Permit CITY OF TIGARD PLUMBING PERMIT
•
I COMMUNITY DEVELOPMENT Permit#: PLM2014-00134
T[GAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/08/2014
Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9508 SW WASHINGTON SQUARE RD J01
Project: Pandora Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Install(1)sink and(1)point of use water heater.
Contractor: PMSI LLC Owner: PPR WASHINGTON SQUARE LLC
21195 NW EVERGREEN PKWY#204 PO BOX 847
HILLSBORO, OR 97124 CARLSBAD, CA 92018
PHONE: 503-466-2222 PHONE:
FAX: 503-466-2211
FEES
Quantity Description Date Amount
1 ea Sink 04/29/2014 $25.02
Specifics: 1 ea Water Heater 04/29/2014 $37.52
1 12%State Surcharge- 04/29/2014 $8.70
Type of Use: COM Plumbing
Class of Work: ALT 10 ea Minimum Fee Adjustment- 04/29/2014 $9.96
Type of Const: Plumbing
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 (ling 503.232.1987 or 1.800.332.2344.
Issued By: � -;' i Permittee Signature: /
/,/ Opt/ f}�i°G/��}�/D�t/
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.
I rom: 04/28/2014 16:19 #110 P.002/003
Plumbing Permit Application
Building Fixtures
HEGRFD
FOR OFFICE L.SE: O\l.\,�/ �/
City of Tigard )ectr'Bea ,029 ! -- aimri �Ox', ��/
• 13125 SW Hall Blvd.,Tigard,OR 97M3� 2 8 2014 Plan Review 7�
l = Phone: 503.718.2439 Fax: 503.59 819 Date/By: /// Other Permit No.: _ (V �/C� 7z/
I WARD Inspection Line: 503.639.4175 CITY OF f IGAR D Date Ready:By: �/ /'/ � kris: fa See Page 2 for
Internet: www.tigar'd-or.gov Notified/Method' '/// Supplemental Information
TYPE OF RI f1 M'',►J( A>«w`,: e , u.1 j ,,,eC:`� FEE* SCHEDULE
`0 New construction ❑Demolition For special information use checklist.
- Description I Qty. I Fa. I Total
®Addition/alteration/replacement ❑Other: New I-2-family dwellings(includes 100 ft.for each utility connection)
-6)CATEGORY OF CONSTRUCTION • SFR(1)bath 312.70
❑ 1-and 2-family dwelling SFR(2)bath 437.78
®Commercial/industrial
SFR(3)bath 500.32
❑Accessory building ❑Multi-family 1
----
Each additional bath/kitchen 5.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 t-�
/5( JOB SITE INFORMATION AND LOCATION Site utilities:
N.
Catch basin or area drain 18.76
Job site address:9 SW Washington Sq Rd y \�
Drywell,leach line,or trench drain 18.76 `
City/State/ZIP:Tigard,OR 97223
Footing drain(no.linear ft.:_) Page 2 O
Suite/bldg./apt.no.:JOI Project name:Pandora Manufactured home utilities 50.03 O
Cross street/directions to job site: Manholes 18.76 v
Rain drain connector 18.76 oQ
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: Lot Lot no.: Fixture or item:
Tax map/parcel no.: /:)?/:,(1/)(1(' z C Backflow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
Clothes washer 25.02
Install sink with point of use water heater Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER 0 TENANT Expansion tank 12.51
------- _ Fixture/sewer cap 25.02
Name:
---_-- �.-_- Floor drain/floor sink/hub 25.02
Address: - Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( 1 Fax:( } Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON - Interceptor/grease trap 25.02
-- ...---- Medical gas(value:$_) Page 2
Business name:
Primer 12.51
Contact name: Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 1 25.02 25.02
------
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
Urinal 25.02
F-mail:
Water closet 25.02
CONTRACTOR
Water heater 1 37.52 37.52
Business name:PMSI LLC - Water piping/DWV 56.29
Address:21195 NW Evergreen Pkwy Suite 204 Other 25.02
City/State/ZIP:Hillsboro,OR 97124 Subtotal 62.54
Phone:(503)466-2222 Fax:(503)466-2211 Minimum permit fee: $72.50 72.50
Plan review (25%of permit fee)
CCB Lic.:158286 Plumbing Lic.no.:34 434P6 State surcharge(12%of permit fee) 8.70
Authorized signatur :Yr/ :.C,(^ „'1'0 1 TOTAL PERMIT FEE 81.20
Print name:Lenell Robinson ✓ Date:4/28/14 This permit application expires if a permit is not obtained within ISO day
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I.Building.Permits PI.M11-PermitApp.doc 10'0109 s40-1616'rt IPOb(7OMtVEB)
From: 04/28/2014 16:20 #110 P.003/003
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule:• Residential Fire Su, •ression S stems:
Qty. Fee(ea). ,Total" �` r':','':.-',:'''""."'.."1... -tr ii art'. F:{
SitE U#ilities" _.a��►�� .;,tits .m.g�•' . {.�� , , .�..�,k., .,, . .n ,..
Footing drain-l'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 edical Gas Systems:
Water Service-each additional 100' 37.52 M - lP. t' �' z yKsgim t a'
Storm&Rain Drain-1st 100' 62.54 S 1.00 to 55,000.00 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
Uther-InSPeCtiOIIS 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 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 S742.00 for the first$50,000.00 and$1.20 for
each additional S 100.00 or fraction thereof
(minimum charge-1/2 hour)
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*. .
Quantiy by Fixture Type Plan Review for Plumbing Installations
Fixture Type for ReplacePlan review is required for any of the following.
Work Performed: Capped Added Relocate Please check all that apply.
PP y
Baptistry/Font
Bath -Tub/Shower ❑ Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
-Jacuzzi/Whirlpool
engineer.
Car Wash -Each Stall
Drive Thru ❑ 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.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
Isometric or Riser Diagram
Car Wash Drain
❑ Isometric or riser diagram is required for new buildings
Garbage -Domestic--non-food
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 1
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes increase of sewer EDUs,a sewer permit will be issued and
Water Extractor
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C:\Users\robinson\Downloads\PLMF-PermitApp(1).doc 2
Debbie Adamski
From: Lanell Robinson <lrobinson @msi-systems.com>
Sent: Wednesday, April 30, 2014 8:15 AM
To: Debbie Adamski
Subject: RE: Pandora
-4\
No send the plumbing permit to me once the sewer fees are taken care of
nor-
Thanks! j•�-k3
Lanell Robinson
Asst. Project Manager Xf�
PMSI LLC/MSI Mechanical Systems, Inc.
503.466.2222 Ext. 122/503.466.2211 fx
Original Message
From: Debbie Adamski [mailto:DEBBIE @ tgard-or.gov]
Sent: Tuesday, April 29, 2014 3:38 PM
To: Lanell Robinson (LRobinson @msi-systems.com)
Subject: Pandora
Lanell,
Attached are the receipt for the plumbing fees, the sewer fee schedule and the sewer worksheet for this project. Did
you want us to issue the permit to whomever comes in to pay the sewer fees?
Debbie Adamski
Senior Permit Technician
City of Tigard I Community Development
13125 SW Hall Blvd.,Tigard, OR 97223
503-718-2450
Original Message
From: CounterCopier @ tgard-or.gov [mailto:CounterCopier @ tgard-or.gov] On Behalf Of CounterCopier@
Sent: Tuesday, April 29, 2014 3:33 PM
To: Debbie Adamski
Subject: Scanned image from MX-M283N
Reply to: CounterCopier@tigard-or.gov<CounterCopier @ tgard-or.gov> Device
Name: Not Set Device Model: MX-M283N
Location: Not Set
File Format: PDF MMR(G4)
Resolution: 200dpi x 200dpi
Attached file is scanned image in PDF format.
Use Acrobat(R)Reader(R) or Adobe(R)Reader(R)of Adobe Systems Incorporated to view the document.
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
9508 SW WASHINGTON SQUARE RD J01,
TIGARD
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2014-00134
George Heimos
Violation Summary:
Inspector Contractor