Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00138
T [ G A R l? 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/24/2012
Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9530 SW WASHINGTON SQUARE RD H10
Project: Apple Store Subdivision: Lot:
Project Description: Relocate (1) sink, reset (1) water heater & install (1) sewerage ejector pump.
Contractor: MODERN PLUMBING Owner: PPR WASHINGTON SQUARE LLC
11120 SW INDUSTRIAL WAY BY THOMSON PROPERTY TAX SERVICES
TUALATIN, OR 97062 ATTN HILARY RAYMOND
2235 FARADY AVE, STE 0
CARLSBAD, CA 92008
PHONE: 503 - 691 -6166 PHONE:
FAX: 503 -691 -6771
FEES
Quantity Description Date Amount
1 ea Sink 05/24/2012 $25.02
Specifics: 1 ea Water Heater 05/24/2012 $37.52
25 Misc Other Fee 05/24/2012 $25.02
Type of Use: COM 1 12% State Surcharge - 05/24/2012 $10.51
Class of Work: ALT Plumbing
Type of Const: 1 ea Fixture /Sewer Cap 05/24/2012 $25.02
Occupancy Grp: 0 12% State Surcharge - 05/24/2012 $3.00
Stories: Plumbing
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: a Permittee Signature: au 4 /2 /1 D
Call 503.639.4175 by 7:00 a.m. for the next available inspection date. ` te r 1 r
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.
•
May. 23. 2012 7:21AM Modern Plumbing No. 5389 P. 1 / /g ��
Plumbing Permit Applie i,, CEl Building Fixtures FOR OFFICE: i sn: UNIX
City of Tigard MAY 2 3 2012
Received .S 44112- Sr P ermit NPZIL4 30 ooug
li q 13125 SW Hall Blvd., Tigard, 04442,33 Da Rev
o Phone: 503.639.4171 Fax: 50 1 6 .' TIGARD Plan y. Other Permit NoFPc Z_ 0� �
1 IU ARL0 Inspection Line: 503•639.4175BUI D iO Eli � iF ;10 �S Datell�dy/By: El Ste Page 2ter
Internet: www.tigard- or.gov Notified/Method: SupplementalIaforma
• TYPE OF WORK . FEE* SCHEDULE d7t .l"AD /! *
❑ New construction ❑ Demolition For special Information rrse drecklizl
Description 1 Qty. I En. L Total
' Addition/elteralion/replacement ❑ Other. New 1 - 2-family dwellings (includes 100 ft. for each utility connection)
CATEGORY OP CONSTRUCTION Site (1) bath 312.70
❑ I- and 2- family dwelling ( Commercial/industrial SPR (2) bath 437.78
bath
❑ Accessory building ❑ Multi- family srR) 500.32
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other:
Fire sprinkler (, sq. R) Page 2
JOB SITE INFORMATION AND LOCATION Slte utilities;
Job site address: Catch basin or area drain 18.76
°1 5 3 0 SW u t;Ls1�. i rev , s
City /Statc2IP :1 \ G. r a r q .Z 2.3 . omyell, leach line, or trench drain 18.76
`1 Footing drain (no. linear ft.: _J Page 2
Suite/bldgJapt. no.: if 1 0 I Project name: A „ S 41.5 Y e Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
ito 1 9 i .1; 6, s- Di Rain drain connector 18.76
Sanitary sewer (no. linear IL: ) Page 2
_Storm sewer (no. linear It.: ) Page 2
Water service (no. linear ft.: ) Page 2
_
Subdivision: I Lot no.: Fixture or (fern:
Tax map /parcel no.: Backflow premier 31.27
DESCRIPTION OF WORK • Backwater valve 12.51
1 Clothes washer 25.02
"ke- IA.0 -4/0' 1 Vin ( r&'e..'v J... # Dishwasher 25.02
B r ea. k ( inn Drinking fountain 25.02
. Ejectors/sump r-25.0
. ❑ PROPERTY OWNER I is TENANT • Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Address: -
Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City /StatefZlP: • - Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT . ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: S ) Page 2
Contact name:
Primer 12.51
_Roof
drain (commercial) 12.51
Address; Sink/basinfiavatory �I. 25.02 )$U}
City/State/LIP: Solar units (potable water) 62.54
Phone: ( ) 1 Fax:: ( ) T1rb/showcr/shower pan 12.51
E-mail: Urinal 25.02
• . • CONTRACTOR Water closet 25.02
Business name: r • 1 O a /1 - - Water beater kes j- ex 1 Si t 37.52 31 S ,
012.. 9 \ um„le) W LA L.O. Q Waterpiping/DWV 56.29
Address: [ 1 \'2-..Q 51 VLt�
J 1. L a S� !''t l , ( uJ&1 B�1 13 Other.
City /State/ZIP: 1 t-rc ,A c r 0 6 Subtotal
Phone: (5 ( I to 1( (p o Fax: ( (DI L ( .-- 11 I Minimum permit fee: $72.50 r
a /, �� Plan review (25% of permit fee) yr
CCB Lie.: x----? -(O� 0,V Plumbing Lic. no.: 3y 2-,St eS 1�
Authorized signa'I / %y' vl. Slate surcharge (12% of penult fee)
C ( TOTAL PERMIT FEB
Print name: MIMI r. , l Seartou erpirea ire permit la not obtained within ISO days
alter it tas been accepted as complete.
`Fey methodology set by Tri- County B uilding Industry Service Board Di
L'1Bu Idmgmeceits�PLMU.PennitAppdee tutor Date: IE MV permit app 140 6 (lae�) j ale -
May, 23. 2012 7:21AM Modern Plumbing No. 5389 P. 2
Plumbing Permit Application - City of Tigard A3
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) - Total Square Footage: Permit Fee:
Footing drain -1 100' 50.03 0 to 2,000 $121.90
Footing drain - each additional 100' 37.52 2,001 to 3,600 $169.69
Sewer - let 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 Valuation: Permit Fee:
Storm & Rain Drain -1st 100' 62.54 $1.00 to $5,000.00 Minimum fee $72.50
Stone & 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
O t11C1' Inspections or F ees Q4'' Fe (ea) Total each additional $100.00 or fraction thereof, to
p and including $10,000.00.
Inspection of existing 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
r (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 that $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 includin: $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: -
Commerci Fixture Work: _ .
Are you capping, adding or replacing fixtures? If "yes ", Plan Review for Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees * . Please check all that apply. •
Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixture Type: Cteplore greater, except systems designed and stamped by licensed
Previous Gus Added Existioe engineer.
Baptistry/Font ❑ New exterior plumbing site utilities for any complex structure
Bath - Tub/Shower as defined in OAR918- 780 -0040.
- Jacuzzl/Whirlpool
Car Wash Each Stall
1:1 Medical gas and vacuum systems for health care facilities.
- Eive Tarn ❑ Any multipurpose Ore sprinkler system.
Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR91 a- 780 -0040.
Dishwasher - Commercial
Domestic Submit Z sets of plans with any of the above.
Drinking Fountain
Eye wash in--- - - _ • Isometric or Riser Diagram
Floor Drain/sink - 2" 0 Isometric or riser diagram is required for new buildings
- 3^ that meet the qualifications above.
- 4'
Car Wash Drain
Garbage - Domestic
Disposal - Commercial
- Industrial Comments regarding fixture work:
Ice MachdRefdg. Drains
Oil Separator (Gas Station) _
Rec. Vehicle Dump Station _ - _
Shower -Gang -
-Stall
Sink - Bar/Lavatory
- Bradley
Commercial _ I *Note: If the fixture wo under this permit results in an -
-Service 1 1 - increase of sewer EDUs, a sewer permit will be issued and
Swimming Pool Filter fees assessed for the sewer increase must be paid before the
Washer - Clothes
Water Extractor plumbing permit can be issued.
Water Closet - Toilet
Urinal
Other Fixtures; •
I:: Buildineermits \PLMP•PermitApp.doc 2