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Permit CITY OF TIGARD PLUMBING PERMIT I "! 8 COMMUNITY DEVELOPMENT Permit #: PLM2011 -00065 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/03/2011 Parcel: 151260000300 Jurisdiction: TIGARD Site address: 9502 SW WASHINGTON SQUARE RD J03 Project: Wetzels Pretzels Subdivision: WASHINGTON SQUARE MALL Lot: 0 Project Description: Interior Plumbing: capping (1) sink and (1) water closet. Contractor: MP PLUMBING CO Owner: PPR WASHINGTON SQUARE LLC PO BOX 393 2235 FARADAY AVE STE #0 CLACKAMAS, OR 97015 CARLSBAD, CA 92008 PHONE: 503 - 655 -9161 PHONE: FAX: 503 - 655 -1726 FEES Quantity Description Date Amount 2 ea Fixture /Sewer Cap 03/03/2011 $50.04 Specifics: 1 12% State Surcharge - 03/03/2011 $8.70 Plumbing Type of Use COM 22 ea Minimum Fee Adjustment - 03/03/2011 $22.46 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 0 C by calling 503.232.1987 or 1.800.332.2344. Issued By: , / Pe ittee Signatures v ' Call 503.63 . y 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 i I, g 66 ? - Building Fixtures , 1>1, (0 11, tt 1 1 1,•', , F311113; of T' and ' - Si SW Ha Blvd., Tigard, OR 97223 ifs I Pfau Review Phone: 503.718.2439 Fax: 503.598.1960 !]thee Permit No.: ° Inspection Lino: 503.639.4175 Date ed/bl may. �� l � Internet: www.tigard-or.gov Notified/blot/Lod: W 1' i ".{, lye,�ot�A r „�, .... ,,,��Ay Vi1�tr +��4 syr .c'l }} i �l p.h d• �'1 P J S,o ddi; f�i, >yt:l : :...... ` , >t 4 Cs r, , ,'' . �an'11T�,, r rNCd' A 7:04,4;�r1i�aelia..�3iXnrJ><?i' S�f l"i,�"w.'iCh�, „�n , �� � d r, '��` 'a'QO� �H19 a��`NNt�Op�.91 *;''a. (' G,.� cr ;.t,,;h• 0.;.� ! htireitt � tout '-r� �W n r , o New construction 0 Demolition "w I jwL,. , r • , .., K Dencri tun grailitlialli Total ii A ddition/alteration/replacement 0 Other: ri New 1- 2- family dwell! (includes 1(10 R. for each utility connection) Z i '+{ v"' is r. h '/ A1M�� r ' V0 { }l��utnr i a ��d Y 2 U. r,: �i�a .�,El`t��,i,q�:�d>riV!�xP!.., . ` A . r <Y4 ... . .... � r .P d .w. ..?�0;t. I t 7 r,u l; 312.70 a ` ❑ 1 - ald2- fishily dwelling C Commercial/industrial ❑ Accessory building ❑ Multi -family SFR (3) bath ©Maettr builder Each additional bath/kitoben 25.02 M. ❑ Other: Page 2 NM } i y. v. ; rgy�, a t A . - ;t, t Vii+ 1 VM:F °�EI7 ?E �N}��«.?1r� �7 _ A �`Sf cA'��0! , ^� j 1 1�h�r t � ��r � V sit. wild.: Job Catch basin or area drain site address: • , A ,p / ' , / Drywell, leach line, or trench drain 18.76 City/Stain/ZIP: . a - q ' - H oatinig dra (no. linear ft.: _ - ) Suite/bldg. /apt. no.: Project name: " 4 • • 0 .....0. Manufactured home utilities MO 50,03 Cross street/directions to job site: -'.. .. - - t l J ... 18.76 Rain drain connector 18.76 Sanitary newer (no, linear ft .: __ _ Page 2 Water service (no. linear R.: ) Paige 2 Subdivision: Lot no.: nature or 11am: Tax map/parcel no.: Backflow preventer IIIIIIIMEI t o » al Vvta 1�,.. !'" f" N S a�li�rrrl t:t'W -�.. i 12.51 l J,� .o��F ;; �"^ �,Xet�t,��s1�������' . "rts � ° �,'!' tir�� a�^a +3' r "'. a R,a�a+,.,,, ,�l,.rdx ,lli, 4�'ira: rr. "1�'1`i,�l? Clothes washer 25.02 EMI * R 1 >/• Dishwaehu 25.02 WM D fountain 25.02 25.02 IIIIIII ` �{ . 4 i� ' „ + r i 4r``g. ' .1y 1�* ,f'�! rqqn t 1 i ,a,y , pO�Sy� p y : i i •^ Expansion l tank 12.51 Name: Fixture/aewcr cap 25.02 Ilia Address: Floor drain/floor aink/hub 25.02 - .,. - ... W,..... Garbage diapoaal 25,02 _ City /State/ZIP; WerallielliMIE 25.02 Phone: ( ) ice maker 11.11111=111111111 � fY{ .`t. r11"K. r .x t1 �r .:Lsr tJ 1r'ri,*r . ^( t } r a "�• ..h.ai.2r..m. ::�:..� "o .., �, ls, 7t�111��, 1. u, � .�.�d1�9a��.,.a, " �,�x�LiN��4�n,� yGlfaOePlOr /gl'e8sch'ap 25.02 Business name: Medical gas (value: S _) IIIIIII Page 2 Primer 12.51 Contact name: Roof drain (commercial) MN 12.51 Address: Sink/basin/lavatory 25.02 MEM City/StatealP: Solar units (potable water) MU 62.54 Phonc: ( ) Fax:: ( ) Tub/shower /shower pan 11=1.11111. soda p urinal 25.02 E • 1 la p ∎ L r r b limo I1'Y\ a A .Sa'�p SrtiY ("r"/K "" ^Y r' / ittle,l�� ; a, 1. r'" A M1"F 6 h -:� ii! 1 .1 N If; Water closet 25.02 ..!Ky� >��r.•..t ' '; 't.- ,J S� n / di, r,a " • 1 u � : i ;.: r G.'t n.�' , ..• . ��r , tr., ° ' Water heater 37.52 �\ ►t• t\ Water piping/DWV 56.29 - Other: 25.02 NMI City/State/ZIP: / -_a. AA I b ` l IO Subtotal MUM Phone: ( - a Minimum permit fee: $72.50 ` s I ( , Plan review (25% of permit fee) r 0 �.c, Plumbing Lic. no.: Z - ( S . . ' Authorized signature: r.�. TOTAL PERMIT FEE , , . • / Date: NMI mi permit application mime If a permit le not obtairad within 110 drys after it has been accepted as caapkte. *Fey me hodoloa_v set by Tri'County Building Industry Service Board. IA llta '1diag1PamilaTIA.RLWerrnillyp.dno uvoutw 440- 4616T(1o1ov1coMtJWEn) Z d L6Lb6ZSOCCoN /90: I I '1S /LO: I I I IOZ a HVW(I1H1) Bu lgt Id dW WOHJ Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: "+� .�, .,fi��.("� �'lh,.,,,., a.,,., � r�� y !!lI IDS. '� ,. . , ` ]�e s gal - � 0 � �. � ��tixi.u'"31�'�r���s, hCi4An "�, �t"^, ��1� �N 4, Raj � -,,,! , i7 r 1r f . ,6 � Si 4f F., Footing drain - I 100' 50.03 0 to 2,000 $121.90 Footiteg drain • each additional to 3,600 3169.69 100' 37.52 3,601 to 7,200 $233.20 Sewer - 1st 100' 62.34 7,201 and greater $327.54 Sower - each additional 100' 37,52 Water Service - 1 et 100' 62s4 Medical Gas Systems: Wear Service - each additional 100' 37.52 Storm it Rain Drain 1st 100' 62.54 , : '''' yr o ,n. ��, t ' i� $1.00 to $5,000.00 Minimum fee $72.50 M u Storm & Rain Drain - each additional 100' . 37. $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for A, ' i "' w i,i � " h J ^ each additional $100.00 or fraction thereof, to „ ` y 1 . ?t i, �, u tiaa and including $10,000,00. Inspection of existing plumbing or for $10,001.00 to $25,000.00 S148.50 for the first 310,000.00 and $1.54 for which no fee is specifically indicated 90.004' (minimum charge —1/2 hour) each additional $100.00 or fraction thereof; to _ and including $25,000.00. $2 Inspections outside of normal business 90.00/hr 5,001.00 to $50,000.00 $379.50 for the fret 525,000.00 and $ 1.45 for hour ( _ minimum Chargt — 2 hours) each additional $100.00 or fraction thereof, to Reinspection Pecs 90.00/hr an d in cluding $so, 000.00 . Additional plan review for revisions - 90.00/hr ' $50,001.00 and up 5742.00 for the first 550.000.00 end $1.20 for (minimum charge — 1/2 hour) each additional $1000.o0 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'. lsbt eelai plan review is required for any of the followin g W� py , , . ,., W '‘y� t .. ' Added ...,tlelveele l , Please chock all that apply. Y Baptistry/Font Bath - Tub/She-wee . J ❑ Any new commercial building with water service 2" and -Jacuzzi/Whirlpool greater, except systems designed and stamped by licensed Car Wash - F.tach Stall engineer. - mow Thru . . ❑ New exterior plumbing site utilities for any complex structure Cuspidor/Water Aspirator ' as defined in OAR918- 780 -0040. Dishwasher - Commercial - _ ❑ Medical gas and vacuum systems for health care facilities. - Domestic © Any multipurpose fire sprinkler system. Drinking Fountain ' ❑ Any complex structure as defined in OAR918- 780 -0040. _ge Wash _ Floor Drain/aink - 2" Submit 1 sets of plans with any of the above. -3" Car Wash Drain Garbage - DomAStio -Wars -food .. ❑ Isometric or riser diagram is required for new buildings Disposal - Domestic related that meet the qualifications above. -Commercial —food related - Industrial-food related Ice MachlRerig. Drains Oil Seperetor (Gas Station) .. I Comments regarding fixture work: Rec. vehicle Dump Station Shower -Gang -Stall Sink/Lav -Non-food 'titled - Bradley . ... . _ - Cammeroial -food related -Service Swimming Pool Filter "Note: If the fixture work under this ermit results in an Washer - Clothes p Water Extractor increase of sewer EDUs, a sewer permit will be issued and Water Closet - Toilet . 1 fees assessed for the sewer increase must be paid before the Urinal - . plumbing permit can be issued. Other Fixtures: ' - http: / /www,tigard- or,gov/ city_ halUdepartmcnts /Cd/docs/PLMF- PenmitApr2doc 8 d L8Lvezeoe8 'oN /80 : L L ' 1S/ Lo : L L L LOZ 8 1VH(11H1) I3u I qun i d dH H0a 1 Accumulative Sewer Tally Parcel # 1S1260000300 Tenant Name: WETZELS PRETZELS This SWR# NONE Site Address: 9502 SW WASHINGTON SQUARE RD This PLM# PLM2011 -00065 Fixture Value Previous Previous Credits Capped Fixture Fixture N roc New # value capped off value added added total total count oft #s count ti value #> 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 - 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 0 0 0 - 3 inch 5 0 0 0 0 0 - 4 inch 6 0 0 0 0 0 - Car Wash Dm 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 Ice Machine /Refrigerator Drain 1 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 - Bar /Lavatory 2 0 1 2 0 -1 -2 - Bradley 5 0 0 0 0 0 - Commercial 3 0 0 0 0 0 - Service 3 0 0 0 0 0 Swimming Pool Filter 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 1 6 0 -1 -6 Urinal 6 0 0 0 0 0 Previous EDU Couni 0 0 Capped EDU Credit 0 TOTALS 0 0 2 8 0 0 -2 -8 Current Fixture Value -8 divided by 16 = -0.5 Current EDU 1 EDU = $ 4,100 Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU Change -8 divided by 16 = -0.5 over (under) $ (2,050.00) Enter EDU Change Here -0.5 Notes: ** *CREDIT* ** Authorized Name /Signature: BRANDEN TAGGART X2449 Date: 3/3/2011 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: \Building \Sewer Tally \SewerTallySheet- 4100.xls 07/01/10