Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00069
T1GARD 13125 SW Hall Blvd., Tigard OR -97223 503.718.2439 Date Issued: 03/28/2012
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9459 SW WASHINGTON SQUARE RD A14
Project: Footlocker /House of Hoops Subdivision:VASHINGTON SQUARE ESTATES NO: Lot: 108
Project Description: Relocate (1) non -food related mop sink and install water heater.
Contractor: CASCADE PLUMBING CO Owner: PPR WASHINGTON SQUARE LLC
2630 N HAYDEN ISLAND DR #3 BY THOMSON PROPERTY TAX SERVICES
PORTLAND, OR 97217 ATTN HILARY RAYMOND
2235 FARADY AVE, STE 0
CARLSBAD, CA 92008
PHONE: 503 - 289 -7095 PHONE:
FAX: 503 - 283 -9514
FEES
Quantity Description Date Amount •
1 ea Sink 03/28/2012 $25.02
•
Specifics: 1 ea Water Heater 03/28/2012 $37.52
1 12% State Surcharge - 03/28/2012 $8.70
Type of Use: COM Plumbing
Class of Work: ALT 10 ea Minimum Fee Adjustment - 03/28/2012 $9.96
Type of Const:
Plumbing
Occupancy Grp:
Stories:
Total $81.20
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:
A t4� end
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 Applic . 1 . . ;:
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Building Fixtures CE! VED FOR OFFICE USE ()NIA' Ci of Tigard Received •
g (■ DateB : 3 AZ ; ��t_ - ermit No.: '44.i...17/.2 - / / , •.
13125 SW Hall Blvd.. Tigard, OR M 'e 2 7 2012 Plan Review
t C Phone: 503.718.2439 Fax: 503.598.1960 Date/By: /�
B Other Permit Nt ,_ e fev / n
T r C A R D Inspection Line: 503.639 CITY OF TIGARD Date Ready/By: Tyre El See Page 3 for .
Internet: www.tigard- or.gov a � tified/Method: I / Supplemental Informa
TYPE :OP' IOR DIVISION. K' FEE °' •9CHEDCIEIj;
❑ New construction ❑ Demolition For special information use Checklist.
Description : 1 Qty.: I Ea. 1 Total
23 Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OP .CONSTRUCTION SFR (I) bath 312,70
❑ 1- and 2- family dwelling ® 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
9ys9 JOB SITE INFORMATION AND LOCATION • . Site utilities:
7 Job site addre a SW WASHINGTON SQ RD Catch basin or area drain 18.76 •
City /State/21P: "f1CARD, OR - QOTLGr!r Drywell, leach line, or trench drain : 18.76
Footing drain (no. linear ft,: _) Page 2
Suite/bldg. /apt. no.: A -14 Project name: HOUSE OF HOOPS Manufactured home utilities 50.03
Cross street/directions to job site: . Manholes 18.76
Rain drain connector 18.76
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.: Back preventer • 31.27
• •
• DESCRIPTION OF WORK • • Backwater valve 12.51
Clothes washer 25.02
RELOCATE MOP SINK, INSTALL NEW WATER HEATER Dishwasher 25.02
Drinking fountain • 25.02
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Ejectors /sump 25.02
0 PROPERTY OWNER • • ❑ TENANT Expansion tank
• 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub • 25.02 - - --_!
Address: Garbage disposal 25,02
City /State/ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) lee maker 12.51
El APPLICANT 0 CONTACT PERSON Interceptor /grease trap 25.02
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Business name: CASCADE PLUMBING COMPANY Medical gas (value: S ) Page 2
Contact name: SHANE PARLEY Primer : 12,51
Address: 2416 N. HAYDEN ISLAND DRIVE Roof drain (commercial) 12.51
Sink/basin/lavatory fop 5,,f . ! f ' 1. � 25,02 - ,0�
City /State/ZIP: PORTLAND, OR 97217 Solar units (potable water) 62.54
Phone: (503) 289 -7095 Fax: : (503) 283.9514 Tub /shower /shower pan 12.51
E-mail: CASCADEPLUMQYAHOO.COM Urinal 25.02
'CONTRACTOR Water closet 25.02
• • Water heater 1 ; 37.52 37.52
Business name: CASCADE PLUMBING COMPANY Water pipinglDWV 56.29
Address: 2416 N. HAYDEN ISLAND DRIVE Other. 25.02
City/State/ZIP; PORTLAND, OR 97217 _ :' Subtotal 62.54
Phone: (503) 289 -7095 Fax: (503) 283 -9514 Minimum permitfeo: $72.50 72.50
CCB Lie.: 120893 / Plumbing Lic. no.: 34 -412PB • Plan review (25% of permit fee)
Authorized signature: State surcharge (12% of permit fee) 8,70 /
TOTAL PERMIT FEE 81.20 t✓
Print name; CRYSTAL JONE I Date: This permit application expires if a permit Is not obtained within 180 days
after it bas been accepted as cent Ode.
'--- 11 t „ ,+, „ e ./�/} r ^ • 105 a _ "Fee methodology set by Tri County Building Industry Service Board.
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• Plumbing Permit Application - City of Tigard •
Page 2 - Supplemental Information
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Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty• Fee ( • Total Square Footage: : Fee: '
Footing drain- 1' 100' - 50.03 0 to 2.000 $121.90 i •
Footing drain - each additional 100' 37.52 2.001 to 3,600 $169.69
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Sewer 1st 100' 62.54 3.601 to 7,200 $233.20
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 Valriatil0111: 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 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for
Other Inspections or Fees Oty, Fee (ea) Total each additional $100.00 or fraction thereof, to
and including $10,000.00:
Inspection of existing plumbing or for $10,001.00 to $25,000.00 $145.50 for the first $10,000.00 and $1.54 for
which no fee is specifically indicated 90.00/hr each additional $100.00 orfraction thereof, to
(minimum charge - 1/2 hour) and including $25,000.001:
Inspections outside of normal business 90.00/hr $25,001.00 to $50,000.00 $379.50 for the first 525,000.00 and $1.45 for
hours (minimum charge -2 hours) each additional $100.00 or t raction 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
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accurately report fixtures could result in increased sewer fees * . .
Quantity by Fixture Type Pla Review for Plumbin Ins
Fixture Type for Replace/
Work Performed: Capped Added Relocate Plan review is required for any of the following.•.
Baptistry/Pant Please check all that apply. •
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 structure
Cuspidor/Witter Aspirator as defined in OAR918. 780.0040.
- Dishwasher - Commercial ❑ Medical gas and vacuum systems for health are facilities.
- Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain Cl Any complex structure as defined in OAR90- 780 -0040.
E e Wash
Floor Drain/sink - 2" _ Submit 2 sets of plans with any of the above.
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Isometric : or Risen D .. . . .
Car Wash Drain
Garbage - Domestic non - food ❑ Isometric or riser diagram is required for new buildings
Disposal - Domestic 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 '
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- Bradley :
-Commercial -food related
- Service
Swimming Pool Filter
Washer - Clothes *Note: If the fixture work under t per results in an
Water Extractor - increase of sewer EDUs, a sewer permit whI be issued and
Water Closet - Toilet fees assessed for the sewer increase' must be; paid before the
Urinal 1 plumbing permit can be issued.
Other Fixtures:
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