Permit (54) CITY OF TIGARD PLUMBING PERMIT
'` .! w COMMUNITY DEVELOPMENT Permit#: PLM2016-00184
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/14/2016
T tGAIt13 Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9585 SW WASHINGTON SQUARE RD Y04
Project: Starbucks Kiosk Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Adding(2)backflow preventers,(4)3"floor drain,(1)ice machine,(1)grease trap,(1)non-food sink,(2)
food-related sinks,(1)utility sink&(1)water heater.
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 Backflow Preventer 04/11/2016 $62.54
Specifics: 4 ea Floor Drain/Floor Sink/Hub 04/11/2016 $100.08
1 ea Ice Maker 04/11/2016 $12.51
Type of Use: COM 1 ea Interceptor/Grease Trap 04/11/2016 $25.02
Class of Work: ALT 3 ea Sink 04/11/2016 $75.06
Type of Const: 1 ea Laundry Tray 04/11/2016 $25.02
Occupancy Grp: ea Water Heater 04/11/2016 $37.52
Stories: 1 12%State Surcharge- 04/11/2016 $40.53
Plumbing
Total $378.28
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 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.
Issued By: OC `�J/ ! Permittee Signature: C_—
C f < <�
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.
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Flumbing Permit Application
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Site Utilities 5..)
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City of Tigard Q� ...�Q�Gj`CReceived ,�
Date '/ 4 Permit No.: Q
13125 SW Hall Blvd.,Tigard, 23 c% �N' y: /� lJ(�/6 d�l"
!(�' Plan Review Other Permit No //II'�,�,�
a Phone: 503.718.2439 Fax: 5 _..598.1911 c5(.01‘..) Date/By: > Z010/6 40/0
TIGARD
Inspection Line: 503.639.4175 � `� Date ReadyBy: lugs: RI See Page 2 for (rJ
Internet: www.tigard-or.gov V` O Notified/Method: Supplemental Information
' TYPEOF WORK " '�4. FEE' SCHEDULE
❑New construction ❑ Demolition For special inforn:ation use checklist.
Description 1 Qty. 1 Ea. 1 Total �I
®Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) z
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
0 1-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78ti
0 Accessory building 0 Multi-family SFR(3)bath 500.32 O
Each additional bath/kitchen 25.02
0 Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 �(P‘JOB SITE INFORMATION AND LOCATION� ' - l Site utilities:
Job site address:9585 SW Washington Square Rd. Catch basin or area drain 18.76 O
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97223 -- W
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: 1'04 Project name:Starbucks Kiosk Manufactured home utilities 50.03 (r!
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.: /5l0/6,oc)o03o0 Backflow preventer ,Z 31.27 6 251
DESCRIPTION OF WORK Backwater valve 12.51
Ne-- {„'c i+ 1'tcee- Kt05/ ` Clothes washer 25.02
}- Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Address: Floor drain/floor sink/hub 25.02 '1 6--v 6
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker I 12.51 1 . S i
0 APJ'LICANI' 0 CONTACT PERSON Interceptor/grease trap 25.02 Ls-OZ
-
Business name:Modern Plumbing Co. Medical gas(value:$ ) Page 2
Contact name:Don George Primer 12.51
---- Roof drain(commercial) 12.51
Address: 11120 SW Industrial Way,Bldg.9-3 Sink/basin/lavatory 1 25.02 Cft(3
City/State/ZIP:Tualatin,OR 97062 Solar units(potable water) 62.54
Phone:(503)691-6166 Fax::(503)691.6771 Tub/shower/shower pan 12.51
E-mail:info@modernplumbing.us Urinal 25.02
Water closet 25.02
CONTRACTOR
- Water healer ' 37.52 57 5-2-
Business name:Modern Plubming Co. Waterg/t to DWV 56.29
p P
Address: 11120 SW industrial Way,Bldg.9-3 Other: 25.02
City/State/ZIP:Tualatin,OR 97062 Subtotal 137, 7)
Phone:(503)691-6166 Fax:(503)691-6771 Minimum permit fee: S72.50
CCI3 Lie.:87906 Plumbing Lic.no.:34-250193 Plan review (25%of permit fee)
Slate surcharge(12%of permit fee) L(U,
Authorized signature: - -101
TOTALPERMITFEE 3-76). Zff-
Print name: Deborah George Date: I� This permit application expires if a permit is not obtained within I80 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service hoard.
1.\Itu ildine\Pcnniti I't.M 11-Per mit Appdoe t y01,u9 440-4616f(10/o2/COMAVti13)
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 S121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 5233.20
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
ValUatlOII: Permit Fee:
Storm&Rain Drain-1st 100' 62.54
S1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 S5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Other Inspections or Fees Qty Fee(ca) Total each additional$100.00 or fraction thereof,to
and including$10,000.00.
Inspection of existing plumbing or for S10,001.00 to$25,000.00 $148.50 for the first S10,000.00 and S1.54 for
which no fee is specifically indicated 90.00/hr cacti 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 S25,001.00 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 S50,001.00 and up $742.00 for the first S50,000.00 and S1.20 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`. 'Sk`
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ plan review is required for anyof the following.
Work Performed: Capped` Added Relocate •
9
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 Wash -Each Stall engineer.
-Drive Thru ❑ 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 0 Any multipurpose fire sprinkler system.
Drinking Fountain 0 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.
4,. Isometric or Riser Diagram
Car Wash Drain
Garbage Domestic-non-food p 0 Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related 2. 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 a� - n . /, A
Shower -GangQ•� '� �D
-Stall ��(�-c,vc,„ • ."
Sink/lav -Non-food related I �D� ! •
-Bradley
-Commercial-food related 2-
-Service I
Swimming Pool Filter *Note: If the fixture work under thisermit results in an
Washer-Clothes p
Water Extractor increase of sewer,'DUs,a sewer permit will be issued and
Water Closet-'toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
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