Permit (15) CITY OF TIGARD PLUMBING PERMIT
'. COMMUNITY DEVELOPMENT Permit#: PLM2019-00223
a 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/28/2019
Tit'.A L"L7 9 Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9345 SW WASHINGTON SQUARE RD T13
Project Altar'd State Subdivision: None Lot: None
Project Description: Plumbing for tenant improvement: CAP(1)2"floor drain,(1)lay and(1)water closet;ADD(1)2"floor drain,(1)
expansion tank,(1)water heater,(1)water piping and(3)primers,RELOCATE(1)drinking fountain,(1)2"floor
drain,(1)lay and(1)water closet.
Contractor: OREGON PLUMBING AND PUMP LLC Owner: PPR WASHINGTON SQUARE LLC
PO BOX 261 PO BOX 847
MOLALLA, OR 97038 CARLSBAD, CA 92018
PHONE: 503-678-9886 PHONE: 865-288-7700
FAX:
FEES
Quantity Description Date Amount
1 ea Drinking Fountain 05/27/2019 $25.02
Specifics: 1 ea Expansion Tank 05/27/2019 $12.51
3 ea Fixture/Sewer Cap 05/27/2019 $75.06
Type of Use: COM 2 ea Floor Drain/Floor Sink/Hub 05/27/2019 $50.04
Class of Work: ALT 3 ea Primer 05/27/2019 $37.53
Type of Const: 1 ea Sink 05/27/2019 $25.02
Occupancy Grp: 1 ea Water Piping/DWV 05/27/2019 $56.29
Stories: 1 ea Water Closet 05/27/2019 $25.02
1 ea Water Heater 05/27/2019 $37.52
1 12%State Surcharge- 05/27/2019 $41.28
Plumbing
Total $385.29
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: � !Cy
CJS �1•�/ /9_70 "9-7 crl
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.
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Plumbing Permit Applicatio> IV tv
Building Fixtures EOR Ori IC1 1 SI, o\i,l'
CityTigard MAY 2 0 2019 Received
of DatelBy: 37Z3�iri '' Penni(x9PG-/*/.?e/J�d.,,02_3
III 13125 SW Hall Blvd.,Tigard,OR 97223 . Plan Review
Phone: 503.718.2439 Fax: 503.598.) Y OF �" G�tf� Date/By: Other Permit No.:
Inspection Line: 503.639.4175 (�! .r: Ready/By: Jura: H See Page 2 for
NG [)IVIS y
TIC AR
BUILDING
Internet: www.tigard-or.gov Notified/Method: Su plemental Information
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0 New construction ❑Demolition For special Information use checklist
Description 1 Qty. I Ea. I Total
jfir Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
�3 `7 r y73, 'w # ^ p,;.4r..?a`1fur , 7 %rf1111 ,y,.c. ,xrz'tr-'+1a;,yre s;7i ,I"y.,t,`` SFR(1)bath 312.70
❑ 1-and 2-family dwelling fgr Commercial/industrial
SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
2 ,iq .•¢.ik t ; r 1,,,:,,r w' �Lt{ r.i , tiiPii rk�..' 1t�t ;s Site utilities:
r: 7a rr .x.k0 .i,,a'""t;'"k'a"g^‘,-;,r: k Ti �°rd.x..,n ''t..' , ,yt+ti k,, r1`�
l.i,.
Job site address: ` �S t.-j 5 SV•j LU ish i 11c tot 1 S civ ,l--e d Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: R.,Cfi S 0. d 37.... Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: 1 Project name:A I tCu 1d S'tCx+t... Manufactured home utilities 50.03
Cross street/directions to job site: 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: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
g' --.I� as - :-1� 7 <, 7 Backwater valve 12.51
`,.,..,91,.
s a .:tftl *' '',i ',.":':`:- fit ;1' (t'Y'tI r53i );,'V" ''riui''Itc S:sti+li'Jl-'1ti�7 1 'a'
m :t,ti i� ,..�.a .... �s.t,7 ,rt�.., 'Jr,T� ^t r .d°4,, ,4 , r a d�# Clothes Washer 25.02
1 t Dishwasher 25.02
Drinking fountain J ✓ 25.02
Ejectors/sump 25.02
7 ss'l?t t r £tt ftE d l'1 tiF ei @ ',1 "ir v4Y. . } ;',111'1.1y ',` r.d a a`.i`tr.: ,;,2 Expansion tank / ! 12.51
:;:til•' Ti _ ..�V 4. � 4 .`b. . 4 •r s. _ -a'.vtr.7-.i...err. '' 1- ,,.„
Name: Fixture/sewer cap 3 / 25.02
Floor drain/floor sink/hubdLv 25.02
Address:
Garbage disposal 25,02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) lee maker 12.51
� ... `'r• - nx j iii ;•'AM : i."tr,4® p 3:f" , , ; -, fr.t of14, � ,,, �44a,4 Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer .5 ✓ 12.51
Contact name:
Roof drain(commercial) 12.51
Address: y
Sink/basin/lavatory !� / 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
e 7.?!.:.!'at €xia �« sa - l} i1 25.02
...._n!a V z 's:atm- a` � _° fi,a b kiL 'i. i2';,,„ E t ''?'rU '-t,-r",+,1t' ae Water closet
Wafts heater 1 ✓ 37.52
Business name:Q�Gcy.)vl Ptk.i+ylbi(\C\ 0._„‘d P:,r rn pWater piping/DWV i ,/ 56.29
Address:PO P.,,D X 2101 Other: 1 25.02
City/State/ZIP:m /C•1 t c OR Qt-10'- '.6 Subtotal
Phone: t Fax; Minimum permit fee: $72.50
CCB Lie.:d1"j Cr S `) Plumbing Lie.no.: PE))." ti 1 Plan review (25%of permit fee)
State surcharge of permit fee)
Authorized signature: iliee, 'TOTALTAL PERMIT FEE
Print name: Dates 1�0.1 16i' 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.
r:l BuildiapPetmitsiPU..f l-PermitApp.doc 10/01/09 440.4616T(1W02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su t 1 ression S stems:
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4i4i44, -,-tI-d,*-4:.s.. F,.,; j/l'1{C t f' 1 P-,,;'
. ij Fl. !}�;. R 1411:4 i' 8_r .;i:1� {1 F`,;,7',-,ft'1.'„,..,4.!=,..L.-,?:N^ 'rz ,,(�na.:L`°9
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Fr�r 53,.E ?-+tee 1..:.,.ix JJk?av}.. IJ^3.S. r.,.< t,.. Rr_
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 $23320
Sewer-1st 100' 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 11'wy --"-‘',4"# •. Pitt- F'4 i, •�,, '' an
Storm&Rain Drain-1st 100' 62.54 1A:,4
" ,.If,00o o' '` �"-""I`u-=.,-,r 5 '�4"-"
$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
� each additional$100.00 or fraction thereof to
VW{ � :: i ) ,fi ,,- q$" �4 i 1...„-' ;£; "l `' 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 how) 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
accuratelyc�+ report fixtures could resultsin increased�"rsewer fees*. tlt
a 4,14 tM-41tSwigiPtrX'S51';:N-s'}',r it e'u t�,>`V r` I ititteri rhiiaidAl� -fill „ � 'tit:, _0)1,-� fit:N. , nils 3 x t tl 7 6 1.:-15 i i "6' i 9•°{r:uc 'r ,
;,yrq�g'^_(i� � naw s.,� ` - Y" . a`-� 6�R4Y „y .=.., it"d- {+.1� ,3,.,A,,,,,,,_:�'�,�a ?" ,�d +
a "iiii^iz 3 iit41 y P M& �A GE 3 +k N(ekNN,14i rifi P W a$41 il,? i'
y< �,; i, -, _ l+,i ��fli"m H �, , �, Plan review is required for any of the following.
` .�urkl's'r�6?rlra , gti-lidaN,:-.-._.m r OK 1 :.. .,l.w
Baptistry/Font Please check all that apply.
Bath -Tub/Shower 0 My 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 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial L ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ° . 0 Any multipurpose fire sprinkler system.
Drinking Fountain C L ❑ Any complex structure as defined in OAR9I 8-780-0040.
Eye Wash
Floor Drain/sink -2" I I Submit 2 sets of plans with any of the above.
-3" r4
-4" :t. ,t 3 4H N r:.,-' 4 i TE.s::- i L °v t^ttgltthi"4*"Vt,,t"',t i-, r iu6}jr
...Yt-''''tkt.1:fti.,10'. • .Li I_"s(; k.ctti.i' ,24-PXn '-vtr. 4 +i4 ti; e u.-- -_
Car Wash Drain
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 J
Oil Separator(Gas Station) Comments regardin fixturr�e work:
Rec.Vehicle Dump Station Ctt22Ne" n y /J•9--Tit'ROoMS ��/S r-
Shower -Gang
Stall ,_-6 7-7 et Ir/A/6- tom/ ,66' ce r-! e
Sink/Lav -Non-food related I I / 4Z-()!'4,'-77/1/0- /3 97 C 0' 1
-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 I I fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C:1Users\Drew\Documents\PLMF PermitApp.doc 2
= Tenant Name: Altar'd State Accumulative Sewer Tally
SWR# N/A
TIGARD Site Address: 9345 SW Washington Squqre Rd PLM# 2019-00223
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 1 2 1 2 0 0
-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:
-Lav/Bar-Non-Food Related 2 0 1 2 0 -1 -2
-Bradley 5 0 0 0 0 0
-Com/Sery/Util-Food Related 3 0 0 0 0 0
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 1 6 0 -1 -6
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 3 10 1 2 -2 -8
Current Fixture Value -8 divided by 16= -0.500 Current EDU 1 EDU= $5,650.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -8 divided by 16= -0.500 over (under) $ (2,825.00)
Enter EDU Change Here -0.500 *
*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: 5/23/2019
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
_.nhmirred to the City of Tigard Building Division to redeem credits towards future s stem develo.ment char.es.
I:\Building\Sewer Tally\SewerTallySheet_5500_070118.xlsx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9345 SW WASHINGTON SQUARE RD T13,
TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2019-00223
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor