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Permit CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit#: PLM2016-00066 T IG ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/09/2016 Parcel: 1 S 1260000300 Jurisdiction: Tigard Site address: 9779 WASHINGTON SQUARE RD D11 Project: Champs-Landlord Work Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S Project Description: Cap(2)lays&(2)water closets. 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 4 ea Fixture/Sewer Cap 02/09/2016 $100.08 Specifics: 1 12%State Surcharge- 02/09/2016 $12.01 Plumbing Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Stories: Total $112.09 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, o • • is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility •,otification 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' rect questions to OUNC • al 'g ' .232.1987 or 1.800.332.2344. ssued By: �l i�,`-A `/ • Permittee Sig 141M Call 503.639.4175 by 7:00 a.m.for the next available insp-• ion 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. Accumulative Sewer Tally ;i ii 41 'Tenant Name: (lamps ***CREDITS*** SWR# N/.\ TIGARD Site.Address: 9779 SW Washington Square Rd 1)11 PLM# 2016-00066 Parcel#: 1S12600003000 1;ixture Value Previous Previous Credits Capped I:ixture 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 Eve 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 I IP) 16 0 0 0 0 0 -Commercial(to 5 I IP) 32 0 0 0 0 0 - Industrial(over 5 IIP) 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: -Lav/Bar-Non-Food Related 2 0 2 4 0 -2 -4 -Bradley 5 0 0 0 0 0 -Com/Sery/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 I:xtractor 6 0 0 0 0 0 Water Closet-Toilet 6 0 2 12 0 -2 -12 Urinal 6 0 0 0 0 0 Previous I IDU Count 0 0 Capped NOV Credit 0 'I'(Yl'.A1.S 0 0 4 16 0 0 -4 -16 Current Fixture Value -16 divided by 16= -1.000 Current I?DEJ 1 EDU= $5,100.00 Previous Fixture Value 0 divided by 16= 0.000 Previous 1?DU Change -16 divided by 16= -1.000 over (under) S (5,100.00) Enter EDU Change Here -1.000 b `Round 1iDUs 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: 2/9/2016 Building Division Note: The property owner shall retain the ORIGIN Al.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:ABuilding\timer Tally ASewer l'allySheet_5111U_070115.xlsx FEB-05-2016 13:36 From: To:5035981960 Page:2'3 Plumbing Permit Applic::I 1ij CE!VE Building Fixtures FOR OU ICE USE ONLY City of Tigard FEB 7 Received 2 , I Permit No.: He2-0o(Q • 13125 SW Hall Blvd.,Tigard,OR 97223 `A^.. Phone: 503.718,2439 Pax: 5®3.g r t,IN oat Review Other Permit No.:Ate l4P-�t� c/ inspection line: 503.639.1175Fax: Li 41f i i(A��5 o�te/py: 'i'i c A K i? PeciT Date Ready/By: lur 61 H See Page 2 for Internet: www.ligard-Or.govBtlILUINIi BIS I IU1 Notified/Method: Supplemental information . TYPE OF.,WORK - .FEE' SCHEDULE ❑New construction 0 Demolition For special information use checklist. -- --•- Description fay- Ea. Total ®Addition/alteration/replacement 0 Other: New 1.2-family dwelt%ga(includes 100 ft.far each utility connection) CA &O TJ RY`.QF',CONS RUCTfON . ,, . . , SFR(1)bath _ 312,70 ❑1-and 2-family dwelling E]Commercial/industrial SFR(2)bath 437.78- SFR(3)bath 500,32 []Accessory building ❑Multi-family -_ Each additional hath/kitchen 25.02 ❑Master builder ❑Other; Fire sprinkler( sq.ft.) Page 2 (.?:19 70B SITE'INFORMATION AND LOCA'TI;O'N , . _ Site utilities: - tub site addre ; . SW Washington Square Road Catch haain arnica drain 18.76 ss City/Sotto/ZIP:Tigard,OR 97223 Drywell,leach line,ur trench drain 18.7(, Fonting drain(no,linear ft.;_) Page 2 Suite/hldg./apt.no.:D11 -1 Project name:Champs Manufactured home utilities 5(1.03 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: I.01 no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK llackwater valve 12.51 Clothes washer 25.02 Cap off piping from old restrnoms __. Dishwasher 25.02 _. Drinking fountain 25.12 Ejectors/sump - 25.02 Na ❑ 1 ROOERTY,OWNER .• 'LI 'r NAN r ,' Expansion tank 1251 mC: F''iz urec/scwcr cap 25.02 !! Floor drain/floor sink/hub 25.112 Address: Garbage disposal 25.02 City/State/ZIP: _ Hose bib 25.02 Phone:( ) Fax:( ) !cc maker 12.51 1:1Xpett•CANT '0 CONTACT PERSON Interceptor/grease trap 25-02• -- Business name: Medical gas(value:$_) Page 2 - -' Primer 12.51 Contact name: Roof drain(commercial) 12.51 Address: _ Sink/basin/lavatory X 25.02 5.414 City/Stale/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax::( ) Tub/shower/shower pan 12.51 F.,-mai l: - Urinal 25.02 " --r,. Water closet 25,02 50.44 . CONTRACTOR - -- ' Water heater 37.52 Business name:Modern Plumbing Co. - Water piping/DWV 5(.29 Address:11120 SW industrial Ways Bldg.9-3 Other: _ 25.02 City/State/ZIP:Tualaltin,OR 97062 Subtotal ipo (6(6 Phone:(503)691-6166 Fax:(503)691.6166 Minimum permit fcc: $72.50 Plan review (25%of permit fee) CCB Lic.:87906 Plumbing tic.no.:34-250PB --- - - . -- Slate surcharge(12%of permit fee) t 2.Op n Authorized signature: /ToTA1.PERMIT FF.F. I 1 7„01 {'h Print name:Deborah George Date:02/05/16 is permit application expires if a permit is not obtained within 180 days after it tuts been accepted as complete. *FCC mCllludulugy%et by'Fri t:ouniy Building Industry Service Board. 1:11luilding\Nermichl'lAil I-Permit App dr,c. IQin l/u9 140-4616T(10/02 x-ne ril) FEB-05-2016 13:36 From: To:5035981960 Pane:3/3 Plumbing Permit Application - City of Tigard Page 2 -Supplemental Information Fee Schedule: Residential Tire Suppression S sr terns: • Qty- Fee(ca) 'roar— Permit Fee: Site�U'tilih"es • S'gnare Foo.`tage: : Footing drain•1"100' 50.03 0 to 2,000 $121.90 2,001 to 3,600 $169.69 Footing drain-each additional 100' 37.52 3,601 to 7,200 $233.20 Sewer-1st 100' 62-54 7,201 and greater $32754 • Sewer-each additional 100' 37.52 Water Service-1st 100' 62.54 _Medical Gas Systems: Water Service-each additional 11X1' 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 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for p.*(7) yagl each additional$100.(x1 or fraction thereof,to Other Ynspections;o,1C e'es. and including S10,000.00. Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 fur the first$10,000-01 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 fur the first$25,000.(0 and$1A5 for hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to Reinspection Fees 90.00/hr and including$50,(xx1.00. Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,(XXl.(x1 and$1.20 for mrmmum aha e_1/2 hour each additional$100.00 ur 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*. naafi b Fixture i-' - • R h y '� - • ;Plan Revlew Torr.Plumbing Installations Fixture Type for• Replace/ Plan review is required for anyof the following. Work Performed: capped Added Relocate9 g- Baptistry/Font Please check all that apply. Bath Tub/Shower ID Any new commercial building with water service 2"and Jacuni/Whirlptt(tl greater,except systems designed and stamped by licensed Car Wash -Each Stall engineer. -Drive Tint ❑ New exterior plumbing site utilities for any complex structure Cuspidur/Water Aspirator as defined in OAR918-780-0)40. Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities. -Domestic ❑ Any multipurpose fire sprinkler system. Drinking Fountain Q 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-no0•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 _ (til Separator(Gas Station) Comments regarding fixture work: Rec.Vehicle Dump Station Shower -(fang -Stall Sink/lav -Non-food related j- -Bradley-Bradley -Commercial-fond 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 he issued and Water Closet-Toilet � fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. Other Fixtures: C:1Users1mary\)ocuments\Downloads\PLMF_PcrmmitApp(11).doc 2 FEB-05-2016 13:36 From: To:5035981960 Page:1'3 LI 1' m0DERf1 PIU BIf1G 11120 SW Industrial Way, Bldg. 9-3 Tualatin.OR 97062 CCB 967906 infoemodernplumbing.us 503.691.6166 FAX COVER SHEET Attention: Permit Specialist City of Tigard Date: February 5, 2016 From: Deborah There are __3_ page in this transaction, including this one. RE: 9585 SW Washington Sq Road, Space D11 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 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 WASHINGTON SQUARE RD D11, TIGARD, OR, 97223 Commercial - Plumbing 399 Plumbing ﬁnal PASS - No C of O PLM2016-00066 Don Sylvester 1. Cap off one bathroom below ﬂoor, and one bathroom above ﬂoor to be reused at a later date.- ok Violation Summary: Inspector Contractor