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Permit City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT Request for Permit Action TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 50 7 4 jrardor.gov TO: CITY OF TIGARD JUN 2 9 2020 Building Division CITY OF TIGARD 13125 SW Hall Blvd.,Tigard, OR 97223 BUtLDINQ DIVI1ION Phone: 503-718-2439 Fax: 503-598-1960 Tiigar utl ing ermits@tigard-or.gov FROM: ® Owner/144AT ❑ Applicant ❑ Contractor ❑ City Staff Check(1)one cREFUNjkR Name: INVOICE TO: (Business or Individual) !-4nna.L. `[�.t_ fur- Mailing Address: j czLo SG WG S1-; fay. S�fet.�' Sc,,ti A-103 _ City/State/Zip: P°4-k-1t:...el a( 9 7ZI(o Phone No.: cA.1 Ao. L454 K� C,FO �d b. �02 -If37 3 t PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): � Jh n�a�. d�` 'Ca.,,, • ANC ,L, Q,ID PERMIT APPLICATION. /.� REFUNb PE IT FEES (attach copy of original receipt and provide explanation below). • IN OR FEES DUE (attach case fee schedule and provide explanation below). Permit#: PLM LOW ' 00 0�.1 �G//'�- 20-20 �-0 Site Address or Parcel#: "I Wc,, S7s ,rt, iitt, Project Name: Subdivision Name: — Lot#: — EXPLANATION: -(tt o�.5„�P(..,,1 .; t was 01, .ftejf v,, dAe k4 Le 6.� Adaish ?Lai• _ ( t k iR,o1V tom►441 IP:)14 :w $ WrOok q1I AtiiNVi 1';}�„to OW 'I'1..�-�M,,.,.'I• -1IL rn)/k G1'.4 1Jr t.MPt 1-: 0 .Ksietu.#a 1..k L!k•, 1'6.. •Rt f ac, ) `b a`k:� hit. /l y d..�-tr.'� e�Ll/wr:le (Sae Cam.. S SLtie{ 'b yea 1—vt1+.04-:.f4 •'' htst 6•t,.04?"4L •.(,I~wf,`e.. -rt6 11Ks jk k/te t Signature: (ZARA c.cv Date: G.zs.Zo Print Name: jKo.kr# 1-414 M 27C.FO $11 S Refund Policy 1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of: • Any fee which was erroneously paid or collected. • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 80%of the application or permit fee for issued permits prior to any inspection requests. 2. All refunds will be returned to the original payer in the form of a check via US postal service. 3. Please allow 3-4 weeks for processing refund requests. FOR OFFICE USE ONLY Route to Sys Admin: Date /47 By Route to Records: Date 1 i` '� ByRefund Processed: Date ' Z Z By JO Invoice Processed: Date By Permit Canceled: Date ../ y9--. B •e Parcel Tag Added: Date By I:\Building\Forms\ReyPermitAction_12 518.doc 1111 Y • TIGARD City of Tigard February 11, 2021 Hannah The Pet Society 10526 SE Washington St, Suite A103 Portland, OR 97216 Re:Permit No. LM2020-00027c SWR2020-00036 Dear Applicant: The City of Tigard has processed a refund for overpayment of permit fees on the above referenced permit for the following: Site Address: 10164 SW Washington Square Rd Project Name: Hannah The Pet Society Job No.: N/A Refund: ►/ Check#238213 in the amount of$738.03. ❑ Credit card"return"receipt in the amount of$ ❑ Trust account"deposit" receipt in the amount of$ . Notes: Revised scope of work resulted in an overpayment of$42.03 on PLM2020-00027 and$696.00 on SWR2020-00036, for total refund of$738.03. If you have any questions please contact me at 503.718.2430. Sincerely, Dianna Howse Building Division Services Coordinator Enc. \sodding\RefunasM125tShWA ItB-4 !',,a,regon 97223 • 503.639.4171 TTY Relay:51H.684.2772 • www.tigard-or.gov 1,1 City of Tigard 1- GA D Accela Refund Request This form is used for refund requests of land use, development engineering and building permit application fees. Receipts, documentation and the Request for Permit Action form (if applicable) must be attached to this request form. Refund requests are due to Accela System Administrator by each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts Payable will route refund checks to Accela System Administrator for distribution to applicant. PAYABLE TO: Hannah The Pet Society DATE: 2/8/2021 10526 SE Washington St,A-103 Portland, OR 97216 REQUESTED BY: Dianna Ornelas TRANSACTION INFORMATION: Receipt#: 427811,427812 Case#: SWR2020-00036,PLM2020- 00027 Date: 1/21/2020 Address/Parcel: 10164 SW Washington Sq Rd Pay Method: CreditCard Project Name: Hannah Pet Society EXPLANATION: Per applicant's request as change in scope of work resulted in overpayment and sanitary sewer SDCs. Refund overpayment in full. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 2300000-43104 $Amount Cash Over 100-0000-48001 $696.00 Cash Over 100-0000-48001 42.03 TOTAL REFUND: $738.03 APPROVALS: SIGNATURES/DATE: If under$5,000 Professional Staff If under$12,500 Division Manager D. L. OrvleZc(4 If under$25,000 Department Manager If under$100,000 City Manager If over$50,000 Local Contract Review Board FOR ACCELA SYSTEM ADMINISTRATION USE ONLY Case Refund Processed: Date: /r�/ By: I:\Building\Refunds\RefundRequest.doc x 09/01/2010 CITY OF TIGARD RECEIPT 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Project Name: Hannah Pet Society Site Address: 10164 SW WASHINGTON SQUARE RD Receipt Number: 436271 - 09/04/2021 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PLM2020-00027 $-42.03 Total: $-42.03 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 238213 DHOWSE 09/04/2021 $-42.03 Payor: Hannah the Pet Society Total Payments: $-42.03 Balance Due: $42.03 Page 1 of 1 CITY OF TIGARD RECEIPT i N 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 T1t=yARL) Project Name: Hannah Pet Society Site Address: 10164 SW WASHINGTON SQUARE RD (9/UP47,7-1— Receipt Number: 427812 - 01/21/2020 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PLM2020-00027 Ejectors/Sump 230-0000-43101 $25.02 PLM2020-00027 Fixture/Sewer Cap 230-0000-43101 $50.04 PLM2020-00027 Floor Drain/Floor Sink/Hub 230-0000-43101 $50.04 PLM2020-00027 Hose Bib 230-0000-43101 $75.06 PLM2020-00027 Primer 230-0000-43101 $25.02 PLM2020-00027 Sink 230-0000-43101 $25.02 PLM2020-00027 Tub/Shower/Shower Pan 230-0000-43101 $12.51 PLM2020-00027 Water Closet 230-0000-43101 $25.02 PLM2020-00027 12% State Surcharge-Plumbing 100-0000-24001 $34.53 1 PLM2020-00027 Cash Over 100-0000-48001 $42.03 Total: $364.29 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 5966939 PUBLICUSERO 01/21/2020 $364.29 Payor: Total Payments: $364.29 Balance Due: $0.00 CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT r Permit#: PLM2020-00027 and OR 97223 503.718.2439 13125 SW Hall Blvd., Ti Z -�� Date Issued: 01/21/2020 T[car1J:.0i 9 Parcel: 1 S 135BA00102 Jurisdiction: Tigard Site address: 10164 SW WASHINGTON SQUARE RD Project: Hannah Pet Society Subdivision: OAKBURG Lot: 9 Project Description: 6/23/2020: REPRINT permit to revise scope of work: CAP(1)sink and(1)urinal;REPLACE(1)water closet;ADD (2)3"floor drains,(2)primers,(1)bath tub,(1)mop sink and(3)hose bibs. Contractor: KODIAK PLUMBING Owner: PPR SQUARE TOO LLC 12030 SE MT SCOTT BLVD PO BOX 847 PORTLAND,OR 97266 CARLSBAD, CA 92018 PHONE: 503-756-4696 PHONE: FAX: FEES Quantity Description Date Amount 1 ea Ejectors/Sump 01/21/2020 $25.02 Specifics: 2 ea Fixture/Sewer Cap 01/21/2020 $50.04 2 ea Floor Drain/Floor Sink/Hub 01/21/2020 $50.04 Type of Use: COM 3 ea Hose Bib 01/21/2020 $75.06 Class of Work: ALT 2 ea Primer 01/21/2020 $25.02 Type of Const: 1 ea Sink 01/21/2020 $25.02 Occupancy Grp: 1 ea Tub/Shower/Shower Pan 01/21/2020 $12.51 Stories: 1 ea Water Closet 01/21/2020 $25.02 1 12%State Surcharge- 01/21/2020 $34.53 Plumbing 42 Cash Over 01/21/2020 $42.03 Total $364.29 Required Items and Reports(Conditions) 'his 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 ssuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Itil:ty 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 r direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. :sued By: Permittee Signature: .Z.,5 4e 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. Pii Plumbing Permit Application l P ►'�-i PL144 21�o2C� --(�O(j Building Fixtures RECEIVED City of Tigard Received //-- �n III "I 13125 SW Hall Blvd.,Tigard,OR 97223 ��N 2 2020 Date/By: 1P Z'/kV Kee/ . Permit Net -i 20 -�2 2 Phone: 503.718.2439 Fax: 503.598.1960 Plan Review 'N / Date/By: Other Permit No.: /B l I G A It U Inspection Line: 503.639.4175 CITY OF TIGARD Date Read Internet: www.tigard-or.gov y y' Juris See Page 2 for RI I!I nINn nly!qnN., Notified/Method: DULES FEE* upplementallnformafion SCHE { TYPE OF WORK _ 0 New construction ❑Demolition For special information use checklist Addition/alteration/replacement 0 Other: Description Qty. Ea. Total New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONS ION SFR(1)bath 312.70 ❑ 1-and 2-family dwelling Commercial/industrial SFR(2)bath 437.78 ❑Accessory building 0 Multi-family SFR(3)bath 500.32 ❑Master builder Each additional bath/kitchen 25.02 ❑Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION g Site utilities: Job site address: /eV 694 kJ 81, /-x e t 1) 6®3 Catch basin or area drain 18.76 City/State/ZIP: /I" /'� � 9�j-- .�5 Footing ing d ain(line,ore trench drain Pageg 2 (� 7 T Footing drain(no.linear ft.: ) 2 Suite/bldg./apt.no.: Project na 1I4A/A It / l J t ' G' i Manufactured home utilities 50.03 Cross street/directions to job site: 04 ; JA, _ pp Manholes 18.76 4 �,tc' , it [)L' I,(�j'�' s4- Rain drain connector 18.76 t�� it ^ f Sanitary sewer(no.linear ft.:_) Page 2 .!- (e 7 1 Sa 5 o i(PO Z 414,11 Storm sewer(no.linear ft.: ) Page 2 ,,a, d /2 BUJ'- Water service(no.linear ft.:_) Page 2 Subdivision: JLot no.: `/ c Fixture or item: Tax map/parcel no.:Y E,tV Je 7 t4-05 c`'Zd$'ca Backflow preventer 31.27 DES 't i : , Backwater valve 12.51 - `j 16 ie1/40/�5 (P j s�s � D �IA/4 Clothes hewasher 25.02 5+ 'K.f.�/� p IG• Dishwasher 25.02 ,t7 It 1448 Q)'r-�' id i fia/Iip Drinking fountain 25.02 Ejectors/sump 1i / 25.02 0 PROPERTY OWNER j ,' s. , Expansion tank ,' , �µ 12.51 Name: r`/J�41,,t1 CJgIA L Fixture/sewer cap , 25.02 Address: L'►/ Floor drain/floor sink/hub .y` a, 25.02 !6/6'V 5�. 1 G�,s l SA)Sow" _ Garbage disposal 25.02 City/State/ZIP: Ti��P d d( (i'2 2 _ _ !! )./Hose bib ,. 3 25.02 Phone:( .,3) 5 b2 -`>/3 7. I Fax: - ) it- .2 ci;`. Ice maker 12.51 0 APPLICANT ❑ CON'tACT PIEtt, Interceptor/grease tra P 25.02 Business nat./ (j� Medical gas(value:$ ) Page 2 Contac aWie � � �� g Y Primer e 12.51 Address: a P O E m i t 12. 4 5, ( A_ ) . tt-(- ,�� Roof drain(commercial) 12.51 --t: JJ 1 p k C7 t - /l a i'� f -t-- 1 l S t t<i! Sink/basin/lavatory 25.02 City/State/ZIP: I. Solar units(potable water) 62.54 Phone: Tub/shower/shower pan 12.51 ( ) 1 Fax :,/� {� (�� (� E-mail: Q'1-t• C�," "J� C� Tt& i 6' tu -St`CL"- Urinal I 25.02 CONTRACTOR Water closet t/' 1 25.02 Business name: U ��Li i A' itA 3.` Water heater 37.52 � '�(n 14'(4:-. Water piping/DWV 56.29 Address: I lop `J ' A c,, f ,„i ' Other: �qq� S IN tt. I I I 25.02 City/State/ZIP: }-�-L� ^ , d LL fZt, q-O Subtotal Phone:(T03 1 .-e ,i§ :1l/ /-+t ei FaxV(tf7 �) 1°2? ci(5�.�! Minimum permit fee: $72.50 CCB Lic.: 1 g t i/ 6- Plumbing Lic.no.: Lt iq po Plan review (25%of permit fee) T`f' State surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE Print name: E�io lE 1.-.�& 4yi 4 3 Date: 1 This permit application expires if a permit is not obtained within 180 days / t"► L after it has been accepted as complete. i�O-I a.Ar f t �(J y�� CO/kC S T ' *Fee methodology set by Tri-County Building Industry Service Board. 1.\Budding'Permits\PL -PermitApp.docvl0/0l/ ` 440-4616T110/02/COM/WPR1 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 s'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 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 ❑ Any new commercial building with water service 2"and Bath: Tu ho' over greater,except systems designed and stamped by licensed acuzz irlpool engineer. Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure Drive as defined in OAR918-780-0040. Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities. Dishwasher: -Commercial ❑ 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. 0 v Floor Drain/sink: -2"a/02101! , e5e4 -3" hie j'�"`,` a' Isometric or Riser Diagram 4 ❑ 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 Mach./Refrig.Drains Comments regarding fixture work' Oil Separator(Gas Station) r� �� ±j_ Fah / �fit M C.4 je Rec.Vehicle Dump Station `[fj !� t Y t Shower: -Gang . jX/i-irJf`ll% lAftr 1 !Lt.k b P tve IA AL. -Stall fy�n (� �� , Sink: Lav/Bar non-food related / py _ (�o P-Ditc,4{qGj / 116 -Bradley or �00 Z(1 ?i 11' (i3 ,;J/3 6 -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 Water Extractor fees assessed for the sewer increase must be paid before the Water Closet-Toilet plumbing permit can be issued. Urinal Other Fixtures: 1:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2 t F PL2020-00027 S R2020-00036 - Hannah Pet Society - 10164 SW Washington Square Rd Bob Logan Thu 6/25/2020 2:06 PM Sent Items To:TigardBuildingPemits@tigard-or.gov <TigardBuildingPemits@tigard-orgov>; ccVernie Santos <vernie@flagassistgolf.com>; kodiakplumbing@comcast.net <kodiakplumbing@comcast.net>;Chrys Barklow <Chrys.Barklow@hannahsociety.com>; 2 attachments (805 KB) SKM_C65920062315540.pdf; permit application refund request.pdf; Dear City of Tigard Building Department, Please find attached a Request for Refund related to permit #: PLM2020-00027, along with supporting documentation. Please call or write if you have any questions or need additional information. Thank you for your assistance, Bob Logan, CFO Hannah The Pet Society mobile: 503.502.4373 From: robert logan <robert.l@arsrig.com> Sent:Thursday,June 25, 2020 1:08 PM To: Bob Logan Subject: Fwd: PLM2020-00027 &SWR2020-00036- Hannah Pet Society- 10164 SW Washington Square Rd Sent from my iPhone Begin forwarded message: From: Vernie Santos <vernie@flagassistgolf.com> Date:June 24, 2020 at 6:07:39 AM PDT To: robert logan <robert.l@arsrig.com> Subject: Fwd: PLM2020-00027&SWR2020-00036- Hannah Pet Society- 10164 SW Washington Square Rd Here is paper work from City of Tigard with a Refund Request form please fill out form and they will return $738.03 to you for overpayment of original permit fees. Vernie Santos Begin forwarded message: From: Gail Santos<kodiakplumbing@comcast.net> Subject: Fwd: PLM2020-00027 &SWR2020-00036 - Hannah Pet Society- 10164 SW Washington Square Rd Date:June 23, 2020 at 6:40:10 PM PDT To: vernie.s@.arsrig.com CITY OF TIGARD PLUMBING PERMIT 1111 a COMMUNITY DEVELOPMENT Permit#: PLM2020-00027 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/21/2020 Parcel: 1S135BA00102 Jurisdiction: Tigard Site address: 10164 SW WASHINGTON SQUARE RD Project: Hannah Pet Society Subdivision: OAKBURG Lot: 9 Project Description: 6/23/2020: REPRINT permit to revise scope of work: CAP(1)sink and(1)urinal; REPLACE(1)water closet;ADD (2)3"floor drains,(2) primers,(1)bath tub, (1)mop sink and (3)hose bibs. Contractor: KODIAK PLUMBING Owner: PPR SQUARE TOO LLC 12030 SE MT SCOTT BLVD PO BOX 847 PORTLAND, OR 97266 CARLSBAD, CA 92018 PHONE: 503-756-4696 PHONE: FAX: FEES Quantity Description Date Amount 1 ea Ejectors/Sump 01/21/2020 $25.02 Specifics: 2 ea Fixture/Sewer Cap 01/21/2020 $50.04 2 ea Floor Drain/Floor Sink/Hub 01/21/2020 550.04 Type of Use: COM 3 ea Hose Bib 01/21/2020 $75.06 Class of Work: ALT 2 ea Primer 01/21/2020 $25.02 Type of Const: 1 ea Sink 01/21/2020 $25.02 Occupancy Grp: 1 ea Tub/Shower/Shower Pan 01/21/2020 $12.51 Stories: 1 ea Water Closet 01/21/2020 $25.02 1 12%State Surcharge- 01/21/2020 $34.53 Plumbing 42 Cash Over 01/21/2020 $42.03 Total $364.29 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 OUNCZ___ifiert4t#_"".., by calling 503.232.1987 or 1.800.332.2344. Issued By: Permittee Signature: °T � C�77a, / C/ /�/ 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 EPg-" Pam` PL 2Oaa --OoO g Building Fixtures RECEIVED FOR OFFICE USE ONLY City of Tigard Received /- Z Permit Neal : u 13125 SW Hall Blvd.,Tigard,OR 97223 .J U N 2 2 2020 [Yale/By: tPf7J� -Q��2Plan Review Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.: T I G n R D Inspection Line: 503.639.4175 CITY OF T I G AR D Date Ready/By: 7uris: ® See Page 2 for Internet www.tigazd-or.gov n" ,1c17t 0: ' Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE El New construction ['Demolition For special Information use checklist Description Qty. I Ea. I Total Addition/alterationIreplacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRU ION SFR(1)bath 312.70 El1-and 2-family dwelling Commercial/industrial SFR(2)bath 437.78 ElAccessory building El Multi-family SFR(3)bath 500.32 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: l Ol& i t j „;,,,t /tt1 1i /w:.t 6--...1Catch basin or area drain 18.76 City/State/ZIP: 716 p L Drywe11,leach line,or trench drain 18.76 e14 N L , )Z 5 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: Projectna Ifa.tiAkth al At !s' Manufactured home utilities 50.03 Cross street/directions to job site: L )l'L A ,0 ��1.641 f?> Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.:_) Page 2 .x r' V!SA A 4.}-y(a 315 g 5 10o `� 4a02-,,s I Storm sewer(no.linear ft.:_) Page 2 `C ,, C,l`l/;? £.O If Water service(no.linear ft.:_) Page 2 Subdivision: C ""�' Lot no.: Fixture or item: Tax map/parcel no..V C^iit-fv le 7y1'1"15 Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 ` Clothes washer 25.02 •7tiV.1('j 2f1191ty2371104 ( f ti'ilk,.1- iy, ,, Dishwasher 25.02 2 44 L4/3 04 u ifJ tali*p Drinking fountain 25.02 Ejectors/sump ✓ / 25.02 0 PROPERTY OWNER ❑ TENANT Expansion tank 12.51 Fixture/sewer cap ✓ 25.02 Name: IJ4 /i.`e t'GA_•. t t_CL(J�� Address: l '/ C J Floor drain/floor sitlk hub y` a 25.02 J'Q 1&4 5 411. W:' '4pi GSA. P L t1 g:9.• Garbage disposal 25.02 City/State/ZIP: -TIG/'d1 1 O r2 7 2)..3 Hose bib .r 3 25.02 Phone:( ") ..j(7,'<-. - T'. 71..3Fax:(. ) ' Ice maker 12.51 APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 l Business na b- �- 1l Medical gas(value:$ ) Page 2 �`G ' ' /R 1 � Z It, c ^�zc ,c Primer ✓ a 12.51 8 _1 iLc Contac t:1 e: .�f C, f Q f e fM i t Pp R I t^i 5' p„A-vJ`-C-{ Roof drain(commercial) 12.51 Address: -4 I)t, ft.cre- jl f2 U t- �tXt- -tt .� I IS . Sink/basin/lavatory M b F' 25.02 City/State/ZIP: Solar units(potable water) 62.54 w R�� E.S�1plNttfi Phone:( ) l� �[.�-F�a/x�:: ) .C Tub/shower/shower pan ‘-'" i 12.51 E-mail: a-I Ci + t- " +v '-PE. i 1 Pil 1O- Urinal 25.02 Water closet ✓ , 25.02 CONTRACTOR Water heater 37.52 Business name: O L i � L Ltylt� � ir3 i N "1 (.. Water piping/DWV 56.29 Address: I �p 30 °J k. 4 t !)` s --4- �/,r� Other: J�,e9 �, r 25.02 City/State/ZIP: f l G it , t )l, 014. a�1�Oc?/;- ,-„`Lf Subtotal Phone:(;�p3 / 1�q1g q Fax:(fd)) n Z- cli45.../ _ Minimum permit fee: $72.50 CCB Lic.: 11g[f L_6 Plumbing Lie.no.: d 14 4pe Plan review (25%of permit fee) T`f State surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE Print name: V G laN le 1...r5� • 'I" Date: 0/%1 l 1,,(j This permit application expires if a permit is not obtained within l90 days 15 after it has been accepted as complete. 14-0d('a 1t .to i` �' cor---ca-sf.�af- •Fee methodology set by Tri-County Building Industry Service Board. I/Buddieg'Pernits� PermitApp.doc tam 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-l' 100' 50.03 0 to 2,000 _ $121.90 Footing drain-each additional 100' 37.52 2,OOl 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: Stonn&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 fast$5,000.00 and$1.52 for Other Ins ections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to p 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 Quantittj 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 El Any new commercial building with water service 2"and greater,except systems designed and stamped by licensed Bath: Su hoover ,' 414jelfe*I' engineer. acuzzr rrlpool Car Wash: -Each Stall El New exterior plumbing site utilities for any complex structure Drive Tall as defined in OAR918-780-0040. ElCuspidor Water Aspirator Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial ❑ 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" 000f/ 3" nt6ny%'`k Isometric or Riser Diagram ❑ 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 Mach./Refrig.Drains Comments regarding fixture work: Oil Separator(Gas Station) _ d 1 . /, 4_ k Fah (- ,�I& iQ�s1;j Rec.hoVehicle Dump Station XL r c,'r`L`" i-tryl �.e l,f r- i i 15 it kr i AA Shower: -Gang .-� 1 �7 r- -Stall ir-is" • /L� 5��/y� Sink: -LavBar non-food related / / e Of"f "• 4 6"" i 4 1 pc,yin5 CC Bradley _ s /� n0 SFrb062-714_4.4 Y yii(37 iAJ//�(J(� -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 it plumbing permit can be issued. Urinal / - Other Fixtures: - I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 Accumulative Sewer Tally • e Tenant Name: ITANN:IH PET IE SWR# 2020-00036 REVISED Site Address: 10164 SW WASHINGTON SQUARE RD PLM# 2020-00027 TIGARD Parcel#: 1S135BA00102 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 1 4 1 4 -Jacuzzi/Whirlpool 4 0 0 0 0 0 Car Wash: -Each 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 0 0 2 4 2 4 -3 inch 5 0 0 0 0 0 -4inch -6 0 0 0 0 0 -Car Wash 6 0 0 0 0 0 Garbage Disposal: -Domestic(to 3/4 HP) 16 0 0 0 0 0 -Commercial(to 5 HP) 32 0 0 0 0 0 -Industrial(over 5 HP) 42 0 0 0 0 0 Icc 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 0 1 2 1 2 0 0 -Bradley 5 0 0 0 0 0 -Com/Serv/Util-Food Related 3 0 0 0 0 0 Swimming Pool Pilter 1 0 0 0 0 0 Washer-Clothes 6 0 0 0 0 0 Water Extractor 6 0 0 0 0 0 Water Closet-Toilet 6 0 0 0 0 0 Urinal 6 0 1 6 0 -1 -6 Previous EDU Count 0 0 Capped EDU Credit 0 TOTALS 0 0 2 8 4 10 2 2 Current Fixture Value 2 divided by 16= 0.125 Current EDU 1 EDU= $5,800.00 Previous Fixture Value 0 divided by 16= 0.000 Previous EDU Change 2 divided by 16= 0.125 over (under) $ 754.00 Enter EDIT Change Here 0.130 *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: Authorized Name/Signature: Dianna Omelas Date: 6/23/2020 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 he submitted to the City of Tigard Building Division to redeem credits towards future system development charges. I:A Building\Sewer Tally\SewerTallyShect_5800_070119.xlsx CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit#: PLM2020-00027 Date Issued: 01/21/2020 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S135BA00102 Jurisdiction: Tigard Site address: 10164 SW WASHINGTON SQUARE RD Project: Hannah Pet Society Subdivision: OAKBURG Lot: 9 Project Description: Interior plumbing:Adding (2)3"floor drains; Replacing (5)sinks, and(1)water closet; Installing(4) hose bibs and (2)primers. Contractor: KODIAK PLUMBING Owner: PPR SQUARE TOO LLC 12030 SE MT SCOTT BLVD PO BOX 847 PORTLAND, OR 97266 CARLSBAD, CA 92018 PHONE: 503-756-4696 PHONE: FAX: FEES Quantity Description Date Amount 2 ea Floor Drain/Floor Sink/Hub 01/21/2020 $50.04 Specifics: 4 ea Hose Bib 01/21/2020 $100.08 2 ea Primer 01/21/2020 $25.02 Type of Use: COM 5 ea Sink 01/21/2020 $125.10 Class of Work: ALT 1 ea Water Closet 01/21/2020 $25.02 Type of Const: 1 12%State Surcharge- 01/21/2020 $39.03 Occupancy Grp: Plumbing Stories: Total $364.29 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 t rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. Yo ma btain a copy of the rules or direct questions to OUNC by calling 503.232.1 r 1.800.332.2344. Issued By: `h Permittee Signature: -<. Call175 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 RECEIVED City of Tigard RE Received Date/By: t Permit No.: ',,�_b -7 g 13125 SW Hall Blvd.,Tigard,OR 97223 to 1 g020 �t uU �N `t• / 2 1 L Date/By:Review Other Permit No.: t IIIPhone: 503.718.2439 Fax: 503.598.1 N Inspection Line: 503.639.4175 - `" T I G A R I) r Ready/By: ® See Page 2 for TIGAR Date Read/B .runs: Internet: www.tigard-or.gov .ITY OF „ . Notified/Method: ". Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑ w construction l ❑ Demolition For special information use checklist. Description Qty. Ea. Total Addition/alteration/replacement 0Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRylION SFR(1)bath 312.70 ❑ 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 buildingSFR(3)bath 500.32 ❑Accessory ❑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: Catch basin or area drain 18.76 �a/ 4I' Lt �c-:�//ilt�t�'rrv/ r Drywell,leach line,or trench drain 18.76 City/State/ZIP: -7 7'q,,,' ae, 972,3 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: Project name: axis y� ti-0C;f f Manufactured home utilities 50.03 Cross street/directions to job site: / tib i Manholes 18.76 2:fr� / Z( Rain drain connector 18.76 / ! o s�Y . -)Cr 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.: (5( 4 i t 0, Backflow preventer 31.27 Backwater valve 12.51 �J �/� Clothes washer 25.02 '/-,-"I�51'Ir9 _" Weer9 ,'%e //#1 S 7)A- Dishwasher 25.02 7�#c c-f P�fc,rl,G 4 /a.Q,�`CGp,`Ls ,&iat ffe'l Drinking fountain 25.02 7._ 71 't' r3 l/1 /.Z de )_S ..cr c (l'. .7 4 pec ,r/� fi Ejectors/sump 25.02 0 PROPERTY OWNER 0 TENANT Expansion tank 12.51 Name: Fixture/sewer cap 25.02 Floor drain/floor sink/hub g 25.02 Address: Garbage disposal 25.02 City/State/ZIP: Hose bib V 25.02 Caj.t jI Phone:( ) Fax:( ) Ice maker 12.51 0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Business name: Medical gas(value:$ ) Page 2 ._A-_ « ) a Contact name: Primer 12.51 5'.,0a- Roof drain(commercial) 12.51 Address: Sink/basin/lavatory 5 25.02 j , I() City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax::( ) Tub/shower/shower pan _ 12.51 E-mail: Urinal 25.02 CONTRACTOR Water closet I 25.02 2C)•6,j-. ir, Business name: Fm. Water heater 37.52 rj �.t i'�?/J /� `dt e . Water piping/DWV 56.29 Address: /22 5� ,,w /,6,[ 44, Other: 25.02 City/State/ZIP: "/. �y� f� Subtotals Phone:(E)lc( ly c�'' / Fax:( )<� - Minimum permit fee: $72.50 �- CCB Lic.: 7. Plumbing Lic.no.:,^.y(Me Plan review (25%of permit fee) State surcharge(12%of permit fee) 3 O1, (� Authorized signature: -. TOTAL PERMIT FEE 30-1 dL.1 Print name: d---,40,fr 5--ipt„,,i, 7-/ � This permit application expires if a permit is not obtained within 180 days Date: 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) ,� „�� 4015 ►-"_:, , ) 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 ec Ins tions or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to p 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 fqr 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 ❑ 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 Car Wash: -Each Stall 0 New exterior plumbing site utilities for any complex structure as defined in OAR918-780-0040. -Drive Thru ❑ Medical gas and vacuum systems for health care facilities. Cuspidor/Water Aspirator Dishwasher: Commercial ❑ 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. Floc DraGsink: -2" 3" Isometric or Riser Diagram 4" ❑ 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) Rec.Vehicle Dump Station Shower: -Gang -Stall _ Sink: -Lav/Bar non-food related dt -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 J plumbing permit can be issued. • Urinal Other Fixtures: 1:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2