Permit CITY OF TIGARD PLUMBING PERMIT
11111111 COMMUNITY DEVELOPMENT Permit#: PLM2015 00234
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/22/2015
TIGARD Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9473 SW WASHINGTON SQUARE RD A08
Project: Sub Zero Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: CAP(1)sink and(1)2"floor drain;ADD(1)hand sink, (1)water heater and(1)expansion tank for new tenant.
Sewer EDU credits of.13 generated for this permit.
Contractor: WEST COAST CENTRAL PLUMBING LLC Owner: PPR WASHINGTON SQUARE LLC
12714 SE MAJESTIC LN PO BOX 847
HAPPY VALLEY, OR 97086 CARLSBAD, CA 92018
PHONE: 503-298-0435 PHONE:
FAX: 503-855-3264
FEES
Quantity Description Date Amount
1 ea Expansion Tank 07/22/2015 $12.51
Specifics: 2 ea Fixture/Sewer Cap 07/22/2015 $50.04
1 ea Sink 07/22/2015 $25.02
Type of Use: COM 1 ea Water Heater 07/22/2015 $37.52
Class of Work: ALT 1 12%State Surcharge- 07/22/2015 $15.01
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $140.10
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. Y u may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ^/(� 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 RECEIVED FOR OFFICE I SE ONLI
City of Tigard
Received
Elltil 13125 SW Hall Blvd.,Tigard,OR 97223 JUL 2 2 2015 Date Review �/� "� Permit N0.:�= ,�/5--_00�3 e
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 JUL Other Permit No.:
TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: kris: gl. See Page 2 for
Internet: www.tigard-or.gov BUILDING o1Vis o Notified/Method: _ Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction 0 Demolition For special information use checklist.
Descri rtion •p. Ea. Total
:' 'ddition/alteration/replacement ❑Other: New I-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ 1-and 2-family dwelling -a Commercial/industrial SFR(2)bath 437.78
building SFR(3)bath 500.32
❑Accesso ry g ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) _ _ Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:(� S1> I 1_1t-_,r�'\ t4;-tre Qd Catch basin or area drain 18.76
City/State/ZIP: �R `'�► Drywell,leach line,or trench drain 18.76
` ' � �,22 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: A 1 0 1 Project name: S.A. p 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: l Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
9 /� 1 Clothes washer 25.02
�v" ^ C.J \V.%dd kA Sl k- a Dishwasher 25.02
\n8tt Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER ( ❑ TENANT Expansion tank 12.51 lZ,,S j
Name:
Fixture/sewer caps)"i/ " a ,,,j 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
❑ APPLICANT let CONTACT PERSON Interceptor/grease trap 25.02
Business name: (r.J(S-R• Coe,:,t, CIL v yyJ PIA t"-L Medical gas(value:$ ) Page 2
Contact name: Primer 12.51
K l s tI�t"�t e/��?' Roof drain(commercial) 12.51
Address: an iti s i 4 , ' e t; lc, Sink/basin/lavatory 1 25.02 ZS,CT`
City/State/ZIP: KA kit...I n 0 ,)e(,, Solar units(potable water) 62.54
Phone:(y--n )`$ S O 3 S Fax: :( ) Tub/shower/shower pan 12.51
Urinal 25.02 X ,P t6l... t.-1 )(,4j � y y
CONTRACTOR Water closet 25.02
l Water heater 1 37.52 3'7.5 ,,
Business name:lie J}•Co f.i 1- Cava, P i to M\L.-i Water piping/DWV 56.29
Address: Z C& pl/I • O(#1C 1.-v` Other: 25.02
City/State/ZIP: 1,4`pp �,�,, - Subtotal ` S.(J:i
Phone: !v f 7 Fax: s) c• C1 5-- Minimum permit fee: $72.50
(y �) B )�i�' r��� Plan review (25%of permit fee)
CCB Lic.: I B'L I Q Q (0(36/,(, Plumbing Lic.no r-,' o
State surcharge(12%of permit fee)
Authorized signature: /11- TOTAL PERMIT FEE 2,.., ah
r / Date: This permit application expires if a permit is not obtained within 180 days
Print name:
�J/ 1.i Lle fit after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
i:l Building\Permits\PLMU-PermitApp.doc 10/01/09 44o-46i6Tp0/02/c0M/WEB) /'fO r /0
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-I"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
Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
Other Inspections or Fees __ _ 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*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/
Capped Added Relocate Plan review is required for any of the following.
Work Performed: Please check all that apply.
Baptistry/Font pp y'
Bath Tub/Shower ❑ Any new commercial building with water service 2"and
Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" 1 / Submit 2 sets of plans with any of the above.
3" . _ ,
4 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
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
'
Sink/Lav -Non-food related I ,/
-Bradley -
-Commercial-food related
. -Service I /
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes increase of sewer EDUs,a sewer permit will be issued and
Water Extractor P
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal _ plumbing permit can be issued.
Other Fixtures:
Macintosh HD:Users:WCCPlumbing:Downloads:PLMF_PermitApp.doc 2
Si Tenant Name: Sub Zero Accumulative Sewer Tally
SWR# N/A
Site Address: 9473 SW Washington Square Rd I'],Al# 2015-00234
Parcel#: IS 1260000300
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value 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 0
Car Wash: -Each Stall 6 0 0 0 0 0
-Drive through 16 0 0 0 0 0
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 1 0 0 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 1 2 0 -1 -2
-3 inch 5 0 0 0 0 0
-4 inch 6 0 O 0 0 0
-Car Wash 6 0 0 0 0 0
Garbage Disposal:
-Domestic(to 3/41 HP) 16 0 0 0 0 0
-Commercial(to 5 I IP) 32 0 0 0 0 0
-Industrial(over 5 I IP) 42 0 0 0 0 0
Ice Machine/Refrigerator Drain 1 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 (I
-Stall 2 0 0 0 0 0
Sink:
-Lav/Bar-Non-Food Related 2 0 1 2 1 2 0 0
-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 0 0 0 0
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 2 4 1 2 -1 -2
Current Fixture Value -2 divided by 16= -0.125 Current EDU 1 EDU= $5,100.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -2 divided by 16= -0.125 over (under) $ (663.00)
Enter EDU Change Here -0.130 *
*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: EDU CREDITS
Authorized Name/Signature: Dianna Howse Date: 7/22/2015
Building Division
ote: 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.
r
I:\Building\Sewer Tally\Sewer l'allySheet_51(N1_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
9473 SW WASHINGTON SQUARE RD A08,
TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2015-00234
George Heimos
Violation Summary:
Inspector Contractor