Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT
Permit#: PLM2020-00338
Date Issued: 8/27/2020
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 1S126CA01100
Jurisdiction: Tigard
Site address: 9009 SW HALL BLVD 100
Project: Target Subdivision: None Lot: None
Project Description: ADD(4)lays and(1)water closet; RELOCATE(2)drinking fountains,(1)eye wash, (3)2"floor drains,(6)lays,(7)
water closets and(2)urinals.
Contractor: PMSI LLC Owner: DAYTON HUDSON CORPORATION
8295 NW EVERGREEN PKWY#204 BY TARGET CORP T-0345
HILLSBORO, OR 97124 PROPERTY TAX DEPT/TPN-0950
PO BOX 9456
MINNEAPOLIS, MN 55440
PHONE: 503-466-2222 PHONE:
FAX: 503-466-2211
FEES
Quantity Description Date Amount
2 ea Drinking Fountain 08/27/2020 $50.04
Specifics: 3 ea Floor Drain/Floor Sink/Hub 08/27/2020 $75.06
10 ea Lavatories 08/27/2020 $250.20
Type of Use: COM 2 ea Urinal 08/27/2020 $50.04
Class of Work: ALT 8 ea Water Closet 08/27/2020 $200.16
Type of Const: 25 Misc Other Fee 08/27/2020 $25.02
Occupancy Grp: 1 12%State Surcharge- 08/27/2020 $78.06
Stories: Plumbing
Total $728.58
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
Issued By: e•C V j� � Permittee Signature: ej� /j-�#96. TJ��
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 ApplicatijCEIVED
Building Fixtures AUG 2 0 2020 IO LI OH f It I I SI (1\l.1
City of Tigard Received Permit N
• 13125 SW Hall Blvd.,Tigard,OROVIY;OF TIGARD Date/By: d/2..S/�) '®O Lr1 Z010-O03,4
:11 / g Plan
■- Phone: 503.718.2439 Fax: 5C�l3P�{A�QG DIVISIONOther Permit
Inspection Line: 503.639.4175 oatefe Review q�� ! �d/�S
P Date ReadyiBy:e J LS/ram o Mir ® See Page 2 for
Internet: www.I igard-or.gov �N�ottiffied/Method: Supplemental Information
TYPE OF WORK v- /47IJ- 101 (g 6- FEE* SCHEDULE
❑New construction 0 Demolition For special information use checklist.
--- Description I Qty. I Fa. I Total
Addition/alterationleplacement 0 Other: New I-2-family dwellings(includes 100 fl.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ I-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.fl.) Pagc 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:��tt Catch basin or area drain 18.76
"t01 Jt,J �c�\\ 1vGk Drywell,leach line,or trench drain 18.76
City/Stale/ZIP: s(ref 0fz 0,--1 Z 3 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.:// - ) Project name: i ' T?)3i is 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(nu.linear It:_) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
y
1 r17}s.\\ bC:. rcj C M gri X.ttJ rC.. . Dishwasher 25.02
Drinking fountain z, 25.02 c..„0.06
Ejectors/sump 25.02
0 PROPERTY OWNER I TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name: T
^r .T Floor drain/floor sink/hub t✓ . 25.02 -7 S'tip
Address: CV)0(‘ )4J i4r.,.\\ a Iv G` Garbage disposal 25.02
City/State/ZIP: - ` Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:S_) Page 2
Business name: p M s i ) I L
Primer 12.51
Contact name: A �� � t Roof drain(commercial) 12.51
Address: i�ZrtS nit: EVGCChfCC!\ 2� SIC-.'r St Ot-1 Sinkfbasin/lavatory LANs f\O 25.02 2S,ZCj
City/State/ZIP: L4 r 1\e 1, :i J ecCy�'?.. CA 1-Lt.( Solar units(potable water) 62.54
Phone:(503) „IAA, 22 Fax::( ) Tubishower/shower pan 12.51
�2.
E-mail:p,� v -,-). _ '""-.1 Urinal s. g 25.02 c , t(
C . r , - `-ySfiCrnS CU Water closet ✓ 25.02 2C�).1(D
CONTRACTOR Water heater 37.52
Business name: T)1\A' L_1_C_. Water piping/DWV 56.29
Address:F*2,.% Air E ve c-c�r r e-i 2li_.N.,i c-{-e 7 GL1 Other: e:y c-" i...J hs i-I V I 25.02
City/State/ZIP: r Subtotal �p�r.5.Z
N t\\t4„:�;'o) p{_ ai 1 1ZI.I
Phone:(�j3) �(o l e- Z27,?, Fax:( )
Minimum permit fee: 572.50
Plan review (25%of permit fee)
CCB Lie.: 1 ,)R 2 R ly Plumbing Lic.no.:3 N_U 3u 1313 State surcharge(12%of permit fee) 7p
a r(Jk.,
Authorized signature:j}i1/,J,: gi TOTAL PERMIT FEE 7Z.g„Se
A "`�"�"� This permit application expires if a permit is not obtained within 180 days
Print name:Jtn'lttirtc �, p,C y e.y Date:Gig,1c%)74)ZU after it has been accepted as complete.
'Fee methodology set by Tri-County Building Industry Service Board.
:dluilding3crmasU'LMU-PcrmirApp.Jac 10N1/09 44046161(IWt2'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- I"100' 50.03 0 to 2,000 S121.90
Footing drain-each additional I00' 37.52 2.001 to 3,600 SI69.69
3,601 to 7,200 $233.20
Sewer- Ist 100' 62.54 7,201 and ercatcr $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
Storm&Rain Drain- 1st 100' 62.54 Valuation: Permit Fee:
S 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 S72.50 for the first$5,000.00 and$1.52 for
Other Inspections or Fees Qty. Fee(ea) Total each additional S 100.00 or fraction thereof,to
and including S 10,000.00.
Inspection of existing plumbing or for S10,001.00 to S25,000.00 $148.50 for the first S10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional S 100.00 or fraction thereof:to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr 525,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional S 100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including S50,000.00.
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-I/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*. Plan Review for Plumbing Installations
Queen"by Fixture Type Plan review is required for any of the following.
Fixture Type far Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
Baptistry/Font ❑ Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
-Jacttzzi/Whirlpool
Car Wash! -Each Stall ❑ New exterior plumbing she utilities for any complex structure
Drive Thr as defined in OAR9I8-780-0040.
Cuspidor,Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
ElDishwasher- Commercial Any multipurpose fire sprinkler system.
Domestic 0 Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash I 1 Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
3" Isometric or Riser Diagram
4" 0 Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
IceMach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -LavBar non-food related W ✓ L /ttrS z /de f� if f`7 /d 9
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase must be paid before the
Water Extractor Water Closet-Toilet plumbing permit can be issued.
�
Urinal
Other Fixtures:
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