Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2015-00344
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718 2439 Date Issued: 10/13/2015
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9642 SW WASHINGTON SQUARE RD G12
Project: Loll;&Pop's Subdivision:VASHINGTON SQUARE ESTATES NO Lot: S
Project Description. Add plumbing fixtures for TI for new tenant (1)2"floor drain,(1)interceptor/grease trap,(3)non-food related
sinks,(1)food related sink and(1)water heater
Contractor: CASCADE PLUMBING CO Owner. PPR WASHINGTON SQUARE LLC
2416 N HAYDEN ISLAND DR PO BOX 847
PORTLAND, OR 97217 CARLSBAD, CA 92018
PHONE 503-289-7095 PHONE:
FAX 503-283-9514
FEES
Quantity Description Date Amount
1 ea Floor Drain/Floor Sink/Hub 10/13/2015 $25 02
Specifics: 4 ea Lavatories 10/13/2015 $100 08
1 ea Water Heater 10/13/2015 $37 52
Type of Use: COM 1 12%State Surcharge- 10/13/2015 $19.51
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp.
Stories.
Total $182 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 stions to UNC by calling 503 232 1987 or 1 800 332 2344
Issue By: / / - Permittee Signcture.
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.
4.
Plumbing Permit Application !I,
CFJVEP
Building Fixtures l 7 FOR OFFICE USE ONLY
City of Tigard 7 2015 Date/By. /0 O / /� ���f Permit NYO, /5_1 039vy
q 13125 SW Hall Blvd,Tigard,OR 97223
II = Plan Review
Phone: 503 718.2439 Fax. 503.598.1�9E1p ry o g g pg p'� Other Permit 1
t1.11Il,H of.
Illl��Y�1t Date/BY' SG�.�R�(,I�� DI�
Inspection Line: 503 639 4175 Date Ready/By. funs ® See Pa e 2 for
TIGARD g
Internet: www tigard-or gov Notified/Method /D-//f.°//5:6--)11b,, Supplemental Information
1 i TYPE OF::',W,ORK „'`:. ": - /.� FEE SCI:TEDULE 1
I=1 New construction ❑ Demolition For special information use checklist
Descnption Qty. I Ea. Total
® Addition/alteration/replacement ❑ Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
•'::417.''':::4, CATEGORY•,,OF;GONSTRUGTION ,; _,:.''.°:.ti`•:.. •S SFR(1)bath 312 70 kA
❑ 1-and 2-family dwelling ® Commercial/industrial SFR(2)bath 437 78 %
❑ Accessory building SFR(3)bath 500 32 p�
ry g ❑ Multi-family • !—/
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other:
Fire sprinkler( sq ft) Page 2
Vim" ,,,L,` E..,,: ,JOB SITE INFORMATION;AND.LOCATION Site utilities:
Job site address:9642 SE Washington Sq Rd Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR Drywell,leach line,or trench drain 18.76
Footing drain(no linear ft.•_) Page 2
Suite/bldg./apt.no.:G12 ( Project name:Lolli&Pop's 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: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31 27
• � <'I.. Backwater valve 12.51
r,�\,.. < R' `;5: DESCRIPTTON ,4\F°=WORK \c :� >
r;: �:. ,, :v:..: ... >: Clothes washer 25 02
plumbing rough in and install fixtures
. Dishwasher 25 02
Drinking fountain 25 02
Ejectors/sump 25 02
PROPERTY OWNER :TEN'ANT" Expansion tank 12 51
Name:
Fixture/sewer cap 25.02
Floor drain/floor sink/hub I 25 02 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12 51
'1'
s,. ❑ APPLICANT ,, ❑�''•CONTikCT 'PERSON `'" n s p 4•-d --t— 25.02 —_ ?
Business name:
A ''\ \ '' - Medical gas(value:$ ) Page 2
Primer 12 51
Contact name:
Roof drain(commercial) 12 51
Address: Sink/basin/lavatory 4 25 02 100 08
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax: :( ) Tub/shower/shower pan 12 51
E-mail: Urinal 25.02
px .• Water closet 25 02
'f
GONTRAC~TOR
Water heater 1 37 52 37 52
Business name:Cascade Plumbing Co Water piping/DWV 56 29
Address:15765 SW 74th Ave#110-A - Other 25 02 Q
City/State/ZIP:Tigard,OR 97224 Subtotal 187 64 'i(Qp.•
Phone:(503)289-7095 Fax:(503)283-9514 Minimum permit fee: $72 50
CCB Lic.:204392 Plumbing Lic.no.:PB1528 Plan review (25%of permit fee) —46 91'4
State surcharge(12%of permit fee) .22.4.1. 11.51
Authorized signature: TOTAL PERMIT FEE ".5r 14-
Print name:Crystal Jones Date: This permit application expires if a permit is not obtained within 180 days {
after it has be ccepted as complete. I QO
*Fee[methodology set by Tn-Cou ty Building Industry Service Board p�
I\Building\Penns\PLMU-PennApp doe 10/01/09 140-1616T(I0102/COM/WEB) / p.. - �p/r3/i(
.
i41;-"J'''`A' l/ 111
J' Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities
Qty. Fee(ea) Total '.:Square Footage: Pern4)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 $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 _,
Storm&Rain Drain-1st 100' 62 54 :valuation: Permit Fee: ,;_
5 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 S10,001.00 to$25,000 00 S148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional S100 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
Remnspection 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/ Plan review is required for any of the following.
Work Performed: Capped Added Relocate 9 y g'
Baptistry/Font 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 -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" _ I Submit 2 sets of plans with any of the above.
Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage -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 _ /B AF//-�
Shower -Gang /✓0 ■-006 P#2-EP -f/N/4' /'EL
Stall • -x�
Smk/Lav -Non-food related /ZeG ge-row._ C 0���e.,7z) ' 0194r---
-Bradley
-Commercial-food related )K- (
-Service
Swimming Pool Filter
Washer-Clothes *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
C:\Users\Cascade Main\Desktop\permit applications\tigard pennit.doc 2
FOR OFFICE USE ONLY— SITE ADDRESS:
This form is recognized by most building departments in the Tri-County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
:,.14.,. ..4
,: .. .. . Transmittal Letter
:ti,d,A LJ 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: C H1 P 0 r D60-) DATE '
DEPT: BUILDING DIVISION r., l 1
,p/v/)4614,r vS��� (S
OCT 8 2015
FROM: ,
Z-011 Pe7
CITY OV fiGA LO
COMPANY: .. (� 'c tom(( 0_,On�+r06/l.,)i BUILDING DIVISION
PHONE: 56 , ,(% 1 CC) (-7l S By._
RE: OL) 't S ( te)/t/ s7 'I ( "L_A/,72 ors'-,00g
(Site Address) (Permit 1 umber)
/
L. LL/ ‘ ed f' s
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
;:;,Copies: . Description: -,,: Copies: Description:
Additional set(s) of plans. Revisions:
Cross section(s) and details. Wall bracing and/or lateral analysis.
Floor/roof framing. Basement and retaining walls.
Beam calculations. Engineer's calculations.
Other(explain): n J
REMARKS: ( 1 �'�� /v O �D ate/ r( C T P
ce /,0Z-t,l c,ii..) Poes i
co' 1�vvci
_
S rgt 5 c,01 1 (ve i /t} ro r si--1)Pfl,%)y e=1,v(41)' Di_spice/
��` „ il; FOitOFFICE USE ONLY44 g ,
Routed to Permit Technician: Date: Initials:
Fees Due: ❑ Yes ❑ No Fee Descrip ion: , - ) Amount Due:
et , ;:,, t:maw u,: ;.= BA' $
0
Special
Instructions: rt
Reprint Permit (per PE): ❑ Yes ❑ No ❑ Done
Applicant Notified: Date: Initials:
I.\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012
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
9642 SW WASHINGTON SQUARE RD G12,
TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
November 10, 2015 at 8:41:02
AM
PLM2015-00344
Don Sylvester
1. Corrections are complete, plumb. Final -ok
Violation Summary:
Inspector Contractor