Permit CITY OF TIGARD PLUMBING PERMIT
• COMMUNITY DEVELOPMENT Permit #: PLM2012 00070
-
T I CARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/03/2012 —
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9611 SW WASH INGTON SQUARE RD L03
Project: Jos A Bank Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: Capping (2) 2" floor drains; relocate (1) lay, (1) water closet and (1) water heater; install (1) new floor sink and (1)
backflow preventer for steam generator.
Contractor: CASCADE PLUMBING CO Owner: PPR WASHINGTON SQUARE LLC
2630 N HAYDEN ISLAND DR #3 BY THOMSON PROPERTY TAX SERVICES
PORTLAND, OR 97217 ATTN HILARY RAYMOND
2235 FARADY AVE, STE 0
CARLSBAD, CA 92008
PHONE: 503 - 289 -7095 PHONE:
FAX: 503 - 283 -9514
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 03/30/2012 $31.27
Specifics: 2 ea Fixture /Sewer Cap 04/03/2012 $50.04
1 ea Floor Drain/Floor Sink/Hub 03/30/2012 $25.02
Type of Use: COM 1 ea Lavatories 03/30/2012 $25.02
Class of Work: ALT 1 ea Water Closet 03/30/2012 $25.02
Type of Const: 1 ea Water Heater 03/30/2012 $37.52
Occupancy Grp: 1 12% State Surcharge - 03/30/2012 $23.27
Stories: Plumbing
Total $217.16
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 ApplicatiREC tV . I.
.G
Building Fixtures FOR OFFICE LISE ONLY
MAR 2 7 2012
Received IN
City of Tigard - 3 =- P erm N o. :
a n 131 SW Hall Blvd.. Tigard, OR 97 ,1 ev °�aF / �L '�O /°? -6007o
g OF TIGRD Pttn Review��� /2 �0st
Phone: 503.718.2439 Fax: 503.59 p an Re v Other Permit No.;
T I c: A P. n Inspection Line: 503.639 BU L !NG DIVISION Dare Ready /By: tya'y �° RI Seel'Page 2 for
Internet: www.tigard -or.gov Notified/Method; "I l Supp
TYPE OP WORK • . . FEE* SC EJU111; 84,e2O /a - DOa -
❑ New construction ❑ Demolition For special info'v' ##ion use &recklist
Description I • I Qty..1' I Ea. I Total
® Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includas 100 ft. Or each utility connection)
CATEGORY OF CONSTRUCTION .. SFR (I) bath I. 312.70
❑ I- and 2- family dwelling Egi CommerciaVindustrial SFR (2) bath I • 437.78
SFR (3) bath I . 500.32
❑ Accessory building ❑ Multi - family Each additional bath/kitchen 25.02
Q Master builder ❑ Other: Fire sprinkler (_. sq. ft.) P4P
JOB SITE INFORMATION AND LOCATION Site utilities: I l
Job site address: 9611 SW WASHINGTON SQ RD Catch basin or area drain I. 18.76
Drywall, leach line, or trench drain • 18.76
City /State/21P: TIGARD, OR Footing drain (no. linear ft.: ) 1 : Page 2
Suite/bldg./apt. no.: L-03 I Project name: JOS A BANK Manufactured home utilities ' 50.03
Cross street/directions to job site: Manholes I ; 18.76
Rain drain connector I :I. 18.76
Sanitary sewer (no. linear ft.; .,,,,.) : Page 2
- Storm sewer (no. linear ft.: ) 1 Page 2
Water service (no. linear ft.: _ Page 2
Subdivision: I Lot no.: Fixture or item: I I ' _
Tax map /parcel no.: Backflow preventer I '; 31.27 31.27
• DESCRIPTION • . 0r WORK • • . • " Backwater valve I : 12.51
Clothes washer • 25.02
• RELOCATE W /C, LAV & WATER HEATER Dishwasher • 25.02
ROUGH IN AND INSTALL NEW RP DEVICE FOR STEAM GENERATOR I.
Drinking fountain • 25.02
ROUGH IN AND INSTALL NEW FLOOR SINK Ejectors/sump 1 25.02
❑ PROPERTY.OWNER • I ❑, TENANT . . ... Expansion tank I j. 12.51
Name: Fixture/aewer ca 3 i V I .I 25.02 SO y de
Floor drain /floor sin ub fqG 1 j 25.02 25.02
Address:
Garbage disposal I I: 25.02
City /State/ZIP: Hose bib ( 25.02
Phone: ( ) Fax: ( ) Ice maker I I 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap I j 25.02
Business name: CASCADE PLUMBING COMPANY Medical gas (value: $ ) I ! Page 2
Contact name: SHANE FARLEY Primer I I 12.51
Roof drain (commercial) I I 12.51
Address: 2416 N. HAYDEN ISLAND DRIVE
Sink/basi avatory I 1 , ; 25.02 25.02
City /State/Z1P: PORTLAND, OR 97217 Solar units po le water) I I• 62.54
Phone: (503) 289 -7095 I Fax: : (503) 283 -9514 Tub /shower /shower pan :f 12.51 w
E -mail: CASCADEP1.UM(YAHOO.COM Urinal I j. 25.02
•
CONTRACTOR Water closet I 1 ;I 25.02 25.02
• Water heater I 1 I 37.52 37.52
Business name: CASCADE PLUMBING COMPANY Water piping/DWV I I: 56.29
Address: 2416 N. HAYDEN ISLAND DRIVE Othe I i 25.02
City /State/ZIP: PORTLAND, OR 97217 I .I Subtotal 143.85
Phone: (503) 289 -7095 Fax: (503) 283 -9514 Minim�un permit; fee: $72.50
6. 7-C .- CB Lic.: 120893 Plumbing Lic. no.: Plan rev (25 °rbofjpermit fee)
o ^ ) TOTAL PERMIT FEE 161.1 I
State s urcharge (12% olf permit fee) 17.26
Authorized signature: (2 9-0 N ✓
Print name: CRYSTAL.ION Date: This permit application expires if a ilermlt is not obtained within 180 days
�
r /y �� after it has been accepted as complete.
� � / n)L7' �t�ct14. � 'Fax methodology Sc, by Tri County Build Industry Service Board. s
1:11:1b; Id ing0P!nhifs\PLMU- PermitApp.d 0/01 440.4616T(10/07/COM/wEB) 7 ._5 . Q
£0 /Z0 3DVd 30VDSVO t'ZS6£8Z£05 h£:et ZZOZ /9Z /£0
:
Plumbing Permit Application - City of Tigard .
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression System$:
Site Utilities • Qty. Fee (ea) Total •• • ' Square FootUle Permit Fee:' - !
Footing drain - I" 100' ' 50.03 0 to 2,000 $121,90
Footing drain - each additional 100' 37.52 - 2.001 to 3,600 $169.69 I I
3.601 to 7,200 $23320 I _1 1
Sewer- 1st 100' 62,54 7,201 and _ •ter $327.54 I 1
Sewer - each additional 100' 37.52
Water Service- 1st 100' 62.54 Medical Gas Systems: ,
Water Service - each additional 100' 37.52 � .
'V alu a t i o n : .. Permit F ee; ? �
Storm & Rain Drain • 1st 100' 62.54 $1.00 to $5,000.00 Minimum fee $72150 .1: -
Storm & Rain Drain • each additional 100' 37.52 $5,001.00 to $ 10,000.00 $72.50 for the firs $5,000.00 and $1.52 for
action thereof, to
Other Inspections or Fees ' Fee (ea) Total ea ch additional $ 00 .00 or f and including $10000.00. I
Inspection of existing plumbing or for $10.001.0010 525.000.00 $148.50 for the fi' t $10,00000 and $1.54 for
which no fee is specifically indicated 90.00/hr each additional $00.00 or fraction thereof, to
(minimum charge - 1/2 hour) and including $2 ,000.00. 1.
Inspections outside of normal business 90.00/hr $25,001.00 to $50,000.00 $379.50 for the fist $25,000,00 and $1.45 for
hours (minimum charge - 2 hours) each additional $I 00.00 or function thereof, to
Reinspection Fees 90.00/hr and including 55(,000.00. a:
Additional plan review for revisions 90.00/hr $50,00 and up $742.00 for the fi 'st $50,000:00 and $1 for
(minimum charge - 1/2 hour) _ each additional $,00.00 or f thereof.
-
Subtotal:
I
.1
I :
Commercial Fixture Work: ,I.
Are you capping, adding or replacing fixtures? If "yes ", il
please indicate work performed by fixture. Failure to
accurate report fixtures could result in increased sewer fees * . :I
Quanti by Fixture Type Plain Review for Plu Ins
Fixture Type for Replace/ ,
review is required for any of the followin ,, .
Work Performed: Capped Added Relocate q g' 'I
Please check all that apply.
Baptistry/Font
Bath - Tub /Shower ❑ Any new commercial building wit water se!j. ice 2" and
/Whir 1 greater, except systems designed and stamp ' till by licensed
- ]aeuzzi Ipoo
Car Wash -Each Stall engineer.
-Drive 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 r health ,I c facilities.
- Domestic ❑ Any multipurpose fire sprinkler syStern.
Drinkin: Fountain ❑ Any complex structure as defined OAR9i - 780 -0040.
E c Wash
Floor Drain/sink - 2” ./?.„M I OM/71 l4 -I Submit Z sets of plans with ay of the above.
Drain Car Wash
Cl�' '' Isometric or Riser Diagirm • O Isometric or riser diagram is reiuired frig new buildings
Garbage - Domestic - non - food Disposal •Domestic-food related 1 j that meet the qualifications ab fie. .1 T
-Commercial-food related , 0 3 112, t I 1
-Industrial-food related
ice Mach/Rohl . Drains v 4.-pr .1 �C� g 1 s regarding fixture work::
(NS .arator (Gas Station) Roe. Vehicle Dum •Station -r .,
Shower -Gang 1 V
-Stall I I I 1:
Sinl /1.av - Non -food related 1 1 - Bradley
- Commercial -food related I .
- Service
Swimming Pool Filter +r [ his � '
*Note: If the fixture work under permit results in an
Washer - Clothes
- increase of sewer EDUs, a sewer permit will be issued and
Water Extractor
Water Closet - Toilet - I fees assessed for the sewer increa must of paid before the
-
Urinal plumbing permit can be issued -
Other Fixtures: '
C: \Documents and Settings \Cascade Plumbing\My Document s \Download2PLMF- PermitApp (1),doc
£0 /ZO 39dd 3a DSVD tIS6£8ZEOS 0£ :0t ZZOZ /9Z /£0
111 . Accumulative Sewer Tally
Tenant Name: Jos A Bank SWR # N/A
TIGARD Site Address: 9611 SW Washington Square Rd PLM # 2012 -00070
Parcel #: 1S1260000300
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: - 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 2 4 1 2 -1 -2
- 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 I-IP) 16 0 0 0 0 0
- Commercial (to 5 I -IP) 32 0 0 0 0 0
- Industrial (over 5 I-IP) 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:
- Lay/Bar - Non -Food Related 2 0 0 0 0 0
- Bradley 5 0 0 0 0 0
- Com /Serv/Util - Food Related 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 0 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0 ,
TOTALS 0 0 2 4 1 2 -1 -2
Current Fixture Value -2 divided by 16 = -0.1 Current EDU 1 EDU = $4,500.00
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -2 divided by 16 = -0.1 over (under) $ (450.00)
Enter EDU Change Here -0.1
Notes:
EDU CREDIT = .1
Authorized Name /Signature: Dianna Howse Date: 4/3/2012
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- 4500.xls 01/18/12