Permit (34) CITY OF TIGARD PLUMBING PERMIT
a 1142 : COMMUNITY DEVELOPMENT Permit#: PLM2016-00637
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/09/2017
T[ �'� '° Parcel: 1 S 135BA00102
Jurisdiction: Tigard
Site address: 10124 SW WASHINGTON SQUARE RD
Project: Costa Vida Subdivision: OAKBURG Lot: 9
Project Description: ADD(1)backwater valve,(9)3"floor drains/sinks/hub drains,(1)primer(1)hand sink in prep area. RELOCATE(1)
hand sink,(2)3"floor drains. CAP(3)3"floor drains.
Contractor: MANZHURA PLUMBING Owner: PPR SQUARE TOO LLC
PO BOX 820429 PO BOX 847
VANCOUVER,WA 98682 CARLSBAD, CA 92018
PHONE: 360-772-8145 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backwater Valve 01/09/2017 $12.51
Specifics: 3 ea Fixture/Sewer Cap 01/09/2017 $75.06
11 ea Floor Drain/Floor Sink/Hub 01/09/2017 $275.22
Type of Use: COM 1 ea Primer 01/09/2017 $12.51
Class of Work: ALT 2 ea Sink 01/09/2017 $50.04
Type of Const: 1 12%State Surcharge- 01/09/2017 $51.04
Occupancy Grp: Plumbing
Stories:
Total $476.38
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: - -- Permittee Signature: S
V
,-v
Call 503.639.4175 by 7:00 a.m.for the next available insp• tion 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 1 f k "l. FOR OFFICE I. ONE)'
City of Tigard Received Date/By: 10/0140/6...z90�1 A4/510 , Permit No.: 457
IN13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
C: Phone: 503.718.2439 Fax: 503tt�8O 9 sl 9 ;1(116 Date/By: Other Permit No. j �� 5i
Inspection Line: 503.639.4175
TIGARDReady/By:Date Juris: See Page 2 for
Internet: www.tigard-or.gov:
r s°' h i i= v ^ i i Notified/Method: Supplemental Information
a 'Lam+DIVISION
-yat ..!i< . PP
TYPE i t! DIV O E FEE* SCHEDULE
4` For special in ormation use checklist
❑New construction 0 Demolition P f b
Description I Qty. Ea. Total
f Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION" SFR(1)bath 312.70
0 1-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:
Fire sprinkler( sq.ft.) Page 2 00
JOB SITE INFORMATION AND LOCATION Site utilities: ,'
Job site address: f 0 i acts i Wei g till..[of 10„-t 9 y 4r a,t (,Qv' Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: 1 Project name: C \ U Is a.(q. 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: 1 Lot no.: Fixture or item:
Tax map/parcel no.: 15135/ i( tiblQ 9.- Backflow preventer / 31.27
D t6i OF WORK
Backwater valve / 12.51
Clothes washer 25.02
I In i"lei N �
L 0 y--4"\ Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER , `I'E1, 1NT `' Expansion tank 12.51
Name: p p (� t4`t G.-,Z 7-00 LI_ Fixture/sewer cap 25.02
Address: L,\130 cg L.( Floor drain/floor sink/hub % J, (1 25.02
v p Garbage disposal 25.02
City/State/ZIP: (ley Ic 'C?t/ j 4. a Z O/ d Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
' 0 APPLICANT
Inters tor/ ease tra 25.02
y
<.,.......�:;< � ��....� .?CONTACT PERSON � ep gt' P
Business name: Medical gas(value:$ ) Page 2
Contact name: Primer12.51
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory ,, 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
CONTRACTO`
Water heater 37.52
'nn
Business name: U v l Alit L ✓t !i1 ti V\144/j 1k/ Water piping/DWV 56.29
P i3 pk C�
Address: - G( 2 Other: 25.02
City/State/ZIP: (xvtcoutveG„- 11 e . I It i- Subtotal
Phone:( U) ?..7Z,- 4 ell
ax: / ) Minimum permit fee: $72.50
CCB Lic.: t.?-1 77 6 f � �" J�bing Lic.no.: P JLC Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: /' TOTAL PERMIT FEE /q7i,
Print name: f•' Date: y This permit application expires if a permit is not obtained within 180 days
/1)--/ �� t � k� 2 ^�� ? pafter it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-ls`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:
$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
Other Inspections or;Fees Qt'' Fee ) Totaleach additional$100.00 or fraction thereof,to
and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 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 $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
Reinspection 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*. Plan Review for Plumbing Installations
Quantity by Future Type Plan review is required for any of the following.
Fixture Type for :"" Replace/ Please check all that apply.
Work Performed: tapped Added Relocate
Baptistry/Font
0 Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall
0 New exterior plumbing site utilities for any complex structure
Drive tall as defined in OAR918-780-0040.
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial
0 Any multipurpose fire sprinkler system.
Domestic ❑ Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2" 2-
3" 1-( _3 JO 2 Isometric or Riser Diagram
-4" tvP"4, 0 Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice MachlRefrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related 4 /
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10124 SW WASHINGTON SQUARE RD,
TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2016-00637
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 .note: provide clean out plug for drain on 4- comp. sink.
Violation Summary:
Inspector Contractor