Permit CITY OF TIGARD PLUMBING PERMIT
11 COMMUNITY DEVELOPMENT Permit#: PLM2014-00280
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/20/2014
Parcel: 1 S 135BA00102
Jurisdiction: Tigard
Site address: 10230 SW WASHINGTON SQUARE RD
Project: Spec Space Subdivision: OAKBURG Lot: 9
Project Description: Install approximately 10'of water service from water meter to future Panera space.
Contractor: PMSI LLC Owner: PPR SQUARE TOO 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
10 If Water Service 08/20/2014 $62.54
Specifics: 1 12%State Surcharge- 08/20/2014 $8.70
Plumbing
Type of Use COM 10 ea Minimum Fee Adjustment- 08/20/2014 $9.96
Plumbing
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 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 r Permittee SignatureeL
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.
From: jj'�((��'' 08/20/2014 22:54 #180 P.001/001
Plumbing Permit AppliBtE.'EIVE
Site Utilities AUG 2^[) 2t14 i OR (II ti( I I tit ()NI 1
City of Tigard DaRectdeiBveyd: i /e /L/ �� Permit No. Ghi /
iii
_64a
• 13125 SW Hal!Blvd.,TigardieleN 241 -TIGARD Plan Review
Phone: 503.718.2439 Fax:1-543f5118. 1 VV Date/B : Other Permit No.:A, �� )
Inspection Line: 503.639 rILDINC DIVISION gi See Pagel for
11 G A k l) Internet: www.tigard-or. t Nol fed Meihhod: lura. Supplemental Information
TYPE OF WORK - ; �,;`it - ! tk - y ,M� 0 t „.F.,. FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist.
Description I Qty. _I Ea. I Total
®Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION = SFR(I)bath 312.70
❑ 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
building SFR(3)bath 500.32
❑Accessory g ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: --
Fire sprinkler( sq.ft.) Page 2-
!Ott) ` JOB SITE INFORMATION AND,LOCATION Site utilities:
Job site address: SW'Washington Square Rd 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 II.:_) Page 2
Suite/bldg./apt.no.: Project name: - / /�_e_ Manufactured home utilities 50.03
Cross street/directions to job site: /�� o` Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear fl:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:10) Page 2 62.54
Subdivision: Lot no.: Fixture or item:
Tax map'parcel no.: Backtlow preventer 31.27
DESCRIPTION OF WORK
Backwater valve 12.51
Clothes washer 25.02
nstall water service from meter to Panera space Dishwasher 25.02
V Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: _ Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:5 ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:PMSI LLC
Water piping/DWV 56.29
Address:21195 NW Evergreen Pkwy Suite 204 1 Other: r 25.02
City/State/ZIP:Hillsboro,OR 97124 Subtotal 62.54
Phone:(503)466-2222 Fax:(503)466-2211 Minimum pennit fee: 572.50 72.50
Plan review (25%of permit fee)
•CB Lie.:158286 Plumbing Lie.no.:34-434PB --
State surcharge(12%of permit fee) 8.70
Authorized signature:' L- . 1 g V4 ST) TOTAL PERMIT FEE 81.20
' This permit application espiree if a permit is not obtained within ISO days
Print name:Lanett R inson Date:8/20/14
after it has been accepted as complete.
•Fee methodology set by Tri-County Building Industry Service Board.
I.Building•Pam.ts'PLMI).PcmrApp-dos 1001:09 4.10--7616T11002-fOSI WT8)
From: 08/20/2014 20:28 #178 P.002/002
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qtr" Fee Oa) Total Square Footage: Permit Fee:
Footing drain- 1" 100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 22.001 to 3,600 $169.69
3,601 to 7,200 _ $233.20 _
Sewer-1st 100' 62.54 7201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service- 1st 100' 1 62.54 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52 alf1Rt10;l1.', Permit Feel .
Storm&Rain Drain-1st 100' 62.54 $1.00 to 55,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 S5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and S1.52 for
tae(as) each additional$100.00 or fraction thereof,to
Qtber:�Jn.SPecti- .Fees and including$10,000.00.
Inspection of existing plumbing or for 510,001.00 to$25,000.00 $148.50 for the first$10,000.00 and 51.54 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 5100.00 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 Replace) any review is required for of the following.Performed: Capped Added Relocate 9 >' g
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 ❑ 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 Draia'sink -2" Submit 2 sets of plans with any of the above.
-3.,
4., -Isometric or.Riser Diagram
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings-Domestic-non-food s
$ Q fi
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
SinkRav -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:
C:\Users\lrobinson\Down loads\PLM U-PennitApp.doc 2
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Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10230 SW WASHINGTON SQUARE RD,
TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2014-00280
George Heimos
Violation Summary:
Inspector Contractor