Permit CITY OF TIGARD PLUMBING PERMIT
III COMMUNITY DEVELOPMENT Permit#: PLM2016-00206
T(CARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/15/2016
Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9625 SW WASHINGTON SQUARE RD FC01
Project: Sarku Japan Subdivision: None Lot: None
Project Description: Relocate and replace(1)sink and(1)water heater
Contractor: CASCADE PLUMBING CO Owner: PPR WASHINGTON SQUARE LLC
15765 SW 74TH AVE#110-A PO BOX 847
TIGARD, OR 97224 CARLSBAD, CA 92018
PHONE: 971-312-1174 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Sink 04/15/2016 $25.02
Specifics: 1 ea Water Heater 04/15/2016 $37.52
1 12%State Surcharge- 04/15/2016 $8.70
Type of Use: COM Plumbing
•
Class of Work: ALT 10 ea Minimum Fee Adjustment- 04/15/2016 $9.96
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 estion •OUNC by calling 503.232.1987 or 1.800.332.2344.
lss ed By: I 0/ /—////bd ) Permittee Signatu 4
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 USE ONLY
City of Tigard Received l/ RI 16-
Op) �^
Date l)s. Permit No.. LH�/ 4,06
w 1),25 S)4'Nall Blvd Tigard.OR 972?�P R 14 2016 _..... ...—_—._-_-
Plan a
I 3 Phone 503.713 2439 Fax 503.598. 960 Other Perim;No
Inspect ion Line: 50 3.639.4175 - evicw
TIGARD Internet: scsssv.(igard-394 CITY QF T�GARD • Date Readyll h,os Ea See Page 2 for
IR i
'vonlled,:Method Supplemental Information
TYPE OF • FEE* SCHEDULE.
Vest consir(ctkm CI Demolition Forspecial infirmarian use chi cblrsr
- ..... - —..- -_-- ... • - .._. 1 Descr )non L Qt ha. TT total
Addition/alteration/replacement I ❑Other: Nen I 2-family dwellings(Includes 100 6 tbt each utilit)..connection)
CATEGORY OF CONSTRUCTION SIR(1)bath 7 312-70
0 I-and_2-)tool) dssellmg ❑Connercial'industrt.tl SIR )hath r 4)r 78
--- SV It(3)hathO 0 32
❑.\ceessor)building i ❑ :Multi-fan il,
- - 1 ich additional bath kitchen 2 0''
[J Hasler builder I ❑Other: I tic sprinkler( sq ft.) Page 2 f
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site tddress: N W Ishington Sy. Rd Catch basin or arca drain 13.76
- -- I Drywell.leach line,,or trench drain 18.76
( as/State/IP.Tigard,OR -.—_ .._._ _..._...}..- -' -----.._..
,-- Footing drain(no linear IL ) Page 2
Suite/bldg/apt.no I C (l1 Project name S1Rkl „IAP�\ - -......___
_.- Manufactured home utilities 50,03
Gross street directions to job site: Manholes 13.76
Rain drain connector 18.76
----------
Sanitary seller(no.linear ft:_) Page 2
1 Storm Buser(no linear ft: ) Page 2
Water service(no.linear II.: ) J l'age 2
Subdinsion Lot no Fixture or teem:
Itis n11(1.p:reel nu,:
Back flow presenter 1.27
Dl SC:RW.1110N OF WORK H teksculer valve 1�5
- - - -- - -- H b Italics washer 25 02
relocate and replace c\isting Fixtures --- ---
- -- Dishwasher 25.02
I.)rinking fountain 25.02
Ejectors/sump 23.02
❑ PROPERTY ERTY OWNER ❑ 'TENANT Expansion tnsion tank 12.51
—_-_- - !..__........_._ ._1
Name: t ISntreisewer cap 25.02
Floor drain/floor sink/huh 25.02
Address:
- --__..-- Garbage disposal 25.02
I______c -(lost bib 25.02
Plume:( ) I Fax:( ) Ice maker 12.51
2 s i
__] _
❑ APPLICANT ❑ CONTACT 1 PERSON Interceptor/grease trap 25-02
__
Medial is(value:S i Page e 2
Business name:
y
-__ .. - ....I Primer 12 51
tont lel name:
--_-+
Roo(drain(commercial) 12.51
\Jdruss:
.--- -_-_...- ___..._.._. ---_-_..-_- _____- .........._ __. Jink'httsinll is itorp 1 ��02 2�02
( it s;Srue:lII'.
Solar runts(potable slater) 62.54
Phone:( ) I I te: ( ) I ub shosser/shower pan 12.51
_- _
1 mail: Urinal 25.02
Water closet 25.02
CONTRACTOR T
- ----..._—__.---------_._-._. . . Water huller I 37.52 37.5'
Business nam. Cascade Plumbing Co
- - - -
Water pipin DWV 56.29 !
Address: 15765 SW 74th Ave 4110-.5 Other 25.02 j
CityState/1I' 'Tigard,OR 97224 Subtotal
Phone (503)289-7095 I a4:(503)2839514 Minimum penia lee 57250 Z sI)
- _ Plan relies
2 r (25%of permit fee) i
all 1 ie 043)_ Plumbing Lie.no•1 1315_8 I
%F. State surcharge(12%of permit lee) 8 70 ,,
\uthoriid signature )•1// / r.1/� fUl it Pt ftStl I FEE {I sir
tyy< 1 L.L- - 1 � -•.•
Print name. Crystal Jones Date:114/13/2016 "I'his permit application expires if a perma is norm pleteed withnt IND daps
_...._.____.__. _ after it has been acceptell as complete.
'Fee methodology lei by fn-County Building Indusia Service noart1
I I;wi.i-r_P.,,,,,,.P:SI!-Primo IrPdo, 14:01.10: uL..:r,leTi pi CMIAVIli,
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
I Site Utilities Qty. Fee(ea) Total ISquare Foota e� l Permit Fee:
I u me drain I" IOU 50 03 0 to2,000
_ —__._.`...._ $12190
_
;outing drmn each additional 100 7 52 2,001 to 3.600
•' $16969
--- 3,6Q1 to 7,2(R) $233 20
Sewer-each additional IOU' -- (il and reatcr $327.5437 52
Iter Service- 1st 1W 62.54
Water Service-each additional IOU' —... Medical Cas Systems:
Valuation: Permit Fee:
!,t,,,,,,&Ram Drain-1st 100' ...
Gt i3 —
$I.(i0 to$5,000.00 Minimum fee$72
StormRain Drain-each additional 100' 37.52 —0- �i1
M &
$5.00100 to S10.000,00 $72 50 for the hnt 53.000 00 and$I 52 tot
Other Inspections or Fees Qty. Fee(ea) Total each additional$I0O 00 or fraction Ihercof.id I
Impection of ousting plumbing or for -.—_ .__ and including$10.000.00a._ ._
fee is specifically indicated 90.00/hr
i $10.(-01 DO to$25.000 tip Id8 50 Cr the tint 510.000 00 and$I 54 for
tueh no
each additional$100 00 or fraction thereof.to
(minimum charge lig hour)
I:ur colons outside of normal business 90.00/hr —_ and mcludma 525 000 00.
_
hours(mimnnun share 7 hours/ li $25.Ui)L00 to$5(1.000 00 I S379 U for the lust$25.00O 00 and SI 45 li r
...— .a ___._..._._._....._.._
eac
ditional
Ilei rpcetion Fees up �$and7Shi including
the gn(0$j 0(00!)(jinn Uacrrof.to
90.01)/hr
rAt e nional plan reyieer tot revisions 90.00'hr $ 0.001.0'1 and —
rnnnimunt charts lit hourt and$I 20 for
- I each additional$100 00 or traction 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 Plumbin. Installations
Fixture Type for Replace/
L,,.!fork Performed: Capped Added Relocate Plan review is required fi>r any of the toll nvint?.
f3aphstrviPnnl Please cheek all that apply.
_.—
C lith Iuh.'.Shocyer ID Any new commercial building ssith water service 2 and
_ IacuzzCWhirtpool greater,except systems designed and stamped by licensed
Car'Nash -Each Stall engineer
l)rive thio ❑ New exterior plumbing site utilities tier any complex structure
Cuspidor/Water Aspiratoras defined in OAR918-7S0(040
Dishwasher -Commercial _ ❑ Medical gas and vacuum Systems Cur health care facilities.
-Domestic ❑ Any multipurpose tire sprinkler system.
IDrinking I-ountain ❑ Any complex structure as defined in OAR91 R-780-0040
se Wash
flour I)rair sink 2' --' — Submit 2 sets of plans with any of the above.
Car Wash Drain '
_ --- Isometric or Riser Dia r ram ��
ktrh igi. Domes!it stun food ❑ Isometric or riser diagram is required for new buildings
Di pr sol Domestic loutl related
that meet the qualifications about,
-Commercial-hood related
-Industrial-10nc1 related —
ice Mach/Rettig.Drams —"
(hl Separator(Gas Stations _ Comments regarding fixture work:
Rc...ychrcic Dumb Station
Shower -Clang �- _�
-Stall --
Sink'1,.0 Non-lixtd related — 1 _
-Bradley _ - — —`
-('ennmercral-t rod related
-Service
S..minimPool Filter
— _..
''`r-oodles *Note: If the fixture work under this permit results in an
SS cc, [Ammo:. —"" increase of sewer EDUs,a sewer permit will be issued and
Water n,r( lust '
oi1`t fees assessed for the sewer increase must he paid before the
l rural _...
— — plumbing permit can be issued.
I.)thrr Futures ..._ ......._.�
( - 1 sers.( -.code Main`.Desktopy.PI-.RMITS'.1 igarcLdue: 2