Permit q CITY OF TIGARD PLUMBING PERMIT
II I - COMMUNITY DEVELOPMENT Permit#: PLM2014-00372
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/02/2015
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9620 SW WASHINGTON SQUARE RD G06
Project: Michael Kors Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Plumbing fixtures for TI of existing space for new tenant.
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 02/02/2015 $25.02
Specifics: 1 ea Primer 02/02/2015 $12.51
1 ea Lavatories 02/02/2015 $25.02
Type of Use: 1 ea Water Closet 02/02/2015 $25.02
Class of Work: 1 ea Water Heater 02/02/2015 $37.52
Type of Const: 1 12%State Surcharge- 02/02/2015 $15.01
Occupancy Grp: Plumbing
Stories:
Total $140.10
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: • ' 'tee Signature: N-fA./.40 1 t 1 a
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.
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Plumbing Permit ApplicatiECE� FD `�� � �' � °L'
Building Fixtures NOV 1 2
Received
City of Tigard / Permit T'o.:
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v 13125 SW Hall Blvd.,Tigard,OR ifilil Plan Review n
Iii e Phone: 503.718.2439 Far. 503. DtSetp Other Permit x62uro�/' or�-
Ins Inspection 503.639Al75 �Iw!'�I?���ln� y'
TIGAItD P DaceRcady/By; furls. Fa See Page 2for
Internet: www.tigard-oegov blotified/t letlrod: Supplemental Information
TYPE OF WORK FEE• SCHEDULE
El New constmclion ❑Demolition
For special inforemflon use checklist.
Description I Qty. I Ea. I Total
%Addition/alteration/replacement ❑Other New 1-2-family dwellings(includes 100 R.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
❑I-and 2-family dwelling Comntcrcialfindustrial SFR(2)bath 437.78
,I
SFR(3)bath 500.32
❑Accessory building ❑Multi-family Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.fl.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: TG,2.0 `j0 �s� �. Sp• Dryw basin or line drain 18.76
"1 Drywell,leach line,or trench drain 18.76
City/State/ZIP: -776,,t,-- , a,e 7. :2 3
Footing drain(no.linear R.:_) Page 2
Suite/bldg./apt.no.: 7 O(p
rf
P roject name: /,. Li„,t .( kflYs Manufactured home utilities 50.03
Cross strceVdirectiots to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear R.: ) Page 2
Water service(no.linear R.: ) Page 2
Subdivision: � j e, /i xia flt,,•tiy`.hyL ,s911-ot no.: Fixture or item:
Tax map/parcel no.: BackRow preventer 31.27
DESCRIPTION OF WORK Backwater valve I2.51
L 1 Clothes washer 25.02
GYi-R.rv'F- /Fs?P2M4• /VC,L L� a�`'L• Dishwasher 25.02
'. of tl - / r rJ._ Ji1dL"'p ,. CL Drinking fountain 25.02
, GK-_! KD7'S i A:7- . Ejectors/sump 25.02
'PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
/ Fixture/sewer cap 25.02
Name:
/!4 LC L/[L� Floor drain/floor sink/hub 25.02
Address: ,901 0•./(its/l.c1-'-e- (j/yd " 7O .I Garbage disposal 25.02
City/Stotc/ZIP: .Sapt,-fu iLloPt tlA„- ,(it 1011 G/ Hose bib 25.02
Phone:(5a)) e,57,7 - (2 S S Fax:( ) Ice maker 12.51
%APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: PG r.y�` - f p f Medical gas(value:S _ _) / Page 2
Contact name: s‘.o 7L- �p�,.,-e„j_ 1 Roof 12.51
li:aof drain(commercial) 12.51
Address: p 1 p St LA- . 3 2_3
Sink/basin/lavatory / 25.02
City/State/ZIP: Pq•fGZp/e K� (,q•- 7/(e)/ Solar units(potable water) 62.54
Phone:((4 J 5 S - 2 1 3 / I Fax::(kz(r) 712 - S 7'1 Z Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet / 25.02
CONTRACTOR
- Water heater / 37.52
'1' Business name: r ,
PCA, 41-L Water piping/DWV 56.29
Address: _4 .4 g . P .. a..., ,r Other: 25.02
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City/State/ZIP: /.j /q&,re, lie " ?ley Subtotal
Minimum permit fee: 572.50
Phone:( m? ) �t`ri(o� Fax:( ) Plan review (25%of permit fee)
can Lie.: /sg',2 (, Plumbing 1.ie.nd.: '?y-y 3146
State surcharge(12%of permit fee) / /
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Authorized signature: C'.. � TO•I'AL PERMIT FEE Q,/0
I Print natmle Date: _ Z-,,` This permit application expires if a permit is not obtained within 189 days
-S�� �t�fti;, '{ after it has beau accepted as complete.
*Fee unctltodology set by Tri•County Building industry Service Board.
I.1BuildingU'ssmes'PLMU-PcmvIApp.doc 100IN9 410.4616T(10.U2,CONMEB)
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Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-la 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' 1 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 1 - 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$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Other Inspections or Fees Fee(ea) Total each additional$100.00 or fraction thereof,to
I� Qty. 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 $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 Type Plan Review for Plumbing Installations
Fixture Type for Replace/ any review is required for of the following.Performed: Capped Added Relocate 9 y ow 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 Drain/sink -2" Submit 2 sets of plans with any of the above.
-3" l
4" Isometric or Riser Diagram
Car Wash Drain s❑ Isometric or riser diagram is required for new buildings
-Domestic-non-food g q g
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 Upgraded existing restroom to ADA
Shower -Gang compliant restroom with new water closet
-Stall
Sink/Lav -Non-food related 1 lavatory with insta hot water heater and
-Bradley new floor drain to replace all existing
-Commercial-food related fixtures.
-Service
Swimming Pool Filter *Note: If the fixture under this permit results in an
Washer-Clothes ure wor uner p
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:
C:\Users\Dianna\AppData\Local\Microsoft\Windows\Temporary Internet2iles\Content.Outlook\KCQ39QIQ\PLMF-PermitApp.doc
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
9620 SW WASHINGTON SQUARE RD G06,
TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2014-00372
George Heimos
Pass
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
9620 SW WASHINGTON SQUARE RD G06,
TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2014-00372
George Heimos
Violation Summary:
Inspector Contractor