Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2016-00019
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/20/2016
Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9779 SW WASHINGTON SQUARE RD D11
Project: Champs-Landlord Work Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Capping(1)lav 8(1)water closet.
Contractor: POWER PLUMBING CO Owner: PPR WASHINGTON SQUARE LLC
PO BOX 19418 PO BOX 847
PORTLAND, OR 97280 CARLSBAD, CA 92018
PHONE: 503-244-1900 PHONE:
FAX: 503-244-8825
FEES
Quantity Description Date Amount
1 ea Lavatories 01/20/2016 $25.02
Specifics: 1 ea Water Closet 01/20/2016 $25.02
1 12%State Surcharge- 01/20/2016 $8.70
Type of Use: COM Plumbing
Class of Work: ALT 22 ea Minimum Fee Adjustment- 01/20/2016 $22.46
Type of Const: Plumbing
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 C.dB
stions to NC by calling 503.232.1987 or 1.800.332.2344Iss Permittee Si nature: '
t O—`
Call 503.639.4175 by 7:00 a.m.for the next available ins tion data
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.
FEB-18-2016 06:45 From: l To:5035981960 Paze:112
Plumbing Permit Ann IVEP
P
Building Fixtures
City of Tigard JAN 19 2016 �„e„r /7/ /4,
Prime No,
13125 SW Hall Blvd-Tigard,OR 97223 plan R�.r W
Phtmc: $03.71 tl.2439 F41c1150 $�196DI�A�U 133WBy_ Other Bruit No. -
InspectionLine: 503.639
. t yr A ly,uea..ymn,,',r tea ® See Pa6e2for
Internet: vnvw.ngard NalfiedR.teah ^-^""' =2 IDfanaation
FEE- WITS �1LE
❑New constru'titm ❑Demoliffon for dd in Pmeamoe ars chrcklt
Dc. tion Ea. I Taal
Addilion(allrrationImplacement ❑other: New 1-2-fame dwvilings(mclutics 100 ft.for each utility connection)
• 'CATEGORY OF CgMTRTJCCION SFR(1)Nth 312.70 oy'
❑
I-and2-family dwelling CommerciallWustrial SFR(2)bath 437.78
SFR(3)Nth 500.32
❑Au smwybuilding ❑Multi-family
Each addilioul NaNkitchrn 25.02 O
❑
Master builder ❑OUter Q Firc spnnklc(_sq.ff.) Page 2 OSl
IOB FfCE.INFORM.4TION,A�1D'I.00KnON.. - Site utilities:
Job site address: 159,5_ 3W tL$h i n Catch basic or area dram K18.
Clty/Sta[eIZIP: 0 GI Z Drywedl,leach Imq or trench train
Fabling dram(no,coeur 0.:SuitP/bldgJapt,tlo.: IProject name: Manufacvord hc utilities Cross street/diretxiots tojds site: Manholes Rain drain connector Smilary sewer(Du.Imes ft.: )
Stnrm uwlx(no.linear ft,: Page 2
Water service(uu.li mem R.:__j Page 2
Subdivision: Lot M.: Fixture or Item:
TM map/parcel no.:
r/5� �(ad.�^JO Backnm preventer 31.27
"DESC1t�'flON OF'WORK? 'I t'
Backwater valve 12.51
r . ..' .' .. •-a ..: '. Clothes washer 25.(12
Dishwasher 25.02
Drinking fountain 25.02
Ejeciors/sump 25.02
❑'PROhkfpr;OWNE3t 13 TENW'. Expartainnunk 12.51
Name. Fixture/sewer cap 251)2
Flour drain floor sink/huh 25.02
Addrecs:
Garbage dispowl 25.02
City/Statc/7IP: Hosc bib 25.02
Phone:( ) Fax:( ) Icc maker 12.51
:a'APP,i:[CANx' . , :❑CORI kT-rERSONa :. Intcrccptor/gJrase trap 25,02
Business name: Medical gas(value:$_) Page 2
Prima
Contact name: Roofdnin(commorcial) 12.51
Address: Sink/basmrlivauuy 25.02 25.07
City/Sl w7W: Q 97.2 O e Solar units(poubk water) 62.54
Phone:(Sp3) a4 -/ Gd sp ) a4N-88zS Tub/shower/shower pan 12.51
E-mail: Unnal 25.02
CORACTORWater ckac 25.02 .D7
. a
22.
. � Water heater 37.52
11"i essname. POr�P.f- u�jyJ,fJ//7 Lp / Watcrpiping/DWV 56.29
Address: [Q[/ yfJ / PI'K A(./C. �l/l l--. a'c: 25.02
Cityisaw7.IP: D �(94K W, SabtoW $�.0
Phone:(-Q3) ;? N' 1,7,a Par:(SW 0(1N-88 •~ Minimum permit fee: $72.50 72.5D
CCB Lic.: SZ 37gPlumbing L;c.ro.: _
Plan review (25%of permit fx)
State surcharge:(12%o(Permit Ice) $.70
Authdmiaed signature: OX03 TOTAL PERMrr FEE
Print name: �„(,(•y'� C.05 Date: �$' �/O ThN Permr applindan exPiree lfapermagerr rbtrinrd rritM1in lfpl days
after It has Deem eoteped u ramplre,
'Fm axtbodotogy xt by TriCoway Building l dwsarySe."&mrd
I:\auiNiay4FnnuaDnlala-MvmilMp.rM 11WtaH a/Pd616T(IDOTKOM/WPa)
FEB-18-2016 06:45 From: To:5035981960 Pase:212I'
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities . Qq- 'Fee(a), 'To'al Square Footage: Permit Fee:
Footing drain-1.100' Sn.O; n to 2,000 f 121.VU
f-cooing dmhr-each additional 100' 37.52 2,001 to 3,600 5169,69
3,001 to 7,200 $233.20
Sewer-Ist 100' 62.54 7101 vnd ter1 $327.54
Sewer-each additional 100' 3752
Water Service-1 it I(V 62.54 Medical Gas S stems:
Water Service-each additional 100' 37.52 VtilllatlOn• 'Permit Fee:
Storm R Rain Drain-lel 100' 62.54 SMK)to$5.000.00 Minimum fee 372.50
Storm k Rain Drain-each additimal I(V 3752 $5,001.00 to$10,000.00 $7250 for the fust$5,000.00 and$152 for
Utber'/ the Qty. Fez fen) ` Total inch additional$100.(x)m fraction thereof.toIn§ OBd Or Fres, and including$lo,UW.00.
inspection of existing plumbing or for $10,001.00 to$25,000.0(1 $149511 fa the fust$10,000.00 and$154 for
which no flee is specifically iodiwind 90.0oft each additional$100.00 or fraction thereof,to
(miniwum charge-112 ham) and includinst 525,000.00,
Impectinaa-wide of normal business v0.00/hr $25,001.00 to$50,000.00 $379,50 for the first$25.000.00 and$1.45
ufa
hours(mman m char•e-2 haus) each additional$1(10.00 or tnctioo thereof.to
Remspacbm fern 90.00/hr and includ $50.000.00.
Additional plain review for revixions 90.00tIv $50.001.00 and up 5742.00 far the fins 550, . ab 5110 for
minimum char -1/2 hots) each additimal$1W.00 or fractiar Juueef.
%blow
Commercial Fixture Work:
Are you capping,adding or replacing Mures? If`yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result In increased sewer feesal.
Quantity by Fismre IMw Pier'Review for P,lumbiti 'Indtallationd
Rr .ork ., CavPlaW
� I :Added RReellackfe Plan review is required for any of the following.
Ba /Font Please check all that apply.
Bath -TublSbowcr ❑ Any new commercial building with water service 2"and
-7acuczi/Whir1l greater,except systema designed and stamped by licensed
Car Wash -Fach Stag engineer.
-Drive grin, ❑ New exterior plumbing site utilities for any complex stnrctu e
Cus iau/watcr Aspirator as defmcd in OAR918.780.0040.
Dishwasher -Cammemal ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system
Drinking Fountain ❑ Any complex structure M defrntetl in OAR918-780.0040.
E e Wash
Floor Dndrr/smk .2- Submit 2 Sets of plum with any of the above.
-an Wach Thain I
Csometric or Riser piin
Garbage -Domestic-noo-food Isometric Or riser diagram is required for new buildings
Disposal -Domestio-fwd related that meet the ualifiulti0n5 above.
-C:omaxacol-food related
-Industrial-fad related
Ice MsehJRciri ,Dram,
Oil Sep" (Gas station) Co�-smrllants regarding fixture work:
Rm.vehicle DumpStation IC2 o d i n A.vl C
Showa -Clang
-Stag
Sink/Lav -Non-fwd related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter eNote: If the fixtarc work tinder this permit results in an
Washer-Clothes
Water Extractor increase of sewer EMS,a sewer permit will be issued and
Water Closet-Toilct fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued-
Other Fixtures:
httpJ/www.tigud-or.gov/dmummL-mnter/Building/PLMff-Pcra itApp.dT
Accumulative Sewer Tally
'Tenant Namc: Champs "'CRI'.DI FS*" SWR# N/A
Sit,.\ddnss: 9779 SW Washington Square Pl At# 2016-00019
fared#: 1 S 1260000300
fixture Value Precious Precious Credits Capped Fixture Fixture New \C0.'
# value count ea ed#s caluc count added# added value total#s total values
Ba tis,rc/Dont 4 0 0 0 0 0
Bath: -Tub/Shon'cr 4 0 0 0 0 0
-)acu>zi/Whirl ool 4 0 0 0 0 0
Cat Wali: -Each Stall 6 0 0 0 0 0
-Drive throu gh 16 1 1 0 0 1 0 0 0
Cuspidor/Water Aspirator 1 0 0 0 0 1 0
Dishwasher: -Commercial 4 0 0 0 0 0
-Domestic 2 0 0 0 0 0
Drinking fountain 1 0 0 0 0 0
Fou Rash 1 0 0 0 0 0
floor Drain/Sink: -2 inch 2 0 0 0 0 0
-3 inch 5 0 0 0 0 0
-4 inch 6 0 0 0 0 0
-
(]at AC'ash 6 0 0 0 0 0
Garba gc Disposal:
-Domestic to 3/4 11I' 16 0 0 0 0 0
-Commercial to 5 111' 32 0 0 0 0 0
-Industrial over 5 IIP 42 0 0 0 0 0
Ice Machinc/lUri gerator Drain 1 0 0 0 0 0
Living Unit 16 0 0 0 0 0
Oil Sc (Gas Station) 6 0 0 0 0 0
R,c.\'hicl,Dom 1 station 16 0 0 0 0 0
Shower: -Gang (per head 1 0 0 0 0 0
-Stall 2 0 0 0 0 0
Sink:
-Lal/Bat-Non-FoodRdxted 2 0 1 2 0 -1 -2
-Bradlee 5 0 0 0 0 0
-Cum/Scry/lltil-Food Rdatcd 3 0 0 0 0 0
Swimnijiig Poul filter 1 0 0 0 0 0
Washer Cloth's 6 0 0 0 0 0
\C ater Fxtractor 6 0 0 0 0 0
\\'atrr Closet- I ,]let 6 0 1 6 0 -1 1 -6
Urinal 6 0 0 0 0 0
Pr,vious I:DICount 0 0
Cupp'd I{DU Cr,dit 0
"1'0I.ALS 0 0 2 8 0 0 -2 -8
Curront Fixture Valu, -8 divided be 16= -0500 Current f.DU 1 EDU = $5,100.00
Previous fixture A'ala, 0 divided be 16= 0.000 Pr,viuus FDU
(hang, -8 divided br 16= -0.500 Deer (under) S (2,550.00)
Enter EDU Change Here -0.500
'Round I':Dl's to the n,ar'st I/100th: a amnt ending in.005 shall b,rounded up to.01,and it count ending in.014 or less shall be rounded down to.01.
Notes: "Clil{DI'GC"-
Authorized Name/Signature: Debbie Adamski Date: 1/20/2016
Building Division
ote: "1'he pro(perty owner shall retain the ORIGIN \L sewer t:Jlp n•cnrd. If credits' exist,this donunent will serve as a voucher which must b,
'ubmirt,d to the in of'I'igard Building Division to redeem credits towards future scstem decclopment charges.
I'.\BuilJinq\Sevrr'I'allr\Sctcrr falkXhcn_i I I M I_U7i I I I isls�
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
9779 SW WASHINGTON SQUARE RD D11,
TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2016-00019
Don Sylvester
Violation Summary:
Inspector Contractor