Permit Support Document (6) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT
r Permit#: PLM2022-00314
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439NW
Date Issued: 8/11/2022
Parcel: 1 S1260000300
Jurisdiction: Tigard
Site address: 9546 SW WASHINGTON SQUARE RD H16
Project: Lululemon Tenant Improvement Subdivision: None Lot: None
Project Description: (1)expansion tank,(2)floor drains,(1)prime,(4)sinks,(2)water closets,(1)water heater
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 08/11/2022 $12.51
Specifics: 2 ea Floor Drain/Floor Sink/Hub 08/11/2022 $50.04
1 ea Primer 08/11/2022 $12.51
Type of Use: COM 4 ea Sink 08/11/2022 $100.08
Class of Work: ALT 2 ea Water Closet 08/11/2022 $50.04
Type of Const: 1 ea Water Heater 08/11/2022 $37.52
Occupancy Grp: 1 12%State Surcharge- 08/11/2022 $31.52
Stories: Plumbing
Total $294.22
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: 7j" Permittee Signature: r, 7
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.
CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT Permit#: SWR2022-00110
Date Issued: 8/12/2022
T 1GARDD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9546 SW WASHINGTON SQUARE RD H16
Project: Lululemon Tenant Improvement Subdivision: None Lot: None
Project Description: New sewer sdcs 2 additional EDUs
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
Description Date Amount
Specifics: Sewer Connection Fee 08/12/2022 $12,170.00
Type of Use: COM
Class of Work: ALT
Install Type:
Fixture Units:
Number of Dwelling Units: 2
Total $12,170.00
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. Tho e rules are set iorth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
Issued By: ('". 2
^jl�/ �/� Permittee Signature: ho9
'/
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. 1}
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.
il
- Accumulative Sewer Tally
Tenant Name: Lululemon TI Washington Square SWR# 5,./R aoDA,- 0 d
TI G n R D Site Address: 9546 SW Washington Square Rd,St H16 PLM# PLM2022-00314
Parcel#: at ci d ,j>af C 4
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 0 0 0 0
-3 inch 5 0 0 2 10 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
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:
-Lay/Bar-Non-Food Related 2 0 0 2 4 2 4
-Bradley 5 0 0 0 0 0
-Com/Serv/Util-Food Related 3 0 0 2 6 2 6
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 0 2 12 2 12
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 8 32 8 32
Current Fixture Value 32 divided by 16= 2.000 Current EDU 1 EDU= $6,085.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 32 divided by 16= 2.000 over (under) $ 12,170.00
Enter EDU Change Here 2.000 *
*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: 0/tll�/i QJ
' d, Date: /fl/ola
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:\Building\Sewer Tally\SewerTalllySheet_6085_070121.xlsx
Plumbing Permit Application
Site Utilities FOR OFFICE I'SE ONLY
City of Tigard Received of
llateBy: �/ u 1 Permit No.:P� r'Ja-,cc t 9
IIIq 13125 SW Hall Blvd..Tigard,OR 97223 Plan Review 1 1 wcn ,t
_ Phone: 503.7182439 Fax 503.598.1960 Date/By: Other Permit No. y�-� )i'(�
T I GA R D Inspection Line: 503.639.4175 Dale Ready/By: luris ®See Page
`2 for �S
Internet: wvw,tigard-or.go Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist
Description 1 Qty. I Ea. 1 Total
ISLiddition/alteration/replacement 0 Other: New I-2-family dwellings(includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ 1-and 2-family dwelling -Ek-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
9 5y(0 JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:
-, Catch basin or area drain 18.76
f"t kinh,.ti trn� >, ;. - HV
City/State/ZIP: '7
y ` ) ) D Drywell,leach line,or trench drain 18.76
I ��r A.\a.-, c � a�223
t Footing drain(no.linear ft.:_) Page 2
Suite/bldg/apt.no.: Project name:
Lv1viCry tc 1 1A�ta hl,i )ar �s- 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.: Back flow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
C.i).,rvt 1j i e t•'L.. c7 i Li ht r\;V s.-y ciCfV . Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER TENANT Expansion tank 12.51 i Z 5 I
Name: Lit,
-t� Fixture/sewer cap 25.02
� ,IC + tc t Floor drain/floor sink/hub 25.02 5C3 C)`-k
Address:8s IAumef" C ,_v`t .FIcx)C Garbage disposal 25.02
City/State/ZIP: , f
� �n4v'�u r'� ��� ti Cc,g %"L.%2.- Hose bib _ 25.02
Phone:( ) Fax:( ) Ice maker 12.51
APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
�� )) 1 "C__ ,� Primer 12.51Sj
Contact name: A0,„,rxex[, '1'1c c S
_ Roof drain(commercial) 12.51
Address: '&2.4c JJUC Eve r- f e.rt p Lw„i ,tc_ 2.O-i Sink/basin/lavatory 14 25.02 lcr)<1,•
City/State/ZIP: f;IIShO(-U C ct-- l'2q Solar units(potable water) 62.54
Phone:(c);) Fax::( ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail: arty ese yrks'i -ls' �'crv,5.co n-. ��
Water closet 25.02 L r Y-1
CONTRACTOR
Business name: _ Water heater 37.52 .^?--7,5•Z
j\ cz j L L_C. Water piping/DWV 56.29
Address: ` ici s- A/6 Bever.,)reel ?1, i``afLl✓�Z - Other: 25.02
City/State/LIP: }.r;-,\‘ ,00,-. (---,) q-1 t Li. Subtotal z z 1O
Phone:(c ) Fax:( } Minimum permit fee: $72.50
w ,{(L a22.2_ .
Plan review (25%of permit fee)
CCB Lie.: 1 SS' Plumbing Lic.no.:> -4 3,-1 p State surcharge(12%of permit fee) `,5 Z
Authorized signature: 6 ^ ,2_Z
Z-f r�s /� .l 2,% TOTAL PERMIT FEE� tat
This permit application expires if a permit is not obtained within 180 days
Print name: '\- r,(,,.-, Date:�'Jz 1 4.2_,
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
L'Su ldingtPermits\PLMU-PermttApp.doc I0/01/09 440-4616T(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: 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 7,20 I 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-I st 100' 62.54 $1.00 to$5,000.00 Minimum tee$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• Pee tea) 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 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 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*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Repla"/ Plan review is required for an}of the following.
Performed: Capped Added Relocate
Baptistry/Font Please check all that apply.
Bath Tub/Shower ❑ Any 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 ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Eve Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
2.-
-4' Isometric or Riser Diagram
Car Wash Drain
Garbage -Domestic-non-food ❑ 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
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-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 fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
t:\Building\Permits\PLMU PermitApp.doc 2
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