Permit CITY OF TIGARD PLUMBING PERMIT
' ' • COMMUNITY DEVELOPMENT Permit#: PLM2015-00235
T tc,ARE) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/23/2015
Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9422 SW WASHINGTON SQUARE RD K06
Project: The Duck Store Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Capping(1)drinking fountain,(1)2"floor drain,(1)lay and(1)water closet.
Contractor: POWER PLUMBING CO Owner: PPR WASHINGTON SQUARE LLC
PO BOX 19418 PO BOX 847
PORTLAND, OR 97280 CARLSBAD, CA 92018
PHONE: 503-244-1900
PHONE:
FAX: 503-244-8825
FEES
Quantity Description Date Amount
1 ea Drinking Fountain 07/23/2015 $25.02
Specifics: 1 ea Floor Drain/Floor Sink/Hub 07/23/2015 $25.02
1 ea Lavatories 07/23/2015 $25.02
Type of Use: COM 1 ea Water Closet 07/23/2015 $25.02
Class of Work: ALT 1 12%State Surcharge- 07/23/2015 $12.01
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $112.09
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 dire uestions OUNC by calling 503.232.1987 or 1.800.332.2344.
Issu d By: C Permittee Signature:
57/i V1 c11 _i
Call 503.639.4175 by 7:00 a.m.for the next available ins••ction 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.
JUL-21-2015 15:35 From: To:5035981960 Page:1'3
Plumbing Permit Application
Building Fixtures RE(_ h VE® I(),, Ofl,CL us,,, 0\,.1•
City Of Tigard 1 2015 Received ! � Purina Nn.: -q,r1 c T 5�601 3
111' DatG/By: 3 �5 ►'��
• 13125 SW Hall Blvd,'Tigard,aW 172 Plan Review
Phone. 503.7182439 Fax: 503598.1 Davy; Ou>er Permit No.: -Dx/5Le/ a,
Inspection Line: 503.639.,( OF l r a D Date Ready/By. AIM: la See Page 2 for
TIG:1RU n S!
Internet: www.tigard-a�.gQyilPEN..-; D{VIv,,;��� Naificd/Mctma: Supplemental Information
",;. t.'TYPE OF *ORB:`' '' '' '• .' . ' FEE't,SCnEDULE .
❑New construction ❑Demolition For special Information use checklist
Desch 'on ! Qty. I Ea. I Total
XAddition/alterationlreplacement ❑Other: New 1-2-family dwellings(includes 1001t.for each utility connection)
C;Ax* Ok'tr'OP CONS1 Ruc1IoN '." ,�'. , SFR(1)bath 312.70
0 1-and 2-family dwelling . CommercialTindustrial SFR(z)bath 437.7R
SFR(3)bath 50032
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25-02
❑Master builder ❑Other: Fire sprinkler(__sq.ft.) Page 2
y ;. •.19B;•SITE`INFORMA,TION AND,LOCATION , • ',i Site utilities:
Job site address: is.� • • /, / n� , F , , -�tch basin or arcs drain 1 R.76
s ywell,leach line,or trench drain 1 8.76
City/Statc/ZIP: -Ti d n fL G]7 2 2 3
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.:,KO tp UI Project name: 7),,u, Da C& 5h)Y..1 Manufadured home utilities _ 50.03
Cross strcct/dircctions to job site: Manholes 1836
Rain drain connector _ 18.76
Sanitary sewer(no.linear tt.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no,linear ft.: Page 2
Subdivision: �" ' Lot no.: Fixture or item:
e C.'
Tax map/parcel no.: l d/ UOcV 3O0 Backflow preventer 31.27
' `- . l)kSCRI(>?2"ION:'O VVO)It1C Backwater valve 1231
��-Qn L t _Clothes washer 25.02
! II / �J (y xT�1,C.ta Dishwasher 25.02
. . .4112//- . / 4 ', • '� - I - IleA , 1, Drinking fountain t 25.02 _25,6 Z
!J Ejectors/sump 25.02
>. 0 Expansion tank 12.51
,,, ) ,r 'P.ROPERTY'OWNER: ' ' " TENANT
Fixture/sewer cap 25.02
Name:
Floor drain/floor sink/hub + 25.02 �S.0
Address:
Cmrbagc disposal
25.02
City/State/ZIP: Hush bib 25.02
Phone:( ) Fax:( ) Ice maker 12 51
,F t❑'APP.LICA T , 1„ 0;00.4,;1 PERSON, ,:., ; Intercepux/gease trap 25-02
Business name: TO sA/t� p/tw'i &' (o Medical gas(value:$ ) Page 2
1' kJ Primer 12-51
Contact name: Roof drain(commercial)
12.51
Address: �� �D�/ /g�/� Sink/basin/lavatory ` 25.02 2S,0 Z
City/State/ZIP: /Q i .a,/„/, ek 9'7�Pe Solar units(potable water) 6254
Phone:(03) e7 tit/.�9ad Fax::( L)/) y y_ � •11lbshower/shower pan 12.51
E-mail: SP ry i c.P&Po�.u.L90/a ,b/v/ r'd, teifn
Urinal 25.02
Water closet 25.02 ,i5-77
CONTRACTOR
1 _ water heater 3732
V) Business name: //j---)w/fir P/�y�.p hy�_ 4 ie' • _/ Water piping/DWV 56.29
Address: L'L.F' // ,S,YIJ Mk///77AYH! .&-: - igiVe2C, Othcr 25"02
R City/State/ZIP: OD 1/9--6144./t 01,,, 44 972 n2�3 oG Subtotal c�
Phone:(5T3) till-/9D4 Fax (st3)a 'T 6/-S o 2 1 inimum permit fee; $7230 Ay), `'a
CCB Lic-: SZ3 78 Plumbing Lic.no.: 31,1_1 )P 3 Plan review (25%of permit fee)
State surcharge(12%of permit fee) /a•/-
Authorized signature: `� a_ Q.t?O S TOTAL PERMIT FEE /fi ` /
Print name: i Date: 11 wit application expires if a permit is not obtained within/t19,07
iSO days
���.{/^�. p(�S 7/�//�� urler it has been acevptsd as wmplete-
•Fee methodology at by Tri-Cnunty Building Indumty Service Board.
IABui41ry"1PamitaLMU-PanwA09.6oc I(W1A9 410-4616T(1WU71COM/WEB)
JUL-21-2015 15:35 From: To:5035921960 Pane:2'3
Plumbing Permit Application - City of Tigard
Page 2-Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities ; . : ' (1), T°t*! Square Footage: Permit:'ee:`
Footing drain-1'100• 50.03 0 to 2,000 $121,90
2,001 to 3,6(0 $169.69
Footing drain-each additional 100' 37.52
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 1(x)' 62.54 Medical Gas Systems:
water Service-each additional 100' 37.52 "
Storm Rain Drain-1st 100' 62.54 Valuation:. . •Permit Fee:
$1.00 to$5,000.00 Minimum ice$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10.000.00 $72.50 for the fast$5,000.00 and$1.52 for —
" Qty. Pee(ea) each additional$100.00 or fraction thereof,to
.;Otlller Insfiect
tons'Or'Fees': . . 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 fcc 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 525,001.00 to$50,000.00 $379,50 for the first$25,000.00 and$1.45 fur
hours(minimum change-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fens 90.0(1/hr and including$50,000.00.
Additional plan review for revisions 90.0(1/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$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*.
Quantl y by Fbaure Type Plan Review.for•PlumbingInstaltations
Fixture Type for Replace/ Plan review is required for any of the following-
Work Performed: r .capped Ads . Relocate
Baptistry/Ftnt
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 -Bach Stall engineer.
-Drive Thor ' ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-7/30-(1(140.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain 1 ❑ Any complex structure as defined in OAR91S-780-0040.
Eye Wash
Floor Drain/sink -2" j Submit 2 sets of plans with any of the above.
-3"
-4.. Isometric or Riser Diagram
Car
Wash Drain ❑ Isometric or riser diagram is required for new buildings-Domestic-non-food
Disposal -Domestic-food 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/tav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter
�
, � C1othGS *Note: If the fixture work under this permit results in an
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 permit can be issued.
Other Fixtures:
httpJ/www.tigard-or.gov/document_cent er/Building/PLMF_PermilApp.di
gi Accumulative Sewer Tally
Tenant Name:The Duck Store SWR# N/A
Site Address: 9422 SW Washington Square Rd PLM# 2015-00235
Parcel#: 1 S1260000300
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# .1lue count capped#s value count added# added value total#s total values
Baptisery/Font 4 0 0 0 0 0
Bath: -Tub/Shower 4 0 0 0 0 0
-Jacuzzi/Whirlpool 4 0 0 0 0 II
Car Wash: -Each Stall 6 0 0 0 0 0
-Drive through 16 0 0 0 0 Il
Cuspidor/Water Aspirator 1 0 0 0 0 0
Dishwasher: -Commercial 4 0 0 0 0 0
-Domestic 2 0 0 0 0 0
Drinking Fountain I 0 I 1 0 -1 -1
Eye Wash 1 n 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 1 2 0 -1 -2
-3inch ss 0 0 0 0 0
-4 inch 6 0 0 0 0 0
-Car Wash 6 u 0 0 0 0
Garbage Disposal:
-Domestic(to 3/4 HP) 16 0 0 0 0 0
-Commercial(to 5 HP) 32 0 0 0 0 0
-Industrial(over 5 HP) 42 0 0 0 0 0
Ice Machine/Refrigerator Drain I 0 0 0 0 0
Living Unit 16 0 0 0 0 0
Oil Sep(Gas Station) 6 0 0 0 0 0
Rec.Vehicle Dump station 16 0 0 0 0 0
Shower: -Gang(per head) 1 0 0 0 0 0
-Stall 2 0 0 0 0 0
Sink:
-Lav/Bar-Non-Food Related 2 0 1 2 0 -1 -2
-Bradley 5 0 0 0 0 0
-Com/Serv/Util-Food Related 3 0 0 0 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer-Clothes 6 0 1 6 0 -1 -6
Water Extractor 6 0 0 0 0 0
Water Closet-Toilet 6 0 0 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit^ 0
TOTALS 0 0 4 11 _ 0 _ 0 -4 -11
Current Fixture Value -I1 divided by 16= -0.688 Current EDU 1 EDU= $5,100.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -11 divided by 16= -0.688 over (under) $ (3,519.00)
Enter EDU Change Here -0.690 *
*Round EDUs to the nearest 1/100th: a count ending in.005 shall be rounded up to.01,and a count ending in.014 or less shall be rounded down to.01.
Notes: ***CREDITS***
Authorized Name/Signature: Debbie Adamski Date: 7/23/2015
Building Division
Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist,this document will serve as a voucher which must be
submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
I:\Building\Sewer Tally\Sewer rallyShcet_5101)_070115.xlsx
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
9422 SW WASHINGTON SQUARE RD K06,
TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2015-00235
George Heimos
Violation Summary:
Inspector Contractor