Permit (58) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2017-00455
T [ aARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/02/2017
Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9493 SW WASHINGTON SQUARE RD A03
Project: Play Live Nation Subdivision: None Lot: None
Project Description: Interior plumbing for TI:Adding(1)sink.
Contractor: BRUNER PLUMBING Owner: PPR WASHINGTON SQUARE LLC
PO BOX 23985 PO BOX 847
TIGARD, OR 97281 CARLSBAD, CA 92018
PHONE: 503-484-5105(CELL) PHONE:
FAX: 503-624-2173
FEES
Quantity Description Date Amount
1 ea Lavatories 11/02/2017 $25.02
Specifics: 1 12%State Surcharge- 11/02/2017 $8.70
Plumbing
Type of Use: COM 47 ea Minimum Fee Adjustment- 11/02/2017 $47.48
Class of Work: ALT Plumbing
Type of Const:
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 questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 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.
Plumbing Permit Application
, .
_ . _ . a - .
Building Fixtures -,,-
t,..lt FOR OFFICE USE ONE,1
City of Tigard i-At‘J '''' Received
411 /
13125 SW Hall Blvd.,Tigard,OR 97223 c., 1 c‘Van Review i/ / C Permit No.:.101/t4,„ /7-
\ '-' hi L v lan 1111 I Phone: 503.718.2439 Fax: 503.598.1960 4‘AO‘J Other Permit No.
Inspection Line: 503.639.4175
Tic_,ARD ,, -ic. A'it.,:...t7i.ckft^40/By: Juris: I 0 See l'age 2 for
Internet: www.tigard-or.gov rAl'i k ' fit.,&Method: Supplemental Information
4.1 rsitkl A
TYPE OF WORK FEE* SCHEDULE
b New construction 0 Demolition For special information use checklist.
Description I Qty. I Ea. j Total
2°Addition/alteration/replacement 0 Other:
New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY,OF CONSTRUCTION " ' ' SFR(1)bath
I I 312.70
0 1-and 2-family dwelling ,2rCommercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
0 Master builder 0 Other:
Fire sprinkler( sq.ft.) I Page 2
JOB SITE INFORMATION AND LOCATION ' Site utilities:
Catch basin or area drain 18.76
Job site address: ("cps- ,5 , 4/Asti/A&7,,,,, ,.?1,0ec p,1, D1ywell,leachlineortrenchin 18.76
City/State/ZIP: T(9, 2-s.„0.1 /7 2-2---1
Footing drain(no.linear ft.: ) Page 2
, . .
Suite/bldg./apt.no.: I Project name: ir,/ (.4 ye &a16 trvi. Manufactured home utilities 50.03
nay
Cross street/directions to job site:
Manholes 18.76
542,c 40_. 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
DEP1-4,,-___ Backwater valve 12.51
1PTIVN OF WORK ,
i --• - Clothes washer 25.02
et-ik a( avkx_ C(AI,E..,
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
, .
1:1 PROPERTY OWNER ' I ' ., 0 TENANT ,.., . Expansion 12.51
Name:
Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP:
Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
APPLICAN'T :421 CONTACT'PERSON ' Interceptor/grease trap 25.02
Business name: c - Medical gas(value:$ ) Page 2
e r /.37.L,,t)
Contact name:
Primer 12.51
Roof drain(commercial) 12.51
Address:
Sink/basin/lavatory
j 25.02 ).. -
City/State/ZIP:
Solar units(potable water) 62.54
Phone:( ) I Fax::( ) Tub/shower/shower pan 12.51
E-mail:
Urinal 25.02
CONTRACTOR
Water closet 25.02
Water heater 37.52
Business name: Rru net - P(c/111141 /-lc- Water piping/DWV 56.29
Address: p.b ,-,
iLs a. c- 2 4) ec--- Other: 25.02
City/State/ZIP: -179a.....„,4
Subtotal
,......._101.
_
Phone:(5 kg) ,2....y- yx.....2r 0 Fax:(503)6 2.tf 2..(7 g Minimum peimit fee: $72.50 72 sy
Plan review (25%of permit fee)
CCB Lic.: s._, r ----, Plumbing Lic.no.:2.r -ctyr FIR
State surcharge(12%of permit fee)
Authorized signature: . .----.----
TOTAL PERMIT FEE V,A)
Print name: uyae,...-4/ z7'e-Line,-- I Date: ///e.../7 I This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I\Budding\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'I: l.ltI� ,
• ,Qty,., :Feel") i' Total ';Square Footage x ...Permit Feet'"
., oto 2,000 $121.90
Footing drain-l'100' 50.03
2,001 to 3,600 $169.69
Footing drain-each additional 100' 37.52 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 ValuntoII ' Permit Fee
Storm&Rain Drain-1st 100' 62.54 $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 f owl each additional$100.00 or fraction thereof,to
Other Inspections or Fees Fee Imo) 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.
$50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
Additional plan review for revisions 90.00/hr each additional$100.00 or fraction thereof.
(minimum charge-1/2 hour)
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
.r
accurately report fixtures could result in increased sewer fees*. Plan Review for PiunIbin�Installations - -
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate 0 Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
-Jacuzzi/Whirlpool 0 New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru 0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator 0 Any multipurpose fire sprinkler system.
Dishwasher: -Commercial 0 Any complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2"
3" '. .,.; x. 'Isometric or Riser'.Diagram* r. ....
4»
0 Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related Comments regarding fixture work:
Ice Mach./Refrig.Drains
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall XC11
Sink: -Lav/Bar non-food related
-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 plumbing permit can be issued.
Water Closet-Toilet
Urinal
Other Fixtures:
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