Permit CITY OF TIGARD PLUMBING PERMIT
''1 a COMMUNITY DEVELOPMENT Permit #: PLM2012 -00280
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/26/2012
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9455 SW WASHINGTON SQUARE RD A15
Project: Things Remembered Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: Relocate existing fixtures. No change in EDU's.
Contractor: CASCADE PLUMBING CO Owner: PPR WASHINGTON SQUARE LLC
2416 N HAYDEN ISLAND DR PO BOX 847
PORTLAND, OR 97217 CARLSBAD, CA 92018
PHONE: 503 - 289 -7095 PHONE:
FAX: 503 - 283 -9514
FEES
Quantity Description Date Amount
1 ea Floor Drain/Floor Sink/Hub 09/26/2012 $25.02
Specifics: 1 ea Lavatories 09/26/2012 $25.02
1 ea Water Closet 09/26/2012 $25.02
Type of Use: COM 1 ea Water Heater 09/26/2012 $37.52
Class of Work: ALT 1 12% State Surcharge - 09/26/2012 $13.51
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $126.09
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 ' work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utili otification Ce ter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or irect questions to O C by calling 503.232.1987 or 1.800.332.2344. �1
I sued By: .4 ' � , ii Permittee Signat re:
4# '.NI/
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 APPlicatftE
Building Fixtures FOR OFI'ICE USE. ONLY
City of Tigard SEP 24 2012 I
Received etla.61 sob PermitNo.:
Date/lly.
IN ...- la 13125 sW Hall Blvd., Tigard, OR 91223 ,
I Phone: 503.718.2439 Fax: 503.5V114 TIGARD Pim Review
Date/Iy co Permit Notu A.1 ,a. oa 1
Inspection tine 503639.4175
: . -
T i (..-; itR D gtilLOINCI n'IllSiOr '' ' At s
o E s S upp" Pag lemen e tal 2 i
Internet www.tigard-orgov ' • • , : t NodfiediMethod: .
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0 New construction 0 Demolition For special Information use checklist
•Description I Qty. I Ea. 1 Total
0 Addition/alteration/replacement • 0 Other: New 1- 2-family dwellings (includes 100 ft. for each utility connection)
, •. : ';' , :f'::'•••••••••• - •••••::: 1 • ,. : '::•',:,.?!..?::ti0Eq.94Y.''9fic,9141,P3Pg1911.1;•,-i:t'i.4::••••••;•:,:t'.:•''.i,:',: 31230
0 1- and 2-family dwelling El commercial/industrial SFR (2) bath 437.78
- . - SFR (3) bath 500.32
• El Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
0 Master builder 0 Other: Fire sprinkler L Sq• ft) Page 2 ----
:..5: 4.44.7.4031:014.140.101t4RD.IiiMR10.0.ATIO,141:LI:... : r...„ . ..L : Site utilities: _ •
Catch basin or area drain 18.76
Job site address;,..95135 WASHINGTON SQ RD
Drywell, leach line, or trench draia 18.76
City/State/ZIP: TIGARD, OR ___- Footing drain (no. linear ft.: .....j Page 2
A.
SuitelbldgJapt no.: 1.4
ii I Project name: THINGS REMEMBERED _ 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.: 151 Als 000300 Backflow preventer 31.27
".' ''''''''' ''"i' a'a ,1 :'''''" • ' " • ''' '. '''-: ..V.:' . "Iikg;;;;L::.*: ii. _., - 'LI. '... .i.... Backwater valve 12.51
Clothes washer 25.02
relocate and install new fixtures -
Dishwasher 25.02
. .
Drinking fountain 25.02
-
Ejectors/sump
-- -- 25.02
• -
12.51
:.:• '. : : ':: alf • : • , . - --
.
Fixture/sewer cap 25.02
Name - Floor drain/floor sink/hub 1 25.02 25.02
Address:
Garbage disposal 25.02 --
City/State/ZIP: 'Hose bib 25.02
---
Phone: ( ) Fax: ( ) lee maker 12.51
. - --
: . 7 ... mi ... 2 5. 02
.:.:::-:•::::.:..iii.:i,;•,,,1.4.-PP14111PAVY,....,N,:...:,,42 ;, PERSON '.......:..:. inlereePtor/Srease trap -
Medical gas (value: S . ) Page 2
Business name: CASCADE PLUMBING CO
Primer 12.51 .
Contact name: CRYSTAL JONES Roof drain (commercial) 12.51
Address: 2416 N. HAYDEN ISLAND DRIVE Sink/basin/lavatory 1 25.02 25.02 ,
- -
City/State/ZIP: PORTLAND, OR 97217 Solar units (potable water) 62.54
Phone: (503) 289-7095 Fax: : (503) 283-9514 11lb/shower/shower pan 12.51 ,
Urinal 25.02
E-mail: CASCADEPLUM@YAHOO.COM
Water closet ' 1 25.02 25.02
. .
- • .•::•:::..""'FF'.:.;:"7: w atee heater 1 37.52 37.52 •
. - -
Business name: SAME AS ABOVE . Water piping/13W 56.29
- -
Address: Other. 25.02 •
- Subtotal 112.58
City/State/ZEP: Minimum permit fee: 172.50
Phone: ( ) Fax: ( ) ---------:----
Plan review (25% of permit fee)
CCB Lie.: 120893 Plumbing Lic. no.: 34-412PB - -
__Iipatni......2„.. _ State surcharge (12% of pennit fee) 13.51
Authorized signature: TOTAL PERMIT FEE 126.09
1 This permit applleadon expires if a permit la not obtained within 180 days
I name: CRYSTAL JONES I Date: after it Ina beeo accepted us complete.
*Fee methodology et by Td-County Building InduSby Service Board
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Plumbing Permit Application - City of Tigard •
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
S ite ,..: . ; , 9y , � �
tilthes..::. -• : • ..:- :.. _.. -:.. -,_ .•.. a.I... . : Total. � < .Square= Foo!tage:r._ .. .._
Footing drain - 1' 100' 50.03 0 to 2,000 $ 121.90
Footing drain - each additional 100' 37.52 2001 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 -1 oo' 6a.sa Medical Gas Systems:
Water Service - each additional 100' 37.52 :. .,= —�
• VaTllatll 0) 1: �;. �s..,_;:: �erII1I>�.�!ee:;:.:. :: -_:: •.::: -... .. .
Storm & Rain Drain -1st 100' 62.54 _ 51.00 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
each additional $100.00 or fraction thereof, to • Other,Iaspeciions or Fees : .:` ..... • • `'
• and including $10,000.00.
Inspection of existing plumbing or for S10,001.00 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 inciudu g 525,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to 550,000.00 5379.50 for the first $25,000.00 and $1.45 for
hours minimum c . : e - 2 hours) each additional $100.00 or fraction thereof, to
Reinspection Fees 90.00/hr and includ of $50,000.00.
Additional plan review for revisions 90.00/hr 550,001.00 and up $742.00 for the first $50,000.00 and $120 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 *.
.. o ... ,
-- ' "puaatity byFiiRui- e'IWlte P lips ll iii ri
the following.
.; ..�P1an=Rev><ew. or Tumbling; to a s:•. :�:_.:::.:
Work Performed: • . .. Cet pec Adder ''Relocate • Plan review is required for any of 11 wing.
Baptistry/Font Please check all that apply
Bath - Tub/Shower ❑ Any new commercial building with water service 2" and
dacum/Whirlpool greater, except systems designed and stamped by licensed
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 for health care facilities.
- Domestic - _ ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918- 780 -0040.
Eye Wash
Floor Drain/sink - 2" 1 Submit 2 sets of plans with any of the above.
-3
-
. ,: • sometae' :o rRilser?Disgir�;.w � - -��-�:
Car Wash Dram ❑ ' ... ..
Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food
��
Disposal - Domestic - food related that meet the qualifications above.
-Commercial -food related
- Industrial -food related
Ice MachJRefrig. Drains.
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dup Station
Shower -Gang
-Stall
Shtlt/Lav -Non-food related 1
- Bradley • _
.Commercial -food related .
- Service .. '
•
Swimming Pool Filter
Washer - Clothes *Note: If the fixture work under this permit results in an
Water Extractor . - increase of sewer EDU's, a sewer permit will be issued and
Water Closet - Toilet — t fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C :'Documents and Settings\Cascade PlumbinglMy Documents \Download.SPLMF- PermitApp.doc
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