Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2014-00300
f[G A RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/04/2014
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9571 SW WASHINGTON SQUARE RD B05
Project: Made in Oregon Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Replace/relocate(1)2"floor drain,(1)lay,(1)water closet&(1)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 Floor Drain/Floor Sink/Hub 09/04/2014 $25.02
Specifics: 1 ea Lavatories 09/04/2014 $25.02
1 ea Water Closet 09/04/2014 $25.02
Type of Use: COM 1 ea Water Heater 09/04/2014 $37.52
Class of Work: ALT 1 12%State Surcharge- 09/04/2014 $13.51
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $126.09
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Not Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or d' questions to NC by calling 503.232.1987 or 1.800.332.2344.
I sued By: Permittee Signature: j
iff
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
I•rom: 09/04/2014 23:13 #195 P.001/002
Plumbing Permit Applic `'E1VEP I 1.; ,L
Site Utilities SEP 4 2014
City Of'Tigard Received 7 ,,``
Dale/By: / 7 Permit Na.: J,� ` ako
• 13125 SW Hall Blvd.,Tigard,Q�i 1`. v1'�c"
_ Phone: 503.718.2439' Fax: 91)315 > TIVARU Plan Review A�iy-o
Date By: Other hermit No.: '/ O�$(O
Ti G A R D Inspection Line: 503.639.412S UILDING, DIVISION
Dale Ready,By: kris: 0 Sce Page 2 Pon
Internet: www.tigard-or.gov Notified/Method. Supplemental Information
TYPE OF WORK I FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist.
- Description I Qty. 1 Ea. I Total
®.Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath ` I 312.70
❑ I-and 2-family dwelling ®Commercial/industrial SFR.{2)bath 437.78
Accessory building SFR(3)bath 500.32
El ry g ❑Multi-family
Each additional bath,/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
7/
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address 9589-cw'Washington Square Rd Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Portland,OR 97220
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name:Made in Oregon 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.:T) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.:
Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
fixtures for tenant improvement Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name:
Fixture/sewer cap 25.02
Address:
Floor drain/floor sink/hub I 25.02 25.02
----------_- -- Garbage disposal 25.02
City/State/ZIP:
_ Hose bib 25.02
Phone:( ) T Fa.,:( ) Ice maker 12.51
0 APPLICANT 1 0•CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:S_) 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
E-mail Urinal 2502 ,-1
Water closet 1 25 02 25.02
CONTRACTOR T----
Water heater 1 3'7.52 j 37.52 1
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 112.58
Phone:(503)466-2222 Y I VI' Fax:(503)466-2211 Minimum permit fee: $72.50
Plan review (25%of permit fee)
..B Lic.:158286 Plumbing Lic.no.:34-434PB
ry }(1.�� State surcharge(12%of permit fee) 13.51
Authorized signatu , LVV Lti-�^ I ` VA TOTAL PERMIT FEE 126.09
Print name:Laneli1Robinson Date:V.0/14.0/14 _ This permit application expires it a permit is not obtained within 180 days
after it has been accepted as complete.
'Fee methodology set by Tri-County Buikling Industry Service Board.
I Building Permits PLMU-PcrrimApp.duc 10.01.09 440-4616T(10.02•C'OM,WEB)
From: 09/04/2014 23:13 #195 P.002/002
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Q 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 5169.69
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 Medical Gas Systems:
Water Service-each additional 100' 37.52
Valuation: Permit Fee:
Storm&Rain Drain-1st 100' 62.54 °
$1.00 to$5,000.00 _ Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to 510.000.00 $72.50 for the first$5,000.00 and$1.52 for
Qty. Fee(ea) Tott+l each additional$100.00 or fraction thereof,to
Uther Inspect on$or 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$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 1u $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 550.000.00.
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 The Plan Review for Plumbing Installations
Fixture Type for Ram Plan review is required for any of the following.
Work Performed: Capped Added Relocate 4 Y g•
B ust Font Please check all that apply.
aP ry
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 Drain/sink -2" 1 Submit 2 sets of plans with any of the above.
_3•
- - 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 1
-Bradley
-Commercial-food related
-Service
-
swimming Pool Filter
Washer-Clothes *Note: If the fixture work under this permit results in an
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet 1 fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
M:Job Files\PMSI Jobs\10882-Made in Oregon\PLMU-PennitApp.docx 2