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Permit CITY OF TIGARD j PLUMBING PERMIT s COMMUNITY DEVELOPMENT .11111 3/3 /b Permit#: PLM2016-00096 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/01/2016 T t G A R D Parcel: 1S1260000300 Jurisdiction: Tigard Site address: 9610 SW WASHINGTON SQUARE RD G01 Project: The Walking Company Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S Project Description: Cap(1)drinking fountain. Relocate 1 restroom:(1)2"floor drain,(1)lay,(1)service sink&(1)water closet. Install (1)expansion tank,(1)primer&(1)water heater. 3/30/16:REPRINT permit to reduce scope of work to CAP(4) fixtures and ADD(1)expansion tank,(1)service sink,and(1)water heater. Contractor: WEST COAST CENTRAL PLUMBING LLC Owner: PPR WASHINGTON SQUARE LLC 12714 SE MAJESTIC LN PO BOX 847 HAPPY VALLEY, OR 97086 CARLSBAD, CA 92018 PHONE: 503-298-0435 PHONE: FAX: 503-855-3264 FEES Quantity Description Date Amount 1 ea Expansion Tank 02/29/2016 $12.51 Specifics: 4 ea Fixture/Sewer Cap 02/29/2016 $100.08 1 ea Sink 02/29/2016 $25.02 Type of Use: COM 1 ea Water Heater 02/29/2016 $37.52 Class of Work: ALT 1 12%State Surcharge- 02/29/2016 $21.02 Type of Const: Plumbing Occupancy Grp: 126 Cash Over 02/29/2016 $126.10 Stories: Total $322.25 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 OUNC by calling 503.232.1987 or 1.800.332.2344. "d./2Issued By: /� Permittee Signature: ea/s/ /I"r.°G/ P,9 770 if 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. CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit#: PLM2016-00096 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/01/2016 Parcel: 1 S 1260000300 Jurisdiction: Tigard Site address: 9610 SW WASHINGTON SQUARE RD G01 Project: The Walking Company Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S Project Description: Cap(1)drinking fountain. Relocate 1 restroom:(1)2"floor drain,(1)lav,(1)service sink&(1)water closet. Install (1)expansion tank,(1)primer&(1)water heater. Contractor: WEST COAST CENTRAL PLUMBING LLC Owner: PPR WASHINGTON SQUARE LLC 12714 SE MAJESTIC LN PO BOX 847 HAPPY VALLEY, OR 97086 CARLSBAD, CA 92018 PHONE: 503-298-0435 PHONE: FAX: 503-855-3264 FEES Quantity Description Date Amount 1 ea Expansion Tank 02/29/2016 $12.51 Specifics: 5 ea Fixture/Sewer Cap 02/29/2016 $125.10 1 ea Primer 02/29/2016 $12.51 Type of Use: COM 1 ea Sink 02/29/2016 $25.02 Class of Work: ALT 1 ea Lavatories 02/29/2016 $25.02 Type of Const: 1 ea Water Closet 02/29/2016 $25.02 Occupancy Grp: 1 ea Water Heater 02/29/2016 $37.52 Stories: 1 12%State Surcharge- 02/29/2016 $34.53 Plumbing 1 ea Floor Drain/Floor Sink/Hub 02/29/2016 $25.02 Total $322.25 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 issu r i is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon i ity Notification Cent, . 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 OUNC a lin 32.1987 or 1.800.332.2344. Issued By: Permitt a Signature: Call 503.639.4175 by 7:00 a.m.for the next available i pection date. This permit card shall be kept in a conspicuous place on thejob ite until completion of the project. Approved plans are required on the job site at the time of each inspection. Plum_bin,g Permit Application Site Utilities RECEIVED City afTi and "Received oll 2 5 2016 i'emtil No. y 13125 SW hall Blvd-Tigard,OR 97 Plan Rcv;ctiv S Phone: 503.718.2439 Pax: 503.598.1 Date.'Hv. Chher Permit No.: gD �0 tQ • Inspection Linc: 503.639417 5 �1 t��L1 (kue Rcady%By- luris: BI See Page 2 for i Intcnret. wwtv.t;eard-nr.goy CITY F 1 fl , Nout'iedWohod: SunniomentalInformation TYPE O FEE* SCHEDULE ❑New consiruction ❑Demolition For special 11t orntoriun use check&t. Description Qlv. I Ea I Total Addition/alteration/replacement ❑Other: Ncw I-2-famil•dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 ❑ I-and 2-family dwelling -"Commercial/industrial SFR(2)bath 437,78 ❑Accessory building ❑Multi-family SFR(3)bath 500.32 Each additional bath/kitchen 25,02 ❑Master builder ❑Other: Fire sprinkler( sq.R.) Page 2 JOB SITE INFORMATION AND I..00ATION Site utilities: .lob site address: <" r C i� Catch basin or area drain 18.76 l� .u�t w t-G. s` Dtywell,Icach line,or trench drain 18.76 ' Fooling drain(no.linear I).: - ) Page 2 Suitc,"bldg./apt.no.: -TP Project narne: j t Q t k ,,-Vetl Manufactured home utilities- 50.03 ? Cross street/directions to job site: �. yr It Manholes 18.76 Rain drain connector 18,76 Sanitary sewer(no.linear ft.:_) Page 2 Storm sewer(no.linear Il.:_) Page 2 Water service(no.linear 11.:_) Page 2 Subdivision: 1-0111o.: Fixture or item: Tax nlep/parcel 110.. Backflow preventer 31,27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 Ze d' ti 4- (`: �y V Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ❑ PROPERTY OWNER ❑ TENANT Expansion tank ) 12.51 Name Fixntrc/sewer cap 25.02 I C Address: Floor drain/floorsink/hub ( 25.02 j C 41 Garbage disposal 25.02 City/State/ZII): Ilose bib 25.02 Phone:( ) Fax:( ) Ice maker 12.51 ❑ APPLICANT ❑ CONTACT PERSON Inlerceptor/grease trap 25.02 Business name: l j{ .,rif Medical gas(value:S_? Page 2 Contact narne: �y Primer 12.51 ) .971 J(,vI & .:..� tf't'ttC. Roofdrain(commercial) 12.51 Address: 'Q-1 C, V, s4 f, L.1 Sink/basin/lavatory 2- 25.02 SOc° City/StatcTZ11): ltc / ��t 2 L� �) Solar units(potable water) 62.54 Phone:( ) _c.:e Fax::( ) `1 ub/shower/shower pan 12.51 Urinal 25.02 L:-mail' i•=.CC. �t...�..b,.� r>.; yn(l,� .C=%��'1 - 1.� ^2• Water closet 25.02 CON"1'CACIOT Water heater 3252 Business name: Water piping/DWV 5629 Address: ).SG, Other: 25.02 City/State/%1P' Subtotal ^ j -- Phone:(('�, ) L<le, C Fax:( ) Minimum permit fce: $72.50 Plan review (25%of permit fee) CCS Lic.: Plumbing l.ic.no.: J� ? State surchttrge(12°/aofpermit fee) 14,.�G Authorized signature TOTAL PF,KMI-f FEE Print name: � 1 t fhis permit application expires if a permit is not obtained within 180 days k!l t.'t.�T r /�I,�� Dalt.: 0^, aner it has been accepted as complete. 'Fce methodology set by Tri-County Building Industry Service Board, I V3aildin�{:Pemri75+Pt.\TU permitApp dee la/dll09 4.1046167!IVjV('01.•1WE8) A I a 71". L-jo' 6:��r Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Su pression Systems: Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee: Footing drain-I" 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- Ise 100- 62.54 7.201 and greater $327.54 Sewer-each additional 100' 37.52 Water Service- Ist 100' 62.54 Medical Gas S stems' Water Service-each additional 100' 37.52 Valuation: Permit Fee: Storni& Rain Drain- I st 100' 62.54 $1.00 to 55.000.00 Minimum fee$72.50 Storm K Rain Drain-each additional 100' 37.52 $5,001.00 to S 10.000.00 $72.50 for the first$5,000.00 and$1.52 for Qty. f�ce(ea) 'total each additional 5100.00 or fraction thereof,to Other Inspections or Fees and including$10,000.00. Inspection of existing thumbing or for $10,001.00 to$25,000.00 5148.50 for the first 510,000.00 and 51.54 for which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof.to (minimurn charge-U2 hour) and including$25.000.00. Inspections outside of nornal business 90 001hr $25,001.00 to 550,000.00 5379.50 for the first 525.000.00 and 51.45 for hours(minimum charge-2 hours) each additional 5100.00 or fraction thereof,to Reinspection Fees 90 001i and including$50.000.00. Additional plan review for revisions 90.00/hr $50.001.00 and up $742.00 for the first 550.0(10.00 and$1.20 for (minimum charge-112 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". uantity by Fixtu Tvpe Plan Review for Plumbing Installations Fixture Type for Replace/ Work Performed: Capped Added Relocate plan review is required for any ofthc liollowing. Ba tistrv/Pont 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 -Tach Stall engineer. -Drive Thru ❑ New exterior plumbing site utilities liar any complex structure Cuspidor/Water Aspirator as defined in OAR918-780-0040. Dishwasher -Commercial ❑ Medical gas and vacuum systems for health can;facilities. -Domestic ❑ Any multipurpose tire sprinkler system. Drinking Fountain j ❑ Any complex structure as defined in OAR918-780-0040. 1-ye wash Floor Drain sink 2- 1 Submit 2 sets of plans with any of the above. 3.. 4" Isometric or Riser Diagram Car Wash Drain Garbage -Domestic-non-find Isometric or riser diagram is required for new buildings Disposal -Domestic-lbod related that meet the qualifications above. -Commercial-food related -Industrial-lbod related Ice Much./Refrig.Drains Oil Separator((;asStation) Comments regarding fixture work: Ree Vehicle Dunip Station Shower -Clang -Stall Sink,'Lan -Non-food related -Bradley _ -Commercial-food related -Service i Swimming Pool Fitter Washer-Clothes *Note: If the fixture work under this permit results in an water Extractor increase of sewer EDUs,a sewer permit will be issued and Water Closet•Toilet I fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. (Other Fixtures: Macintosh HD:Users:WCC 1)lumhing:Down loads:P1.MU_Perin itApp-3.du2 Accumulative Sewer Tally Tenant Name: The Walking Company ***CREDITS*** SWR# N/A Site Address: 96 10 SW Washington Square Rd PLM# 2016-00096 Parcel#: 1 S 1260000300 Fixture \:due Previous Previous Credits Gapped Fixture Fixture New New # \.clue count ca ed#s \aluc count added# added value total#s total values Ba tise /Font 4 0 0 0 0 0 Bath: -'IIub/Shower 4 0 0 0 0 0 -jacuzzi/Whirlpool 4 0 0 0 0 0 Car Wash: -1 ach Stall 6 1 0 0 1 0 0 0 -Drive through 16 0 0 0 0 0 Cuspidor/Water Aspirator 1 0 0 0 0 0 Dishwasher: -Commercial 4 0 0 0 0 0 Domestic 2 0 0 0 0 0 Drinking Fountain 1 1 0 1 1 1 0 -1 -1 Eye Wash 1 0 0 0 0 0 Floor Drain/Sink: -2 inch 2 0 0 0 0 U -3 inch 5 0 0 0 0 0 -4 inch 6 0 0 0 0 0 -Car Wash 6 0 0 0 0 O Garbage Disposal: Domestic to 3/4 HP). 16 0 0 0 0 (1 -Commercial to 5 HP 32 0 0 0 0 0 Industrial over 5 HP 42 0 0 0 0 11 Ice Machine/Refrigerator Dnnn 1 0 0 0 0 (1 Living Unit 16 0 0 0 0 0 Oil Se Gas Station 6 0 0 0 0 0 Rec.Vehicle Dump 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: -Lav/Bar-Non-Food Related 2 0 0 0 0 0 -Bradley 0 0 0 0 0 -Com/Serv/Utd-Food Related 3 0 0 0 0 0 Swimmin•Pool Filter 1 0 0 0 0 0 Washer-Clothes 6 0 0 0 0 0 Water Extractor 6 0 0 0 0 0 Water Closet-Toilet 6 0 0 0 0 0 Urinal 6 0 0 0 0 0 Previous EDU Count 0 0 Capped EDU Credit 0 TOTALS 0 0 1 1 1 1 1 0 1 0 1 -1 1 -1 Current Fixture Value -1 divided by 16= -0.063 Current EDU 1 EDU= $5,100.00 Previous Fixture Value 0 divided by 16= 0.000 Previous EDU Change -I divided by 16= -0.063 over (under) $ (306.00) Enter EDU Change Here -0.060 * *Round EDUs to the nearest 1/100th: a count ending in.005 shall be rounded up to.01,and a count ending in.014 or less shall be rounded down to.01. Notes: ***CREDITS*** Authorized Name/Signature: Debbie.\damski Date: 2/29/2016 Building Division Pl�ote: The property owner shall retain the ORIGINAL,sewer tally record. If credits exist,this document will serve as a voucher which must be ubmitted to the City of Tigard Building Division to redeem credits towards future system development charges. 1:\Buil ding\Sewer'Pally\Sewer f ally Shee t_5100_070115.xlsx 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 9610 SW WASHINGTON SQUARE RD G01, TIGARD, OR, 97223 Commercial - Plumbing 399 Plumbing ﬁnal PASS - No C of O PLM2016-00096 Don Sylvester Violation Summary: Inspector Contractor RECEIVED City of Tigard • COMMUNITY DEVELOPMENT (DEPARTMENT r Request for Permit Action MAR 3 0 2016 q CITY OF TIGARD 1.1(, p D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 ww\___KlialikaatNG DIVISION TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov FROM: ❑ Owner ❑ Applicant Contractor ❑ Cite Staff Check(V)one REFUND OR Name: INVOICE TO: (Business or Indiriduap e T- C(•)AV; C - . v Mailing Address: I Z-1 I' S17 01, -,s-es-s- .� I /� , il City/State/Zip: 't� _, �, V'Q2 4 `7700. Phone No.: 'j_Q_f`S-- `-2. I. - Ge3,0l b — PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): • , , VOID PERMIT APPLICATION. 2,0 REFUN ERMIT FEES (attach copy of original receipt and provide explanation below). ii 1 •ICE FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit #: r L 1/1/1 _ 3.000 Site Address or Parcel #: St vJ L,�, 5l„_l • � R4 ?Of . - o1 — 77223 '- Subdivision Name: Lot #: EXPLANATION: C LA-AIL 6 c Chi by Lv t Signature: ‘13 G.C. Date: -- c.)--I 6 Print Name: ?)6\p \\ `n \ 1�� Refund Policy (` `YO Cs �� c� G�` r'7'�Z I. The city's Community Development Director,Building()fticial or City Engineer may authorize the refund of: • .Any fee which was erroneously paid or collected. • Not more than 80°%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 80°'o of the application or permit fee for issued permits prior to any inspection requests. 2. .All refunds will be returned to the original payer in the form of a check via VS postal service. 3. Please allow 3-4 weeks for processing refund requests. Route to Sys Admin: Date By Route to Records: Date tf /3 %, By Refund Processed: Date 103/jf.., By Invoice Processed: Date By Permit Canceled: Date ,i// B; Parcel Tag Added: Date By I:ABuilding\Forms\Re JPennit.Actiun_II 231-t.duc TIGARD City of Tigard April 13, 2016 Central Plumbing Coast 12714 SE Majestic Ln Happy Valley, OR 97086 Re: Permit No. PLM2016-00096 Dear Applicant: The City of Tigard has processed a refund for overpayment of permit fees on the above referenced permit for the following: Site Address: 9610 SW Washington Square Rd Project Name: The Walking Company Job No.: N/A Refund: ® Check#220703 in the amount of$126.10. ❑ Credit card"return"receipt in the amount of$ ❑ Trust account"deposit" receipt in the amount of$ Notes: A change in the scope of work resulted in reduced permit fees. Refund overpayment of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, Dianna Howse Building Division Services Coordinator Enc. I:\Building\RefunOS AZ5u SW�o��l�IR ,lv ,�,p r��, g gon 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard-or.gov 111City of Tigard TIGARD Accela Refund Request This form is used for refund requests of land use, development engineering and building permit application fees. Receipts, documentation and the Request for Permit Action form (if applicable) must be attached to this request form. Refund requests are due to Accela System Administrator by each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts Payable will route refund checks to Accela System Administrator for distribution to applicant. PAYABLE TO: West Coast Central Plumbing DATE: 3/31/2016 12714 SE Majestic Ln Happy Valley, OR 97086 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt#: 402251 Case#: PLM2016-00096 Date: 2/29/2016 Address/Parcel: 9610 SW Washington Sq Rd Pay Method: CreditCard Project Name: The Walking Company EXPLANATION: Per applicant's request as the change in scope of work reduced fixture work resulting in a refund for overpayment of permit fees. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund` Example: Building Permit Fee • Example: 2300000-43104 `$Amount. Cash Over 100-0000-48001 $126.10 TOTAL REFUND: $126.10 APPROVALS: SIG_NATURES/DATE: If under$5,000 Professional Staff If under$12,500 Division Manager If under$25,500 Department Manager If under$50,000 City Manager If over$50,000 Local Contract Review Board FOR TIDEMARK SYSTEM ADMINISTRATION USE O Case Refund Processed: Date: Y/ /3 /- By: I:\Building\Refunds\RefundRequest.doc x 09/01/2010 INAccumulative Sewer Tally Tenant Name: The Walking Company ***CREDITS*** SWR# N/A Site.Address: 9610 SW Washington Square Rd PLM# 2016-00096 REVISION 1 TIGARD Parcel#: 1S 1260000300 Fixture Value Previous Previous Credits Capped Fixture Fixture New New # value count capped#s value count added# added value total#s total values Baptistry/I ont 4 0 0 0 0 0 Bath: -Tub/Shower 4 0 0 0 0 0 -Jacuzzi/Whirlpool 4 0 0 0 0 0 Car Wash: -I Stall 6 0 0 0 0 0 -Drive through 16 0 0 0 0 0 Cuspidor/Water Aspirator 1 0 0 0 0 0 Dishwasher: -Commercial 4 0 0 0 0 0 -Domestic 2 0 0 0 0 0 Drinking Fountain 1 0 1 1 0 -1 -1 Fye Wash 1 0 0 0 0 0 Floor Drain/Sink: -2 inch 2 0 1 2 0 -1 -2 -3 inch 5 0 0 0 0 0 -4 inch 6 0 0 0 0 0 -Car Wash 6 0 0 0 0 0 Garbage Disposal: -Domestic(to 3/4 IIP) 16 0 0 0 0 0 -Commercial (to 5 I IP) 32 0 0 0 0 0 -Industrial(over 5 I IP) 42 0 0 0 0 0 Ice I\lachine/Refrigerator Drain 1 0 0 0 0 0 Living Unit 16 0 0 0 0 0 Oil Sep(Gas Station) 6 0 0 0 0 0 Rec.Vehicle Dump 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: -Lav/Bar-Non-Food Related 2 0 1 2 1 2 0 0 -Bradley 5 0 0 0 0 0 -Com/Sere/Vtil-Food Related 3 0 0 0 0 0 Swimming Pool filter 1 0 0 0 0 0 Washer-Clothes 6 0 0 0 0 0 Water I Extractor 6 0 0 0 0 0 Water Closet-Toilet 6 0 1 6 0 -1 -6 Urinal 6 0 0 0 0 0 Previous 1?D1J Count 0 0 Gapped I?DU Credit 0 TOT.ALS 0 0 4 11 1 2 -3 -9 Current Fixture Value -9 divided by 16= -0.563 Current I':DU 1 EDU= $5,100.00 Previous Fixture Value 0 divided by 16= 0.000 Previous 1?DU Change -9 divided by 16= -0.563 over (under) S (2,856.00) Enter EDU Change Here -0.560 ' "Round I:DUs to the nearest I/100th: a count ending in.005 shall be rounded up to.01,and a count ending in.014 or less shall be rounded down to.01. Notes: ***CREDITS*** Authorized Name/Signature: Dianna I Iowse Date: 3/31/2016 Building Division Note: The property owner shall retain the(>RIGINAl.sewer tally record. if credits exist,this document will serve as a voucher which must be submitted to the City of Tigard Building Division to redeem credits towards future system development charges. I:ABuilding\Sewer Tally\Sewer'fallyShect_51U0_117111I5.xlsx