Permit NgCITY OF TIGARD PLUMBING PERMIT
• COMMUNITY DEVELOPMENT Permit#: PLM2015-00057
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/26/2015
Parcel: 1 S 1260000300
Jurisdiction: TIGARD
Site address: 9530 SW WASHINGTON SQUARE RD H10
Project: Athleta Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Replace/relocate(1)drinking fountain,(2)lays,(1)service sink,(1)toilet&(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 Drinking Fountain 02/26/2015 $25.02
Specifics: 1 ea Sink 02/26/2015 $25.02
2 ea Lavatories 02/26/2015 $50.04
Type of Use: COM 1 ea Water Closet 02/26/2015 $25.02
Class of Work: ALT 1 ea Water Heater 02/26/2015 $37.52
Type of Const: 1 12%State Surcharge- 02/26/2015 $19.51
Occupancy Grp: Plumbing
Stories:
Total $182.13
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•.- ions o c. C b Iling 503.232.1987 or 1.800.332.2344.
Is ued By: / . Permittee Sig ure:
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 rt-,m: 02/25/2015 21:52 #281 P.001/002
Plumbing Permit APPit tt 1 M Ep
Building Fixtures L �L L
2015
Date y. . a5 / �l l s-oo06-7
City of Tigard j_ q§ y Permit No..
13125 SW Hall Bhd..Tigard, 9 fit`e q
Pan Review eS i C7
Phone: 503.718.2439 Fax: 503.598.1960 Other Permit No.:
{ Date/By:
Inspection Line: 503.639t41)4I�j' ()1' F IGARU Date Ready'By lure,
TIGARD I H See Page 2 for
interns/ tiH so tir_ard-,___ A ,, � N 0 i lfied xlrilo d I Supplemental information
TYPE OP WORK . - •3 FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist
Description I Qty. I Ea. I Total
®Additiott'alteration replacement ❑Other: New I-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ 1-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family -
-
- Each additional bathkitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
9712' JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address::3'SW'Washington Square Rd Catch basin or area drain 18.76
- - - - Dwell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97223
Footing drain(no.linear It.:_) Page 2
Suite/bldg./apt.no.: the Project name:Atbleta Manufactured home utilities 50.03
Cross street/directions to job site: 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.:_) 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
Plumbing for tenant improvement
Dishwasher 25.02
Drinking fountain 1 25.02 25.02
- Ejectors sump 25.02
❑ PROPERTY OWNER * f ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floorsink/hub 25.02
Address:
---.-.-- ---- Garbage disposal 25.02
-
City/State/ZIP: _ - Hose bib 25.02
Phone:( ) ' Fax:( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON interceptor/grease trap 25.02
Business name: Medical gas(value:S ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 3 25.02 75.06
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
CONTRACTOR Water closet I 25.02 25.02
-__- 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 162.62 .
Phone:(503)466-2222 Fax:(503)466-2211 Minimum permit fee: $72.50
CCB Lic.:158286 Plumbing Lk.no.:34-434PB Plan review (25%of permit fee)
' , State surcharge(12%of permit fee) 19.51
Authorized signatur . Gl Pl t/ TOTAL PERMIT FEE 182.13
Print name: Lanell obinson Date:2125/15 This permit application expires if a permit is not obtained within 1110 days
after it has been accepted as complete.
*Fee methodology set by l n-County Building Industry Service Board.
,Bud tag-Permits PLMU-PamitApp.doc 109109 440-46161110-02 COIN WEB)
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From: 02/25/2015 21:53 #281 P.002/002
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Q '. Fee(ea) Tow Square;Footage: 1 Per]<nit Fee;
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 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 Sp( ons� � Fce(a) ')rota! 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 S1.54 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 S50,000.00 $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/ Plan review is required for any of the following.Performed: Capped Added Relocate 9 Y 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 1 ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Dram sink -2" Submit 2 sets of plans with any of the above.
-3.,
4., 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 2
-Bradley
-Commercial-food related
-Service I
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 l fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
http://www.tigard-or.gov/document_center/Building/PLM F_PermitApp.dt
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9530 SW WASHINGTON SQUARE RD H10,
TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2015-00057
Inspection Type: Inspector:
399 Plumbing final George Heimos
Result:
PASS - NoCofO
Comments:
NOTE Re-caulk mop sink.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9530 SW WASHINGTON SQUARE RD H10,
TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2015-00057
Inspection Type: Inspector:
399 Plumbing final George Heimos
Result:
FA I L
Comments:
1 . Caulking required on fixture(s) at: mop sink 310.3/407.2
2. Correct leak on bathroom sink. 310.0
3. Cleanout to be readily accessibility at primer location. Larger panel needed. 708.8
4. Recall inspection when corrections have been completed. Re-inspection required.
103.5.6.1
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9530 SW WASHINGTON SQUARE RD H10,
TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2015-00057
Inspection Type: Inspector:
399 Plumbing final George Heimos
Result:
FA I L
Comments:
1 . Work not completed, no inspection made. Recall when ready. 103.5.4
Violation Summary:
Inspector Contractor