Permit CITY OF TIGARD PLUMBING PERMIT
''111 • • COMMUNITY DEVELOPMENT Permit#: PLM2015-00343
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/07/2015
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9618 SW WASHINGTON SQUARE RD G05
Project: Helzberg Diamonds Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Add(1)non-food related sink.
Contractor: RAYBORN'S PLUMBING INC Owner: PPR WASHINGTON SQUARE LLC
PO BOX 69 PO BOX 847
19990 SW CIPOLE RD CARLSBAD, CA 92018
TUALATIN, OR 97062
PHONE: 503-692-4139 PHONE:
FAX: 503-691-2328
FEES
Quantity Description Date Amount
1 ea Sink 10/07/2015 $25.02
Specifics: 1 12%State Surcharge- 10/07/2015 $8.70
Plumbing
Type of Use COM 47 ea Minimum Fee Adjustment- 10/07/2015 $47.48
Plumbing
Class of Work: ALT
Type of Const:
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 questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 07-/Z___ 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 Applicati CEl IV D
Building Fixtures +y FOR OFFICE USE ONLY
City of Tigard OCT / 2��5 Received / /0 �� ����U(�J
q
MI I 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: �0 7 Permit No
Plan Review
Phone: 503.718.2439 Fax: 503 c p�6Q�i, ` �,G Date/By: Other Permit tSidea'���
Inspection Line: 503.639.4175 �jl 1 "l 111UAIW �D ��
TIGARD Internet: www.tigard-or.gov BUILDING DIVISION Date fiRd/ : luris See Page 2 for
Notified/Method: Supplemental upplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction El Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement ❑Other: New I-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
El I-and 2-family dwelling El Commercial/industrial SFR(2)bath 437.78 1\
ID Accessory building El Multi-family SFR(3)bath 500.32 V\
Each additional bath/kitchen 25.02
❑ Master builder 111 Other: Fire sprinkler( sq.ft.) Page 2
f6/K JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: k A 5 ! �-j-V� sa J rL� Catch basin or area drain 18.76
City/State/Z1 P:
/`� l�-� Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: i Project name: pp_I--12- y Z.• Manufactured home utilities 50.03
Cross street/directions to job site: D i 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: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
A S ` Ki g � (g 1 Clothes washer 25.02
/r{- f°- r�� Dishwasher 25.02
�U4-44- -- i Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Address:
Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Contact name:
Primer 12.51
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 1 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax: :( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
CONTRACTOR
Water closet 25.02
� ! Water heater 37.52
Business name: .,�wVS e'L4)644 I 1i
! v t"'+ t-�.l�- Water piping/DWV 56.29
Address: (' //y ‘,7 Other: 25.02
City/State/ZIP:-77(ei f��/ OX. .'7D 6�� Subtotal
Phone:( ) "'ff Fax:( ) Minimum permit fee: $72.50 `lZ S�
CCB Lic.: e7'�s _ g Plan review (25%of permit fee)
Plumbin Lic.no.:
State surcharge(12%of permit fee) g 7 0
Authorized signature: TOTAL PERMIT FEE $/
Print name:t- %. C. \T S Dti Date:a. 7 n/ S This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
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1.\Btu lding\Permits\PLMU-Permit App.dot 10/01/09 440-4616T(10/02/COM/WEB)
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