Permit (82) t CITY OF TIGARD PLUMBING PERMIT
111 2 COMMUNITY DEVELOPMENT Permit#: PLM2016-00308
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/16/2016
TIGARD. 9 Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9609 SW WASHINGTON SQUARE RD L02B
Project: Shoe Mill Subdivision: None Lot: None
Project Description: Relocate(1)2"floor drain,(1)primer, (1)lay, (1)water closet&(1)water heater.
Contractor: POWER PLUMBING CO Owner: PPR WASHINGTON SQUARE LLC
PO BOX 19418 PO BOX 847
PORTLAND, OR 97280 CARLSBAD, CA 92018
PHONE: 503-244-1900 PHONE:
FAX: 503-244-8825
FEES
Quantity Description Date Amount
1 ea Floor Drain/Floor Sink/Hub 06/16/2016 $25.02
Specifics: 1 ea Primer 06/16/2016 $12.51
1 ea Lavatories 06/16/2016 $25.02
Type of Use: COM 1 ea Water Closet 06/16/2016 $25.02
Class of Work: ALT 1 ea Water Heater 06/16/2016 $37.52
Type of Const: 1 12%State Surcharge- 06/16/2016 $15.01
Occupancy Grp: Plumbing
Stories:
Total $140.10
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 BC 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.
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Plumbing Permit.Applicar to I v�
Building Fixtures V
D.
Rcocived /_ 'A
City of Tigurd III N Dax/By: CP pi /(p Permit No.: ( t W-�
:� • 13125 SW Ball Blvd.,Tigard,OR 9721/ 13 2016
C Phone: 5()3.71 l.2439 rax: 503 960 DDate/By: Other Permit No,:f)j l4, c )I gy
Inspection Line: 503.639.4175 Li I I T OF TIGARD Date Rcady/By: Inns: 0 See Pate 2 tor
Internet www.tigard-or-guy BIM DIG n1VirN Notified/Method: $upptema tat information
I
TYPF OF WORK .. r' 'r „•FEE''SCI3 Dui*. _'.1i t
❑Ncw construction ❑Demolition
Nor special information use dualist.
Description 1 Qty. 1 Ea. 1 Total
F. Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.far each utility connection)
r• ' 'CATEGORY,OF CONSTRQC ON .',„.' , . ,•;;' SFR(1)bath 312.70
a1-and 2-family dwelling Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: F1 sprinkler(_sq.it) Page 2
°I. • 'ftl° IOW SITE INFORMATION AND 1 ATIO '' "I' ,+ Site utilities:
Job site address: A. S O �' � .) Catch basun Ch area drain 18.76
City/State/ZIP: Gii344t,;-
44X11,ICach line,nr trench drain 18.76
Footin drain(no.linear ft.: ) Pagc 2
} 6
Suite/bldgJapt.no.: Project name: 3 h Q t2 Mt j ( Manufactured home utilities 50.03
Cross street/directions to job site: 1 Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear IL: ) Page 2
Storm sewer(no,linear ft.:___,1 Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
'+'4.1 I; io» s.. .. Backwater valve 12.51
;$'' + ' I: r+ DESCitIPTION�O ;WO1RK ,, + :".-1,",1714:i.
j` Clothes washer 25.02
.�� '.1 0 rr�'Q.mv Dishwasher 25.02
r ! _ A _ t - A. al 1 ' L.- 111..P_- Drinking fountain 25.02
p e 1 14 LA . Ejectors/sump 25.02
ri),.'.<v IPRO RTYiO�WNt ER; ei c,' 't I 0 T 1NT +� r• Expansion tank 12.51
Name: Fixture/sewer r cap 25.1.12
Floor drai floor sink/hub 1 25.02 26 b
Address:
age disposal 25.02
City/State/ZIP: Hose bib . 25.02
Phone:( ) Fax:( ) Ice maker 12.51
' n• ' APELICANLI 7, , i ih f.(05t440,PFR ON It,, Interceptor/grease trap 25.02
Business name: pD lou ' P 1 u c r!.Lit Medical gas(value:$ W ) Page 2
Contact name: Pr1uner 4 12.51 II,5)
..b. _ . / r- *AI n rain(commercial) 12.51
Address: , 4 . SiniJbas. aunts j 25.02 P Z"
City/State/ZIP: / o/ / / l (sY e,-ip-g Solar units(potable water) 62.54
Phonc:603)-1-'4'-f-1,9 D p 1 Fax::5Q .244,-21-2-__5 Tub/shower/shower pan 12.51
E-mail: i/' / Urinal 25.02
�i / . / 'i/ 4/ I !_V Watercloset t 25.02 O�
• r. CONTRA OR , 4. I 37.52 ryTj i+
- Water heater
Business name: /� waterpiping/DWV 56.29
Address: 14 . a, Other: 25.02
.EijiMIIIIIIIINIII� -
Subtotal 12.6
Minimum permit fee: $72.50
EMIIIPPKEEP Plumbing Lic.no.: . EMI.
Plan review (25%of permit fcc)
State surcharge(12%of permit fee) 15 o f
Authorized signature / A • TOTAL PERMIT FEE 140 I 0
Print Warne: i Date: This permit application expiry;if a permit is not obtained within 180 days
R/S J I /4. after it has been tuXepted a4 Complete.
i •fee methodology set by'hi-Comfy Building industry Service Board,
I:\Duilding\PenuiAPLMU-l'raiiApp.doc 101U1 0) 44.44I6T(10/022COM/WGn)
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Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site'Utiltiea.. ', Qty, Fct(ta) 'Total . sSquareFootage: . • :Pernut„Fee :
Footing drain-1”100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,60t) _$169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 623 4 7201 and goner $32754
y
Sewer-each additional 100' 37.52
Water Service•1st 100' 62.54 Medical Gas Systems:
water Service-each additional 100' 3732 ^V8lnati012'- .',Pei iiit:F,ee: .' . ,
Storm&Rain Drain-1st 100' 62. $1.10 to$5,000.00 Minimum fee$72.50
Storm Et Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.(X) $72.50 for the first$5,000.00 and$1.52 for
i•' Qt . 'Fee'(ea),,,V ^T'dtal'' each additional$100.00 or fraction thereof,to
;Qtr YI19peCt10IUS.Or Fees, ,. and including 510,000.00-
inspection of existing plumbing or for $10,001.00 to 525,00.0(1 $14830 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 $37930 fur the first$25,000.00 and$1.45 for
hours(minimum charge—2 hours) each additional$1(1(1.00 or fraction thereof.to
Reinspection Fees 90.00/11r and including$50,000.00.
Additional plan review for revisions ' 90.1X1/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge-112 hour) each additional$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
;, Qtirtutiy byFlrttare Type , ; 'i lPta n ttevi'ew for;:Plumbing lnstall'ations',, ,.
'wokType for • Replant: Plan review is required for any of the following,
Performs : .:e ,.` s.r. , Capped, itdded' Relocate:.
Baptistry/Font/Font Please check all that apply.
Bath -'ilth/Shmver 0 Any new commercial building with watcr service 2"and
greater,except systems designed and stamped by licensed
-Jacuzzi/Whirlpool
Car Wash -Each Stall engineer.
-Drive.L Inn 0 Ncw cxtcriur plumbing site utilities for any complex structure
Cuspidor/Water Aspiratoras defined in OAR918-780-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health cart facilities.
•Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR91}i-780.0040.
•Eye Wash
Floor Drain/sink -2" --$/ T , Submit 2 sets of plans with any of the above.
3"
;Isointetrlcor Ristei Dll'agam,
C.ar wasb Drain ❑ Isometric or riser diagram is required for new buildings
Garbage -Domcatie-non-food
Disposal -Domestic—food related that meet the qualifications above.
-Commercial—food related
-Industrial-food related
Ice MachiRefrig.Drains
Oil Separator(Gas Station) _ Comments regarding fixture work:
Rat:.Vehicle Dump Station y//k
Shower -Gang 111 �T1,
Stall l� t.dG`-tet Lek-e�4 .p-
Sink/i av -Nom-food related -.1-"" { •4J —
-Bradley I ' J
-Commercial-food related
-Service
Swimtuitlgfbol Filter *Note: If the fixture work under this permit results in an
Washer-Clothes increase of sewer EDUs,a sewer permit will be issued and
Water
Extractoor
Water Closet-Toilet ' i fees assessed for the sewer increase must be paid before the
Urinal ,,j/y,/�,����+ plumbing permit can be issued.
Other Fixtures:0,412‘41‘,424/1
(Y1 rG 1+ , 1
http:llwww.tigard-or.gov/documen L_cen LerfBui lding/PLMF_PermitApp.dt