Permit CITY OF TIGARD PLUMBING PERMIT
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'9 ; • COMMUNITY DEVELOPMENT Permit #: PLM2012 -00029
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/10/2012
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9636 SW WASHINGTON SQUARE RD G10
Project: Buckle Subdivision: Lot:
Project Description: Interior plumbing.
Contractor: D & F PLUMBING Owner: PPR WASHINGTON SQUARE LLC
4636 N ALBINA AVE BY THOMSON PROPERTY TAX SERVICES
PORTLAND, OR 97217 ATTN HILARY RAYMOND
2235 FARADY AVE, STE 0
CARLSBAD, CA 92008
PHONE: 503 - 282 -0993 PHONE:
FAX: 503 - 288 -0604
FEES
Quantity Description Date Amount
2 ea Floor Drain /Floor Sink/Hub 02/10/2012 $50.04
Specifics: 3 ea Sink 02/10/2012 $75.06
2 ea Water Closet 02/10/2012 $50.04
Type of Use: COM 1 ea Water Heater 02/10/2012 $37.52
Class of Work: ALT 1 12% State Surcharge - 02/10/2012 $25.52
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $238.18
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: 5 Signature: / 2 "f 1
-
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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.
Feb 09 12 12:35p D & F PLUMBING CO 5032880604 p.1
Plumbing Permit Applicatio t
Building Fixtures ?M FOR OFFICE USE ONLY
City Of Tigard Received �,� /� pcnni[14 °- i t -1 L.r^
n 13125 SW Hall Blvd., Tigard, OR 97223 FEB 2012 12 Darc By: d. T Lr
Plan Review Other Permit No.: /�, _ ,0�, �
?hone: 503.718.2439 Fax: 503598.1960 TIGARD !�/✓t
TIGARD Inspection Line, 503.639.4175 CITY OF TIGARD Date Ready /By. Juris 21 See Page 2 for
Internet: vlwvw.tigard or.gov Notifiedlvtethod: I J. Supplemental Information
TYPE OF WO �� U 1G. DIVI)IvN IEEE* SCHEDULE .
For speci�rlinformation use checklist.
❑ New construction ❑ Demolition
Description I Qty. I Ea. I Total
1 4-Addilion/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bads 312.:0
❑ I- 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
'I:
IT 'FORMATION AND LOCATION ' ' Site utilities:
Catch basin or area drain 18.76
Job site address: ' , _ C,,,'4-•:/,,..,,l-A.,.-1, ( �9
_ Dry well, leach line, or trench drain 18.76 I
Citi.'!State /ZIP: q1 7 � " ' ""'
f {=Q't`t -f� ��� 4 - Looting drain (no. linear ft.: �) Page 2
Suite /bldg. /apt. no.: Project name:,.' pLb ,bra Manufactured home utilities 50.03
Cross streetidirections to job site: Sg °t fr (-r- - ji L Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: ____) Page 2
Storm sewer (no. linear fl.: ) Page 2
Water service Ito. linear ft.: _) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Back /low preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
. Clothes washer 25.02
Cjr L L'r Y'vtti`-r.a K. tF 1 Dishwasher 25,02
Drinking fountain 25.02
Ejectors /sump 25.02
❑ PROPERTY OWNER .'TENANT Expansion tank 1151
}
{. 7 Fixture/sewer cap 25.02
Name: j7G . / v .' (! / . - 9
Floor drain/floorsinF;/ltub 25.02 U
Address: Garbage disposal 25.02
City /State /ZIP: Hose bib 25.02
Phone: ( I Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON lnterceptorigrease trap 25.02
Medical gas (value: S ) Page 2
Business name: .
Primer 12.51
Contact name: Roof drain (commercial') 12.51
Address: Sink/basin/lavatory 25.02 75 Ok
City /State/ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
Urinal 25.02
L-' -mail -
Water closet `) 25.02 c7).. 04
CONTRACTOR
Water heater 1 37.52 3 7, -a-2
Business name: IN, ,,'' 1- t i r)w'1 tZt , Water piping/DWV 56 29
Address: Zi ,A1i t.I . A'O Other: 25.02
City/State/ZIP: T' �9 , e, 7 7 >! 7 Subtotal v 2./a,_k (
�� L hv^ Minimum permit fee: $72.50
Phone: (;t:s ) :rZ_ -Of f 3 Fax: ( ;3) 2.1..7;;r' -44G- 0ii Plan review (25% of permit fee)
CCB Lic.: 4 S l) /3d hop. Plumbiug Lic. no.: 2 Z f/ State surcharge {:2` o of permit fee) t 9_57 5,Z
Authorized signature: (44��]/1�� 7 / ■ / TOTAL PERMIT FE ; , it
Jd This permit application expires if a permit is not obtained :thin 151 days
Print name: �,.,v/. /44 t;114 i
Date: -2 - f.L after it has been accepted as complete.
'fee ncethocotogp set by Tri -County Building Industry Service Beard.
I
I:, II, itdin e+PttiriaVPLAtU- PermiiApp.doc t0 /010 440 4615T(10;02)COMAV
Feb 10 12 11:10a D & F PLUMBING CO 5032880604 p.2
Plumbing Permit Application - City of Tigard
- Page 2 - Supplemental Information
Fee Schedule:
,0%,\A� 1
Residential Fire Suppression Systems:
Site Utilities Qty. Fee (na1-9ihF
Square Footag Permit Fee: .
Footing drain - 1" 100' 1 " �d I ' ,t J 0 to 2.000 $121.90 •
Foot:ng drain - each additional 100' ® 347,52 N
Sewer - 1st 100' 62 S i� ` � ^..Ct 3,601 to 7,200 $233.20
0 . " x , 01 a nd greater $327.54
. •
Sewer - each ad 100' 37 ®s x t \C O J
N
Water Service -1st 100' 62.54c \'r*\ ' Medical Gas Systems:
Water Service - each additional 100' 37.529,\ \\•••"" -
Stomt & Rain Drain - 1st 100' Valuation: Permit Fee:
62.54 51.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 37.52 55,001.00 to 510,000.00 S72.50 for the first S5,000.00 and $1.52 for
Other Inspections or Fees Qty. Fee (ea) Total each additional S100.00 or fraction thereof, to
and including $10,000.00.
Inspection ofexisting 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 to $50,000.00 S379.50 for the first $25,000.00 and $1.45 for
]ours (minimum charge —2 hours) each additional $100.00 or fraction thereof, to
Rcinspection Fees 90.00 /hr and including 550.000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first $50,000.00 and S1.20 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 Fiatur•e Type Plan Review for Plumbing Installations
Fixture Type for Replace,' Plan review is required for any of the following. Performed: Capped • Added Relocate 9 t•
Baptist,
Font Please check all that apply.
Bath Tub/Shower ; ❑ Arty 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 Aspirate, 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.
4' Isometric or Riser Diagram
Car Wash Drain
Garbage - Domestic — non -food 9- ❑ Isometric or riser diagram is required for new buildings
Disposal - Domestic - food related that meet the qualifications above.
- Commercial —food related
- Industrial -food related
ice Mach. /Refrig. Drains
Oil Separator (Gas Statico) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang t'` t/ (.,,i7,� =-Y�- }•vttive, / .e;,-,,-.4 t' ri
Stoll Line e - 1
Sick /Lac -Non -food related 3
- Bradley %,G "��iG, ,, G ,): 4 /1I4'1 C.i !1;'t
n�
- Commercial -food related , _r (i
- Service 1
Swimming Pool Filter 'Note: If the fixture work under this permit results in an
' V,'esher - Clothes P
Water Extractor increase of sewer El)Us, 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:
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