current P.T)Ij -8
0 divided by 1 G = 0,0 1 EMI = $ 4,100
Change ..a — � 1. rcvious GDS
divided by 16 ,IC -0.5
Enter EDU by over (under) $ (2,050.00
tree: " * *C:R.I;;DITr "" �$ a Here O -S
Authorised Natne /Sigxrarvre: 13RAND) N TAGGART X24 Z1
49
vi ntr: 313/2011
Au Win Di
m- The prol,cet ov+ner ti hsll r ctaifl the c ) I
Knitted to the C;i of 7'S It redtc sc redi tally rcenr I f e cruclic
-stem eiciar
de , this e{.. document t char w ill 5crv ns a voucher w hi ch must
Tigard I3uildinG Division to rCtlrcm credits towards future a se de; t car e,
'inkling\ Sewer Tally \SCwctTtiiyShpah oo.ids 07 /f1 i / 10
Accumulative Sewer Tally Parcel # 1 S1 260000300
Tenant Name: Wetzel's Pretzels This SWR# 201 1 -00080
Site Address: 9502 SW Washington Square Rd 103 This PLM# 201 1 -001 74
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 0 3 6 3 6
- 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 1 1 1 1
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 1 3 1 3
- 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 0 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0.5 8
TOTALS 0 0 0 0 7 15 7 7
Current Fixture Value 7 divided by 16 = 0.4 Current EDU I EDU = S 4,100
Previous Fixture Value 0 divided by 16 = 0.0 _ Previous EDU
Change 7 divided by 16 = 0.4 over (under) $ 1,640.00
Enter EDU Change Here 0.4
Notes: CREDITS FROM PLM2011 -00065 APPLIED TO THIS PERMIT.
Authorized Name /Signature: Debbie Adamski Date: 6/3/2011
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
,_