Permit (204) CITY OF TIGARD PLUMBING PERMIT
` .' COMMUNITY DEVELOPMENT Permit#: PLM2019-00220
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/22/2019
i Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9631 SW WASHINGTON SQUARE RD FC03
Project: Bombay Wala Subdivision: None Lot: None
Project Description: Interior plumbing for TI:Replacing(1)ice maker and(5)sinks.
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: 206-390-0059
FAX: 503-691-6771
FEES
Quantity Description Date Amount
1 ea Ice Maker 05/22/2019 $12.51
Specifics: 5 ea Sink 05/22/2019 $125.10
1 12%State Surcharge- 05/22/2019 $16.51
Type of Use: COM Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $154.12
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: -y
—71
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
nlIllr-MAY-16-2019 08:30 From: To:5035981960 Pa9e:2/5
Plumbing Permit Application
Building Fixtures RECEIVED Nt1R tlri.i .'t: I_si': 1.1m_.,
Received "�"
City of Tigard Dai 1....--7,./.4.701- 4, Permit No.:����/�/�.i et_ oki
1312.5 SW Hall Blvd.,Tigard,OR 97z AY 1 6 2019 Plan Review �" / -a �C��
H Phone: 503.718.2439 Fax: 503.598.1960 wtemy. Other Permit No.: W�l01C/ C1.r17i
T:: ,SRC inspection line. 503.639.4175 CITY OF TIGARD ,,;,C Ready/ny, ,, B See e2Ibr /
Internet: www.tigard-or.gov BUILDING DIVISION Norined/Melhnd: .. ,..regtSupplemental Information
.,i I q 'I' 1 h1 i. J„,,!,,. I 1 111"1$ 4 kt.104J ll.t,
�, it TYPE OF WORK
n I i
u.... �... �. � hr '1 �'Q II N ,u � i �' ... ..�� ..r 19 ..Ic. .,u, I,„A, ,.!.Ih... ..
❑New construction 0 Demolition ^ For special information use cheeklist.
- Description I Qty. I Ea. I Total
®Addition/alteration/replacement ^❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connectionL
',CATEGORY',OF,CONS'RVCr1ON 'I!1 "' 'r;I' 9„. SFR(1)bath 312-70
0 1-and 2-family dwelling ❑Commercial/industrialSFR(2)bath 437.78
SIR(3)bath ±,_.. •
50032
❑Accessory building 0 Multi-family
F,ach additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
:).0,0"S'..0 -41461 ,1,E11i< ION„AND"LOCATION• . P 1,,:` ''' „, Site utilities:
lob site address:9631 Washington Square re Road Catch basin or area drain __ 18.76
gtnn
City/Stale/ZIP:Tigard,OR 97223 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bidgJapt.no.:FC-03 Project name:Bombay Wala Manufactured home utilities 50.03
Cross atreel/directions La job site: Manholes I8,76
-'-
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:____) Page 2
Storm sewer(no.linear It.:_) Page 2
_. Water service(no.linear ft.:._) Page 2
Subdivision: Lot 00.: Fixture oritem: -.
Tax map/parcel no, Flackflow preventer ~TT31.27
n 1 1t, i,ry`'„d Backwater valve 1251
• y1:1: D SCiti!!N-IQIi( QF WIORK'db 1i„ ',y�ilVlhh, o r I, I. „11 •'sl Clothes washer 25.02
remove and reinstall fixtures on exisitog rough in
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
•
' 111❑ Pielti'ER*Yt owl ER, ,, ,; ., rf I 'I'Bi IP!TEN/ TIP.,/t, .11i . Fxpansion tank 12.51
Name: Fixture/sewertop 25.02 d
Floor drain/floor sink/hub 25.02
Address: "`-
Garbage disposal 25.02
CityIStateJ7.IP: Host bib 25.02
Phone:( ) Fax: ) Ice maker 12..51 (1 5
VIII
19 I,ai. Jr w lI 'I ( I.
interceptor/grease
III ' Q1 ' ❑ "OF I h w', T .o' Ntrap
2502
Business name:Modern Plumbing Co Medical pis(value:$ ) T Page 2
Primer I2.51
Contact name:Deborah George
Roof drain(commercial) 12,51
Address:11120 SW Industrial Way, Bldg 9-3 Sink/basin/lavatory 5 25.02 i 015 1)
City/State/ZIP:Tualatin,OR 97062 Solar units(potable water) 62.54
Phone:(503)691-6166 Fax::(503)691.6771 Tub/shower/shower pan 1251
E-mail:deborah@modernplumbing,us
Urinal 25.02
. . n. , _- ,,...... ., ,e, ,,e. '1901 `1,P ihl Water closet 25.02
',I;d0 .., CONTRACTOR„•„ ,. .......... .. Water heater 37.52
Business name:Modern Plumbing Co Water piping/DWV 56.29
Address:11120 SW Industrial Way, Bldg 9-3 Other: 25.02
City/State/ZIP:Tualatin,OR 97062 Subtotal 0 37 t I
Phone:(503)691-6166 Fax:(503)691-6771 Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lie.:87906 mbing iic.no.:34-250PB - state surcharge(12%of permit fee)7. (4 ,j
Authorized signature: - a TOTAL PERMIT FEII rill 0.
Print name:Deborah George Date:5-,tj-1 l Thu permit application expires if a permit is not obtained within 180Idays
after it has been accepted as complete.
*Fee methodology set by Th-County Building Industry Service Board.
I:1Bu,7dnekP nIntakPLINU-PcnoitApp. 10/01/19 441.461r,'tttlMt2/CR•tM1wFR1
MAY-16-2019 08:30 From: To:5035981960 Pane:3/5
Plumbing Permit Application - City of Tigard
Page 2-Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
site utilities i I. ' m '„ w u ( ,„a iFca(€t)i!' ...Total+.. ual>1O °T'OO H t .. .. y..Perm it.Niel. µ'» il' 19'ii r Ih
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-1st 100' 62.54 7,201 and greater 5327,54 „
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Servide-each additional 100' 3 .. pe
7.52 t :A.0. 'Iv
Storm&Rain Drain-1st 100' 62.54 $1,0010$5,000.00 Minimum fcc$72.50
Storm&Rain Drain•each additional 100' 37.52 $5,001.00 to$10,000.0) $7250 for the first$5,000.00 and$1,52 for
)Ree each additional$100.00 or fraction thereof,to
Other Inspections Or reel*" 'I 1'g .�......:. _ and including$10,000.00.
Inspection of existing plumbing or for $10001.00 to$25,(1313).00 $1413.50 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 $2-5,(x)1.00 to$,50,0(11.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum chargeg 2 hours) each additional$100.0)or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,00L00 and up $742.00 for the fust$50,000.00 and$1.20 for
(minimum charge-1/2 hour) each additional S100110 or fraction thereof,
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
;i r,, "I'" flhainti,bvilaloreT' '�? 'Plan Revhevl' ori aanibmi jiistI'llattans 4n R
, rp7Y)efor, ' ;;'. I ,'b.1 RRcloratA y Plan review is required for01(he following.
i1g,` • . • 'CapM�' 1, ctikd �_gducale,,. eq any
Haptistrennt Please check all that apply,
Bath -Tub/Shower 0 Any new commercial building with water service 2"and
-
-Jacur.7i/Whirlpoot greater,except systems designed and stamped by licensed
nse d
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor I)rain/sink .2" Submit 2 sets of plans with any of the above.
-3"
•4" I$Ometne Or RiserMiS
Car Wash Irain_
Garbage Domestic-non-food
0 isometric or riser 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
-Bradley
-Commercial-fond related 5
-Service
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;
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
9631 SW WASHINGTON SQUARE RD FC03, June 6, 2019 at 8:47:04 AM
TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2019-00220
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor