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Permit Support Document (64) v I • 3A-FA . RECEIVE City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENTII ""® _: Request for Permit Action 2019 1✓ITY OF2 TIGARD TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • «ww.til;ard-` I'I7FEB1NG DIV6ISION TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov FROM: ❑ Owner J Applicant ❑ Contractor ❑ City Staff Check(✓)one REFUND OR Name: INVOICE TO: (Business or Individual) � J �C$—.{` Cyt �r'r kf UAG\. Mailing Address: 110 City/State/Zip: P& LL,l., CA 7110 I Phone No.: /c. 5. 25 PLEASE TAKECTION FOR THE ITEM(S) CHECKED (✓): CAINCEL/VOID PERMIT APPLICATION. ---RE—FUND PERMIT FEES (attach copyof original receipt and provide explanation below). INVOICE FOR FEES DUE (attach�caase fee schedule and provide explanation below). Permit#: P�.1�' • i�o - Site Address or Parcel #: fj j U,/ i Co 7 Project Name: /05 p�f- f Subdivision Name: UJ'ch,-S4 � itArr Ma 1) Lot#: EXPLANATION: v ��r ` [ i'-</c<4. I► ., Ufa?"' &Lil U pp I r. /j/e rr�rv� i� l°GM:324l - CA;07�; . Signature: '� Date: vi/;Ch • Print Name: toI{' f Jl.erS Refund Policy 1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of: • Any fee which was erroneously paid or collected. • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 80%a of the application or permit fee for issued permits prior to any inspection requests. 2. All refunds will be returned to the original payer in the form of a check via US postal service. 3. Please allow 3-4 weeks for processing refund requests. FOR OFFICE USE ONLY Route to Sys Admin: Date • /1 By •,, Route to Records: Date /* By 13' Refund Processed: Date , By Invoice Processed: Date By Permit Canceled: Date 3 2-I//9 By Parcel Tag Added: Date By I:\Building\Forms\RcyPcrmitAction_l 0518. oc V 0 1 Plumbing Permit Application3 q / Building Fixtures 9 t f - cox oii IC 1 ',I_. (i\�_I Ci of Tigard Received �/ _j� IR III13125,SW Hall Blvd.,Tigard,OR 97223 �,1 O U 2�1 Datemy. /7,..9.,7///f- 4f 1/ Permit N1p4H /P'DO5 2.s it Phone: 503.718.2439 Fax: 503.598 (` .3 ,;*l Plangy_eOther PemiitS fl i�'-A1,4 Inspection Line: 503.639.4175 /T 1„J Aa"t y Flu A R D , t E` tTh a w.;.`„ t `b Date Ready/By ./ 4F'� Juris ® See Page 2 for Internet: www.tigard-or.gov g.-3.4 it,"., Notified/Metho / /�� Supplemental Information TYPE OF WORK E.971.- SG`O'IIFEE* SCHEDULE ❑New construction ❑Demolition For special information use checklist Description Qty. I Ea. I Total ®Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 ❑ 1-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 ❑Accessory building ❑Multi-family Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address:9685 SW Washington Square Mall Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP:Portland,OR 97223 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.:C-07 I Project name:Casper Manufactured home utilities 50.03 Cross street/directions to job site:SW Washington Square Mall&SW Blum Rd. 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:Washington Square Mall I Lot no.:300 Fixture or item: Tax map/parcel no.:1S126-00300 Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 Existing toilet room to remain(inch sink/faucet,toilet,and floor drain). Dishwasher 25.02 Install new mop sink/faucet,Elec.Water Heater and floor cleanout.Suspend Drinking fountain 25.02 Water Heater per drawings. 9 bili/rF7 ,$,,v'`,L.. /'F"f tie C T Ejectors/sump 25.02 ® TENANT �"�`1 wry_ Expansion tank b 12.51 0 PROPERTY OWNER I / -Fixture/sewer cap 4'-- . 25.02 Name:Casper,Inc, 1 Floor drain/floor sink/hub r __ 5.02 50.04 Address:230 Park Ave.South,136 Fl. r•� Garbage disposal 25.02 City/State/ZIP:New York,NY 10003 Hose bib 25.02 Phone:(908)625-1689 Fax:( ) Ice maker 12.51 0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Business name:Permits Today Medical gas(value:$ ) Page 2 Primer 12.51 Contact name:Scott Daves Roof drain(commercial) 12.51 Address:140 So.Lake Ave.,Suite 323 Sink/basin/lavatory s?-,;'"°?-" 1 25.02 25.02 City/State/ZIP:Pasadena,CA 91101 Solar units(potable water) 62.54 Phone:(626)585-2931 Fax::(626)792-5777 Tub/shower/shower pan 12.51 E-mail:permitstoday@aol.com Urinal 25.02 Water closet 25.02 CONTRACTOR .''S"F Water heater 1 37.52 37.52 Business name: Water piping/DWV 1 56.29 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal 168.87 Phone:( ) Fax:( ) Minimum permit fee: $72.50 CCB Lic.: Plumbing Lic.no.: iv Z i r `Cli ' .. .._ '_ °,of r- rmi .. State surcharge(12%of permit fee) ,,24: 6'" Authorized si ?�m'e:`'° TOTAL PERMIT FEE ,-.2.3-1.735-- Print name:Scott Daves Date:11/20/18 This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. jiyf I:\Builaieg1Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) _.. - 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 $121.90 Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69 Sewer3,601 to 7,200 $233.20 -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 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 Other Inspections or Fees Qt'. Fee(ea) Total each additional$100.00 or fraction thereof,to 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 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*. Quantity by Fixture Type Plan Review for Plumbing Installations Fixture Type for Replace/ Work Performed: Capped Added Relocate Plan review is required for any of the following. Baptistry/Font Please check all that apply. Bath Tub/Shower 0 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 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,> 1 Car Wash Drain Isometric or Riser Diagram Garbage Domestic-non-food 0 Isometric or user 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 Oil Separator(Gas Station) Comments regarding fixture work: Rec.Vehicle Dump Station Shower -Gang -Stall Sink/Lav -Non-food related 1 -Bradley -Commercial-food related -Service ,1'"" :, 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 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\CS\Desktop\Casper-Portland,OR PLMF_PermitApp.doc 2 Accumulative Sewer Tally s Tenant Name: Caspar SWR# 2018-00263 TI GARD Site Address: 9685 SW Washington Square Rd PLM# 2018-00542 Parcel#: 1 S 1260000300 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 0 0 0 0 -3 inch 5 0 0 1 5 1 5 -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 1 2 1 2 -Bradley 5 0 0 0 0 0 -Com/Sery/Util-Food Related 3 0 0 1 3 1 3 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 0 0 3 10 3 10 Current Fixture Value 10 divided by 16= 0.625 Current EDU 1 EDU= $5,650.00 Previous Fixture Value 0 divided by 16= 0.000 Previous EDU Change 10 divided by 16= 0.625 over (under) $ 3,559.50 Enter EDU Change Here 0.630 * *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: Authorized Name/Signature: Dianna Howse Date: 12/7/2018 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\SewerTallySheet_5500_070117.xlsx Branden Taggart From: Branden Taggart Sent: Thursday, February 28, 2019 10:47 AM To: permitstoday@aol.com Cc: #Building Permit Technicians Subject: RE: Casper Plumbing Permit: PLM2018-00542 - 9685 SW Washington Square Mall Hi Scott, Thank you for completing the Request for Permit Action form to void the Casper plumbing permit. We are able to read everything. Thanks, Branclen Taggart lipiWL City of Tigard M • Senior Permit Technician - Community Development I WARD 13125 SW Kali Blvd T"igar€,OR 97223 (503)718-2449 bra ndent©tigard-or,gav From: permitstoday@aol.com <permitstoday@aol.com> Sent:Tuesday, February 26, 2019 7:46 AM To: Branden Taggart<brandent@tigard-or.gov> Cc:#Building Permit Technicians<TigardBuildingPermits@tigard-or.gov> Subject: Re: Casper Plumbing Permit: PLM2018-00542-9685 SW Washington Square Mall How's this? Scott pt Permits Today 140 South Lake Ave., Ste 323 Pasadena CA 91101 P. 626/585-2931 F. 626/792-5777 Original Message From: Branden Taggart <brandent a(�tigard-or.gov> To: permitstodavaol.com <permitstodayaol.com> Cc: #Building Permit Technicians <TigardBuildingPermits(a�tigard-or.ciov> Sent: Mon, Feb 25, 2019 3:57 pm Subject: Casper Plumbing Permit: PLM2018-00542 - 9685 SW Washington Square Mall Hello Scott, 1 The plumber for Casper at Washington Square Mall, Earl J. Wisdom Plumbing, submitted a new plumbing application with a reduced scope of work. He informed us that(2) new sinks were being added, and everything else was existing. Since you submitted the initial application on November 26, 2018, we would appreciate it if you would complete the above Request for Permit Action form to void plumbing permit PLM2018-00542. No fees were paid. If you have questions, please let me know. Thank you, Branden Taggart I( r City of Tigard $ Senior Permit Technician Community Development 13125 SW Hall Blvd Tigard,OR 97223 (503)718-2449 bra ndent@tigard-or.gov DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained by the City of Tigard in compliance with the Oregon Administrative Rules "City General Records Retention Schedule." 2 Branden Taggart From: Branden Taggart Sent: Monday, February 25, 2019 3:57 PM To: permitstoday@aol.com Cc: #Building Permit Technicians Subject: Casper Plumbing Permit: PLM2018-00542 - 9685 SW Washington Square Mall Attachments: Req PermitAction_120518.pdf Hello Scott, The plumber for Casper at Washington Square Mall, Earl J. Wisdom Plumbing, submitted a new plumbing application with a reduced scope of work. He informed us that (2) new sinks were being added, and everything else was existing. Since you submitted the initial application on November 26, 2018,we would appreciate it if you would complete the above Request for Permit Action form to void plumbing permit PLM2018-00542. No fees were paid. If you have questions, please let me know. Thank you, Branden Taggart q City of Tigard Senior Permit Technician Community Development TIGARD ui 13125 SW Hail Blvd Tigard,OR 97223 (503)718-2449' brandentrtigard-or.gov 1