Permit (67) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2017-00248
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/22/2017
Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9504 SW WASHINGTON SQUARE RD J02
Project: Tumi Subdivision: None Lot: None
Project Description: Demolishing and capping of plumbing fixtures only: CAP(4)2"floor drains,(1)hand sink,(1)commercial sink,(1)
water heater,and(1)grease trap for new tenant.
Contractor: BEAVERTON PLUMBING INC Owner: PPR WASHINGTON SQUARE LLC
13980 SW TV HWY PO BOX 847
BEAVERTON, OR 97005 CARLSBAD, CA 92018
PHONE: 503-643-7619 PHONE:
FAX: 503-643-7620
FEES
Quantity Description Date Amount
8 ea Fixture/Sewer Cap 06/22/2017 $200.16
Specifics: 1 12%State Surcharge- 06/22/2017 $24.02
Plumbing
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $224.18
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: Permittee Signature: & , / *,,z //t/4./
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.
From:Beaverton Plumbing 5036437620 06/19/2017 08:47 #334 P.001/002
Plumbing Permit Applicatit� Cr.,� �
Building Fixtures
VED
L Received / 9ce
City of Tigard JUN UN 1 9 2017 I /7 Pennit N L o // a
r 13125 SW Hal!Blvd.,'figard,OR 972 Datr,`E3y:
( Plan Review
1,1 C Phone: 503.718.2439 Fax: 503. �j4(rp�� 1 Other Perini!Na
f� TT (�A i UateBy:
TIGARL)
Inspection Linz 503.639.4175 tiAl 1 1 Uate Read}d8y: j/jj/j7 orris 0 See Page 2 for
Internet wxvw.tlgard or.gov UIL®11�1(� ��1/0[+ION Nottfied/Mathod: Supplemental information
TYPEOF %%ORh , ' fi: s *SCHEDULE
❑New construction 'Demolition For special information use checklist.
Description I Qty. I Ea, I Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF tONSTRUcFIOr SFR(1)bath ( 312.70
❑ 1-and 2-family dwelling OCommercial/industrial SFR(2)bath 437.78
❑Accessory building SFR(3)bath 500.32 -s.❑Multi-family
Each additional bath/kitchen 25.02 N)
0 Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 1
:::::::'...'::,•:• ,.,,:•:",.:::,..::•'.., •-•,,,•'„..4.0A.ShfL.INFORMATION.AND LOCATION '. Site utilities:
Job site address: Gap 6-1.,) Lubstu.'n yh)n , . R� Catch basin or area drain 18.76 {
City/State/7.[P: a IDrywell,leach line,or trench drain 18.76
t f arid. CIL T o�e�.� Footing drain(no.linear R.: ) Page 2
Suite/bldg./apt.no.: G a - Project name:LOS=i L,W t t land.
Lo&d Manufactured home utilities 50.03
Cross street/directions to job site: tt)o(Z�' 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.: _ _ Backtlow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
_.Deal. ()MAI 1 3-1 n nr S i n e S, 1 - J 1'Orly. S ii 0 kI Dishwasher 25.02
1.
1 rv,L 1d ,„Si11'k., I (A)O e!yl.!akt-( t i-5 rt(hE lT ap Drinking fountain 25.02
"
1 f Ioor t,�,Y Q,l n Re-i-,jerzei C' /0Ejectors/sump 25.02 _
`❑ PROPERTY OWNER ❑ TENANT -- Expansion tank 12.51
Fixture/sewer cap ( 25.02 e i rk
Name:
Floor drain/floor sink/hub �/' 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib I 25.02
Phone:( ) Fax:( ) Ice maker _ _ 12.51
El APPLICANT , CON7:4CT,PERSON Interceptor/grease trap 25.02
Business name: �l� n PJ u m 'nC •
Medical gas(value:S ) Page 2
Primer 12.51
Contact name: aur k,e, ta,„tt
L� tn � ' 1 ', LL 11 Roof drain(commercial) 12.51
Address: t 3 q 8 O S t.J-T�Al c - h V 3 T"tU�I __ Sink/basin/lavatory _�/ 25.02
City/State/ZIP: 1Z r Olt ct -rocs -+ Solar units(potable water) /" 62.54
Phone:(s-3) b y 3-71D 1 q ),f O(fl Fax::(S63) b 4 3_- e a:6 Tub/shower/shower pan 12.51
Urinal 25.02
E-mail: Ja(.Kt.e. beauerton,plumhi ni Cam
Water closet
CONTRACTOR ___� _i 2 5.02
w - • Water heater7.52
Business name: �y 1 hC • ___. �3�-""
(t,usr�h T1� Water 56.29
Address:1 3 9 8O S W T1LataiSn V Q% 1-1(J \ Other: 25.02
City/State/ZIP:.f)eatur Eon t 'Q g, q 1 o 0 S Subtotal ,gc®t/(,
Phone:(613) f1.3-7(01 q k. 1 Oto Fax:(spa) (q Y'S•7 (Da-o I Minimum permit fee. $72.50
I Plan review (25%of permit fee)
CCB Lic.: ia86c Plumbing Lie.no.: 3 -4 Pt$ I# State surcharge(12%of permit fee) ,I yr(1
Authorizedsignature:(9--5jutte:�L OT,/,,...i.„02.121 l TOTAL PERMIT FEE A,2yi/1"
This permit application expires if a permit is not obtained within 180 days
r Print nam[: tjQ lc Date: q,76/ 7 1
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I liuilding'Permits`:PlAttl•PermitApp doc 10/01/09 440-0610T110102/COM/WEB)
From:Beaverton Phi nnblvmj 50364.371520 08/113/2017 0/447 At 3314 P.002/002
Plumbin. Permit A. , icatio 1 - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Sy_sSems:
Site Utilities ::-..-..:::.2:i"::::' i;cl*;.[-TO:"0C.'Ts41-!': I: 4:ii4ielisiifi';i:: •. ., 1.0i-.;,it.Feei:':`.‘..'I'._;-:':.',..'..• .7
Footing drain.1"100' saw 1_212 j'..!,290 $121.00
Footing drain-each additional 10037.52 1_2,001 to 3,600 1160.69
1_3,601 to 7,200 $733.20
Sewer•1st 100' 6234 L,7 201 andstreater $327.54
Sewer-each additional 100' 37.52
Water 'Service-1st 10062.54
... Medical Gas Systems:
Water Service•each additional 100' 37.52 I viiiiiiti6iii'.... .,,: .. ifirmit.IF4i-.--'' '' i':.:'''''''.'1::::- • .
Storm&Rain Drain- tit 100' 62.54 _ 51,00 to S5.4=00 Minimum fee S72.50 _
Storm&Rain Drain'each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the dal$5,000.00 and 51.52 fbr
each additional S100.00 or fraction thereof,to
totheelnipectous or'sFeetr,,, .00,. ; Yfit.0). - TRI-0 . and including$10.000.00.
'l.nspect.ica to(casting plumbing or for 510,001.00 to$25,000.00 S F411.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 9000/hr each additional$100,00 or ftaction thereof,to
(minimum charge-1/2 hour) aced including$25,000.00.
inspections outside of normal business 90.00/hr -525,001.00 to$50,000.00 $37930 fbr the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof.to
Reinspection Fees 90.00thr and including$50,000.00. •
Additional plan review for revisions 90.00Ihr 550.001.00 and up 5742.00 for the first$50.000.00 and$1.20 for i
(minimum Marge-In hour) .. each additional$100.00 or fraction themot
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? if"yes",
please indicate work performed by fixture. Failure to
accurate! re.ort fixtures could result in increased sewer fees*
.-.-,,-,..--..., •:....,-:..,:..::,.,:,\ •',''.' s.z• Quautly bx Fixture Tyne :::'.:. ,.'.2,: ::.iiiiii:iiiiiiirleiviiimbilikliiitaiikki.
nature TYPefo.r..•.':.--• r'-',..:,': • .'. ,. :...::. jAeatece/.-'- ,
Plan review is required for any of the following
WprIr Performed:. • ''"': ':.'...:.."• .' Cowed Added ' 'Relocate '
Brhairy/Font Please check all that apply.
-
Beth -Tub/Shower 0 Any new commercial building with water service 2"and
-Jacuzzi/Whirl.00l MIIIIMIIMIIIMIMIIMIIIIIIMI greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru 0 New exterior plumbing site utilities for any complex structure
r
CusnidorfWater Aspirator 29 defined in OAR918-780-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health um facilities.
I
-Domestic El Any multipurpose fire sprinkler system.
Drinkina Fountain . 0 Any complex structure as defined in OAR918•780-0040.
Eve Wash
Floor Drain/sink -2" • Submit;sets of plans with any of the above.
-3..4" :'., 1 • Isom- _ or Riser Diairaiai
Car Wash Drain
0 Isometrc or ser diagram is required for new buildings
Garbage -Domestic-non•fuod iri
Disposal -Domestic-food related that meet the qualifications above.
-Commerciat-food related
-Industrial-food related
lee Mach./Refrlg.Drains ,.
Oil Separator LGas Sutton) - Comments regarding fixture work'
Rec.Vchick Dump Station . $ ' la '1
Shower -Gang
---- 61 -- e-- a AI.._.,_
_stall
SinVlav .No -fond related , 1 4 V
Li 41am%ski IC,Bradity do; a. A . 1.** 116or- 0 • •,-) .
6,)3.„,„0._ -Commercial-food related Illr__MIIIIIIIIIII1101101 „, ,.. .....- .
-Service
Swinimin:Foal Fiber '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 Wares: _.! , - , .
/ ha4id stm 4 1
r 3 C-13717palf4 44-114-
http://www.tigard-or.gov/document_center/Fluilding/PLMF_PermitApp-..1. 3 t/DO r Sle.-rt-k 3, /PS-0 t- #4C-Itt-4
/ Weser ILe,-, /-au_stat lk-af
Accumulative Sewer Tally
a Tenant Name: Tumi SWR# N/A-EDU CREDIT
T1 GARD Site Address: 9504 SW Washington Square Rd PLM# 2017-00248
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
Eye Wash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 4 8 0 -4 -8
-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 HP) 16 0 0 0 0 0
-Commercial(to 5 HP) 32 0 0 0 0 0
-Industrial(over 5 HP) 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-Food Related 2 0 0 0 0 0
-Bradley 5 0 0 0 0 0
-Com/Sery/Util-Food Related 3 0 2 6 0 -2 -6
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 0 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 6 14 0 0 -6 -14
Current Fixture Value -14 divided by 16= -0.875 Current EDU 1 EDU= $5,300.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -14 divided by 16= -0.875 over (under) $ (4,664.00)
Enter EDU Change Here -0.880 *
*Round EDUs 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: EDU Credit Only
Authorized Name/Signature: Dianna Howse Date: 6/22/2017
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_5300_070116.xlsx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9504 SW WASHINGTON SQUARE RD J02,
TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2017-00248
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
Violation Summary:
J
Inspector Contractor