Permit p r in-td
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2009 -00126
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/22/2009
Parcel: 1 S 1260000300
Jurisdiction: TIGARD
Site address: 9751 SW WASHINGTON SQUARE DR D01
Subdivision: Lot: 0
Project: Signature Day Spa
Project Description: Install (1) backflow, (1) clothes washer, (8) 2" floor drains, (1) pnmer, (4) service sinks, (1) lay,
and (1) w/c
Owner: FEES
PPR WASHINGTON SQUARE LLC Quantity Description Date Amount
BY THOMPSON PROPERTY TAX SERVUCES,
2235 FARADAY AVE STE #0 1 ea Backtlow Prevention - 05/22/2009 $46 40
COM
PHONE: 1 ea Clothes Washer 05/22/2009 $16.60
8 ea Floor Drain/Floor Sink/Hub 05/22/2009 $132.80
Contractor: 1 ea Primer 05/22/2009 $16.60
MODERN PLUMBING 4 ea Sink 05/22/2009 $66.40
11120 SW INDUSTRIAL WAY 1 ea Lavatories 05/22/2009 $16.60
TUALATIN, OR 97062 1 ea Water Closet 05/22/2009 $16.60
1 12% State Surcharge - 05/22/2009 $37.44
PHONE: 503 - 691 -6166 Plumbing
FAX:
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $349.44
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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1 800.332.2344.
s.
Issued By: _4_1111L• • Permittee Signature: 0 I t ^ O
Call 503.639.4175 by 7:00 a.m. for an inspection that business day. U
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.
Oct. 9. 2009 12:22PM Modern Plumbing No. 6035 P. 1
Plumbing Permit Application
Building Fixtures l t 'O!.l l(. 1JSl ONLY'
City of Tigard Received Permit No
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
pi, YYl OO�i • 1.). b
g Plan Review
1 I ; Phone. 503.639.4171 Fax' 503 598 1960 Daily Other Permit No.
l'1 U A It la Inspection Line: 503 639.4175 Date Ready/By. - him ® See Page 2 for
Internet' www.tigard- or.gov Notr&ed/Method. Supplementallatormanon
' TYPE OF WORK FEE* SCHEDULE
[] New Construction 17 Demolition
for special information use checklist ~
Description I Qty, I Ea L Total
V Addition/alteration/replacement ❑ Other: 4 New 1- 2-family dwellings (includes 100 It for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
❑ 1- and 2- family dwelling aCommercial/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
— p (_ sq. ft ) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address. `I 15I 614 (.0 �S ky S 1 r Catch basin or area drain 18 76
"^ r ` ° 1 `l Drywall, leach line, or trench drain 18,76
City/State/ZIP: -- 1 ' c , j law., el 1)? 3 - Footing drain (no linear ft.: , ) Page 2
Suite/bldg./apt. ❑o.: project name: 51 a+ . m. ., s er... Manufactured home utilities 50.03
Cross street/directions t Manholes 18.76
Rain drain connector 18.76
` Sanitary sewer (no, linear ft.' ) Page 2
-_ — lP Storm sewer (no linear ft ' ) Page 2 _
—. Water service (no linear ft ) Page 2
Subdivision: Lot no.: Fixture or item: __
Tax map /parcel no.: Backflow preventer 2, 3127
DESCRIPTION OF WORK
Backwater valve 12.51
Clothes washer 25 02
?Iii Akbtir 0 f 1 rid. _ Dishwasher 25 02
Q tr Mt ¥ P, ) (5 u ) >1 Qom' Drinking fountain 25 02
'P(- fH Zoo 1 - t O 1 .. to Ejectors /sump 25 02
' ❑ PROPERTY OWNER ' I ' ❑ TENANT Expansion tank 12 51
_ Name: Flamm/sewer cap 25 02
Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25 02
City /State/Z1P; Hose bib 25.02
Phone. ( ) Fax. ( ) Ice maker 12.51
—
0 APPLICANT 1:1 CONTACT PERSON , , Interceptor /grease trap 25.02
Business name.
Medical gas (value: $ ) Page 2
Primer 12 51
Contact name:
Roof drain (commercial) 12 51
Address: Sink/basin/lavatory 2- 25 02
City /State/ZIP; Solar units (potable water) 62 54
r
Phone: ( ) Fax: : ( ) Tub/shower /shower pan 12 51
E-mail: - Urinal 25 02
Water closet / 25.02 .
CONTRACTOR
Water heater 37.52
Business name: 0' d e V/41. e I t � _ ,4 3 t " 9 ;v Water piping/DWV 56.29
Address: ) () S Y s E SL,, , l "1 Other. pQ . t e0 r ip __ t.lm, dS -. 3 25 02
City /State/ZIP: ' F L ) -' em .„ f i v. O v ''l-1 p Subtotal
Phone: (5 (cat k {u U :L , r I Fax: 6:03 ( r 9 I/ - 11 I 0 T e �: S') 11 e
CCB Lic.: VI ' 0 Plumbing Lio. no.3-G) as -„ os f n Lk � t�t z 1Q 1 / -
Authorized signature: / a t-tx_ CiL -t7, h _'
Print name: � 1 yr / � T ^ Date: /O .- 9 •�
This permit applicai....-. - .,. --_.- .
after it has been accepted as complete.
'Fee methodology set by Tri•County Building Industry Service Board.
t .\Hm!dmglPermits'PLMU- PennitApp doe 10/03/09 440-4616T00/02/COM/WEB)
CITY OF TIGARD PLUMBING PERMIT
"! �. - COMMUNITY DEVELOPMENT Permit #: PLM2009 -00126
Date Issued: 05/22/2009
T i GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639 4171 Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address:, 9751 SW WASHINGTON SQUARE DR D01
Subdivision: Lot: 0
Project: Signature Day Spa
Project Description: Install (1) backflow, (1) clothes washer, (8) 2" floor drains, (1) primer, (4) service sinks, (1) lay, and
(1) w /c.
Owner: FEES
PPR WASHINGTON SQUARE LLC Quantity Description Date Amount
BY THOMPSON PROPERTY TAX SERVUCES, 1 ea Backflow Prevention - 05/22/2009 $46 40
2235 FARADAY AVE STE #0 COM
PHONE: 1 ea Clothes Washer 05/22/2009 $16 60
8 ea Floor Drain /Floor Sink/Hub 05/22/2009 $132.80
Contractor: 1 ea Primer 05/22/2009 $16.60
SENA PLUMBING LLC 4 ea Sink 05/22/2009 $66.40
7274 NE STONEYBROOK ST 1 ea Lavatories 05/22/2009 $16.60
HILLSBORO, OR 97124 1 ea Water Closet 05/22/2009 $16.60
PHONE 503 - 484 -7715 1 12% State Surcharge - 05/22/2009 $37.44
FAX: Plumbing
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $349 44
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 -0100. You may obtain a copy of the rules
Issued By: 4 • r , / Permittee Signature: —
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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 RECEIVED
Building Fixtures FOR OFFICE USE ONLY ,,
r City of Tigard MAY 21 2009 Received Permit No
Date/By P♦' -Gtr , `.%
V 13125 SW Hall Blvd , Tigard, OR 97223 Plan Review
Phone 503 639 4171 Fax 503 598 196GI'f\( OF TIGARD Date/By Other Permit No lb 1 /
Inspection Line 503 639 4175
TI GARD BUILDING DIVISIO Date Ready /By Jun ® s See Page 2 for
Internet wwwtl and -or gov g g Notified/Method Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty I Ea I Total
Addition /alteration/replacement ❑ Other. New 1- 2- family dwellings (includes 100 ft - for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249 20
❑ I- and 2- family dwelling gi Commercial /Industrial SFR (2) bath 350 00
❑ Accessory building ❑ Multi - family SFR (3) bath 399 00
❑Master builder Each additional bath/kitchen 45 00
❑ Other:
Fire sprinkler ( sq ft ) Page 2
JOB SITE INFORMATION AND LOCATION
�
j , ) Site utilities
Job site address: _ Z- j C) J � 5 W , UV4,Sl�f/r0'i ,, 5 . f. 1 - o1Catch basin or area drain 16 60
City /State /ZIP • '� an d ' l ✓ 7 2 3` Drywell, leach line, or trench drain 16 60
JJ��
Footing drain (no linear ft ) Page 2
Suite/bldg. /apt. no I Project name: S yi a • ua pi I/ S,a
Cross street/directions to job site:
// Manufactured home utilities 110 00
Manholes 16 60
Rain drain connector 16 60
Sanitary sewer (no linear ft ) Page 2
Storm sewer (no linear ft _) Page 2
Subdivision: Lot no.: Water service (no linear ft _) Page 2
"Fixture or item
Tax map /parcel no.: Absorption valve 16 60
DESCRIPTION OF WORK - Backflow preventer T Page 2 W y0
Backwater valve 16 60
Clothes washer / 16 60 ) C„,(2)
Dishwasher 16 60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain ] 6 60
Ejectors/sump 16 60
Name: Expansion tank 16 60
Address: Fixture /sewer cap 16 60
City /State /ZIP: Floor drain/floor sink/hub V 16 60 I 2 , e
Phone ( ) Fax. ( ) Garbage disposal 16 60
A APPLICANT ❑ CONTACT PERSON Hose bib 16 60
Ice maker 16 60
Business name: .i ' It A 11 6,, )fUC74 ) /J Interceptor /grease trap 16 60
Contact name: wed Medical gas (value $ ) Page 2
Address: I f�4/ 8 5 E p?- / Primer / 16 60
City /State /ZIP. per ii, „A � 9 723J Roof drain (commercial) 16 60
Phone (5D3) 66 4 /Uo Fax: (5 ) X65 6200 Sink/basin/lavatory 16 60 / • �;
/_ Tub /shower /shower pan 16 60
E-mail. Besse e CJ /dl /c�'i
a,,$fraL /i � 4, fit) ”) Urinal 16 60
CONTRACTOR Water closet / 16 60 / 6. 60
Business name: Se-NA- 4'LtJ ote, 1 A16- L._ /_L' Water heater 16 60
Address: _7274- /v( - STllt�'��eizeot -/� s"ft Other
/ f a U ® lZ � Subtotal
City/State /ZIP: ?)1a_00 o�- -00
F[ I
Minimum permit fee. $36 25
Phone. (9y3) 77/4- F ( ) / Resi dential backflow minimum permit fee $36 25
CCB Lie.: 17O (130 5. Is. t Plumbing Lic. no.: 73Q.e. - /,F13 p Plan review (25% of permit fee)
Authorized sign. r- AO "7 • %- kt 12 v State surcharge ( of permit fee) 37
TOTAL PERMIT FEE 3qq. 4�
Print name: � imp. / Date: 5791209 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tn -County Building Industry Service Board
I \Budding\P tsWLMF- PermitApp due 12/27/06 440- 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 - 1" 100' 55 00 0 to 2,000 $115 00
Footing drain - each additional 100' 46 40 2,001 to 3,600 $160 00
3,601 to 7,200 $220 00
Sewer - 1st 100' 55 00 7,201 and greater $309 00
Sewer - each additional 100' 46 40
Water Service - 1st 100' 55 00 Medical Gas Systems:
Water Service - each additional 100' 46 40
Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' 55 00 $1 00 to $5,000 00 Minimum fee $72 50
Storm & Rain Drain - each additional 100' 46 40 $5,001 00 to $10.000 00 $72 50 for the first $5,000 00 and $1 52 for each
Q ty. Fee (ea) Total additional $100 00 or fraction thereof, to and
Fixture or Item including $10,000 00
Commercial Back Flow Prevention Device 46 40 //(6 $10,001 00 to $25,000 00 $148 50 for the first $10,000 00 and $1 54 for
Residential Backflow Prevention Device each additional $100 00 or fraction thereof, to
(minimum permit fee $36 25) 27 55 and including $25,000 00
Rain Drain, single family dwelling 65 25 $25,001 00 to $50,000 00 1 $379 50 fordhe first $25,000 00 and $1 45 for
Inspection of existing plumbing or each additional $100 00 or fraction thereof, to
specially requested inspections - per hour 72 50 and and including first 0 00
Subtotal: p $50,001 00 d up $742 00 for the e first $50,000 00 and $1 20 for
2 7g'. F each additional $100 00 or fraction thereof
ixture Work: Plan Review for Plumbin g Installations
Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees *. ❑ Any new commercial building with water service 2" and
Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: Replace engineer
Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cuspidor /Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic
Drinking Fountain Isometric or Riser Diagram
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain sink 2" that meet the qualifications above.
3
- 4"
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach /Refrig Drains
Oil Separator (Gas Station)
Rec Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
I
- Bradley *Note: If the fixture work under this permit results in an
- Commercial increase of sewer EDUs, a sewer permit will be issued and
- Service � , fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes 1
Water Extractor •
Water Closet - Toilet
Urinal
Other Fixtures
\Bu iding\Perrmts\PLM- PernutApp doc 12/27/06