Permit (12) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2016-00090
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/23/2016
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9374 SW WASHINGTON SQUARE RD R05
Project: Verizon Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Adding(1)drinking fountain(no drain),(1)primer&(3)water heaters.Capping(1)water closet.
Replacing/relocating(3)sinks&(2)water closets.
Contractor: FIVE STAR PLUMBERS INC Owner: PPR WASHINGTON SQUARE LLC
PO BOX 28 PO BOX 847
BANKS, OR 97106 CARLSBAD, CA 92018
PHONE: 503-324-0717 PHONE.
FAX: 503-324-0883
FEES
Quantity Description Date Amount
1 ea Drinking Fountain 02/23/2016 $25.02
Specifics: 1 ea Fixture/Sewer Cap 02/23/2016 $25.02
2 ea Floor Drain/Floor Sink/Hub 02/23/2016 $50.04
Type of Use: COM 1 ea Primer 02/23/2016 $12.51
Class of Work: ALT 1 ea Sink 02/23/2016 $25.02
Type of Const: 2 ea Lavatories 02/23/2016 $50.04
Occupancy Grp: 2 ea Water Closet 02/23/2016 $50.04
Stories: 3 ea Water Heater 02/23/2016 $112.56
1 12%State Surcharge- 02/23/2016 $42.03
Plumbing
Total $392.28
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notifi . •.n Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or dirt questions to .- NC b calling 503.232.1987 or 1.800.332.2344.
I -ued By: // Permittee Sig :ture: ) /
Call 503.639.4175 by 7:00 a.m.for the next available insp ction date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit AAiIc 'I dIVE1)
Building Fixtures FOR OFFICE USE ONL1
Cityof Tigard g C 2016 Received ry ' ,��Q
d Date/Dy: D Permit No. ( i Qw‘IJ�N T0
�� _ • 13125 SW Hall Blvd.,Ti ar , 9La.) Plan Review
Phone: 503.718.2439 Fax:.503.598.1 6 Other Permit Noo �ofG-�
Date/Ry:
Inspection Line:.503.639�1�7t y i)� �A�� Date Ready/By:
T1C,AILU �A loris_ 671 See Page 2 for (�
Internet: www tigard oivituct Notified/Method: a�3� ($.�" 1
-...:•':',-.'- ,.,:::',-_:'.:',••:--•';',,',-,-
. EIA' fabl A ,k R�,r Supplemental Information
T Z<-A .,Ps-43/tri FEE* SCHEDULE
❑New construction ❑Demolition _ For s eclat information use checklist. ry
Description ] 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 r_.
❑ I-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78 fl
buildingSFR(3)bath 500.32 I
❑Accessory 0 Multi-family
Each additional bath/kitchen 25.02 O
❑Master builder ❑Other.
/� tpl
� Fire sprinkler(__sq.ft.) Page 2 j
9 ''2t ,..; JOB SITE INFORMATION AND LQCA'IION Site utilities:
Job site addresSW Washington Square Road Catch basin or area drain 18.76
s.a
Drywell,leach line,or trench drain 18.76 ON 1
City/State/ZIP:Tigard,OR 97223
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name:Verizon Wireless 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: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Tenant Improvements. Installing fixtures. Dishwasher 25.02
_ _ Drinking fountain 1 25.02 25.02
Ejectors/sump 25.02
PROPERTY OWNER +a Expansion tank 12.51
Fixture/sewer cap I 25.02 2Name:Verizon Wireless
s az
Floor drain/Boor sink/huh 25.02 ,
Address:9355 SW Washington Square Road Garbage disposal 25.02
City/State/ZIP:Tigard,OR 97223 Hose bib 25.02
Phone:(503)620-0395 Fax:( ) Ice maker 12.51
D API!I Ie,'NT CONTACT:PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:S ) Page 2
Primer I 12.51 12.51
Contact name:
Roof drain(commercial) 12.51
Address:
Sink/basin/lavatory 3 25.02 75.06
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 2 25.02 50.04
. .CO1..TRt1CTOA = Water heater 3 37.52 112.56
Business name:Five Star Plumbers,Inc. Water piping/DWV 56.29
Address:PO Box 28 Other: 25.02rev�J
City/State/ZIP:Banks,OR 97106 Subtotal 326,13
Phone:(503)324-0717 Fax:(503)324-0883 Minimum permit fee: $72.50 22
CCB Lie.: 169703 P1 • bing Lie.no.:P11108
Plan review (25%of permit fee)~ 4,}C3
' -r State surcharge(12%of permit fee) `/
Authorized signa ' /►' / TOTAL PERMIT FEE �r, l n 9'0
This permit application expires if apermit is not obtained wit n 80 days 1
Print name:GregHenes Date:02/16/16 p pp P >
��
after it has been accepted as complete. •3
•Fee methodologyset byTri-County BuildingIndustry Service Board.
7
1-:Bu itditgTeemits PLMU•PermitApp.doc 10'01'09 440-46161110'07COM'WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Qty. Fee(ea) Total
Site Utilities Q• 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-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 '
5.00 to S5.000.00 Minimum 0.c 572.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to S10,000.00 $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
I� and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 S148.50 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 90.00.1tr 525.001.00 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 90.00.1n and including$50,000.00.
Additional plan review for revisions 90.00;hr 550,001.00 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 `York:
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*. Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace! Please check all that apply.
Work Performed: Capped Added Relocate
Baptistry Font
El Any new commercial building with water service 2,-and
greater,except systems designed and stamped by licensed
Bath: -Tub,Shower
-Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive tall as defined in OAR918-780-0040.
CICuspidor/Water Aspirator Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial II Any multipurpose fire sprinkler system.
Domestic pp 0 Any complex structure as defined in OAR918-780-0040.
Drinking Fountain AID ►J
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drainisink: -2"
3" Isometric or Riser Diagram
4, ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
that meet theualifications above.
Garbage -Domestic non-food q
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related
-Bradley
Com/Sery/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase must beaid before the
Water Extractor p
Water Closet-Toilet / , plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
From: 02/18/2016 10:30 #006 P.001/002
FIVE STAR
* * * * *
PLUMBERS
FACSIMILE TRANSMITTAL SHEET
FO, FROM
Permitting Angela Strauss
C(.)MP.ANV: n)ATI:
City of Tigard 02/18/16
FAX NUMBER: TOT.AI.NO.OF('AGES INCLUDING COVER:
503-598-1960 2
PHONE NUMBER, SENDER'S REFERENCE NUMBER:
503-718-2439
RE: YOUR REFERENCE NUMBER:
Issuing Permit 5766
Np I RGFN1r 0 FOR REVIEW 0 PLEASE COMMENT 'LEASE REPL\. 0 PLEASE IRI.::YCt.F.
No I IC<•(_OMMI_N IS
Attached is a permit application for Verizon Wireless located in Washington Square mall. I need this
permit issued asap, we will begin work on Monday. I was unable to locate a credit card authorization
form online and when I try to call I only get voicemail and no one has returned my call from Tuesday.
Please contact me for payment.
Contact Info:
Ph: 503-324-0717
Email: angelanfivestarplumbers.orq
Thank you,
Angela
P.O. Box 28,Banks,OR 97106 * Phone:(503)324-0717,Fax(503)324-0883 * CCB# 169703
LICENSED • BONDED • INSURED
Accumulative Sewer Tally
N-- -
Tenant Namc: Verizon Wireless SWR# 2016-00030
Sir. 1ddress: 9374 SW Washington Square Rd R05 PLM# 2016-00090
I'.orcel #: 1S1260000300
Fixture \.iluc Pr.\i, II, Previous Credits Capped 1.ixture Fixture Ncvv New
.tine count capped#s value count added# added value ora#s total values
Baptistry/Font 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: -Each 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 0 0 0 0
Eye\'ash 1 0 0 0 0 0
Floor I)rain/Sink: -2 inch 2 0 0 0 0 0
-3 inch 5 0 0 2 10 2 10
-4 inch 6 0 0 11 0 0
-Car Wash 6 0 0 0 0 0
Garbage Disposal:
-Domestic(to 3/4 11P) 16 0 0 0 0 0
-Commercial(to 5 HP) 32 0 0 0 0 0
-Industrial(over 5 1-IP) 42 0 0 0 0 0
Ice Machine/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:
-Lay/Bar-Non H.,.1 IL•I.u.J 2 0 0 0 0 0
-Bradley 5 0 0 0 0 0
Com/Serv/Util-Fo,,d 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 Extractor 6 0 0 0 0 0
Water Closet-Toilet 6 0 1 6 0 -1 -6
Urinal 6 0 11 0 0 0
Preys ous I'DU Count 0 0
Capped EDU Credit 0
• TO'I•\I.S 0 0 1 6 2 10 1 4
Current Fixture \.due 4 divided by 16= 0.250 Current EDU 1 EDU= $5,100.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 4 divided by 16= 0.250 over (under) $ 1,275.00
Enter EDU Change Here 0.250 *
*Round EDUs to the nearest 1/100th: a count ending in.005 shall be round.,l up to.01,and a count ending in.014 or less shall be rounded down to.01.
Notes:
Authorized Name/Signature: Debbie.Adamski Date: 2/23/2016
Building Division
Note: The property owner shall retain the ORIGINAL 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:\Building\Sewer Tally\Sewer rallySheet_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
9374 SW WASHINGTON SQUARE RD R05,
TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2016-00090
Don Sylvester
Violation Summary:
Inspector Contractor