Permit 1 1 •
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2009 -00101
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/28/2009
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9530 SW WASHINGTON SQUARE RD H10
Subdivision: Lot: 0
Project: Apple Store
Project Description: Install (1) lay.
Owner: FEES
PPR WASHINGTON SQUARE LLC Quantity Description Date Amount
BY THOMPSON PROPERTY TAX SERVUCES, 1 ea Lavatories 04/28/2009 $16.60
2235 FARADAY AVE STE #0 1 12% State Surcharge - 04/28/2009 $8.70
PHONE:
Plumbing
56 ea Minimum Fee Adjustment 04/28/2009 $55.90
Contractor: - Plumbing
WESTERN PLUMBING
9460 SW TIGARD, AVE STE 101
TIGARD, OR 97223
PHONE: 503 - 639 -5296
FAX: 503 - 684 -9015
Type of Use: COM
Class of Work: ALT Type of Const:
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 -0100 You may obtain a copy of the rules
Issued By: g n X aat n / ,, [ , Permittee Signature: �• x Call 503.639.4175 by 7:00 a.m. for an inspection that busineessss
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.
.•`r -,04/T4/2009 08:03 5036849015 WESTERN PLUMBING INC PAGE 01/03
Plumbing Permit APpiicatif I D Hunt urFICF. USE ONLY , -
City of Tigard Received li 2. -09 _ Permit No,: •
. 13125 SW Hall Blvd., Tigard, OR 07223Q 2 4 2009 DatelB : PL �� t`r �r� 0 .
Pl
Phone: 503.639.4171 Fax: 503.598. D an Review Other No.:
inspectionIine: 503.639A175 atell3y. Z. ma 'Q
TI G RD Internet www tigard�r gov CITY OF TIGARD Date Ready/By: See Page 2 for
Notified/Method: S S Information
Iris 7t i° �: { � `� re `t^^;. j f ."KC C'J - -4-,; ,C' / -a2T T f n'Rr r<'Ycr :: { r """ . Kt
f r �,, >,. . {. y rr y �t,�2`P .J,su { - L e t 9 f ✓'• : 'rA'v1r .:l - v` -. i _.,.,. �
, a r-lr i9r' lAr•v i , r '' -. --- i' -.
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❑ New construction • ❑ Demolition
For special information use checklist.
Description I Qty. I Ea. I Total
Addition/alteration/replacement ❑ Other:
New 1- 2 - family dwellings (includes 100 ft. for each utility connection
N r " 9 e �*'>" + .k s l k, ?�?-r r " pv 7,7,3 r• r.... .r... I 6 I Fes+ {zt'' ( sc � (
t ".: "twlrr ;t .n.1 1 �l�i , tf: � � 5 y f ix.t `l Per v `- ,. y�,, ,, .∎ T , t 1 { � , ; ;c SFR (1) bath 249.20
.. .:G..._.,Tt,,._. 1 .�.... -•_ ` .. �,,^. �: L f�'':i:.d..rµu.,......i_:. F >. r- ..r �� Sc
❑ 1- and 2- family dwelling K Commercial/industrial SFR (2) bath 350.00
ID Accessory building ❑ Multi family SFR (3) bath 399.00
❑ Master builder 10 53o ❑ Other; Each additional bath/kitchen 45.00
�,� - Fire sprinkler sq. ft.) Page 2
7 - �")7- �" , ( j 7d D (' f11 ,y0 ^M� 10 ""PJr st ',,,, f� w `, :-,4 ,h r y {'
.. _„.�,,,,� ). ....,. 5._r.. ._2 �.,r^rn , ., !,, ,:.?,t,•'...:?:
... , r , ., A '4�Y . Y � ,..,: { .>v5 Site gttlides
lob site address: 2 Ie]!I , ► l a. 1. 1 .,818)! 1 ► r catch basin or area drain 16.60
City /State /ZIP: • • -.1.1/14/01 of, ` • Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no. Project name: t 1 �1 1 Footing drain (no. linear f.: _�,) Page 2
Cross street/directions to job sic
home utilities 110.00
Manholes _ 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: __) Page 2
-
Storm sewer (no. linear ft.: ) Page 2
Subdivision; f Lot no.:
Water service (no. linear ft.: ) Page 2
Absorption or item
Tax rxAap /parcel no.: 1 2 Lo 00003 O `
.� ( x 1
_Fixture
tion valve
v =)� 1 t� � _ �j`� ✓°rill r r,`� l�•^- qr••� ""!."� / � t � b ;: . tp 16.60
„ v2,« : i, `if , U.` 2? zr ,. tG t . 5rR3 ; sr L . v -S tec , rs i
�t- .�.�. _ �__. -:� - ,,,.. W r' -; >;ackflow preventer Page 2
. Backwater valve 16.60
3--1-15 A *A tag - / ,i, AA..1k t Clothes washer 16.60
♦� Dishwasher 16.60
,,, x ',, j ✓ I`1 � x r n.,13�?^h 1 - 7,`'' 7,1 .:� AITUS..I , 4 - - 1 . 1.1 . - t� c'�ur - ^lac Drinking fountain 16.60
Ejectors/sump 16.60
Name:
Expansion tank 16.60
Address:
Fixture/sewer cap 16.60
City /State /ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal •16.60
!�� tf`J - .: .1,�1f --� r +"' f �r . ��� � .d. :I � 1� i f 1 f '' r ". . '.1•.' � ✓•�. Hose bib 16.60
;u.+j.-2. v+f 2IG .4'._ r'i 41 1`A Y.r ri �
�' .,- rS .. - '�t.,wr,� „a.,: -`i `.`�._ , _>:,. n� ^r. -w 1� .1.,c`� ,� +. ,.. ate �_, l. Ice maker 16_60
Business name: _
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address; Primer 16.60
..
City /State/ZIP. Roof drain (commercial) 16 60
Phone: ( ) Fax: : ( ) Sink/basin/lavatory 16.60 4 r
E Tublshower /shower pan ■ I6.60
{ � ,c.. r l r, .r, .3-.77..,,,_.• , A „.yt iF is 1 vim, '� 5y] C"T 7 , t vl 1'4r} -e1 Urinal 16 60
..f- R,i5 �.r.4';';' , xh, ,._ C irlfYS` 4 , .' i '.'� 2vr :, h r 1'4 � , . ��, f � li'-.a Water closet
Business name: Western Plumbing, Inc. Water heater 16.60
Address: 9460 SW Tigard Avenue, Suite 101 Other
City /State /ZIP: Tigard, Oregon 97223
- Minimum permit fee: $72.50
Phone: (503) 639 -5296 Fax: (503) 684-9015 , : 1
_ _ , • r� O
CCB Lie.: 2439 Plumbing Lic. no.- 3429PB _
TOTAL PERMIT FEE Plan review (25% of permit fee)
y Sta te surcharge (12 %ofpermit fee)- c ; � Authorised signalure
.Q l ♦ y UJ J t
L rint name: Dana Jensen Date, r_ ..pq This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Trl -County Building Industry Service Board.
1.1nn,M,nv,CPern es1PLr1 PemAaMp.aoc 06
440 -4616TO 0 /02/Comrwm
I a es6-353 3O 0
'04/14/2009 08:03 5036849015 WESTERN PLUMBING INC PAGE 02/03
Plumbins Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su • • ression S stems:
r � { � e ,. n.. : � 2 4, L.,7 t ,.,e T x Z - -- �• - - r . 2 _ r ••-� ti �-- t1• �--5'+r'�,L� r-•�• -w.x ,g-,-
. . _ k'i �. �{.f_u .3 V.. 1...,� .�«k �: e .,� - 1a t .a'�"a� r cwr;_ 'ltr i is i- 7f 1E �'i i ,� [E57'Z '''�?t ��. F a �i �_,
Footing drain -V' 100' 5 5.00 0 to 2,000 $115 00
Footing dram - each additional 100' 46.40 2,001 to 3,600 5160.00
3,601 to 7,200 $220.00
Scwor • 1st 100' 55.00 7,201 and greater $309.00
Sewer - each additional 100' 46.40 MI
Water Service - 1st 100' INN 55 00 Medical Gas S stems:
Water Service - each additional 100' IMO 46.40 --. .at. k .G n r
� a5 r�i y i * S � '�'zt�.� i
Storm Bc Rain Drain -1st 100' 55.00
�iA'4U �N1 -,• '- G R } �' °� w ` �'� _.i;Pgy "� , n 1�-,)`�
$1.00 to $5,000.00 Miniroum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 MI $5,001 00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
h, s� e. L, r ' :?
i a , rr5 u , x R Id a y vF: n ry rC:' additional $100.00 or fraction thereof, to and
"
including $10,000.00,
Commercial Back Flow Prevention Device 46.40 $10,001 00 to $25,000,00 5148.50 for the first $10,000.00 and $1.54 for
Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to
minimum ermlt fee $36.25 27.55 _ and including $25,000.00.
Rain Drain, single family dwelling 65.25 11.11 $25,001,00 to $50,000.00 $379.50 for the first $25,000.00 and $1 45 for
Inspection of existing plumbing or each additional $100 00 or fraction thereof, to
and including
s i eciall re, uested ins . ections - ' et hour 72.50
0.00.
Subtotal: $50,001,00 and up $742.00 fbr the e first $50,000 00 and $1.20 for
each additional $100 00 or fraction thereof i
Fixture Work: r -{-. h r Y : =• „�- t t5s7t. • .
W LP '!i Y ,
Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to ' Please check all that apply.
accuratcl re.ort fixtures could result in increased sewer fees *. ❑ Any new commercial building with water service 2" and
x1 ti ' -,-rr 7 i7 77 tit, , ;' ; , dv t, greater, except systems designed and stamped by licensed
4 ,1 Nj K - hia � l �. -- V s7 r \ 5.,. Y gr ;, of engineer.
2 ro r,. , 111 My new exterior plumbing site utilities.
= =- El Medical gas and vacuum systems for health care facilities
Bath - Tub /Shower
)acuzzi/Whirl� 1111 ❑ Any multipurpose fire sprinkler system -
Car Wash -Each stall - - -- ❑ Any complex structure as declined in OAR918- 780 -0040.
-Drive Thru MOM Submit Z sets of plans with any of the above.
Gus idor /Water As, irator -- p Y
Dishwasher - Commercial - - -IM.
- Domestic UNE ;' y > �:- ,i -a�r�
Dnnkm • Fountain IMMOMINIM
E e Wash � �� � ❑ Isometric or riser diagram is required for new buildings
Floor Drain /sink - 2" NM MOM that meet the • uallfications above.
3 » liMiiiiiii
- 4 " =MI Comments regarding fixture work:
Gar Wash Drain - - -MEMO
Garbage - Domestic INIMMINIMI -
Disposal - Commercial - -- -
- Industrial 111111.
Ice Mach./Refri: Drains - MIMI -■111111
Oil se,arator Gas Station - __-
Rec. Vehicle Dom, Station -
- -
Shower -Gang MIMI MEM
- Stall MIMI -- *Note: If the fixture work under this permit results in an
Sink - Bar /Lavatory 1 NMEMMINE increase of sewer EDUs, a sewer permit will be issued and
- Bradley - MEN fees assessed for the sewer increase must be paid before the
- Commercial ME= - plumbing permit can be issued.
- Service -
--
Swimmin: Pool Filter - - --
Washer - Clothes - - -�
Water Extractor - - MIMI `
Water Closet - Toilet 1 - --
Urinal IIIIIIN -MINI
Other Fixtures: -
,.Iauild7w \P.nm,.'PLM-Parmi.App die O9/22/06