Permit CITY OF TIGARD PLUMBING PERMIT
11111
11 COMMUNITY DEVELOPMENT Permit#: PLM2015-00009
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/20/2015
Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9650 SW WASHINGTON SQUARE RD G15
Project: Ivivva Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Replace(1)toilet,(1)lay sink and(1)water heater. Add(1)new bar sink.
Contractor: CHARTER MECHANICAL CONTRACTORS INC Owner: PPR WASHINGTON SQUARE LLC
7940 SW HUNZIKER ST PO BOX 847
TIGARD, OR 97223 CARLSBAD, CA 92018
PHONE: 503-691-1700 PHONE:
FAX: 503-691-1717
FEES
Quantity Description Date Amount
1 ea Expansion Tank 01/20/2015 $12.51
Specifics: 1 ea Sink 01/20/2015 $25.02
1 ea Lavatories 01/20/2015 $25.02
Type of Use: COM 1 ea Water Closet 01/20/2015 $25.02
Class of Work: ALT 1 ea Water Heater 01/20/2015 $37.52
Type of Const: 1 12%State Surcharge- 01/20/2015 $15.01
Occupancy Grp: Plumbing
Stories:
Total $140.10
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 dire7,,,sr on s to • NC by calling 503.232.1987 or 1.800.332.2344.
Issued By: /, i io , I � / Permittee Signature: �jy O
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 Applic
Buildin g Fixtures CE1VEP FOR OFFICE USE ONLY
Received
Date/By: / /S �`
City of Tigard
Permit No.:Pa/ /S-4mo9
III M • 13125 SW Hall Blvd.,Tigard,OR 0 O 5 Plan Review
Phone: 503.718.2439 Fax: 503. 8.19 Date/By: Other Permit No.: .9p/s_erel
T IGARD Inspection Line: 503.639.4175 CITY OF TI ARD Date Ready/By: Suds. See Page 2 for
Internet: www.tigard-or.gov CITY Notified/Method: Supplemental Information
111'1 (W WORK DIVISION 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 312.70 SO
❑ 1-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78 0'
El Accessory building ❑Multi-family SFR(3)bath 500.32 ^R
Each additional bath/kitchen 25.02 l
VS
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2 Ct
94, JOB SITE INFORMATION AND LOCATION Site utilities: '53
Job site address:25 V Washington Square Rd.Space G 15 LI
-
Catch basin or area drain 18.76
City/State/ZIP:Tigard,Ore.97223 Drywell,leach line,or trench drain 18.76 00
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name:Ivivva Athletica 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: l Lot no.: Fixture or item:
Tax map/parcel no.: /'5/9aOd00 506 Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Replace(1)toilet,(1)lavatory sink and(1)water heater. Dishwasher 25.02
Add(1)new bar sink Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tank 1 12.51 12.51
Name:Macerich Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:11411 N.Tatum Blvd.
Garbage disposal 25.02
City/State/ZIP:Phoenix,AZ.85028 Hose bib 25.02
Phone:(602)953-6750 Fax:( ) Ice maker 12.51
® APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name:Charter Mechanical Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Rick O'Brien
- Roof drain(commercial) 12.51 ` 04
Address:7940 SW Hunziker St. Sink/basin/lavatory 2 25.02 5a
City/State/ZIP:Port.Or.97223 Solar units(potable water) 62.54
Phone:(503)691-1700 Fax::(503)691-1717 Tub/shower/shower pan 12.51
E-mail:rick.obrien @chartermechanical.com Urinal 25.02
Water closet 1 25.02 25.02
CONTRACTOR
Water heater 1 37.52 37.52
Business name:Charter Mechanical
Water Pip 1 m WV 56.29
Address:7940 SW Hunziker St. Other: 25.02 ia5-et4
City/State/ZIP:Portland,Or.97223 Subtotal 1.31
Phone:(503)691-1700 Fax:(503)691-1717 Minimum permit fee: $72.50
CCB Lic.:171657 $114 I i 1p Plumbing Lic.no.:BP8 Plan review (25%of permit fee)
State surcharge(12%of permit fee) /6.4
Authorized signature: /4e/r�(J TOTAL PERMIT FEE /Ye)./D
Print name:Rick O'Brien Date:1-16-15 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 Board.
11:1Building\Pennits\PLMU-PermitApp.doc 10/01/09 440-4616T(l0/02/COM/WEB)
Plumbins Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total q r'e Footage: Permit Fee:
Footing drain-1' 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 to 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 Systems:
Water Service-each additional 100' 37.52
Valuation: Permit Fee:
Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional I00' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 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 including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 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*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ Plan review is required for any of the following.Performed: Capped Added Relocate q Y g•
Baptistry/Font Please check all that apply.
Bath Tub/Shower ❑ Any new commercial building with water service 2"and
Jacuzzi/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" Submit 2 sets of plans with any of the above.
-3"
Car Wash Drain Isometric or Riser Diagram
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./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station (1)new bar sink for employee breakroom
Shower -Gang Replacing(1)existing toilet
-Stall
Sink/Lav -Non-food related 1 1 Replacing(1)existing lavatory sink
-Bradley Replacing(1) 10 gallon water heater
-Commercial-food related Adding(1)thermal expansion tank
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes un P
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet 1 fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures: 1
S:\service\Customers\R Miller Inc\Ivivva @ Washington Square\Tigard plumbing permit.doc