Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00034
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/16/2012
Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9612 SW WASHINGTON SQUARE RD G02
Project: Claires Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: Interior plumbing.
Contractor: WEST COAST CENTRAL PLUMBING LLC Owner: PPR WASHINGTON SQUARE LLC
12714 SE MAJESTIC LN BY THOMSON PROPERTY TAX SERVICES
HAPPY VALLEY, OR 97086 ATTN HILARY RAYMOND
2235 FARADY AVE, STE 0
CARLSBAD, CA 92008
PHONE: 503 - 298 -0435 PHONE.
FAX: 503 - 855 -3264
FEES
Quantity Description Date Amount
1 ea Floor Drain /Floor Sink/Hub 02/16/2012 $25.02
Specifics: 1 ea Sink 02/16/2012 $25.02
1 ea Water Closet 02/16/2012 $25.02
Type of Use: COM 1 ea Water Heater 02/16/2012 $37.52
Class of Work: ALT 1 12% State Surcharge - 02/16/2012 $13.51
Type of Const: Plumbing
Occupancy Grp:
Stories:
•
Total $126.09
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: -- Permittee Signature:
Call 503 :639.4175 by 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.
02/15/2012 17:40 5035981966 CITY OF TIGARD PAGE 01/03
Plumbing Permit Application
Building Fixtures sec % - _
° fi e , u 1 ,,R, (tt l it i I It +e \1
City of Tigard — Received
• 13125 SW Hall Blvd_ Ti ' 7 2j3�a Data : '
R Phone; 503.7f 8.2439 ,�Fmtti 598 <1960 0��
Inspection Line: 509.639 41 .�Nz Anrc Rcady/By r Pmnit No.: `� d0' .' `�
Internet: ww.tigatrd -ar r.t ` ,-.: ` 0 0 l
*inc. z
atificdiM Se See age r ter Internet: w
,.f 15 DF y�•linc ,.;ON' ���`'��,e P �P Se • . mantle . Sf Inlb '. ' ' •
IJIGK
Q New construeliart (IVern0i For special i
afornh++ arse Andean.
.'+ � � Addition/alteration/replacement . i s ' ° dui "oT' •cs • Ea Total
•
Newt- 2- far»Ily dwelling's includes 100 R for each utility cormcction)
. " 'CATEGORY Of 'COI iiCITON SFR (1) bath 312.70 IIIIIII
Q 1- and 2- family dwelling gCsrmrnerciaibndauuial SFR (2) bath 11111111136/11=111
I ❑ Accessary building ❑ Multi - family 5FR (3) bash 500,32
0 Master builder . Each additional battukitchen 25.02
Q Other_ Fire sprinkler ( sq. ft)
JOB SI E I ORMJ►7i10N / D LO+CA►7 [Ot�i j Page 2 1
t � life utilifi.a:
obtc address: I :e �.1 �. . "'tRIII TM? Catch basin ors= drain
k ��
I i Drywall, leach line, or trench drain
F ooting drain (no. hoc' nr ft.: __, Page 2
-x`19
=tl� i. 50,03
Cross street/directions to job silt:
. h Latch __.r . , Manholes 111.76
R IAMM 1 Raliti drain tormentor IMEIMIll
Sanitary sever (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision; Water service (no, linear It.: ) Page 2
1 Lot no.: Fixture or Item:
Ta's map/parcel no.;
Backflow ptsvcnkr 31.27
DESCRIPTION OF W.QRi( Ba ^kaaltr valve 12.51
Clothes wnthcr 25.02
[ � • a�7t1' /'tiI l� �R ►]Rr /,�i� ` Dishwasher
1m a L 25.02
. a Drinkin eoon sin 25.02
IM!'it,' /. t" Ejectors/sump 25.02
D PROPERTY OWNER El TENANT Expansion bulk 1 2.51
Name: Fixturclsewer cop 25.02
Address: Floor drain/fl oor,inkillub M. 25.02 Ilif_ •o
City/Statc/ap: Garbage disposal 25.02
Hese bib
Phone: ( ) Fax: ( ) 25.02
11.111111E - !cc maker 12 5 1
Q CONTACT PERSON Interceptor/grease trap
� 25.02
' ._ l i ► IiR'i d 'tfcdical gas (value: S,) pagc 2
►. a , 0 Primer 12,51
Roo( dram(cornmereiai) 12.51
- no Sink/basin/lavatory Mil 25.02 WRIM
,rq � ! L �
mi Ph star units (potable water) 62.54
MO": ( ) /� .{ 7t- MAIM Fax :: ( ) ` . 21, Ill Tub /shower /shower pan
E-mail: a (' at • a Come - he
25.02 MEE
atilt 25.02 2_5. b2—
8usincsa name; �� r wow !wafer 37.52
_t bd. 4 Water ''�� '�
Address: - 4 2 3.29 -
L.. fl Other. 2.5.02
� si i* sL :! /0.,
�. 4 Fax: (, is f GJra. Minimum I�mit Tec: 572.50
CCB Lie.: 14,2 r
. , a MIMI Plumbing Lie. no.: rg rt - _ Plan review (2 59'4 of permit fee)
a
Au signature: � L' j � _ °7 t hi/ State surcharge (12% elm* (cc) p . i 1 j ,5
I
" 1ffitilff g ` Date: 1 penes wnllcatten ' • • I/ r
Q ME — rn aids its permit nProt attained withia_180 days__ 1� v 1
a ttar ti nix bete melon! as camplere
'Ice m shodology set by T1i- Connty &lading Industry Service Board.
t:lauhmtaanntgunlu- 1mniN9P.Me lorolroa //� i j l — j�
e •Qfid / MoZICAM \ c , u -\\, , B T �t 51 110
Z d ti9Z£998 E09 6ulgwnld Dom dL9 :j70 Z L 91. ded
02/15/2012 17:40 5035981960 CITY OF TIGARD PAGE 02/03
Plum bing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities -. • • . QV. •Fee NO Tatei 1 ] Square Footage: PeriiiiFeei • .
Footing drain - 1" 100- 50.03 0 to 2,000 5121.90
•
Footing drain - each additional 100' 37.52 2.001 to 3.600 S169.69
Sewer -1st 1.00 62.54 1-601 to 7,200 5233.20 1
I 7201 and greater 5327.54 J
Sewer - each sdditioraI 100' 3 7.52
Water Service - 1st 100' 62,54
Water Service- each additional i00' Medical Gas Systems:
37,52 ValUafjouu; ' Pern it Fee: j
Storm do Rain Drain - 1st 1013' 62.54
• Storm R Rain Drain -each additional 109' 37.52 51.00 to 55,000.00 Minimum fee 572.50
$S.00i.00 to 510.000.00 572.54 for the first 55.000_00 and S1.52 for
Other Inspections Or Fees • Qty • Fee (ea) Total each additional 31 00.f?0 or fraction thereof. to
Inspection 0fexisting plumbing or For and including $10,000.043.
which no fee is specifically indicated 5I 0,00 1.00 to 525,000.00 5149.50 for the dm 510.000.00 and 51.54 for
90.00/hr
(minimum charge -1/2 hour) each additional 5100.00 or !tact on thereof, to
inspections outside of normal business and including 525,000,00.
90A0fir 525.001.00 to 550.000.00 �S379.50 For the fir4 525.000.00 and $1.45 for
hours (minimum charge- 2 hours) each additional 51 00,00 or fraction thereof. to
Reinspection Fees_ 90.00/hr and including 550.000.00
At diGOr al plan review for revisions 90.00/hr 55 0.0 0 1.00 and up 5742.00 for the first 550.000.00 and 51.20 for
{minimum charge - la hoar) . each additional 51 oaten 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 .Pfau Review for Plumbing Altastallations
Flatn►eT for fin' by Fixture Type ' Plan review is required for any of the following.
ype w eed Please check all that apply.
Work Performed: Capped Added Relbcale
Baptistry/Fort 1:3 Any new commercial building with water service 2' and
Beth: - Tub /Shower
greater, ccpt systems designed and stamped by licensed
engineer.
•Iacuzv/whicipool
Car Wash -Each Sod' ❑ New exterior plumbing site utilities for any cgmrttx structure
-Drive 'Ara as damned in OAR 918 -7$0 -0040.
Cuspider/Waler Aspirator ❑ Medical gas and vacuum systems for health care facilities.
CJishwasher. (+mmerciat El Any multipurpose fire sprinkler system.
-Domestic ❑ Any - complex structure as defined in OAR9 1 13-780-0040.
Drinking Fountain
Eye Wash Submit 2 seta of plans with any of the above.
FloorDrain/sink: -2" i 140 . 1 yP,S
_ a - Isometric or Riser Diagram
-Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage - Domestic non -food that meet the qualifications above.
Disposal: -Domestic food related
- Commercial fond related .
- lndusuial Food related
Ice IvlachJRefj. Drains Comments regarding fixture work:
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower: -Gang
- tat)
Sink: - LavTEtar non- -food related D 0
- Bradley P.S
- Corn /Scry /Iltil fond rclaird
Service
Swimming Pool Filter *Note: If the nature work under this permit results in an
washer - C)othes t increase of sewer EDUs,a sewer permit will be issued and
` wares Extractor fees assessed for the sewer increase must be paid before the
Water Closet- Toilet "1\10 NID Yp4 plumbing permit can be issued.
Urinal
l Other Fixtu _
I: t . BuitdingLPemiit ,c1PLMF- PcrmitApp.doc 08/04,2011 — 2
£'d 1792£998 £O9 6uigwnid 0DM dOZ:90 Z l 9 i. qed