Permit CITY OF TIGARD PLUMBING PERMIT
` COMMUNITY DEVELOPMENT Permit#: PLM2019-00289
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/22/2019
Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9585 SW WASHINGTON SQUARE RD
Project: Wetzels Pretzels Subdivision: None Lot: None
Project Description: Site utilities for kiosk Y06: 15 ft.of sanitary sewer and 75 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:
FAX: 503-691-6771
FEES
Quantity Description Date Amount
15 If Sanitary Sewer 07/19/2019 $62.54
Specifics: 75 If Water Service 07/19/2019 $62.54
1 12%State Surcharge- 07/19/2019 $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 503.232.1987 or 1.800.332.2344.
Issued By: �t� Permittee Signature: C� 47.--"'" C•-•"'"1""Ef ..—`
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.
Plumbing Permit Application
Building Fixtures RECEIVED
Cityof Tigard Received
an3j U L 1 1 2 019 Date/By: ��/ jJ-- Permit No.: /17,4.1 ) L1
III NI 13125 SW Hall Blvd.,Tigard,OR 9722 civ
Plan Review
Phone: 503.718.2439 Fax: 503.598Other Permit No.:
Inspection Line: 503.639.4175 OF TIGARD Date/By:
i lc,A it ti Internet: www.ti and-or. ov BUILDING D IVI S 10 N Date Ready/Bty: loris: ® See Page 2 for
8 g Notified/Method: Supplemental Information
0 New construction 0 Demolition For special information use checklist.
Description I Oty. I Ea. I Total
®Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
f ' ,,A../.....,,,•r t ® t`. 4r0 4. ° wSFR(1)bath
,,,,,, , .:; :: .4{ 4 , 0 ;VA,. 312.70
❑1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
(fit ve ) e 6tt ."`• Site utilities:
Job site address:9585 SW Washington Square Road, Kiosk Y06 Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97223 ` Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Y06 I Project name: P��,(.j19--e-17( (J Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:15) i Page 2 62.54
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.:75 1 Page 2 62.54
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
° t a l "" ® '1 ,4 Backwater valve 12.51
0•-*; rVit , r.'. '4,-,i*.F „ 1z
:. n .' .;,.,,,,v4. Clothes washer 25.02
install 1"pex water line from main behind Sees candy to new kiosk. Install 4" Dishwasher 25.02
ABS waste line from existing sewer clean out in front of space Drinking fountain 25.02
Ejectors/sump 25.02
Thp120 4. E . .5 4t re . .;;.147:'1:4,,,,,%44' Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
p r.., Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
-
_ z E-mail:
25.02- CONTRACCOR" td, , Water closet
`. '' " - -' ''',4-' „
- Water heater 37.52
Business name:Modern Plumbing Water piping/DWV 56.29
Address:11120 SW Industrial Way,Bldg 9-3 Other: 25.02
City/State/ZIP:Tualatin, OR 97062 Subtotal 125.08
Phone:(503)691 6166 Fax:(503)691-6771 Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.:87906 Plumbing Lic.no.:34-250PB
State surcharge(12%of permit fee) �.ct
Authorized signature:
1(11/1.---..
TOTAL PERMIT FEE 1.9,08'(i 4; ji
Print name Deborah George Date:7/11/19 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.
1:1Building\Permits\PLMU•PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Branden Taggart
From: Branden Taggart
Sent: Thursday, July 18, 2019 6:59 PM
To: Deborah George, Modern Plumbing
Cc: #Building Permit Technicians
Subject: RE: Plumbing permit applicatioin Washington Square Kiosk Y06
Hi Deborah,
The permit for this kiosk is ready to issue. However, before we issue this permit, we will need to know who will be
occupying this space. The balance due is$140.09, and the permit fees can be paid online now at
https://aca.accela.com/TIGARD/Default.aspx or in person between the hours of 8:00 a.m. and 4:30 p.m., Monday
through Thursday. We are closed on Fridays. If paid online, please notify us at tigardbuildingpermits@tigard-or.gov,
and I will email you the permit paperwork.
Thank you,
Branden Taggart
w City of Tigard
R • Senior Permit Technician
• , Community Development
TIC ARO
13125 SW Mail Bird.
Tigard,OR 97223
(503)718-2449
brandent@tigard-er.gev
From: Deborah George, Modern Plumbing<george4715@comcast.net>
Sent:Thursday,July 11, 2019 12:37 PM
To:#Building Permit Technicians<TigardBuildingPermits@tigard-or.gov>
Subject: Plumbing permit applicatioin Washington Square Kiosk Y06
Caution! This message was sent from outside your organization. Allow sender I Block sender
Good Afternoon -
Attached please find a plumbing permit application for Kiosk Y06 at Washington
Square Mall.
1
F'iease let me know when the permit is ready to issue and I will pay the fees on
line.
ThankY ou
beborah
deborah@modernplumbing.us
503-691-6166
2
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 PLM2019-00289
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . Plumbing underslab for 15ft. Of Bldg Sewer, and 75ft of water service.- Approved
with test.
Violation Summary:
Inspector Contractor