Permit •
Er CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00129
• Date Issued: 05/23/2012
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9681 SW WASHINGTON SQUARE RD C06
Project: Tesla Motors Subdlvlslon:VASHINGTON SQUARE ESTATES NO.. Lot: 108
Project Description: Relocate (1) lay, (1) water closet and (1) water heater for restroom.
Contractor: D & F PLUMBING Owner: PPR WASHINGTON SQUARE LLC
4636 N ALBINA AVE BY THOMSON PROPERTY TAX SERVICES
PORTLAND, OR 97217 ATTN HILARY RAYMOND
• 2235 FARADY AVE, STE 0
CARLSBAD, CA 92008
PHONE: 503 - 282 -0993 PHONE:
FAX: 503 - 288 -0604
FEES
Quantity Description Date Amount
1 ea Sink 05/23/2012 $25.02
Specifics: 1
ea Water Closet 05/23/2012 $25.02
1 ea Water Heater 05/23/2012 $37.52
Type of Use: COM 1 12% State Surcharge - 05/23/2012 $10.51
Class of Work: ALT Plumbing
Type of Const: 2 ea Fixture /Sewer Cap 05/23/2012 $50.04
Occupancy Grp: 0 12% State Surcharge - 05/23/2012 $6.00
Plumbing
Stories:
Total $154.11
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: d n e J� a7 „ /
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.
•
May 21 12 02:13p D 8t F PLUMBING CO 5032880604 p.2
Plumbing Permit Applica
Building Fixtures Cp /E FOR OFFICE USE ONLY
Received
Ili _ City of Tigard 144 21 2012 DrteBy:J /
u 13125 SW a . 1-2-* -- 1 • ... °Pt 20/02eV/A9 SW F all Blvd.. Tigard, OR 9 i� Plan Review
Phone: 503.718.2439 Fax: 503.5 'X
8.10 Dr.te/By: OlherPennitN Ra •
p ` r
Inspection Line: 503.639.4175 CITY OF TIGARD r BGl9'
TIGARD Date Ready.'Dy: j /�I�l la See Page 2 for
Internet: w\vw.tigard- or • , i • ' Nodfiei'Methe . '" A Supplemental Iafornmlion
TYPE OF WORK . ' ` • •..5 v4y FEE* SCHEDULPetVegola 00a
o New construction D Demolition / For special information use check list
Description I Qty. 1 Ea. I Totat
Addition /alteration/replacement ❑ Other: New 1- 2-Lamily dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION
SFR(1)bath 312.70
❑ I- and 2- family dwelling Wonlmercial /industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi- family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
476 Ay JOB SITE INFORMATION AND LOCATION Site utilities:
e address: "y Ad ilt Sl rn Catch basin er area drain 18.76
Job site
`� �`�� C- Drywcll, leach line, or trench drain 18.76
Ciq' /Sts :t /Z1P: 0 �" Footing drain (no. linear ft.: ) Page 2
Suite /bldg. /apt. no.. I Project name: TeSm M c 72/4S' Manufactured home utilities 50.03
Cro strcetidirec: ions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no. linear R: _ ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: Lot no.: Fixture or item:
Tax mapipareel no.: /sci. 300 Backtlow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
yr Clothes washer 25.02
/ f t7 i/' it :.•-t. l'v% r o ar. Dishwasher 25.02
AT A) , -A 49A/67 Drinking fou 25.02
Ejectors /sump 25.02
• CI PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02 sQ r or
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 . intercepter /grease trap I 25.02 I •
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 /sho\ver pan 12.51
Urinal 25.02
E -mail:
Water closet i i 25.02
CONTRACTOR Water heater / 37.52
Business name: r j, r PLr; M.15iAts' 1 ' Water piping/DWV 56.29 1
i
. Address: teL. N . A LOl,v A- Aev a Other: 25.02
.City,./State/ZIP: ror.4-I1A•• &it- q /Zf 7 Subtotal 87 SZ Phone: 1 r Fax: ( ) �crr-1i Minimam permit fee: $72.50
Plan review (25% of permit fee) ,.......•••""
,„0
" 449( C BLie.: .Q( � Plumhing Lie. no.: Z J
t,= 2> ea -
State surd:aree (12% of permit fee) /
Ai:thorized signature: ( ,/ �Q TOTAL PERMIT FEE 9?. 17
(I
This permit application eNtri if a permit is not obtained within 180 days
��
Print name: 1 t3 r
I Date: - � 1 2..- after it has been accepted iu com plow.
.Fee methodology set by Tr.- County Building Indusrry S -twice Board.
1 :18 y'Jkr
�rildinrauslP amii App d IC,OION 450- 45ICT(Io.02(C01V WED ) �` / S /1
/VE - & - & A9 CtoMP 4E-7--e /- "t c,e. -i6//V G /i LgES
May 21 12 02:14p D & F PLUMBING CO 5032880604 p.3
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:
Fooling 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 _
3,601 ID 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 Sems:
Water Service - each additional 100' 37.52 Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' 62.54
$1.00 to $5,000.00 Minimum fcc $72.50
Storm & Rain Drain - each additional 10-3' 37.52 $5,001.00 to $10,000.03 $72.50 for the first S5,00C.00 and SI.52 for
Other Inspections or Fees Qty- Fee (ea) ' Total each additional $100.00 or fraction thereof( to
11 and including 510,000 -00.
Inspection of existing plum bing cr for $10,001.00 to $25,000.00 5148.50 for the first $t0,000.00 and S1.54 for
which no tee is specifically indicated 90.00thr each additional $100.00 or fraction thereof, to
(minimum charge -1n- 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 S25,C00.00 and 51.45 for
hours (minimum charge - 2 hours) each additional $100.00 or fraction thereof, to
Rcinspection Fees 90.001hr and including $50,000.00.
Additional plan review for revisions 90.00 /hr $50,001.00 and up $742.00 for the first S50,C00.00 and $1.20 for
(minimum charge -12 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 * .
. .. Quantity by Fixture Type , - • Plan Review for Plumbing Installations
Fixture Type for Rent :lief Plan review is required for any of the following.
Vt'ork Performed: Capped Adde um Please check all that apply.
Baptistry /Font ❑ Any new commercial building with water service 2" and
Bath - Tub:Shower greater, except systems designee and stamped by licensed
- iactrt2ilWhirlpool
Stall Car Wass, -Cn :lt St engineer.
Drive tall ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator I as defined in 0AR918- 780 - 0040.
Dishwasher - Commercial ❑ Medical gas and vacuum systems for health care facilities.
- Domestic I ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918 780
Eye Wash
' Floor Drain/sink - 2" Submit 2 sets of plans with any of the above.
•3"
- . Isometric or Ris Diagram .
Car Wash Drain
Garbage Domestic - non - food ❑ Isometric or riser diagram is required for new buildings
Disposal - Domestic -food related that meet the qualifications above.
- Commercial -food related
- Industrial -food related _
•
Ice Mach.iRefrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehic:e Dump Station
Shower -Gang ,I4i
-Stall O v 1
• • Sink /Lav - Non•food related f �
- Bradley
-Commercial -food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer - Clothes
'.Water Extractor I ( increase of sewer EDUs, a sewer permit will be issued and
'r'aler Closet - Toilet fees assessed for the sewer increase must be paid before the
Uri:ial plumbing permit can be issued.
Other Fixn:res:
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