Permit CITY OF TIGARD PLUMBING PERMIT
e COMMUNITY DEVELOPMENT Permit #: PLM2013 00184
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/11/2013
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9618 SW WASHINGTON SQUARE RD G -5
Project: Helzberg Diamonds Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Relocate (1) floor drain, (1) lay, (1) toilet, (1) primer and install (1) water heater. Repiping for water and drain lines
to meter.
Contractor: PETERS PLUMBING LLC Owner: PPR WASHINGTON SQUARE LLC
334 SE 18TH AVE PO BOX 847
PORTLAND, OR 97214 CARLSBAD, CA 92018
PHONE: 503 - 853 -2535 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Floor Drain/Floor Sink/Hub 06/11/2013 $25.02
Specifics: 1 ea Primer 06/11/2013 $12.51
1 ea Lavatories 06/11/2013 $25.02
Type of Use: COM 2 ea Water Piping /DWV 06/11/2013 $112.58
Class of Work: ALT 1 ea Water Closet 06/11/2013 $25.02
Type of Const: 1 ea Water Heater 06/11/2013 $37.52
Occupancy Grp: 1 12% State Surcharge - 06/11/2013 $28.52
Stories: Plumbing
•
Total $266.19
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 t les adopted by the Oregon
Utility Noti • enter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You ay • •tain a copy of the rules
or dir questions to OUNC b . ling 503.232.1987 or 1.800.332.2344. !�
Is ed By: / / I Permittee Signature: \ �� \\
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 Application
Building Fixtures FoR OFFICE USE ONLY Da
City of Tigard Received // / 2 J i , Permit No.: I �t 3- efloZ
a 13125 SW Hall Blvd., Tigard,OR 97223 n Re
C Phone: 503.718.2439 Fax: 503.598. Plan Review
1960 Date/By: Other Permit No.: ��3. `/
Inspection Line: 503.639.4175 1 U N 1 1 1 3 Date Read B lu rir ®See Page 2 for
TIGARD Ready /By: g
Internet: www.tigard- or.gov
OFTIGARD Notified/Method: Supplemental Information
TYPE OF W. . LDINGDNISION FEE* SCHEDULE
❑ N w construction ■Demolition For special information use checklist
Description I Qty. I Ea. I Total
V Addition/alteration/replacement 0 Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
❑ 1- 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
(Mil 0 JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: CO AS H,>J 1 s ' ( Catch basin or area drain 18.76
City /State /ZIP: "�l , Drywe11, leach line, or trench drain 18.76
/� Footing drain (no. linear ft.: _) Page 2
Suite/bldg./apt. no.: I Pr na E(�Z_ E 'C 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: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
C ft P O A i t A- � o Clothes washer 25.02
,, S C Dishwasher 25.02
tt
►V > 1 it SIB u F � c � /1-{ Drinking fountain 25.02
RoOS Ft l N i(3 C J��`I.CR$ Roo I oK Etors /sump 25.02
PROPERTY O NER I ❑ TENANT Expansion tank 12.51
Name:
Fixture /sewer cap 25.02
Floor drain/floor sink/hub ) 25.02 • R So'-
Address:
Garbage disposal 25.02
City /State /ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: pe P Q / kl ( Medical gas (value: $ ) Page 2
p 7 Primer 1 12.51 l A• S
Contact name: \ k? Q _ g c• Roof drain (commercial) 12.51
Address: r Sink/basi avatory) l 25.02 5iO
City /State /ZIP: J Solar units (potable water) 62.54
Phone: ( 501 g S 3 L 91S Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
Water closet 1 25.02 ?
• CONTRACTOR Water heater / 37.52 5 7.5
Business name: - • - , v " j , • Water piping/Ip9V A # 56.29 a 2.5
Address: r- P rr , '.5 - PL. n) a 1.7-e-- Other: 25.02
City/State /ZIP: 354 6 Ng 41)6 • 2. S
Po aT -i_.a, r ,Qb, i ,2. c" X237• ( Q %
Phone: (503) $S3 -• 2.S3S Fax: ( ) Minimum permit fee: $72.50 -+
CCB Lic.: `$ y'p 7 "A/917/3 Plumbing Lic. no.: 8 / 3 j� Plan review (25% of permit fee) -�
State surcharge (12% of permit fee) 2.4g • 5
Authorized signatu - TOTAL PERMIT FEE I A44 Pi
Print nam �
�� Date: 6/I I i 3 This permit application expires if a permit is not obtained within 180 days
a it h as b een accep es comp
'Fee methodology set by Tri - County Building Industry Service Board.
1:\ Building \Pennits\PLMU- PermitApp.doc 10 /01/09 440.4616T(10 /02/COM/WEB)
Plumbing Permit Application - City of Tigard
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
3,601 to 7,200 $233.20
Sewer - 1st 100' 62.54 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
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 Qty. Fee (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
(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 first $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 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
accurately report fixtures could result in increased sewer fees * . Plan Review for Plumbing Installations
. Quantity by Fixture Type Plan review is required for any•of the following.
Fixture Type for Replace/ Please check all that apply. • •
Work Performed: - , . , Capped Added Relocate .
Baptistry/Font ❑ Any new commercial building with water service 2" and
greater; except systems designed and stamped by licensed
Bath: - Tub /Shower
- Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive Thru as defined in OAR918- 780 -0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher Commercial ❑ Any multipurpose fire sprinkler system.
Domestic ❑ Any complex structure as defined in OAR918 -780 -0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: - 2"
3" Isometric or Riser Diagram ;
❑ Isometric,or•riser diagram is required for new buildings
-Car Wash Drain
Gaibage Domestic non -food that meet the qualifications above
Disposal: - Domestic food related
- Commercial food related
- Industrial food related
Ice Mach./Refrig. Drains Comments regarding fixture work:
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower: -Gang
-Stall • ..- ti
Sink: - Lav/Bar non -food related •
- Bradley •
' - Com/Serv/Util food related •
- Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer - Clothes fees assessed for the sewer increase must be paid before the
Water Extractor
• Water Closet Toilet plumbing permit can be issued.
Urinal _ •
Other Fixtures:
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