Permit CITY OF TIGARD PLUMBING PERMIT
3 COMMUNITY DEVELOPMENT _ Permit#: PLM2015-00209
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 � Date Issued: 07/08/2015
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9485 SW WASHINGTON SQUARE RD AO6A
Project: Build-A-Bear Workshop Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Replace/relocate:(1)2"floor drain&(1)service sink,(1)lay and&(1)water closet.No new additional fixtures.
8/3/15.adding(1)capped fixture(floor drain)to permit.
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 07/07/2015 $25.02
Specifics: 1 ea Sink 07/07/2015 $25.02
1 ea Lavatories 07/07/2015 $25.02
Type of Use: COM 1 ea Water Closet 07/07/2015 $25.02
Class of Work: ALT 1 ea Water Heater 07/07/2015 $37.52
Type of Const: 1 12%State Surcharge- 07/07/2015 $16.51
Occupancy Grp: Plumbing
Stories: 1 ea Fixture/Sewer Cap 08/03/2015 $25.02
0 12%State Surcharge- 08/03/2015 $3.00
Plumbing
45 Misc Administration Fee 08/03/2015 $45.00
Total $227.13
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 stions to•-NC by c• • g 503.232.1987 or 1.800.332.2344.
Issu d By: / / I Permittee S‘nature: !i
Call 503.639.4175 by 7:00 a.m.for the next available in :•ction 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.
mtive Sewer Tally
Tenant Name: Build-A-Bear ***CRAccuI I)I'1ul'aS*** SWR# N/A
Site Address: 9485 SW Washington Square Rd PLM# 2015-00209
Parcel#: 1 S 1260000300
fixture \•.1lu. Previous Previous Credits Capped Fixture Fixture New New
# Aloe count ripped#s \.clue counr added# added value total#s total values
Baptisery/Font 4 0 0 0 0 0
Bath: -Tub/Shower 4 0 0 0 0 0
-Jacuzzi/Whirlpool 4 0 0 0 0 (1
Car Wash: -Each Stall 6 0 0 0 0 0
-Drive through 16 0 0 0 0 0
Cuspidor/Water Aspirator 1 0 0 0 0 II
Dishwasher. -Commercial 4 0 0 0 0 II
-Domestic 2 0 0 0 0 Il
Drinking Fountain 1 0 0 0 0 II
E'ye Wash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 I 2 0 -1 -2
-3 inch 5 0 0 0 0 0
-4 inch 6 0 0 0 0 0
-Car Wash 6 0 0 0 0 0
Garbage Disposal:
-Domestic(to 3/4 HP) 16 0 0 0 0 0
-Commercial(to 5 HP) 32 0 0 0 0 0
-Industrial(over 5 HP) 42 0 0 0 0 11
Ice Machine/Refrigerator Drain 1 0 0 0 0 0
Living Unit 16 0 0 0 0 0
Oil Sep(Gas Station) 6 0 0 0 0 0
Rec.Vehicle Dump station 16 0 0 0 0 0
Shower: -Gang(per head) 1 0 0 0 0 0
-Stall 2 0 0 0 0 0
Sink:
-Lay/Bar-Non-Food Related 2 0 0 0 0 0
-Bradley 5 0 0 0 0 0
-Com/Serv/Util-Food Related 3 0 0 0 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer-Clothes 6 0 0 0 0 0
Water Extractor 6 0 0 0 0 0
Water Closet-Toilet 6 0 0 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 1 2 0 _ 0 -1 -2
Current Fixture Value 2 divided by 16= -0.125 Current EDU 1 EDU= $5,100.00
Previous Fixture Value a divided by 16= 0.000 Previous EDU
Change -2 divided by 16= -0.125 over (under) $ (663.00)
Enter EDU Change Here -0.130 *
*Round EDUs to the nearest 1/100th: a count ending in.005 shall be rounded up to.01,and a count ending in.014 or less shall be rounded down to.01.
Notes: ***CREDITS*** •
Authorized Name/Signature: Debbie.\damski Date: 8/3/2015
Building Division
Note: The property owner shall retain the ORIGIN Al,sewer tally record. If credits exist,this document will serve as a voucher which must be
submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
I:\Building\Sewer Tally\SewerTallyShect_5100_070115.xlsx
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2015 00209
T I G AR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/08/2015
Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9485 SW WASHINGTON SQUARE RD AO6A
Project: Build-A-Bear Workshop Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Replace/relocate:(1)2"floor drain&(1)service sink,(1)lay and&(1)water closet. No new additional fixtures.
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 07/07/2015 $25.02
Specifics: 1 ea Sink 07/07/2015 $25.02
1 ea Lavatories 07/07/2015 $25.02
Type of Use: COM 1 ea Water Closet 07/07/2015 $25.02
Class of Work: ALT 1 ea Water Heater 07/07/2015 $37.52
Type of Const: 1 12%State Surcharge- 07/07/2015 $16.51
Occupancy Grp: Plumbing
Stories:
Total $154.11
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notificat' Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct stions to UNC calling 503.232.1987 or 1.800.332.2344.
Issued y: i Ca./0A PermitteeSignature: � .$ x/ `,
Call 503.639.4175 by 7:00 a.m.for the next available i ction 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: j�jj((�� 07/01/2015 23:36 #349 P.001/002
Plumbing Permit Applie�1��1��4NEI 1'�T EP
Building Fixtures JUL 1 2015
City of Tigard r��(�
Date By: 7 q fi S (,Re /1 Permit No.:
•ilh, 13125 SW Hall. 4 9 TiFax: i I,!r•AKD Plan Review _^ n,�'e� ��
= Phone: 503.718.2439 Fax: gg��' V [� Other Permit No5to t 6 J
Date/By:
Inspection Line 503.639.4M/ DIVIS101` Date ReadyB lute: 0 see Page 2 for
7 tGAND �MUU 3 ne
Intcmel www.tir;lyd-or.gt Notified/Method: Supplemental Information
TYPE OF WORK tf t, , n +�,{ 'i yy� f+;.�. .�-
F,V.,k,r! r ,..�r t'�F"�,w' �A�{i, h,l.aA.H 3�x�f4'� � �w�.G�� "�[S T�,3,r.
❑New construction ❑Demolition For special information use checklist.
--- - Description I Qty. I Ea. I Total
®Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) tp
CATEGORY OF CONSTRUCTION • SFR(1)bails 312.70
1:1 I-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32 ,r
❑Accessory building ❑Multi-family - A
Each additional bath/kitchen 25.02 (-)1
❑Mastfr builder ❑Other: Fire sprinkler( sq.ft.) Page 2 I
/l/ JOB SITE INFORMATION AND LOCATION Site utilities: 0
Job site address:95 Washington Square Rd Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76 Q
City/State/ZIP:Tigard,OR 97223 -
Footing drain(no.linear ft.:_) Page 2 w
Suite/bldg./apt.no.:,lava l Project name:Build-A-Bear 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.:_) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: / Si 94 oQQ 50a$10 ___ Lot no.: _ Fixture or item:
Tax map/parcel no.: Backflow preventer 3127
DESCRIPTION OF WORK x,r Backwater valve 12.51
`._',. t .,,, ..., Clothes washer 25.02
Plumbing for tenant improvement
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
-❑ PROPERTY OWNER ❑ TENANT' Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub I 25.02 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
r
❑ 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 2 25.02 50.04
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
,, .�s Water closet 1 25.02 25.02
°F''r"°" Water heater 1 37.52 37.52
Business name:PMS1 LLC Water piping/DWV 56.29
Address:21195 NW Evergreen Pkwy Suite 204 Other. 25.02
City/State/ZIP:Hillsboro,OR 97124 Subtotal 137.60
Phone:(503)466-2222 Fax:(503)466-2211 Minimum permit fee: S72.50
CCB Lic.: 158286 Plumbing Lic.no.:34-434PB Plan review (25°/a of permit fee)
State surcharge(12%of permit fee) 16.51
Authorized signatu miff" ! -(,[
TOTAL PERMIT FEE 154.11
L"
Print name:Lanell Robinson LDate:7/1/15 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
`fee methodology set by Tri•County Building Industry Service Board
I,Buildutg Permits PLMU•PermtApp.dc.e 10 01 09 440-7616T(1002-COM WEB)
From: 07/01/2015 23:37 #349 P.002/002
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:
Fooling drain- I" 100' ;:i.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 $23320
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 Inspections or Fees Qty. Fee(ea) Total each additional 5100.00 or fraction thereof,to
l� 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 90.001ir 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 S1.45 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 additignal 5100.00 or fraction thereof.
Subtotal: (`
‘, ii+41));(";
Commercial Fixture Work: /
Are you capping,adding or replacing fixtures? If"yes", i
please indicate work performed by fixture. Failure to r p�% , 3[11b A
accurately report fixtures could result in increased sewer fees*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/
Work Performed: Capped Added Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath 1 ub/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.
Dove Thn, ❑ 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.
-4
Car Wash Drain Isometric or Riser Diagram
Garbage Domestic-non-food El 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./Refiig.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 1
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 I fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C:\Users Irobinson\Downloads\PLMF_PennitApp(1).doc 2
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information RECEIVED e ,'rt at.&
Fee Schedule: Rei enti li41% Suppression Systems:
Site Utilities - Qty. Fee(ea) Total . ti Prt3fIRD Permit Fee:
Footing drain- 1' 100' 5003 . t-tot . : CION $121.9(1
Footing drain-each additional 100' 37 52 r t �' �r'� �*""" $169.69
3,601 to 7,200 5233.20
Sewer- I st 100' 62.54 �_-........_._._...
7,201 and greater $327.54
Sewer-each additional 100' 37.52
WaterService- 1st 100' 62.54 Medical Gas Systems:
Water Service-each additional IOO 37.52 Valuation: Permit Fee:
Storm&Rain Drain-lsl 100' 62 54 $1.00 to 55,000.00 Minimum f'ee$72.50
Storm R Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first 55,000.00 and$1.52 for
Other inspections or Fees Qty, Fee(ea) Total each additional$100.00 or fraction thereof,to
P and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25.000.00 $148.50 for the first 510,000.00 and SI.541ia'
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 90.008v $25,001.00 to$50,000.00 $379.50 for the first$25.000.00 and SI.45 for
hours(minimum charge--2 hours) each additional$100.00 or traction thereof,to
Reinspeetion 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 se •
Quantit9 by Fix Type Plan Review for Plumbing Installations
Fixture Type for Replace! Plan review is required for any of the following.
Work Performed: Capped d Relocate ul Y
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 Thn, ❑ 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.
Eve Wash
Floor Drain/sink -2" I Submit 2 sets of plans with any of the above.
�..
'i Isometric or Riser Diagram
Car Wash Drain
Garbage Dcnnestic-non-food ❑ Isometric or riser diagram is required for new buildings
Disposal -Domestic-tuod 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 nJ�� Q � OZ
Shower -Gang C:451.--d—t..-Stall I
Sink Lav -Non-loud related I , r- �7 a•-Bradley �C) I
-Commercial-food related
-Service I
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
Water EA tractor increase of sewer EllUs,a sewer permit will be issued and
Water Closet-Toilet I fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
M:Vob FilesTMSI Jobs'.40544-Build a Bear\PLMF_PennitApp(I).docx 2
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
9485 SW WASHINGTON SQUARE RD A06A,
TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2015-00209
George Heimos
Violation Summary:
Inspector Contractor