Permit (3) CITY OF TIGARD PLUMBING PERMIT
Fk�! COMMUNITY DEVELOPMENT Permit#: PLM2020-00040
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/27/2020
TIGARD Parcel: 1 S135BA00100
Jurisdiction: Tigard
Site address: 10125 SW WASHINGTON SQUARE RD
Project: Jaguar/Land Rover Subdivision: None Lot: None
Project Description: Backflow preventer for car wash steam cleaner.
Contractor: ASSOCIATED PLUMBING CO Owner: PPR SQUARE TOO LLC
200NE VICTORY AVE"C" PO BOX 847
GRESHAM, OR 97230 CARLSBAD, CA 92018
PHONE: 503-492-1922 PHONE:
FAX: 503-492-1923
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 01/27/2020 $31.27
Specifics: 1 12%State Surcharge- 01/27/2020 $8.70
Plumbing
Type of Use: COM 41 ea Minimum Fee Adjustment- 01/27/2020 $41.23
Plumbing
Class of Work: ALT
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
Building Fixtures FOR OFFICE USE ONLY
Received
Cityof Tigard Permit No.: /
INli 131 SW Hall Blvd.,Tigard,OR 9' iE C E IV E D Date/By:Review tr7 de QfU L`r7
_ Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.: r
Inspection Line: 503.639.4175 JAN 27 2020 �� ` `��
T I G A R D p Date Ready/By: -lug). ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: / v Supplemental Information
F' WOR lT 1 .;, FEE* SCHEDULE
I I LD j SION For special information use checklist.
1::]New construction emo ition
Description I Qty. I Ea. I Total
gl 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
❑ 1-and 2-family dwelling Commercial/industrial SFR(2)bath 437.78
buildingSFR(3)bath 500.32
0 Accessory ❑Multi-family
Each additional bath/kitchen 25.02
0 Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: 4..„a/ / o.e 97�-33
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: --SL, 1arf(4 e,d 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: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer / 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
ti
fcl7 4-P Pe-Y.,/;ti, 4.4 C,i'f '^'etr4 $',,$ ', Dishwasher 25.02
L fp...t er- Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER 1 ❑ TENANT Expansion tank 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
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
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
Urinal 25.02
E-mail: i, '-,�( 7/1 j 70.5 ,,.., F� I. 4ivk
,CONTRACTOR Water closet 25.02
Water heater 37.52
Business naniv saLi77- 7is pcv„.-.Si,,c- lL Water piping/DWV 56.29
Address: Fr.., dfk ,g L,7 Other: 25.02
City/State/ZIP: 7., i. y,Qti, ../ air, 97.)j> Subtotal
Phone:(";)})ryq�_/Q Fax:(3-o7 )y9z./9 Minimum permit fee: $72.50
CCB Lic.: --7gga Plumbing Lic.no.: /"...‘,-yiZt'
Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
l This permit application expires if a permit is not obtained within 180 days
Print name: �f,� �us� Z�-Z
y. � Date: /- oZ o 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)