Permit (108) n CITY OF TIGARD PLUMBING PERMIT
1111 ' COMMUNITY DEVELOPMENT Permit#: PLM2016 00074
T[GARS 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/16/2016
Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9585 SW WASHINGTON SQUARE RD Y04
Project: Starbucks Kiosk Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: 200'of water service and 60'of sewer service for kiosk
Contractor: MODERN PLUMBING Owner: PPR WASHINGTON SQUARE LLC
11120 SW INDUSTRIAL WAY PO BOX 847
TUALATIN, OR 97062 CARLSBAD, CA 92018
PHONE: 503-691-6166 PHONE:
FAX: 503-691-6771
FEES
Quantity Description Date Amount
60 If Sanitary Sewer 02/15/2016 $62.54
Specifics: 200 If Water Service 02/15/2016 $100.06
1 12%State Surcharge- 02/15/2016 $19.51
Type of Use: COM Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $182.11
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 q OUNC by calling 503.232.1987 or 1.800.332.2344.
Issu•. By: I / Permittee Signature:
_ .'. r► �' ./I,wr _rr�• o
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.
FEB-10-2016 11:48 From: To:5035981960 Page:2/2
Plumbing Permit Application
Building Fixtures RECEIVE) 1'011; 014ICE USE ONLY
City of Tigard Received
.Zm/4, ei Pa n,it No.,A/v.1,M a...,:appy
:
13125 SW Hall Blvd„Tigard,OR 97223 FEB 10 2016 Plan Review
■ Phone: 503.718.2439 Fax: 5(13.598.1960 Date/By: other
Per it No.:/ (.Apo"ZD/s�35-er
Inspection 1 i ne. 503.639.4175 Date Ready/By: l uu: ® Sec Page 2 for
C1G:\h.D Internet: www_tigard-or.gov ��,
B CITY OF TIGA . Dai Ready/By: 'v>I Suppteaten{at Information
• TYPE OF W( �DING'DIVV OIV FEE• sCHEDU
❑New construction ❑flemolition For special information use checklist.
--- - Description ..__ I OtY• I F-a. I Total
❑Addition/alteration/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 ®Commercial/industrial SFR(2)bath 437.78 _
SFR(3)bath 500.32
❑Accessory building ❑Multi-family -
_ Each additional bath/kitchen 25,02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
: • JOB SITE INFORMATION AND'LOCATION . .. -siteudildes.
lob site address:9585 Washington Square Road Catch basin or area drain 18.76 -
Drywell,leach line,or trench drain 18.76
City/Statc/ZIP:Tigard,OR 97223 - -
_. Footing drain(no.linear ft.: ) Page 2
Suitc/bld /a t.no.:Y04 name:Landlo work for Kiosk
& P ProjectManufactured home utilities 50-03
Cross street/directions to job site: t jJ c . .7- - o ckt l tict act,(G�i Cc[ Manholes - 18.76
i Jcet e c 3 400 �C✓iikti.^• {, Rain drain connector 18,76
Sanitary sewer(no.linear ft.: Page 2 62.54
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.:200) Page 2 100.06
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
- Backwater valve 12.51
DESCRIPTION�QF WORK :
Clothes washer 25.02
water and sewer lines for future kiosk • -Dishwasher 25.02
Drinking fountain 25.02
F.jcctors/sump -- 25.02
❑ PROPER'1'S( OWNER 0 TENANT Expansion tank - -
12_51
Fixture/sewer cap 25.02
Name: - -_
Floor drain/floor sink/hub 25.02
Address: " '
-._. ....._.. Ciarbagc disposal 25.02
City/State/ZIP: hose bib 25.02 _-
_
Phone:( ) Fax:( ) _ lee maker 12.51
CONTACT PERSON , interceptor/grease trap 25_02
Business name:Modern Plumbing Co. Medical gas(value:S ) Page 2
-- - Primer 12.,51
Contact name:Deborah George --
Roof drain(commercial) 12.51
Address:11120 SW Industrial Way,Bldg.9-3 Sink/basin/lavatory 25.02
City/State/ZIP:Tualatin,OR 97062 Solar units(potable water) 62.54
Phone:(503)691.6166 Fax::(503)691-6771 Tub/shower/shower pan 12,51
E-mail:deborah(a?modernplumbing.ns Urinal _ 25.02
. • ---- Water closet 25.02
c.O
�VTRAGTOIR
= � Water heater 37.52
Business name:Modern Plumbing Cn. Water piping/DWV 56.29
Address:11120 SW Industrial Way,Bldg.9-3 Other: 25.02
City/State/ZIP:Tualatin,OR 97062 Subtotal 162601
permit fee; $72.50
Phone:(503)691-6166 Fax:(503)691.6771 Minimum p .
CCH lie.:l ic.:87906
7010�// lambing Lic.no.:34-250PB Plan review (25%of permit fee)
/Y State surcharge(12%of permit fee) 19.5/
Authorized signature (i TOTAI.PERMIT FEE 182/1
// it This permit application expires Ira permit is not obtained within 1811 days
Prins name:Deborah Ccorgc ` Date. 6 after it has leen accepted as complete.
*Fee methodology yet by 76-County milling industry Service Board.
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FEB-10-2016 11:48 From: To:5035981960 Paee:1'2
:44 MODERf
tumaunG as
11120 SW Industrial Way, Bldg. 9-3
Tualatin. OR 97062 CCB#87906
infonodernplumbing.us 503.691.6166
FAX COVER SHEET
Attention: Permit Specialist
City of Tigard
Date: February 10, 2016
From: Deborah
There are __2 pages in this transaction, including this one.
RE; 9585 SW Washington Sq Road, Space Y04
Attached please find the permit application for the above address.
Please let me know when the permit fees are calculated and I will pay
them online.
Thank you
Deborah
Deborah@modernplumbing.us
Fax 503 691 6771