Permit CITY OF TIGARD PLUMBING PERMIT
a COMMUNITY DEVELOPMENT Permit #: PLM2009 -00071
Date Issued: 04/03/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639 4171 Parcel: 1S1260000300
Jurisdiction:
Site address: 9665 SW WASHINGTON SQUARE RD CO2
Subdivision: Lot: 0
Project: ARITZIA
Project Description: TI - Remove and replace (4) fixtures, floor drain, lay, water closet and water heater. No change in
EDU's.
Owner: FEES
PPR WASHINGTON SQUARE LLC Quantity Description Date Amount
BY THOMPSON PROPERTY TAX SERVUCES,
2235 FARADAY AVE STE #0 1 ea Floor Drain /Floor Sink/Hub 04/03/2009 $16.60
PHONE: 1 ea Lavatories 04/03/2009 $16.60
1 ea Water Closet 04/03/2009 $16.60
1 ea Water Heater 04/03/2009 $16.60
Contractor: 1 12% State Surcharge - 04/03/2009 $8 -70
PMSI LLC Plumbing
21195 NW EVERGREEN PKWY #204 6 ea Minimum Fee Adjustment - 04/03/2009 $6.10
HILLSBORO, OR 97124 Plumbing
PHONE: 503 -466 -2222
FAX: 503- 466 -2211
Type of Use: COM
Class of Work: ALT 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 • • a i• . -nter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or • • ect questions to • • • ; ing 503.246 6699 or 1.800.332.2344.
Iss , ed By: • , / ' I Permittee Signat ' /
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
._,- From: 04/01/2009 11:15 #062 P.001 /002
Plumbing Permit ApplicatioRECE1VED
Building Fixtures FOR OFFICE LSE ONLI . _
APR -1 2009 Received •
IN oil City of Tigard DatelBY y / D 3 7g PemutNo. 'Lify _.' 7
13125 SW Hall Blvd, Tigard, OR� � j4 OF TIGARD Plan Review
Phone: 503.639.4171 Fax: 503 Other Pemut No.
Inspection Line. 503.639.4175 LNG DIVISION Date1By
T I G A R U Dale Ready/By 1 H See Page 2 for
Internet: www.tigard or Notified/Method ( Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑Demolition For special information use checklist
Description I Qty. I Ea. I Total
® Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 It for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
❑ l- and 2- family dwelling ® Commerciallndustrial SFR (2) bath 350.00
ID Accessory building ❑ Multi - family SFR (3) bath 399.00
1:1 Master builder Each additional bath/kitchen 45.00
❑ O ther.
Fire sprinkler (__ sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 9665 SW Washington Square Rd Catch basin or area drain 16.60
City/State/ZIP: Tigard, OR 97223 Drywell, leach line, or trench drain 16.60
Suite/bldg./apt. no.: CO2 l Project name: Arline Footing drain (no. linear ft: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16 60
Rain drain connector 16.60
Sanitary sewer (no. linear It: _J Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Lot no:
I
Water service (no. linear R: ) Page 2
Tax map /parcel no.: Fixture or item
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
Plumbing for tenant Improvement - 4 fixtures Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER l ❑TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: Expansion tank 16.60
Address. Fixture /sewer cap 16.60
City/State/ZIP: Floor drain/floor sink/hub 1 16 60 16.60
Phone: ( )
Fax: ( ) Garbage disposal 16.60
Hose bib 16.60
❑ APPLICANT ❑ CONTACT PERSON
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name:
Medical gas (value: S ) Page 2
Address: Primer 16.60
City/State/ZIP: Roof drain (commercial) 16.60
Phone. ( ) p er:: ( ) Sink/basin/lavatory 1 16.60 1660
Tub/shower /shower pan 16.60
E -mail. Urinal 16.60
CONTRACTOR Water closet 1 16 60 16.60
Business name: PMSI LLC Water heater 1 16.60 16 60
Address: 21195 NW Evergreen Pkwy Suite 204 Other.
City/State/ZIP: Horo, OR 97124 Subtotal 66.40
t7lsb
Mininuun permit fee: $72.50 72 SO I
Phone: (503) 466 -2222 Fax: (503) 466 -2211 Residential bacldlow minimum permit fee: $36.25
CCB Lic.: 158286 � Pllumbibing�Lie, no: 34-434PB Plan review (25% of permit fee)
�.'t "LL1 g) l /�� ..,..' State surcharge (12% of permit fee) 8.70
Authorized signature: TOTAL PERMIT FEE 81.20
Print name: Lanes Robinson Date: 4/1/09 This permit application expires if a permit Is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I \Buddmg\Pnntds\PI,MF- PenmtApp doc 12/27/06 440-4616T(10/02/COM/WEB)
From: 04/01/2009 11:16 #062 P.002/002
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Tom Square Footage: Permit Fee:
Footing drain - 1 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer - 1st 100' 55.00 7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40
Stone & Rain Drain -1st 100' 55.00 Valuation: Permit Fee:
_ $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof, to and
including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148 50 for the first $10,000.00 and $1.54 for
Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to
(minimum permit fee $36.25) 2755 and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or and including $50,000.00.
specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: each additional $100.00 or fraction thereof.
Commercial Fixture Work: Plan Review for Plumbing Installations
Are you capping, adding or replacing fixtures? If "yes", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees *. ❑ Any new commercial building with water service 2" and
Quantity by (Future) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: Replace engineer.
Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub/Shower ❑ Medical gas and vacuum systems for health care facilities
- Jacuzzi /Whirlpool ❑ My multipurpose fire sprinkler system.
Car Wash - Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040
- Drive Tiuu
Cuspidor /Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic
Drinking Fountain Isometric or Riser Diagram
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain/sink - 2" 1 1 that meet the qualifications above.
-3
- 4"
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
Stall —
Sink - Bar /Lavatory 1 1
- Bradley *Note: If the fixture work under this permit results in an
- Commercial increase of sewer EDUs, a sewer permit will be issued and
-Service fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes
Water Extractor
Water Closet - Toilet 1 1
Urinal
Other Fixtures:
r \Build ng\Penmts\PLM- PenoitApp doc 12/27/06