Permit CITY OF TIGARD PLUMBING PERMIT
2 . COMMUNITY DEVELOPMENT Permit #: PLM2011 -00285
T[C 4RD 13125 SW Hall Blvd , Tigard OR 97223 503.718.2439 Date Issued: 09/15/2011
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9597 SW WASHINGTON SQUARE RD B13
Project: Lush Subdivision: Lot:
Project Description: (1) 2" floor drain, (1) non -food related sink and (1) water heater
Contractor: PMSI LLC Owner: PPR WASHINGTON SQUARE LLC
21195 NW EVERGREEN PKWY #204 BY THOMSON PROPERTY TAX SERVICES
HILLSBORO, OR 97124 ATTN HILARY RAYMOND
CARLSBAD, CA 92008
PHONE: 503 - 466 -2222 PHONE:
FAX: 503- 466 -2211
FEES
Quantity Description Date Amount
1 ea Floor Drain /Floor Sink/Hub 09/09/2011 $25.02
Specifics: 1 ea Sink 09/09/2011 $25.02
1 ea Water Heater 09/09/2011 $37.52
Type of Use: COM 1 12% State Surcharge - 09/09/2011 $10 51
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $98.07
•
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: 7, Permittee Signature: ' 41- /�
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.
Sep. 9. 2011 11:15AM No. 4486 P. 2
Plumbing Permit Applicatio a rin. Irk
Building Fixtures E' L e:.4 L L i ou oFlrlc :E usl ()MA
lei SE Page 2 for
City of Tigard S E P 9 2 011 Received . I f /7 6. Permit N o - /�Uy // QD A's
I 'r 13125 SW Hall Blvd., Tigard, OR 97223 p1 Reim: • -
l • Phone: 503.718.2439 Fax; 503.598.19 D OF Other l _ E(,�/� �e ) /
i nspection Li rte: .. u OF TIGMD NtuBy h
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h t[e i n rnce www.tlgard- or.gov 5036394171 BIJOU DING Di''VL h _ � Notifed/1Ne DRd/ - / r Supplemental Information
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Far special information toe cltecklist
Description I Qty. I Ea. I Total
0 Addition/alteration/replacement LI Other: New 1- 2 -famil • dwellin i (includes 100 II. for each tttili connection)
• • • SFR (1) bath 312.70
■ El , SFR (2) bath 137.78
■ ■ SFR (3) bath 500.32 Multi-family .
Each additional bath/kitchen 25.02
CI Master builder ■ Fire sprinkler ( sq. 11.) Page 2
• t • r e _ Site t„ 'Rifles;
Job site addressz-9 Washington Square Rd ?.55" 7
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 R,: ) Page 2
Suite/bldg./apt. no.: 1313 Project name; Lush 4- ti•-517 Manufactured home utilities • 50.03
Cross ' • • job Under o' d court Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear R.: ) Page 2
Stone sewer (no. linear ft.: ,__) Page 2
Water service (no, linear ft.: . ) Page 2
Subdivision: Lot no.: Fixture or item;
Tax map /parcel no.: Backllow preventer 31.27
Beekwater valve 12.51
_ _= ' ze- e- °--- --.... - - =-- --- - ::D=ais,; ;, ;i r `; :s� '{
Clothes washer 25.02
Plumbing for tenant improvement, 3 fixtures Dishwasher 25.02
• Drinking fountain 25.02
Ejectors/sump 25.02
z� Y _ _Pn R c '' s ,._ i1 _s: ii 3T- __ _ _ iiik -iS ° _L `-`.-':x_=_ Expansion tank 12.51
Fixture /sewer cap 25.02
Floor drain/floor sink/hub 1 25.02 25.02
Garbage disposal 25.02
Hose bib 25.02
Phone: Ice maker 12.51
L- Y a Interceptor/grease ire
'S`' q" � ^Y��_�_rl�1PPJ�Jf�tS.s�3:�?�'' ��i��ro ■;�0.�P1"X��?- ��i�)�_ -_ - P 25.02
Medical gas (value: $ ) Page 2
...
Contact name:
Primer 12.51
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 1 v 25.02 25.02
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax:: ( ) Tub /shower /shower pan 12.51
E-mail: Urinal 25.02
I ` "= -- =g ;,'.i* - - - - - -- - Water closet 25.02
��:- .....__.._.__.._. Walcrheater 1 37.52 37.52
Business name: PMSI LLC Water piping/DWV 56.29
Address: 21195 NW Evergreen Pk1vy Suite 201 Other; 25.02
City/State /ZIP: Hillsboro, OR 97124 Subtotal 87.56
Phone: (503) 466 -2222 Fax: (503) 166-2211 Minimum permit fcc: $72.50
Plan review (25% of permit fee)
CCB Lie.: 158286 Pltrmbing Lic. no.: 34 -434PB State surcharge (12% of permit fee) 10.51
Authorized sigzta1u c---. J! J r TOTAL PERMIT FEE - 98.07
Print name: Lanett Robinson Dote: 9/9/11 This permit application expires If a permit Is not obtained within 186 days
after It has been accepted as complete,
'Fee methodology set by Tri -Coumy Building Industry Service Board.
midi lafna\Penuhs\Pf.;<fll•eem,3tapp eec 10/01109 444- 6167110'0vContnVEB)
Sep. 9. 2011 11:15AM No. 4486 P. 3
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su ■ iression S stems:
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Footing drain - l 100' 50.03 0 to 2,000 5121.90
Footing drain - each additional 100' - - 37.52 2 001 to 3 600 5169.69
3,601 to 7,200 5233.20
Sewer - 1st 100' 62.54 7 201 and • eater $327.54
Sewer - each additional 100' 37.52
Water Service 1st 100' 62.54
t IVlledical Gas Systems:
Water Service - each additional 100' 37- 52 e .r,• r• y, - -, __ - _ -__ - ,� :_ _ _
z1tYiYkt alt R Ui t' f's111 J1 F :. .zf - __:-_ -_ _ _.: Y
Storm & Rain Drain - 1st 100' 62.54 $1.00 to $5,000.00 Minimum fcc $72.50
Storm & Rain Drain - each additional 100' 37.52 55,001.00 so $10,000.00 $72 50 for the first $5,000.00 and 51,52 for
p'Y : - 9,i. -7 ' --- _ ;:L : '- a �`A ,4.1 each additional $100.00 or fraction thereof, to
g 4i , -p
C tl ykAuSpe tzon O'; Q? e s �,= i : =_ = - ,\. ,, �M. xs>;�;
- " "" " " "" "� " -- -- • and including, S10,000.00.
Inspection of existing plumbing or for $10,001.00 to $25,000.00 5148.50 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 525,000.00 and 51.45 for
hours (minimum charge - 2 hours) each additional 5100.00 or fraction thereof, to
Reinspection Fees 90.00 /hr and including $50,000.00.
Additional plan review for revisions 90.00/hr 550,001.00 and up $742.00 for the first 550,000.00 and $1.20 for
(minimum charge -1/2 lieu 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
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fiit =a
.ti 11? - -. ':,c :::-, Plan rev i required for any of the following.
' urkperfaril d:.. :=4 r- 9 Y g -
Baptistry/Font Please check all that apply.
Bath 7ubJShower ❑ 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 Thni _ ❑ 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 OA1t918 -780 -0040.
Eyc Wash
Floor Drain/sink - 2" 1 Submit 2 sets of plans with any of the above.
-3"
3 -s = =T 1, der., Yag>cam= _=
4 -- _ -
__
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings -Domestic-non-food
g' 9 l; s
Disposal - Domestic related . that meet the qualifications above.
- Commercial -food related - ■
- Industrial -food related .
Ice Mach./Refrig. Drains ,
Oil Separator Oas Station) i Comments regarding fixture work:
Rec. Vehicle Dump Station _
Shower -Gang
-Stall
Sink/Lav - Non -food related 1 - "
- Bradley
-.Commercial-food related
- Service _
Swimming Pooh Filter *Note: If the fixture work under this permit' results in an
Washer - Clothes p
`"
Water extractor . increase of sewer EDT7s, 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:
http: / /www,ti gg rd- or. gov/ eity_hali/departments /cd/docs/PLMF- PennitApedoc