Permit IN CITY OF TIGARD PLUMBING PERMIT
Permi
_ , COMMUNITY DEVELOPMENT t#: PLM2021-00179
Date Issued: 5/10/2021
T[G A RI) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9681 SW WASHINGTON SQUARE RD C06
Project: Fabletics Subdivision: None Lot: None
Project Description: Complete plumbing system
Contractor: PMSI LLC Owner: PPR WASHINGTON SQUARE LLC
8295 NW EVERGREEN PKWY#204 BY MACERICH RET
HILLSBORO, OR 97124 PO BOX 4085
SANTA MONICA,CA 90411
PHONE: 503-466-2222 PHONE.
FAX: 503-466-2211
FEES
Quantity Description Date Amount
1 ea Expansion Tank 04/29/2021 $12.51
Specifics: 1 ea Water Heater 04/29/2021 $37.52
1 12%State Surcharge- 04/29/2021 $8.70
Type of Use: COM Plumbing
Class of Work: ALT 22 ea Minimum Fee Adjustment- 04/29/2021 $22.47
Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
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:
1-fatlyVouv e,Wege OwApplicatti,on
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 Applicatig4 +
Building Fixtures RECEIVED FOR OFFICE USE ONLIM
Cl Of Tigard Received , Permit No..?Lvr IZOZ\-
fy g APR 2 8 2021 Dateivy: 1-'I 2ci z� v 11g
111 q 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
■ Phone: 503.718.2439 Fax: 503.598.(ffyOFTIGARD Date/By: Other Permit No.:
TIC:1 R n Inspection Line: 503.639.4175 Date Ready By: yl'2. t y�<rwtlGl r ri ® See Page 2 for
Internet: www.tigard-orgov 3UILDING DIVISION Nulificd4vlethod: t i r lrt Supplemental Information
TYPE OF W& '1' ,.FEE* SCHEDULE
❑New construction 0 Demolition For special information use checklist
Description Qty. Ea. I Total
®Addition/alteration/replacement D Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
EIMIELCATEGORY OF CONSTRUCTION SFR(I)bath 312.70
❑ 1-and 2-family dwelling ®CommerciaUindustrial
SFR(2)bath 437.78
SFR(3)bath 500.32
['Accessory building 0 Multi-family
Each additional bathAkitchen 25.02
❑Master builder 0 Other: Fire sprinkler(_sq.ft.) Page 2
tr
JOB SITE INFORMATION AND LOCATION Site utilities:
lobvteaddress: 9681 SW Washington Square Rd 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.: I Project name: Fabletics 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: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
IF
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Complete plumbing system Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER11 ® TENANT Expansion tank 1 12.51 12.51
Name: Fabletics Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 9681 SW Washington Sq Rd Garbage disposal 25.02
City/State/ZIP: Portland, OR 97223 Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
® APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: PMSI LLC Medical gas(value:$_) Page 2
Primer 12.51
Contact name: Amanda Reyes Roof drain(commercial) 12.51
Address: 8295 NE Evergreen Parkway, Ste 204 Sink/basin/lavatory 25.02
City/State/ZIP: Hillsboro, OR 97124 Solar units(potable water) 62.54
Phone:(503 ) 466-2222 Fax: :( ) Tub/shower/shower pan 12.51
E-mail: areyes@msi-systems.com Urinal 25.02
Water closet 25.02
CONTRACTOR Water heater 1 37.52 37.52
Business name: PMSI LLC
Water piping/DWV 56.29
Address: 8295 NE Evergreen Parkway, Ste 204 Other: 25.02
City/State/ZIP: Hillsboro, OR 97124 Subtotal 50.03
Phone:( 503) 466-2222 Fax:( ) Minimum permit fee: $72.50 22.'41
CCB Lie.: 158286 Plumbing Lie,no.: 34-434PB Plan review (25%of permit fee)
State surcharge(12%of permit fee) g•'10
Authorized signature4 i_ TOTAL PERMIT FEE ei.Z6
This permit application expires if a permit is not obtained within 180 days
Print name: Amanda Reyes Date: 04/28/2021
after it has been accepted as complete.
*Fee methodology set by Trt-County Building Industry Service Board.
I:tBuilding\Permits\PLMU-PermitAppdoe 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: it Fee:
Footing drain-I'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 $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 $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 Qty. 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
(minimum charge-1/2 hour) and ncladudingal2 ,$100.00. or fraction thereof,to
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*. Plan Review for l u"mbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
Baptistry/Font ElAny new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
ElCar Wash: Each Stall New exterior plumbing site utilities for any complex structure
Drive Thr as defined in OAR918-780-0040.
Cuspidor/WaterAsirator El Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial El Any multipurpose fire sprinkler system.
Domestic El Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
3" Isometric or Riser Diagram
4 ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lay/Bar non-food related
-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
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
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