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Permit N � CITY OF TIGARD PLUMBING PERMIT . = COMMUNITY DEVELOPMENT Permit#: PLM2014-00345 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/22/2014 T1G;ARD! g Parcel: 1S1260000300 Jurisdiction: Tigard Site address: 9487 SW WASHINGTON SQUARE RD A05 Project: Auntie Anne's Pretzels Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S Project Description: Add(1)sink. Reconnect(1)floor drain and(1)sink. Contractor: MODERN PLUMBING Owner: PPR WASHINGTON SQUARE LLC 11120 SW INDUSTRIAL WAY PO BOX 847 TUALATIN, OR 97062 CARLSBAD, CA 92018 PHONE: 503-691-6166 PHONE: FAX: 503-691-6771 FEES Quantity Description Date Amount 1 ea Floor Drain/Floor Sink/Hub 10/21/2014 $25.02 Specifics:, 1 ea Interceptor/Grease Trap 10/21/2014 $25.02 2 ea Sink 10/21/2014 $50.04 Type of Use: COM 1 12%State Surcharge- 10/21/2014 $12.01 Class of Work: ALT Plumbing Type of Const: 56 Cash Over 10/21/2014 $56.04 Occupancy Grp: Stories: Total $168.13 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 ions •UNC by calling 503.232.1987 or 1.800.332.2344. Issu d By: , LIwtiLL4/ Permittee Signatu 111111V_ �i ✓/ l AGCY C� 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. Plumbin Permit A licati Building Fixtures EivED FOR OFFICE USE ONLY Ilit City of Tigard q Received /0 GV//f7/ .,O Permit No.:Pa-i% ' iO 16 v 13]25 SW Hall Sh d.,Tigard,OR 972 C T t 2 Q 2014 Plan Review Phone: 503.718.2439 Fax: 503.593.1960 Date/By: Other Permit No. 2,20/4f-LAO 1/.2. TI CARD Inspection Line: 503.639.4175 ITV OF WARD. Date Ready/By: luris El See Page for Internet: www.tiprd-or.gov CITY Nodfied/ivtethod: Supplemental Information '•TYPE OF:W4.'v• U14' /rinr _ FEE* SCHEDULE ❑New construction , ❑Dethotition For special information use checklist 1° Description 1 Qty. I ' Ea I Total XAdditionialteration/replacement El Other: New 1-2-family dwellings(includes 100 it.for each utility connection) . CATEGORY OF CONSTRUCTION • ' SFR(I)bath 312.70 I=1 1-and 2-family dwelling 14,Commerciallindustrial SFR(2)bait 437-78 n El Accessory building El Multi-family at L (3)bath 500.32 f Each additional bath7:itchen • 25.02 4 ❑Master builder El Other: Fire sprinkler sq.ft) Page 2 Q• . •• ••. JOB•.SITE 'INFORMATION AND..LOCATION• Site utilities: . Job site address: �j � Catch baSiSl or area drain I8.76 '`1 J ��t Drywell,leach line,or trench drain 18.76 City/State/ZIP: -r1 9 C, re( i Foo ting dram'. (no.linear ft: J Page 2 Suitc/bldgJapL no.:A-()S f Project name: l n-' � �.eJ M� •actuf ed home utilities ! 50.03 Cross street/directions to job site: ! Manholes I • 18.76 Rain drain'connector 18.76 • Sanitary seiner(no.linear ft.:J Page 2 - Storm sewer(no.linear ft.: ) Page 2 . Water service(no.linear ft.: ) Page 2 Subdivision: �q Lot no.: Fixture orilitem: ! Tax map/parcel no.: /.5/o�(odD 300 Backflow preventer 31.27 DESCRIPTION OF WORK Backwaterlvalve 12.51 _ } Clothes washer 25.02 I-P ICI C (L'�' 1 rv-N. p t�-e-t��t- Dishwasher 25.02 1 Drinking fountain 25.02 0 Ejectors/su kp 25.02 G se, ' ❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.5] �/, Fixture/se4er cap 25.02 h Name: Floor draid/floor sink/hub ( I 25.02 .5ca of -ire Address. Garbage disposal 25.02 City/State/ZIP: • Hose bib I 25.02 Phone:( ) Fax:( ) fee maker I 12.51 t;`Y CI C APPLICANT ❑ CONTACT PERSON Interceptor grcasc trap I 25.02 •U L.- T' Business name: Medical gds(value:$ ) Page 2 ---- -•-- Primer I 12.51 el! Contact name: . , Roof drain�(commercial) 12.51 9� Address: Sink/basinaavatory 0 25.02 -7s..8 to- City/StateiZIP: Solar tmitsf potable water) 62.54 Phone:( ) Fax::( ) Tub!showe'l I/shower pan 12.51 E-mail: Urinal 25.02 • Water closgt 25.02 CONTRACTOR Water healer 37.52 Business name: 140 decd J tz Ito i �I U--)(3-41._/ 2 Water pipiQg/DW V 56.29 • i Address:I j 1 W S I n ce-U51- mil ZzJ c-�3 Other. I 25.02 I O. City/State/ZIP:j u a.l GI-1-1 f\� O�L 1 7 V le pIp Subtotal 11 S7i 1aTl'�W V(r))(O c ( (l I. (5 (O 9/ (o�7-Zj 11 Minimum permit fee: b72.50 t +�' ii Phone: Fax: ) , 'CB Lie.: S-1 4 b Pl bing Lie.no.: 3v-__z_ j _ _. Plan review (25%of perm t fee) I {! f + State surcharge(12%of permit fee) ( f 0;4' Ot Authorized signature: �--- I TOTAL PERMIT FEE :�>�S.i 3j Iv !! f 1 This permit application ezpira if a permit is not obtained within 180 days Print name: �� Date: (() l r Idl9Y,"/ Cf. after it has been accepted as complete. Fee •hodolopy setby'fri-County Building Industry Service Board. Ifauitdinrg1Pcrmirs\PLTlU-PermitApp.doa 70r01i09 440-4515r(IWe?'COWWaE) `/- } I j��e) not, Z'd 6Z1769LL£09 ONIBWITId N21300W etZ:LO I6 OZ PO I Plumbing Permit Application - City of Tigard ! , Page 2 -Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities . Qty. Fee(ea) Total Sivare.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 j $233.20 Sewer-1st 100' 62.54 7201 and greater 1 $327.54 Sewer-each additional 100' 3752 ! Water Service-1st 100' 62.54 Medical Gas Systems: Water Service-each additional 100' 37.52 1 Valuation: j Permit Fee: Storm& Rain Drain-l st 100' 62.54 _ $1.00 to$5,000.00 i Minimum fee$72.50 Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to 510,00 .00 $72.50 for the first$5,000.00 and$1.52 for Other Inspections or Fees • Qty. Fee(ca) Total each additional 5100.00 or fraction thereof,to h and including$10,000.00. Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$1 Q000.00 and$1.54 for ' which no fee is specifically indicated 90.00/hr each additional 5100.00 or fraction thereof,to (minimum charge-1/2 hour) and including$25,000.00_ I Inspections outside of normal business 90.00/hr $25,001.00 to$50,010.00 5379.50 for the first$25,000.00 and$1.45 for hours(minimum charge-2 hours) each additional 5)00.00 or fraction thereof,to Reiinspection Fees 90.00/hr and including$50,000.00. . Additional plan review for revisions 90.00/hr $50,001.00 and up 5742.00 for the first$50,000.00 and$1.20 for (minimum charge-1/2 hour) each additional 5)00.00 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''. i Quantity by Fixture Type: Plan Review for Plumbing Installations Fixture Type for Replace/ Work Performed Capped added Retocate Plan review is required for any of the following. Please check all that apply. Baptistry/Font Bath -Tub/Shower ❑ Any new cop mmercial building with water service 2"and Jacuzzi/Whirtpool j greater,except systems designed and stamped by licensed Car Wash -Each Stall engineer. I -Drive Thru ❑ New exteri fr plumbing site utilities for any complex structure I Cuspidor/Water Aspirator as defined is OAR918-78.0-0040. Dishwasher -Commercial ❑ Medical gaA and vacuum systems for health care facilities. -Domestic ❑ Any multipurpose fire sprinkler system. Drinking Fountain ❑ Any complex structure as defined in OAR918-7804040. Eye Wash I Floor Drain/sink -2- i Submit 2 sets of plans with any of the above. a 1 Isometric or Riser Diagram Car Wash Drain Garbage Domestic-non-food ❑ Isometric or riser diagram is required for new;buildings Disposal -Domestic-food related that meet the qualifications above. -Commercial-food related I I. j i -Industrial-food related Ice Mach_/Refrig.Drains I I Oil Separator(Gas Station) Comments regarding fixture work: i Rec.Vehicle Dump Station _ I II Shower -Gang "� r _ / Mr., 'J , -Stall `J 1 'I 4 Sink(Lav -Non-food related I j h4-f�'A /. \_n- -Bradley / d W.423.12.A.Q.A✓1 II ` 9/r1 lam. J -Commercial-food related !j J -Service • r .Swimming Pool Filter *Note: If the fixture work under this permit results in an Washer-Clothes n I Water Extractor increase of sewer EDUs,a sewer permit will be issued and Water Closet-Toilet fees assessed for the sewer increase must be paid before the Urinal - plumbing perm can be issued. Other Fixtures: C.',Userstdeborah\Downloads\PLMF PermitApp(1).doc 2 i. £'d 6Zb69LL£09 JN181Aflld N?J30O1/11 etiZ:LO 17 6 OZ PO Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 9487 SW WASHINGTON SQUARE RD A05, TIGARD, OR, 97223 Commercial - Plumbing 399 Plumbing ﬁnal Scheduled PLM2014-00345 George Heimos Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 9487 SW WASHINGTON SQUARE RD A05, TIGARD, OR, 97223 Commercial - Plumbing 399 Plumbing ﬁnal FAIL PLM2014-00345 George Heimos 1. Correction dated 10/30/14 not completed. Add to existing permit 3-ea ﬁxtures. 2. Re-inspection required, no inspection made, recall. Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 9487 SW WASHINGTON SQUARE RD A05, TIGARD, OR, 97223 Commercial - Plumbing 399 Plumbing ﬁnal PASS - No C of O PLM2014-00345 George Heimos Violation Summary: Inspector Contractor 1 PifCity of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT r~ Request for Permit Action TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits @tigard-or.gov FROM: ❑ Owner ❑ Applicant ❑ Contractor IQ City Staff Check(1)one REFUND OR Name: INVOICE TO: (Business or Individual) O`.AL,3 A � etc) Mailing Address: //Ma c6.4.3 £u City/State/Zip: �u Q_� L;,�� e. ?76(0 2- Phone No.: `j03-(y 9/-i.010(o PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): ❑ _ OID PERMIT APPLICATION. dREFUND ' RMIT FEES (attach copy of original receipt and provide explanation below). • ►' + E FOR FEES DUE (attach case fee schedule and provide explanation below). REMOVE/REPLACE CONTRACTOR ON PERMIT (d o not cancel permit). `3 Permit#: PLM &O /Y -OO ' /f 5f Site Address or Parcel#: 9`./$7 �e� l tier-a-4� .� �v� teLAIL. . Project Name: Ot tt--rk" tj j et/Wk./410 A-sjZ Subdivision Name: Lot#: EXPLANATION: 2.0-vite7A....eiT-2- ,1 • • . e-��i e_ ' ,d24_ Signature: L.ee[�ieyj c.ai Date: /4/0-1■0 Print Name: i > h/f �Qa g�-/5,(,•� Refund Policy 1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of • Any fee which was erroneously paid or collected. • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 80%of the application or permit fee for issued permits prior to any inspection requests. 2. All refunds will be returned to the original payer in the form of a check via US postal service. 3. Please allow 3-4 weeks for processing refund requests. 1 OR OFFICE USE ONI to S s Admin: Date /0LanallEMEM Route to Records: Date /Q�7�� B u J•J Refund Processed: Date/i A�, B, ,.;d• Invoice Processed: Date B Permit Canceled: Date k'• B' 4 "121 Parcel Tat Added: Date B I:\Building\Forms\RcyPermitAction_092314.doc — TIGARD City of Tigard October 30, 2014 Modern Plumbing 11120 SW Industrial Way Tualatin, OR 97062 Re: Permit No. PLM2014-00345 Dear Applicant: The City of Tigard has processed a refund for overpayment of permit fees on the above referenced permit for the following: Site Address: 9487 SW Washington Square Rd Project Name: Auntie Anne's Pretzels Job No.: N/A Refund: ® Check#215411 in the amount of$56.04. ❑ Credit card"return" receipt in the amount of$ ❑ Trust account"deposit" receipt in the amount of$ Notes: Change in scope of work resulted in overpayment of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, ear Dianna Howse Building Division Services Coordinator Enc. I:\Building\RefunciN n5)g i ,avg4-igattelAi gon 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard-or.gov City of Tigard TIGARD Accela Refund Request This form is used for refund requests of land use, development engineering and building permit application fees. Receipts, documentation and the Request for Permit Action form (if applicable) must be attached to this request form. Refund requests are due to Accela System Administrator by each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts Payable will route refund checks to Accela System Administrator for distribution to applicant. PAYABLE TO: Modem Plumbing DATE: 10/23/2014 11120 SW Industrial Way Tualatin, OR 97062 REQUESTED BY: Dianna Howse DA TRANSACTION INFORMATION: Receipt#: 198078 Case#: PLM2014-00345 Date: 10/21/2014 Address/Parcel: 9487 SW Washington Sq Rd Pay Method: CreditCard Project Name: Auntie Anne's Pretzels EXPLANATION: Scope of work change resulted in overpayment of fees. Refund difference. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 2300000-43104 $Amount Cash over 100-0000-48001 $56.04 TOTAL REFUND: $56.04 APPROVALS: SIGNATURES/DATE: If under$5,000 Professional Staff If under$12,500 Division Manager If under$25,500 Department Manager If under$50,000 City Manager If over$50,000 Local Contract Review Board FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY Case Refund Processed: Date: /V3e//1 I By: I:\Building\Refunds\RefundRequest.doc x 09/01/20W