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Permit CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit#: PLM2021-00285 T'r i;A RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 7/15/2021 Parcel: IS 1260000300 Jurisdiction: Tigard Site address: 9374 SW WASHINGTON SQUARE RD R05 Project: Peloton Subdivision: None Lot: None Project Description: Plumbing fixtures for tenant improvement: CAP(2)3"floor drains,(2)lays,(1)sink,(2)water closets;ADD(1) shower,(1)drinking fountain,(2)2"floor drains,(3)lays/sink/mop sink,(1)water closet,floor cleanout,wall cleanout,recirculation pump and primer. Contractor: MODERN PLUMBING Owner: PPR WASHINGTON SQUARE LLC 11120 SW INDUSTRIAL WAY BY MACERICH RET TUALATIN, OR 97062 PO BOX 4085 SANTA MONICA, CA 90411 PHONE: 503-691-6166 PHONE: FAX: 503-691-6771 FEES Quantity Description Date Amount 1 ea Drinking Fountain 07/06/2021 $25.02 Specifics: 7 ea Fixture/Sewer Cap 07/06/2021 $175.14 2 ea Floor Drain/Floor Sink/Hub 07/06/2021 $50.04 Type of Use: COM 1 ea Primer 07/06/2021 $12.51 Class of Work: ALT 2 ea Sink 07/06/2021 $50.04 Type of Const: 1 ea Lavatories 07/06/2021 $25.02 Occupancy Grp: 1 ea Tub/Shower/Shower Pan 07/06/2021 $12.51 Stories: 1 ea Water Closet 07/06/2021 $25.02 75 Misc Other Fee 07/06/2021 $75.06 1 12%State Surcharge- 07/06/2021 $54.04 Plumbing • Total $504.40 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: Permittee Signature:Holly vart,De/w 0 Appl%ca LOYI 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. Rlumbing Permit Annli p,";:rj-1,sp Building Fixtures SUN 2 3 7.021 hole or1�ict: rsF ()NIA 13125 of Hll Blvd Tigard d .7 • 4 6 PermtN.ID Zcu -002,5 .� laws SW Hall Blva.,Tigard,o�Jls q> 3pF TiGARD PimJaView ??1 u Phone: 503.7182439 Fax: ICI.. DIVISION Date By: Ogler Permit No.: I I ,t U Inspection Line: 503.639.4175 Dam Ready/By: �} r„r B see Page 2 for Internet: www.tigard Or.Boy NatifuNMdltod?��� 4t� Supplemental lnformadoa TYPE OF WORK jyy,r. efy/L/__ FEE* SCHEDULE 0 New construction 0 Demolition For spe sal Infommadon use checklist Description I Qty. I Ea. I Total 0 Addititm/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 ❑t-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 ❑Accessory buildingSFR(3)bath 500 32 0 Multi-family Each additional badlAcimhm 25M ❑Master builder 0 Oar: Fire sprinkler(_sq.ft.) Page 2 . JOB SITE INFORMATION AND LOCATION Site utilities: ' lob siteaddress:9374 SW Washington Square Road Catch basin orereadrain 18.76 City/State/Z1P:Tigard, OR 97223 Drywall,leach line,or trench drain 18.76 • Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.:R05 Project name:Peloton Washington Square Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Washington Square Road Rain dminconnector 18.76 Sanitary sewer(no.linear ft.:_) Page 2 Stonn sewer(no.linear ft.:_) Page 2 Water service(no.linear lt.:_) Page 2 Subdivision:Washington Square Mall Lotno.: Fixture or item: Tax map/parcel no..1 S 1260000300 Ba k low prevr"aT 31.27 DESCRIPTION OF WORK Backwater valve f 251 Clothes washer 25.02 Tentant Improvement-Enlarge restrooms and install private restroom Dishwasher 25.02 ' 1 ENANT IMPROVEMENT:NEW SHOWER,RESTROOM,DRINKING FOUNTAIN,KITCHENETTE.. AND MOP SINK,WITH DRAINS AND CLEANOUTS AS REQ.TOTAL FIXTURE COUNT 12 Drinking fountain ; 25.02 Ejectors/sump 25.02 ❑ PROPERTY OWNER I 0 TENANT Expansion tank 12.51 Name:One Peloton FixharJsewerrap 7 25.02 Address:125 W 25th Street, lath Floor Floor drarn/ftoorsink/hub 2 25.02 Garbage disposal 25.02 City/State/ZIP:New York, NY 10001 Hose biib 25.02 Phone:( ) Fax:( ) Ice maker 12.51 0 APPLICANT ® CONTACT PERSON Interceptor/grease trap 25.02 Business name:Pai'c.. ,I„Associates Medicalgaa(valuaS_) Paget Contact name:April HOuS Primer 12.51 Roof drain(commercial) 12.51 Address:3017 SW Charlestown St Sink/basin/lavatory 25.02 City/State/ZIP:S eattle, WA 98126 Solar units(potable water) 62.54 Phone:(206 A78-0844 Fare:( ) Tub/shower/shower pan 1 12.51 E-mail:permits©parolineassociates.com Urinal 25.02 Water closet 1 25.02 CONTRACTOR Water heater 37.52 Business :FBD 'e10 of r - ? irY ;(1.) Water m WV 56.29 I� ` \� � ` PiP � Address: ``1 (rU �/i ��W1[1���� wG(� , EANOUT RECIRCULAT ON PUt.`: 25.02 /75. . op City/State/LIP: -CVA470-1tom CQ GilCG2'Z J Subtotal Minimum permit fee: $72.50 Phone:(c-01 (ocll" Cott& Fax:( ) CCB Lic.: Q��Q(o Plumbing Lic.no.:'�t,�-2,T'O Plan review(25%ofpemt fee) State surcharge(12%ofpermit fee) Authorized signature: 1 f///f / f TOTAL PERMIT FEE yi yo Print a�emn / �q /.r _ _ Date: e/V! zo This permit application expires if a permit ie not obtained within 180 days li^'`�,( "JJ '`� "��""^^�'•CC after It has bons Accepted as complete. *Fee methodology set by Tri-Comely Building industry Service Board 41911.4' F{pu Sty lAkildvgkPw ml&wPLMU.Pe itAppdoe I0,OIR79 440ea16T(10103/OnMIWEZ) 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-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 grader $327.54 Sewer-each additional 100' 37.52 Water Service-1st 100' 62.54 Medical Gas Systems: Water Service-each additional 100' 37.52 Valuation: Permit Fee: Storm&Rein 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$100.00 or fraction thereof,to and including$I0,000.00. 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 chartie-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 includin $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 Plumbing Installations Quantity,by Future Type Plan review is required for any of the following. Fixture Type for Replace/ Please check all that apply. Work Performed: Capped Added Rebeafe ❑ Any new commercial building with water service 2"and Baptis tnlFont Bath: Tub/Shower t greater,except systems designed and stamped by licensed gi -Jacuzzi/Whirl pool r. Car Wash: -Each Stall ElNe New ew e exxterior plumbing site utilities for any complex structure as defined in OAR918-780.0040. -Drive Thru Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities. Dishwasher. Commercial 0 Any multipurpose fire sprinkler system. Domestic ❑ Any complex structure es defined in OAR918-780-0040. Eye Wash kin ountarn I Submit 2 sets of plans with any of the above. Floor Drain/sink: -2" ✓ 2 3" 2 Isometric or Riser Diagram 4„ 0 Isometric or riser diagram is required for new buildings -Car Wash Drain that meet the uualifications above. Garbage -Domestic non-food r Disposal: -Domestic food related -Commercial food related -Industrial food related [ce Mach./Refrig.Drains Comments regarding fixture work: Oil Separator(Gas Station) TOTAL FIXTURE COUNT 12 15 Rec.Vehicle Dump Station Shower -Gang -Stall 4 Sink: -LavBarnon-food related 2 ✓ 3 -Bradley -Com/Serv/Util food related 1 -Service *Note: If the fixture work under this permit results in an Swimmin8Pool Filter increase of sewer EDUs,a sewer permit will be issued and Water ExtractoClothes r fees assessed for the sewer increase must be paid before the WaterClose-Toiler 2 / I plumbing permit can be issued. Urinal Other Fixtures:FLOOK t-LtANW I,WALL 3 ' LLtAIVUU r, 1:\Building\Pe I§ IPrgillll&pp.doc 08/04/2011 2 r i ,,-f 'rPlumbing Permit ApplicR ''E�VE,D Building Fixtures Jl1N 2 3 2021 FOR OFFICE I sr; OILY City of Tigard Received Penni(No.: Date/By: • 13125 SW Hall Blvd.,Tigard,O1U30F TIGARD Plan Review Phone: 503.718.2439 Fax: 8�,q�gr� DIVISION De,� Other Permit No.: Inspection Line: 503.639.4175 1 G y I 1 c:;A I:I) P Date Ready/By: Juris: 63 See Page 2 for Internet: www.tigard-or.gov Notified/Method: Suppkmental Information TYPE OF WORK FEE* SCHEDULE ❑New construction 0 Demolition For special Information use checklist Description I Qty. I Es. I Total ®Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(I)bath 312.70 CI1-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.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address:9374 SW Washington Square Road 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.:R05 I Project name:Peloton Washington Square Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Washington Square Road Rain drain connector 18.76 Sanitary sewer(no.linear ft.: ) Page 2 Storm sewer(no.linear ft.: ) Page 2 Water service(no.linear It.: ) Page 2 Subdivision:Washington Square Mall Lot no.: Future or item: , Tax map/parcel no.:1 S 1260000300 Backflow prevernir 31.27 DESCRIPTION OF WORK Backwater v a 12.51 Clothes wather 25.02 Tentant Improvement-Enlarge restrooms and install private restroom Dishwasher 25.02 -ENANT IMPROVEMENT:NEW SHOWER,RESTROOM,DRINKING FOUNTAIN,KITCHENETTE, AND MOP SINK,WITH DRAINS AND CLEANOUTS AS REQ.TOTAL FIXTURE COUNT 12 Pinking fountain 1 25.02 ,.EJectors/sump 25.02 0 PROPERTY OWNER al TENANT Expansion tank 12.51 Name:One Peloton Fixture/sewer cap 25.02 Floor drain/floor sink/hub 2 25.02 Address:125 W 25th Street, 11th Floor Garbage disposal 25.02 City/State/ZIP:New York, NY 10001 Hose bib 25.02 Phone:( ) Fax:( ) Ice maker 12.51 0 APPLICANT 0 CONTACT'PERS° Interceptor/grease trap 25.02 Business name:Paroline &Associates � )Medical gas(value:$_) Page 2 Primer 1 12,51 Contact name:April Hous V� Roof drain(commercial) 12.51 Address:3017 SW Charlestown St ( \> Sink/basin/lavatory 3 25.02 City/State/ZIP:Seattle, WA 98126 Solar units(potable water) 62s4 Phone:(206 478-0844 Fax: :( ) (�� Tub/shower/shower pan 12.51 E-mail:permits@parolineassociates.com CONTRACTOR i� Urinal 25.02 �' Water closet ' 1 25.02 Water heater 37.52 Business name:T B D Water piping/DW V 56.29 rLUUK L,LLANUU I.MALI Address: �er:CLEANOUT,RECIRCULATION PUMP 3 25.02 City/State/ZIP: Subtotal Phone:( ) Fax:( ) Minimum permit fee: $72.50 CCB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee) State surcharge(12%of permit fee) Authorized signature: y� TOTAL PERMIT FEE Print namet� (7 Date: G//G/ZO r/ This permit application expires if a permit is not obtained within 180 days l`��«/ YY after it has been accepted as complete. "Fee methodology set by Tri-Count Building Industry Service Board. 1:1Budding,Pernuts1PtMU-PemnaApp.doc 10/01/09 440-4616T(10/02/COM/WEB) re l''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-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 $327.54 Sewer-each additional 100' 37.52 Water Service- 1st 100' 62.54 Medical Gas Systems: Water Service-each additional 100' 37.52 Valuation: Permit Fee: 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 P 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 nomtal 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 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-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 Plumbing Installations Quantity by Fixture Type Plan review is required for any of the following. Fixture Type for Replacer Please check all that apply. Work Performed: Capped Added Relocate Baptistry/Font 12 Any new commercial building with water service 2"and greater,except systems designed and stamped by licensed Bath. -Tub/Shower I engineer. -Jacuzzi/Whirlpool Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure as defined in OAR918-780-0040. Cuspidor/WaterAs-Drive DDr Stallr vet t' u ElMedical gas and vacuum systems for health care facilities. Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system. Domestic ❑ Any complex structure as defined in OAR918-780-0040. Drinking Fountain 1 Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: -2" 2 3" Isometric or Riser Diagram 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 Ice Mach./Refrig,Drains Comments regarding fixture work: Oil Separator(Gas Station) TOTAL FIXTURE COUNT 12 Rec.Vehicle Dump Station Shower: -Gang -Stall Sink: -1.,avBar non-food related 3 -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 I plumbing permit can be issued. Urinal Other Fixtures:-LUUK LLtANUU I,WALL tl L-LtANUU I, :1Ruilding\Pe tR HRIVApp.doc 08/04/2011 2 Dianna Ornelas From: #Building Permit Technicians Sent: Friday, July 2, 2021 5:50 PM To: permits@parolineassociates.com Subject: PLM2021-00285 - Peloton - 9374 SW Washington Square Rd Attachments: PLM2021-00285.pdf; PLM2021-00285_Sewer_SDC_Credits.pdf Hello April, This permit is ready to issue and the balance due is$504.40 (see attached invoice). I have also attached a copy of the sewer tally sheet where the scope of work resulted in sanitary sewer SDC credits. Please provide this to the property management for future use. It is their responsibility to present this document to receive credits for future sewer SDCs. The fees can be paid online at https://aca-prod.accela.com/TIGARD/Welcome.aspx by searching for the permit record number PLM2021-00285 under the Building tab. Payment can be made by`card' for a 3%service fee or select the 'check' payment option and there is no service fee. Please email the permit technicians at TigardBuildingPermits@tigard-or.gov once the fees are paid so that we can issue the permit and email a copy. Please note that a licensed plumbing contractor must be identified prior to permit issuance. Please notify the permit technicians when you have this information so that we can add it to the permit. Thank you. Dianna L. Ornelas Building Division Services Supervisor City of Tigard I Community Development 13125 SW Hall Blvd I Tigard, OR 97223 503-718-2430 Direct 1503-718-2439 Permits 1 Dianna Ornelas From: #Building Permit Technicians Sent: Friday, June 25, 2021 2:52 PM To: permits@parolineassociates.com Subject: 9374 SW Washington Square Rd - Peloton Attachments: SKM_C65921062514300.pdf; Peloton_Estimate_062521.pdf Hello April, On the attached plumbing permit application that was submitted it only lists the new fixtures being added. Are there any fixtures that will be capped, or replacing/relocating any existing fixtures? If so,these also need to be included on both Page 1 and 2 as follows: • Capped fixtures will be entered on Page 1 under Fixture/sewer cap for the total number of capped fixtures and on Page 2 under the capped column according to type/size of fixture so that proper SDC credits can be applied. • Replaced/relocated fixtures must be entered on Page 1 by the quantity for each type and on Page 2 under the Replace/Relocate column. I have also attached an estimate for all new fixtures added per the application submitted. This is subject to change if there were any existing fixtures capped. Please advise and submit amended application if applicable. Thank you. Dianna L. Ornelas Building Division Services Supervisor City of Tigard I Community Development 13125 SW Hall Blvd I Tigard, OR 97223 503-718-2430 Direct 1503-718-2439 Permits 1 Accumulative Sewer Tally ■ • Tenant Name: Peloton SWR# N/A T G n I'n Site Address: 9374 SW Washington Square Rd PI.M# 2021-00285 Parcel#: 1 S 1260000300 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 1 4 1 4 -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 1 1 1 1 Eye Wash 1 0 0 0 0 0 Floor Drain/Sink: -2 inch 2 0 0 2 4 2 4 -3 inch 5 0 2 10 0 -2 -10 -4inch 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 l iving 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: -Lay/Bar-Non-Food Related 2 0 2 4 3 6 1 2 -Bradley 5 0 0 0 0 0 -Com/Serv/Util-Food Related 3 0 1 3 0 -1 -3 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 2 12 1 6 -1 -6 Urinal 6 0 0 0 0 0 Previous EDU Count 0 0 Capped EDU Credit 0 TOTALS 0 0 7 29 8 21 1 -8 Current Fixture Value -8 divided by 16= -0.500 Current EDU 1 EDU= $5,800.00 Previous Fixture Value 0 divided by 16= 0.000 Previous FDU Change -8 divided by 16= -0.500 over (under) $ (2,900.00) 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: **.50 EDU CREDITS** Authorized Name/Signature: Dianna Omelas Date: 7/2/2021 • 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 submitted to the City of Tigard Building Division to redeem credits towards future system development charges. I:\Iluilding\Sewer Tally\Sewer 1'allySheet_5800_070119.xlsx