Permit 11111 n
CITY OF TIGARD PLUMBING PERMIT
' , COMMUNITY DEVELOPMENT Permit#: PLM2015 00273
Tigard OR 97223 503.718.2439
13125 SW Hall Blvd.,Ti Date Issued: 08/19/2015
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Parcel: 1 S1356A00102
Jurisdiction: Tigard
Site address: 10108 SW WASHINGTON SQUARE RD
Project: Cost Plus Subdivision: OAKBURG Lot: 9
Project Description: Relocating(1)drinking fountain and replace(1)toilet with ADA toilet.
Contractor: MCLANE PLUMBING INC Owner: PPR SQUARE TOO LLC
7675 HIGHBANKS RD#3 PO BOX 847
CENTRAL POINT,OR 97502 CARLSBAD,CA 92018
PHONE: 541-664-1880 PHONE:
FAX: 541-664-4216
FEES
Quantity Description Date Amount
1 ea Drinking Fountain 08/19/2015 $25.02
Specifics: 1 ea Water Closet 08/19/2015 $25.02
1 12%State Surcharge- 08/19/2015 $8.70
Type of Use: COM Plumbing
Class of Work: ALT 22 ea Minimum Fee Adjustment- 08/19/2015 $22.46
Type of Const: Plumbing
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 952-001-0090. You may obtain a copy of the rules
or direct• - ions to •• C by g 503.232.1987 or 1.800.332.2344.
Issu.d By: / Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available in pection date.
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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 liECEIVEP
Received ç// / c f City of Tigard Permit No.: LNPOIJ 260 x73
DateBy;
34
.. 13125 SW Hall Blvd.,Tigard,O R Pe30 9 2015 Plan Review
Phone: 503.718.2439 Fax: 503. 96'p Date/By: Other Permit No.:
T I G A R D Inspection Line: 503.639.4175+ ,p I u Date Ready/By: kris. 0 See Page 2 for
Internet: www.tigard-or.gov l,l TY of I I(,A1( ) Notified/Method: Sup.lemental Information
❑New construction ❑Demolition For special information use checklist
Description I Qty. 1 Ea. I Total
Addition/alteraion/replacement ❑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 IgCommercial/industrial SFR(2)bath 437.78
❑Accessory building SFR(3)bath 500.32
g ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( ,sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION jillir Site utilities:
Job site address: Catch basin or area drain 18.76
101 o c 3 s‘,.1 '.h/ct s h. 9 to r s1 Drywell,leach line,or trench drain 18.76
City/State/ZIP: r, L 6/C. H3LZ
9 a Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: NIA I Project name: 6.00 Pit,4 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 ,11111 Backwater valve 12.51
Clothes washer 25.02
I,-e)oc(4.11 e4(tS4V (iv.r%ic. , Feir4. , Io..nre-,n
5 5 � ) S Dishwasher 25.02
e41c-1017 v-d-c- cl.Set Co,- ,t QA cco-v,p\/n ee 10- Drinking fountain / 25.02
M evi r e(.4 vvo.1-. Ejectors/sump 25.02
E PROPERTY OWNER I ❑ TENANT i Expansion tank 12.51
Name: pi,g S 9 0,11"e To, i•,t-C Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: po B . S 41
Garbage disposal 25.02
City/State/ZIP: GA r It b,e/, CA cl 101 l Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
MIE ' APPLICANT MIIIIL _❑ CONTACT PERSON ,111. Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name: cc I C o-,S-►r,.c l t a
Primer 12.51
Contact name: j A(■, Sp rN, c
`J Roof drain(commercial) 12.51
Address: 1 j 121 N ri,..e..s .)d c ?k-.--j. C v. -, A Sink/basin/lavatory 25.02
City/State/ZIP: Po 41,01 d , 0 it- c "12 3 o Solar units(potable water) 62.54
Phone:(641 ) q De- 2.-;I s Fax::( ) Tub/shower/shower pan 12.51
E-mail: j...(a' . Cr(A-5el-aJr►lac.co-v% Urinal 25.02
t Water closet i 25.02
. CONTRACT')
- Water heater 37.52
Business name: A4 c L u,e PI L.w,6/'1..9 Water piping/DWV 56.29
Address: 1-.6 15 14 ;9 h B n h k i (la• A 3 Other: 25.02
City/State/ZIP: C e v,l,•.1 1 pc,,} , b a y`So Z Subtotal
S13 Minimum permit fee: $72.50 /?
Phone:(541 ) 145- 4400 Fax:( )
CCB Lic.: q0 3 3'L 64/7 Plumbing Lic.no.: 1G-14& p g Plan review (25%of permit fee)
State surcharge(12%of permit fee) �, 7 O
Authorized signature: ) 4
TOTAL PERMIT FEE �l . r�
Print name: j S�., ( i Date: This permit application expires if a permit is not obtained within 180 days
S °, 1 I 9 Z 1 S after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\BuildingWermiMPLMU-PaartApp.doc 10/01/09 44O.4616T(IWO2/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-151 100' 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 S stems:
Water Service-each additional 100' 37.52
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
each additional$100.00 or fraction thereof,to
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*.
I ; I
>ttt Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
ptistryil unt ❑ Any new commercial building with water service 2"and
Ba -Tub/Shower greater,except systems designed and stamped by licensed
Bath:pti
engineer.
-Jacuzzi/Whirlpool
Car Each Stall ❑ New exterior plumbing site utilities for any complex structure
-Drive tall 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 mer ❑ 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 is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the I ualifications 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
Sink: -LavBar 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 plumbing permit can be issued.
Water Closet-Toilet / p g p
Urinal
Other Fixtures:
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