Permit CITY OF TIGARD PLUMBING PERMIT
�° • COMMUNITY DEVELOPMENT Permit#: PLM2013 00274
T[G AR O 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/08/2013
Parcel: 1 S 1260000300
Jurisdiction: TIGARD
Site address: 9585 SW WASHINGTON SQUARE RD OFFICE
Project: Washington Square Mall Chiller Plant Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Backflow preventer for the replacment of(3)700T chillers,(3)cooling towers and(6)pumps
Contractor: MCKINSTRY COMPANY LLC Owner: PPR WASHINGTON SQUARE LLC
16790 NE MASON ST., STE. 100 PO BOX 847
PORTLAND,OR 97230 CARLSBAD, CA 92018
PHONE: 503-331-0234 PHONE:
FAX: 503-331-6907
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 08/08/2013 $31.27
Specifics: 1 12%State Surcharge- 08/08/2013 $8.70
Plumbing
Type of Use: COM 41 ea Minimum Fee Adjustment- 08/08/2013 $41.23
Plumbing
Class of Work: OTR
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 UNC 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 Application
Building Fixtures RECEIVE) TOI% OI I IC: : USE ONLY
City of Tigard AUG 2013 Received Tj t /3 4 Penait No/011-4,./0/3' -0Da°J5/
RI 13125 SW Hall Blvd.,Tigard,OR 97223 h1 l] Plan Review
w
Z Date/By:ew 1f�p2O/3�ef/73
Phone: 503.718.2439 Fax: 503.598.19 �p� DatelBy: Other Permit
T I G n It p Inspection Line: 503.639.4175 OF�Gt]l�l J e Ready/By: ) ': See Page 2 for
Internet: www.tigard-or.gov BUILDING DNISIO ttified/Method: � Supplemental Information
. • TYPE OF WORK FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist
Description I Qty. I Ea. I Total
0 Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
- - CATEGORY OF CONSTRUCTION' , . - SFR(I)bath 312.70
I-and 2-family dwelling SFR(2)bath 437.78
❑ y g ®CommerciaUindustrial
❑Accessory building ❑Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
El Master builder El Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:9585 SW Washington Sq Rd Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,WA 97223 Footing drain(no.linear ft.: ) Page 2
•Suite/bldg./apt.no.: I Project name:Chiller Plant Renovation 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.: Backflow preventer 1 31.27 31.27
• . _DESCRIPTION OF WORK - Backwater valve 12.51
Clothes washer 25.02
Install a new RPBP for chiller plant make-up water Dishwasher 25.02
Drinking fountain 25.02
•
Ejectors/sump 25.02
.0. PROPERTY OWNER - • I - -❑ TENANT Expansion tank 12.51
Name:PPR Washington Square LLC Fixture sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:9585 SW Washington Sq Rd Garbage disposal 25.02
City/State/ZIP:Tigard,OR 97223 Hose bib 25.02
Phone:(503)639-8865 Fax:(503)620-5612 Ice maker 12.51
. 0.APPLICANT . : 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:McKinstry Medical gas(value:$ ) Page 2
Contact name:Melisa Vasquez
Primer 12.51
Roof drain(commercial) 12.51
Address: 16790 NE Mason St Sink/basin/lavatory 25.02
City/State/ZIP:Portland,OR 97030 Solar units(potable water) 62.54
Phone:(503)407-8124 Fax: :(503)331-6907 Tub/shower/shower pan 12.51
E-mail:Melisag @mckinstry.com Urinal 25.02
CONTRACTOR • --• • .
Water closet 25.02
Water heater 37.52
Business name:McKinstry Water piping/DWV 56.29
Address: 16790 NE Mason St Other: 25.02
City/State/ZIP:Portland,OR 97030 Subtotali-
Phone:(503)407-8124 Fax:(503)331-6907 Minimum permit fee: $72.50 C '0'
CCB Lic.:172811 Plumbing Lic.no.:37-22PB
- Plan review (25%of permit fee) ,..--1417-15-----
1 / State surcharge(12%of permit fee) 0.70
Authorized signature: A�[� TOTAL PERMIT FEE -+39:f0�
Print name:Melisa asquez j Date:8-8-13 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service ard,_
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1: M/
itsTLMU-PennitApp.doc 10/01/09 440-4616T(10/02/COWEB)