Permit (10) INCITY OF TIGARD PLUMBING PERMIT
r ''- COMMUNITY DEVELOPMENT Permit#: PLM2016-00356
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/06/2016
Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9355 SW WASHINGTON SQUARE RD T19
Project: Lululemon Subdivision: None Lot: None
Project Description: Replace/relocate(2)2"floor drains,(1)lay,(1)break room sink,(1)mop sink,(1)water closet,(1)bottle filler&(1)
water heater.
Contractor: D&F PLUMBING Owner: PPR WASHINGTON SQUARE LLC
4636 N ALBINA AVE PO BOX 847
PORTLAND, OR 97217 CARLSBAD, CA 92018
PHONE: 503-282-0993 PHONE:
FAX: 503-288-0604
FEES
Quantity Description Date Amount
2 ea Floor Drain/Floor Sink/Hub 07/06/2016 $50.04
Specifics: 2 ea Sink 07/06/2016 $50.04
1 ea Lavatories 07/06/2016 $25.02
Type of Use: COM 1 ea Water Closet 07/06/2016 $25.02
Class of Work: ALT 1 ea Water Heater 07/06/2016 $37.52
Type of Const: 25 Misc Other Fee 07/06/2016 $25.02
Occupancy Grp: 1 12%State Surcharge- 07/06/2016 $25.52
Stories: Plumbing
Total $238.18
I 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 l)letifleatton--,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 rect questions to O,UNC b calling 503.232.1987 or 1.800.332.2344.
I sued By: �_�'r ��b� /� Permittee Signature:�� ; �'
U� ( ;owal Lam�.�----�
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 til completion of the project.
Approved plans are required on the job site at the time of each inspection.
Jul 01 2016 04:01 PM HP Fax page 1
Plumbing Permit Application
Site Utilities V#L . .,, FOR OFFICE.E LSE ONLY
Permit No.:
Cityof Tigard D 2�y_
g � 'L 6 2016 dat(BYa 7 � l�0 (/� ,L.�"lrTr'��� t�JJt['
I
13125 SW Hall Blvd.,Tigard,OR 9723 Plan Review
Phone: 503.718.2439 Fax: 50x4 60,u., r datelB Other Permit No.: 44,/4--006/3/
t 1, !� ti y:
T I GARi] Inspection Line: 503.639.4175 I.../ �t �j x t t, tax Date Ready/By: loris' 0 See Page 2 for
Internet www.tigard-or.gov d j1L P 'it4v r 3°fl«;, r ;+,; Notified./Method: Supplemental information
�...,. w.��i�'TC�w .. -,.........7% .----.FF,-4.riCr ..,.. �..Kl
❑New construction ❑Demolition For special information use checklist.
Description I Qty. ! Ea. i Total
"i54 Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
i a ORY W (R� -� ''` SFR(I)bath 312.70
_ �-....,... ,..m>.,,...,_... mai,+ .-
121-and 2-fame{y dwellingCommercial/industrial
SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
L'-'1 ,5": zdlr €'dk f 4i7UItliali 1 L `1"Iiflrl''_ stat r lt`, Site utilities:
Catch basin or area drain 18 76
Job site address: _ �l ��
r"w u f t s ate �s 17 S/� fr ts` 6 Drywell,leach line,or trench drain 18.76
City/State/ZIP: . 7 L' //l)�� / Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no. I Project name: Z1/41,1 hitt fi7'//7/C 6,-- Manufactured home utilities 50.03
Cross street'directions to job site: Manholes 16.76
-itiks, !`��./ 7/ -/9,IAr e ` // ,� 049/ Rain drain connector 18.76
1 �!` t�1 7 ! 5/34, Sanitary sewer(no.linear R.:_„) Page 2
Storm sewer(no.linear ft.:�) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map parcel no.: Backflow preventer 31.27
iF;swmrnr � ga is .tel n't .._e
Backwater valve 12.51
..�ir '�ts«,„,,:, . i- rt1FN R_ -._.4f ""`°'
Clothes washer 25,02
` i-% iGf AM / 4���'"v✓ f /�/fOG1�✓Y1 ftLLof Dishwasher 25.02
lj- A 47L2-7-- Drinking fountain 25.02
Ejectors/sump 25.02
us" al #....�_., .. - _ " --. ,$ain .... , f e. n rg,H ! Expansion tank 12 51
. . a«fe..,, � --iiet • .. , M �. .:c -, __-. ,iFixture/sewer cap 25.02
Name:
Floor drain/floor sink/hub 2- 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
sr at" rt - a a '�°+jp .- t lnterceptnr/greasap 25.02
Business name: Medical gas(value:S ) Page 2
Primer 12.51
Contact name: Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) id,, Fax::( ) Tub/showershowerpan 12.51
O • ^ (� nal 25.02
E matt -tea-v,cX L0./ 1' 1 L t CO M -
F ater closet 25.02
_= ��
: �F' ori ._ .�., .� fni „,..z��.. = _Water heater f 37.52
1.
Business name: ��. p�ij,n1 K 5 CG5 Water pipinggDWV 56.29
Address: �c,�7(� / A-r ipl,t Other: ` if to I'l I�.Q-I• 1 25.02
` J �,�1 Subtotal
City/State/ZIP: iley/7 Fi yt, PA- /?72/
Phone: ) 44?--2 ci3 V Fax:( ) Zfr 0't O. permit Minimum fee: $72.50
Plan review (25%of permit fee)
7
CCB Lic.: " ]r .“.1)
v'Plumbing Lic.no.:26 Z- Pg State surcharge(12%ofpermit fee)Authorized signature: TOTAL PERMIT FEE /41,479
Date: -7 This permit application expires if a permit is not obtained within 80 days
Print name:r
! vz,07 KIP'(A /_/ after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I-.'-.melding\PconitclPLMU-PccmitApp.doc IO/)I%]9 4.0-46I dT(I O/Ot'COMANTB) '023 q>1 g
Jul 01 2016 04:01PM HP Fax page 2
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule:
, ,.,._ awe."r :....., w _ ........ ..�. .......... ..3{.,, ,.,...,.�.... ,.. . ....t, Residential Fire Suppression Systems:
mke reet �l � �
.,.
J �' 2 . _ i-�ttnM .,,_, � -^ .;.
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-3st 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 = j���i{y� t
.., taM1'R1C{.w.. ' �!3: iA1 ilati.�G.e..-,...,- ii 32C_..; o,.... n:Zi
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
,a iiiii _ , -roam. .1 each additional$100.00 or fraction thereof,to
m. .ca,�,�a. -`-'rte- ..,..,....,a and including 10,000.00.
Inspection of existing plumbing or for $10,001.0010 525,000.00 $148.50 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/hr $25,001.00 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/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$1.20 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*.
,1•lit0e * � Plan review is required for any of the following,
t1',grTc l? er�eaed<-._._: i i:i'l.. ' wPtd;R, xtd'd _.Il i
BaptistryfFont Please check all that apply.
Bath -Tub/Shower El 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 Thor 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 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.
-3"
i ^
u �arty r Y4{a��yp . .y,.n. �/� r t� ,
"': � [Alll�R+"MR.F.M '�� �.-. �6.T,etit�.: -ii.ki I}.IYr
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach.fRefrig,Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall _
Sink/Lav -Non-food related f
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractor increase of sewer EDUs,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:
C:\Uscrs\randy'\AppData\Local\Temp 1PLMU_PermitApp.doc 2
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
9355 SW WASHINGTON SQUARE RD T19,
TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2016-00356
Chip Barnett
Violation Summary:
Inspector Contractor