Permit (53) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2019-00110
TEGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/21/2019
Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9585 SW WASHINGTON SQUARE RD
Project: Yi Fang Subdivision: None Lot: None
Project Description: Site utilities landlord work for new kiosk located close to AT&T in space Y16: 15 ft.of sanitary sewer and 60 ft.of
water service.
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: 206-778-5184
FAX: 503-691-6771
FEES
Quantity Description Date Amount
15 If Sanitary Sewer 03/20/2019 $62.54
Specifics:, 60 If Water Service 03/20/2019 $62.54
1 12%State Surcharge- 03/20/2019 $15.01
Type of Use: COM Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $140.09
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, 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 503.232.1 . 32.2344.
Issued By: 4.40.0,7z._ Permittee Signature: A
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.
4
Plumbing Permit Application
Building Fixtures RE ,NED FOR OFFICE USE ONLY
Cityof Tigard
Received
Permit No.:
lig III 13125 SW Hall Blvd.,Tigard,OR 97223 DateBy: /'�lj9--,---" /�C1'7 )1���eft,��/}
Plan Review
• Phone: 503.718.2439 Fax: 503.598.196MAR 13 to la DateBy: Other Permit No.:0:1",;4...vii'
.eityl
Inspection Line: 503.639.4175 rpt R Date Ready/By: Juris: El Seee 2 forTIGARD �y ,yltty Y Y
Internet: www.tigard-or.gov V 1 (3A Notified/Method: f,,,-; Supplemental Information
t
0 New construction ❑Demolition For special information use checklist.
Description I Qty. I Ea. I Total
Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
t - # SFR(1)bath 312.70
❑ 1-and 2-family dwellingCommercial/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 0 Other.•
Fire sprinkler( sq.ft.) Page 2
# : #: Site utilities:
Catch basin or area drain 18.76
Job site address: 1575 .5 10 100ih1Gtr I-Dyl q-� /J4 fJ Drywell,leach line,or trench drain 18.76
City/State/ZIP:
't q 0k e , 9I7 1 Z 3 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.:JOS)(Y.aroject name: s / ui., Ta 0/.4..r f' Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
18. 6
/j 47 ,r14��y� 4 7/11;-7
7 Rain drain connector / 2
/'' /'� i 0-1/7%.14,
/d� Sanitary sewer(no.linear ft.:� / Page 2 i L 4
V -Z"i/':Y..,j L4 bv'1 J •r"L�1,A `t.►Cc v7i d r':-L/�fr.J
/� ,� Storm sewer(no.linear ft.:_,,)� Page 2
G.�'rt f !(/Zit v`r'�r.,vT+� irc("")'r cv-e-4 iti '"`tr may+ Water service(no.linear ft.:6C/) / Page 2 L,a,54
Subdivision: %/G.i ',y mac,,, .. .3/42,,/,,,e/ /5. Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve 12.51
/1l Clothes washer 25.02
tei4 kOrt,/I. WOv l/ ordy h4OtuM>!J f�
/ '/ll '/ Dishwasher 25.02
bele tei /;4-e- f 14u fiu/e- /K/p$4 Drinking fountain 25.02
Ejectors/sump 25.02
• a'aExpansion tank 12.51
Fixture/sewer cap 25.02
Name: s e...el/rl.G
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
1 City/State/ZIP:y Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
10 # Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name: //oar /1/U4 ) th?
Primer 12.51
Contact name: i401,1ar /
Re
to ,^ Roof drain(commercial) 12.51
e....\ Address: 1 1112-0 Sto litPuT t✓1 la,g, I , 9.-1 Sink/basin/lavatory 25.02
(Yf City/State/ZIP: ;taht,t,nf 0,,e e, q? Solar units(potable water) 62.54
WI Phone:(103 ) ‘9/_6/44 Fax::(Tp3) 6f/.. 6 7 7/ Tub/shower/shower pan 12.51
Urinal 25.02
. -.1..1,1„
mail: Ol) 9/ ,,��,
'•
Water closet 25.02
Water heater 37.52
Business name: 44o e4 7x Y ///1 h(ti , q Water piping/DWV 56.29
_H Address: /f l� vcJj 2-;,,n u,t flil� is i s, l-3 Other: 25.02
City/State/ZIP: T edza-r N. / o✓2 , 9 7a/L___ / Subtotal 0_,..-7:c..'0"
Phone:(SPY) 69/,. 4 a/v Fax:(fp3) 4'ff/' G 77/ Minimum permit fee: $72.50
CCB Lic.: if 79 06 Plumbing Lic.no.:3 y_25,0Atj Plan review (25%12of permit fee)
i State surcharge(12%of permit fee) i , r ,
Authorized signature: TOTAL PERMIT FEE 1' ), 0'J
Print name: 'It Date: ..../z.....I q This permit application expires if a permit is not obtained within 1S0 days
/ after it has been accepted as complete.
/ POHa1,/ %ra7 Pi
*Fee methodology set by Tri-County Building Industry Service Board.
L\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
J
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su. r ression S stems:
t11111V�
Footing drain-151 100' 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' W, 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' -, 62.54 Medical Gas S stems:
Water Service-each additional 100' 37.52
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
: ! i !
each additional$100.00 or fraction thereof,to
E
and including$10,000.00.
Inspection of existing plumbing or for ■ ■ $10,001.00 to$25,000.00 $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 char:e-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 char_e-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 char e-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*.
Z:€ Yrs 1 t t P 4 * I @
rap
rn r :4'10 a) �. .ii e
Plan review is required for any of the following.
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 ❑ 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"
Car Wash Drain ❑ Isometric or riser diaam is required for new buildings
Garbage -Domestic-non-food q g
Disposal -Domestic-food related that meet the g ualifications 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
-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:\Users\georg\AppData\Local\Packages\Microsoft.MicrosoftEdge_8wekib3d8bbwe\TempState\Downloads\PLMF PermitApp(1).doc
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9585 SW WASHINGTON SQUARE RD, TIGARD,
OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2019-00110
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . Plumbing final for San sewer and water service stub in only- ok to cover.
Violation Summary:
Inspector Contractor