Permit ,, CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2011 -00224
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/14/2011
Parcel: 1S 1260000300
Jurisdiction: Tigard
Site address: 9627 SW WASHINGTON SQUARE RD FCO2
Project: Sonic Subdivision: WASHINGTON SQUARE MALL Lot:
Project Description: Replace (1) 3" floor drain, (1) ice maker, (2) non -food related sinks and (2) commercial food - related sinks; install
(1) backflow preventer and (2) primers.
Contractor: AL'S PLUMBING Owner: PPR WASHINGTON SQUARE LLC
5655 CROSSLER CT. S. BY THOMSON PROPERTY TAX SERVICES
SALEM, OR 97306 ATTN HILARY RAYMOND
CARLSBAD, CA 92008
PHONE: 503 - 508 -0041 PHONE:
FAX: 503 - 375 -3444
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 07/14/2011 $31.27
Specifics: 1 ea Floor Drain /Floor Sink /Hub 07/14/2011 $25.02
1 ea Ice Maker 07/14/2011 $12.51
Type of Use: COM 2 ea Primer 07/14/2011 $25.02
Class of Work: ALT 4 ea Sink 07/14/2011 $100.08
Type of Const: 1 12% State Surcharge - 07/14/2011 $23.27
Occupancy Grp: Plumbing
Stories:
Total $217.17
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. •
Issued By: i/ J Permittee Signature:
/LS/ DPI/ /i C e9 -- j70/V
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Jul 14 11 02:29p Al's Plumbing, Inc. 5033753444 p.1
PIumbing Permit Application__
ElE
Building Fixtures FOR OFFICE 1.:51 ONLY
City of Tigard Received
-
13125 g 1 L 14 20 Date /By: �� 1 - Permit No.:PL /1 D � ol �
1 3125 SW Hall Blvd., Tigard, OR 97
Plan Review
Phone: 503.718.2439 Fax: 503.59$.1960 QiherPennit Nr "
Inspection Line: 503.639.4775
CITY OF TIGARD DataBy:
T 1 Gr> R D Date Ready/By: furls Eli See Page 2 for
lntemet: www.tigard or.gov BUILDING DIVISION Notified/Method: ' Cr Supplemental Information
TYPE OF WORK FEE* SCHEDULE ektPozOft DU // y
❑ New construction ❑ Demolition For special informmion sire ckecklin
Description I Qty. I Ea. I Total
.. ddition/alterationireplacement ❑ 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 Tid Commercial /industrial SFR (2) bath 437.78
❑ Accessory building ❑ Multi - family SFR (3) bath 500.32
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft) Page 2
9 ,7 JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: �' J(.� . .) Catch basin or area drain 18.76
i:� �s � s..x- ..�1�► Sc Q .� .
Drywell, leach line, or trench drain 18.76
City/State/ZIP: '776 t1 L4L , C
r Footing drain (no. linear ft.: ) Page 2
Suiteibldg. /apt. no.: J Project name: SQn/, e Manufactured home utilities 50.03
Cross street/directions to job site: Li . . N %.46,-vc`,s t J C.) .s a.2. Manholes 18.76
�(
Rain drain connector 18.76
VA toil Co Cyr) C..4:0..; ._'
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 preventer i 31.27 - 51 , 7:2
DESCRIPTION OF WORK Backwater valve /2.51
Clothes washer 25.02
�,7.7-` 1rnr`. 1 ,77-' '44.' 1 i. - .16' •� ; %,_':44a 3.1 ` Dishwasher 25.02
i IN, S G t...; r C.. a .. t q.-,,. :_ Drinking fountain T 25.02
Ejectors /sump 25.02
❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: Fixture /sewer cap 25.02
Address: Floor drain /floor sink/hub t v z'
25.02 2.5 . u
Garbage disposal 25.02
City /State/ZIP:
Nose bib 25.02
Phone: ( ) Fax: ( ) Ice maker
1 ✓ 12.51 t2. .5 1
❑ APPLICANT ❑ CONTACT PERSON interceptor /grease trap 25.02
Business name: Medical gas (value: S ) Pa gc 2
Primer 'Z 12.51 215 , �%-
Contact name:
Roof drain (commercial) 12.51
Address:
Sink/basin/lavatory 4 / 25.02 too ., e
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub/shower /shower pan 12.51 ,
E -mail: Urinal 25.02
Water closet 25.02
CONTRACTOR Water heater 37.52.
Business name:
i--S DL S1.3C- + WaterpipinglDW4' 56.29
Address: j j., (L -� �v , S , Other: _ 25.02
City/State /ZIP: c' rw =�. * CA . G'1 "C L. Subtotal n 3 ,
Phone: (t ) -s-7 S- a ri Fax Minimum permit fee: S72.50
r � Plan review (25% of permit fee) Al , 2 7
CCB Lie.: O a � � Plumbing Lie. no.: Z 1 . 2 - 1 ? 3 State surcharge (12% of permit fee) + _1
Authorized signature; "- c______ .2r / //Y TOTAL PERMIT FEE
Print name: c'y L., . Date: ' 7 _ l 4 - 1 ■ The permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
"Fee methodology set by Tri- County Building Industry Service BBoo
1: 18uilding1 PennitslPLMU- Pe� M'.v
nitApp.dac 10(01!09 440.4616T(I0'02/COEB) Q`1 /90/
Jul 1411 02:29p AI's Plumbing, Inc. 5033753444 p.2
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 dram - 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 $23320
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 $5,031.00 to $10,000.00 $72.50 for the first $5.000.00 and $1.52 for
Other Inspections or Fees Qt' Fee [ea) Toil each additional 5100.00 or fraction thereof, to
and including $10,000.00.
Inspection of existing plumbing or for $10,001.00 to $25,000.00 5148.50 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/ plan review is required for any of the following. Performed: Capped Added Relocate
Please check all that apply.
y g
Baptistry/Font
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 ❑ Any complex structure as defined in OAR918 -780 -0040.
Eye Wash
Floor Drain /sink - 2" Submit 2 sets of plans with any of the above.
3" t
4,. Isometric or Riser Diagram
Car Wash pram ❑ Isometric or riser diagram is required for new buildings - Domestic - food s
diagram q $
Disposal - Domestic -food 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 Z.
- Bradley
- Commercial -food related 2.
- Service
Swimming Pool Filter
Washer - Clothes *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 - Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
httpilwww.tigard -or. gov /city_hal l/ departments /edldocs /PLMF- PermitAp S doc