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Permit
CITY OF TIGARD PLUMBING PERMIT 1114 44 g COMMUNITY DEVELOPMENT Permit#: PLM2016-00097 T IG ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/01/2016 Parcel: 151260000300 Jurisdiction: Tigard Site address: 9609 WASHINGTON SQUARE RD LO2B Project: Shoe Mill Subdivision: None Lot: None Project Description: Capping(1)lay and(1)water closet. Contractor: MODERN PLUMBING Owner: PPR WASHINGTON SQUARE LLC 11120 SW INDUSTRIAL WAY PO BOX 847 TUALATIN, OR 97062 CARLSBAD, CA 92018 PHONE: 503-691-6166 PHONE: FAX: 503-691-6771 FEES Quantity Description Date Amount 2 ea Fixture/Sewer Cap 03/01/2016 $50.04 Specifics: 1 12%State Surcharge- 03/01/2016 $8.70 Plumbing Type of Use: COM 22 ea Minimum Fee Adjustment- 03/01/2016 $22.46 Plumbing Class of Work: ALT 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 que : I UNC by calling 503.232.1987 or 1.800.332.2344. Issued :y: / • Permittee Si ature: Call 503.639.4175 by 7:00 a.m.for the next available in 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 ApplicaRECEIVED Site Utilities FEB 2 5 2016 INCit of Tigard Received • - Y g Date/By: a al4 Permit No.: o • 13125 SW Hall Blvd.,Tigard,(CITY. e/^_ARD )' ,�0 C'N�1�_��`7 p� � ! LII Dae Review 2 nnO/tc-i0�2 Phone: 503.718.2439 Fax r�E9D�yRQ(�G/'� �(y� Other Permit No.: /Q�/'O J�Q C71LUIIVS,a DIVISION Date/Re Inspection Line: 503.639.41 i�� Read)/By: 9J See Page 2 for TtGARLt Internet: www.ti and-or. ov N:neRd/Met tor~: g g Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE 0 New construction 0 Demolition For special information use checklist. Description I Qty. I I-ia. I Total ®Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION ' SFR(1)bath 31230 ❑1-and 2-family dwelling ►5 Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 ❑Accessory building 0 Multi-family Each additional bath/kitchen 25.02 0 Master builder ❑Other. Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCAEION Site utilities: Job site address:9609 SW Washington Square Road Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP:Tigard,OR 97223 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.:LO2B I Project name:Shoe Mill 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 Cap off toilet and lay Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 0 PROPERTY OWNER 0 TENANT Expansion tank 12.51 Fixture/sewer cap 25.02 Name: Floor drain/floor sink/hub 25,02 Address: Garbage disposal 25.02 City/State/ZIP: flaw bib 25.02 Phone:( ) Fax:( ) Ice maker 12.51 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Medical gas(value:$ ) Page2 Business name: Primer 12.51 Contact name: Roof drain(commercial) 12.51 Address: Sink/basin/lavatory 1 25.02 City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) 1 Fax::( ) Tub/shower/shower pan 12.51 E-mail: Urinal 25.02 CONTRACTOR Water closet 1 25.02 Water heater 37.52 l3usiness name:Modern Plumbing Co. Water piping/DWV 56.29 Address: 11120 SW industrial Way,Bldg.9-3 Other: 25.02 City/Stale/ZIP:Tualatin,OR 97062 Subtotal Phone:(503)691-6166 Fax:(503)691-6771 Minimum permit fee: $72.50 72.50 CCI3 Lie.:87906 Plumbing Lic.no.:34-250PI3 Plan review (25%of permit fee) State surcharge(12%of permit fcc) 8.70 Authorized signature: TOTAL PERMIT FEE 81.20 Print name:Deborah jGeorge Date: -2�-//fo This permit application expires if a permit is not obtained nithin 180 days after it liar been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I.NIL itdingAPcrrniis\I'r.MU.I'crrniiApp.doc t0/01/09 440-46 16T(1oi021COM,WEn) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee(ea) Total Square 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 VaIuatiol: Permit Feei:! Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50 Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for Other Inspect•ions' Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to and including S10,000.00. Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and S1.54 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 51.45 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 51.20 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 anyof the following. 1Vork Performed: Capped Added' Relocate 9 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\Vash -Each Stall engineer. -Drive Thru 0 New exterior plumbing site utilities for any complex structure Cuspidor/Water Aspirator as defined in OAR918-780-0040. Dishwasher -Commercial 0 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" „ Isometric or Riser Diagram• Car Wash Drain Garbage Domestic-non-food 0 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 Shower -Gang -Stall Sink/lav -Non-food related 1 -Bradley -Commercial-food related -Service Swimming Pool Filter 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 1 fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. Other Fixtures: C:\Users\many\Documents\Downloads\PLMU_PermitApp(3).doc 2 ,�. m DERn Pwm131nG t0. I I 11120 SW Industrial Way, Bldg. 9 - 3 Tualatin. OR 97062 CCB #87906 pit R'; info©modernplumbing.us 503.691.6166 FAX COVER SHEET Attention: Permit Specialist City of Tigard Date: February 25, 2016 From: Deborah There are _3 pages in this transaction, including this one. RE: 9609 SW Washington Sq Road, Space L02B Attached please find the permit application for the above address. Please let me know when the permit fees are calculated and I will pay them online. Thank you Deborah Deborah@modernplumbing.us Fax 503 691 6771 Accumulative Sewer Tally 11114 'Tenant Name: Shoe Mill ***CREDITS*** SWR# N/A Site.Address: 9609 SW Washington Square Rd 1,02B PLM# P1,M2016-00097 1-IGARI) Parcel#: 1S1260000300 Fixture Value Previous Previous Credits Capped Fixture Fixture New New # value count capped#s value count added# added value total#s total values Baptisery/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 lye Wash 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 -Car Wash 6 0 0 0 0 0 Garbage Disposal: -Domestic(to 3/4 1 IP) 16 0 0 0 0 0 -Commercial(to 5 11P) 32 0 0 0 0 0 -Industrial(over 5 l 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: -l,av/Bar-Non-Food Related 2 0 1 2 0 -1 -2 -Bradley 5 0 0 0 0 0 -Com/Serv/Util-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 Iixtractor 6 0 0 0 0 0 Water Closet-Toilet 6 0 1 6 0 -1 -6 Urinal 6 0 0 0 0 0 Previous I?MU Count 0 0 Capped 1:DU Credit 0 '1'()T.U.S 0 0 2 8 0 0 -2 -8 Current Fixture Value -8 divided by 16= -0.500 Current 1?DU 1 EDU= $5,100.00 Previous Fixture Value 0 divided by 16= 0.000 Previous I DU Change -8 divided by 16= -0.500 over (under) S (2,550.00) Enter EDU Change Here -0.500 ` "Round [DUs 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 Note: The property owner shall retain the ORIGIN.A1,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. 1:A Building\SewcrTally\Sewer'I'allyShcet_5111U_u7o115.xlsx L