Permit (24) CITY OF TIGARD PLUMBING PERMIT
i II
COMMUNITY DEVELOPMENT Permit#: PLM2019-00079
Date Issued: 05/23/2019
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9753 SW WASHINGTON SQUARE RD D02
Project: 85C Bakery Subdivision: None Lot: None
Project Description: Interior plumbing fixtures for new tenant improvement:Adding(2)drinking fountains,(17)2"floor drains/sinks,(3)
Ice machines,(9)sinks,and(2)water closets; Installing(1)trench drain,(3)backflow preventers, (1)expansion
tank,(1)grease trap,(4)primers,(2)water heaters,and(13)other fixtures(see scanned paperwork).
Contractor: FIEKEN PLUMBING LLC Owner: PPR WASHINGTON SQUARE LLC
17007 SW MEINECKE RD PO BOX 847
SHERWOOD, OR 97140 CARLSBAD, CA 92018
PHONE:
PHONE: 971-264-8646
FAX:
FEES
Quantity Description Date Amount
1 ea Drywell,Leach Line or Trench 05/21/2019 $18.76
Specifics: Drain
3 ea Backflow Preventer 05/21/2019 $93.81
2 ea Drinking Fountain 05/21/2019 $50.04
Type of Use: COM
Class of Work: ALT 1 ea Expansion Tank 05/21/2019 $12.51
17 ea Floor Drain/Floor Sink/Hub 05/21/2019 $425.34
Type of Const:
3 ea Ice Maker 05/21/2019 $37.53
Occupancy Grp:
Stories: 1 ea Interceptor/Grease Trap 05/21/2019 $25.02
4 ea Primer 05/21/2019 $50.04
g ea Sink 05/21/2019 $225.18
2 ea Water Closet 05/21/2019 $50.04
2 ea Water Heater 05/21/2019 $75.04
325 Misc Other Fee 05/21/2019 $325.26
1 Plan Review 05/21/2019 $347.14
1 12%State Surcharge- 05/21/2019 $166.63
Plumbing
Total $1,902.34
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. 4,...7-Issued By: \. Permittee Signature: 61
✓47
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
wilding Fixtures 1:0R of tici I Si. ()NEN
tij
City of Tigard v E/ " Received
1 Date/By: l//lmPt Nf ~..- �
C'
e 13125 SW Hall Blvd.,Tigard,OR 2
Plan Review
,.L SMI a_ Phone: 503.718.2439 Fax: 503.598.19 n ii Other Permit o° er,��j_j r'
I ccpp 2 5 2Q�J DateBy: 3`".9-� ! � y J/9 4/ 9
Inspection Line: 503.639.4175 GQ Date Read/B a r Suns. See Page 2 for
IIGARD Ready/By: f
Internet: www.tlgard-or.gov Ark l_, Notified/Method: )j 161 4"t Supplemental Information
TYPE OF WORKCt�Y vt ;i�:a SION /, /�f FEE* SCHEDULE
������ 9 3,11.1 3.,.,F11�/I IvY c1, C, Z 1_sV'v�
❑New construction In Demolition
For special information use checklist
Description I Qty. j Ea. I Total
IS:I Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
1
CATEGORY OF CONSTRUCTION SFR( )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 ❑Other: Fire sprinkler( sq.ft.) Page 2
JOE SITE INFORMATION AND LOCATION Site utilities:
`Job site address: 9753 SW Washington Square Road Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: Tigard, OR 97223
Footing drain(no.linear ft.: ) Page 2
Suite/bIdg./apt.no.: D02 I Project name: 85C BAKERY Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
WASHINGTON SQUARE MALL Rain drain connector 18.76
, ¢ / ;.',r,f"" ete721i� n l''''./.6-
, Sanitary sewer(no.linear ft.: ) Page 2
" Storm sewer(no.linear ft.:_) Page 2
- r jc /t4 1.A4;.-3 re Water service(no.linear ft.: ) Page 2
,,, Subdivision: :0" )t 9 :4.-..--ii rm., 11--;•,. I Lot no. f Fixture or item:
l` Tax map/parcel no.: 1S1260000300/ R236587/R236596 Backflow preventer 1 31.27 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
.4 TENANT IMPROVEMENT FOR A BAKERY, NEW FINISHES Clothes washer 25.02
Dishwasher 25.02
MECH, ELEC, PLUMB, NEW HC TOILETS Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER , ® TENANT Expansion tank 12.51
A Name: 85C BAKERY Irv-
,: r. 25.0 , ,
Floor drain/floor si ub e a• 1 1 25.02 275.22
Address: 9753 SW Washington Square Road
Garbage disposal 25.02
h City/State/ZIP: Tigard, OR 97223 Hose bib 25.02
t• Phone:( ) Fax:( ) Ice maker 1 12.51 12.51
i 3 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: SMITH CO LLC Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: KEITH SMITH
Roof drain(commercial) 12.51
Address: 1725 WESTLAKE AVE. N., SUITE 210 Sink/basin/lavatory 9 25.02 225.18
Y'City/State/ZIP: SEATTLE, WA 98109 Solar units(potable water) 62.54
Phone:(206 ) 713-4076 Fax: :( ) Tub/shower/shower pan 12.51
t-mail: KSMITH@SMITHCO.ORG Urinal 25.02
Water closet 2 25.02 50.04
CONTRACTOR -
.� Water heater 2 37.52 37.52
Business name: T.B.D. F1 E.. t(tM A'` t\ (),,, Water piping/DWV 56.29
Address: `"+ -'# SvJ , _e_s_4_ X. Other: 25.02
City/State/ZIP: . C CA.--VO-NO Subtotal 631.75
Phone:(cro ,'Lt �� Fax ( ) Minimum permit fee: $72.50
CCB Lie.: Plumbing Lie.no. \ � Plan review (25%of eit fee) 157.94
State surcharge(12%of permit fee) 75.81
Authorized signatu t \ TOTAL PERMIT FEE 233.75
Print name: KEITH L. kM ITH Date: 02.21.19 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:\Building\Pernuts\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
A
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-1'100' 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 Valuation• 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
Other Inspections or Fees Qty. Fee(ea) Total each 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 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 ❑ New exterior plumbing site utilities for any complex structure
Car Wash: Each Stall as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: -Commercial ❑ Any multipurpose fire sprinkler system.
Domestic 0 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"
3" 11 Isometric or Riser Diagram
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
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station) ( 3) He911/4S S/' W. 1--/mak.)
Rec.Vehicle Dump Station 7* tg E CVS -Ce., y 1 s
Shower: -Gang ((..
�(2„.
,r�,/���
-Stall
Sink: -Lay/Bar non-food related ) L'f" ..P/VMS
-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 thesewer increase must be paid before theWater Extractor
Water Closet-Toilet 1 plumbing permit can be issued.
Urinal
Other Fixtures:
I.\Building\Permits\PLMF PerrnitApp.doc 08/04/2011 2
Plumbing Permit Application
Building Fixtures
City of Tigard Received 2 Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: J /ii ��M a���'Q���
NI = Plan Review 04 Other Permit No.:
Phone: 503.718.2439 Fax: 503.598.1960 p ( �p`t�f� � tx
Inspection Line: 503.639.4175 Date/By: -�-I t g/^/t" �l r
T I G A R D p Date Ready/By: j loris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: 3/)��l`l' % Supplemental Information
TYPE OF WORK t j'd"b*7t y41 'tin. LI�Y�_"' FEE* SCHEDULE
❑New construction 0 Demolition For special information use checklist
Description I Qty. Ea. I Total
%Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTR�TION SFR(1)bath 312.70
❑ 1-and 2-family dwelling Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: C, 153 S 00�(K . , �' Catch basin or area drain 18.76
` _ Drywell,leach line,or trench drajp / 18.76 i 8.94
City/State/ZIP: T t g c r 0 R.. q 9 a3
Q �iFooting drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: 'DO), Project name: 85 C Baikey y Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
�y ��-y,("I Sanitary sewer(no.linear ft.:_) Page 2
�� � ��� 1,1� - = Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: �/ Lot no.: Fixture or item:
Tax map/parcel no.: � % P- Backflow preventer 3 31.27 r{3„�j
i7`tr9 '? tt
Backwater valve 12.51
DESCRIPTION OF WORK
Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 2 25.02 50.0 q
Ejectors/sump 25.02
0 PROPERTY OWNER 0 TENANT Expansion tank / 12.51 /a. 5 t
urkxtts e/%w.ey.c., 1. ' .. 02
Name:
Floor drain/floor sink/hub • 7 /r] 25.02 415 34
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Icemaker4d- ;C2 ckeft-=2 .3 12.51 3 7,5 3
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap f 25.02 05,02
Medical gas(value:$ ) Page 2
-
Business name:
Contact name: Primer 4 12.51 se),0 et
Roof drain(commercial) 12.51
Address: 1Sink/basin/lavatoiy 25.02City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) ( Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Watercloset v- 25.02 56.04
CONTRACTOR - Water heater a37.52 75,01
Business name: WaterPiP �in DWV 56.29
Address: Other: jet lick +-or G Il,e y i 3 25.02 $964 G
City/State/ZIP: Subtotal t'7 ,.# 'F
Phone:( ) Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee) :Mtn
/4
CCB Lic.: Plumbing Lic.no.: ff .'. IState surcharge(12%of permit fee),, f
Authorized signature: TOTAL PERMIT FEE'i fl 4r" '
Print name: Date: 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:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) LAV 2 2.
$itN\kS z 7
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-151 100' 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 Valuation: 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
Other Inspections or Fees Qty. Fee(ea) Total each 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 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
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.
111Car Wash: Each Stall New exterior plumbing site utilities for any complex structure
Drive as defined in OAR918-780-0040.
111Cuspidor/Water Aspirator Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial 111 Any multipurpose fire sprinkler system.
Domestic 0 Any complex structure as defined in OAR918-780-0040.
Drinking Fountain l
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2" /17
3" Isometric or Riser Diagram
ElIsometric 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
Ice Mach./Refrig.Drains 'a, Comments regarding fixture work:
Oil Separator(Gas Station) et// C. .1 741 &vz_f/')et.t" Al
Rec.Vehicle Dump Station /001', e 8; ilflet re Ge.1...,4r':►• rnitrf Ate? l v.
Shower: -Gang
-Stall 7f4/l1 .,y./
N Sink: -Lay/Bar non-food related I j
-Bradley
-Com/Sery/Util food related f 3
-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 I
fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet-Toilet 1 f plumbing permit can be issued.
Urinal
Other Fixtures:
I:ABuilding\Permits\PLMF PermitApp.doc 08/04/2011 2
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Accumulative Sewer Tally
11111 1, "Tenant Name:
SWR#
OM Site Address: 9753 SW Washington Square Rd D02 PLM#
Parcel#:
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s value count added# added value total#s total values
Baptisery/Font 4 0 0 0 0 0
Bath: -Tub/Shower 4 0 0 0 0 0
-Jacuzzi/Whirlpool 4 0 0 0 0 0
Car Wash: -l.ach Stall 6 0 0 0 0 0
-Drive through 16 0 0 0 0 0
Cuspidor/Water Aspirator 1 0 0 0 0 0
Dishwasher: -Commercial 4 0 0 0 0 0
-Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 9 0 9 0 0 0 0
-3 inch 5 0 0 0 0 0
-4 inch 6 0 0 0 0 0
-Car Wash 6 0 0 0 0 0
Garbage Disposal:
-Domestic(to 3/4 l IP) 16 0 0 0 0 0
-Commercial(to 5 FIP) 32 0 0 0 0 0
-Industrial(over 5 IIP) 42 0 0 0 0 0
Ice Machine/Refrigerator Drain 1 0 0 0 0 0
Living Unit 16 0 0 0
0 0
Oil Sep(Gas Station) 6 0 0 0 0 0
Rec.Vehicle Dump station 16 0 0 0 0 0
Shower: -Gang(per head) 1 0 0 0 0 0
-Stall 2 0 0 0 0 0
Sink:
-Lay/Bar-Non-Food Related 2 7 0 1 0 0 0 0
-Bradley 5 0 0 0 0 0
-Com/Servkt—R>cereal 3 1 0 1 0 0 00 ,'
Swimming Pool Filter 1 0 0 0 0 0
Washer-Clothes 6 1 0 1 0 0 0 0
Water I extractor 6 0 0 0 0 0
Water Closet-'l Toilet 6 1 0 1 0 0 0 0
Urinal 6 0
0 0 0 0
Previous EDU Count 19 0 0
Capped EDU Credit 19 35_ 0
'TOTALS 0 0 0 0 0 0 0 0
Current Fixture Value 0 divided by 16= 0.000 Current EDU 1 EDU= $5,650.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
('elG,vrd a Change 0 divided by 16= 0.000 over (under) $
r -
! 49 Enter EDU Change Here 0.000
*Round EDUs to the nearest 1/100th: a count ending in.005 shall be rounded up to.01,and a count ending in.014 or less shall be rounded down to.01.
Notes: 1 Restroom with 1 toilet and 1 lay; 6 other hand sinks (non-food); 1 utility sink(non-food); 9 floor sinks; 1 dishwasher
*47,14,1"/ (t? 4;7.,-w-1 t 1 t e 14 A,--......,/ •...clA I r41.41- '>d .
Authorized Name/Signature: Date: 03.04.19
Building Division
Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist,this document will serve as a voucher which must be
submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
I:ABuilding\Sewer Tally\SewerTallyShect_5500_070118.xlsx