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Permit CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT ay �� Permit#: PLM2015-00363 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/21/2015 Parcel: 1 S126BC01500 Jurisdiction: Tigard Site address: 9000 SW WASHINGTON SQUARE RD Project: Embassy Suites Hotel Subdivision: 2005-035 PARTITION PLAT Lot: 3 Project Description: Plumbing associated with TI of public spaces: Capping(1)2"floor drain,(1)toilets&(1)urinal.Adding(1)ice machine drain&(1)shower stall. Relocating/replacing(1)2"floor drain,(3)lays/hand sinks,(3)food prep sinks& (1)toilet. 11/19/15 Reprint to add:replacement of(3)lays,(9)showers&(6)toilets. 12/24/15,adding(1)hand sink. Contractor: PORTLAND MECHANICAL CONTRACTORS Owner: FO PORTLAND PROPERTY LLC 2000 SE HANNA HARVESTER DR BY WINSTON HARTON HOLDINGS LLC MILWAUKIE, OR 97222 745 FIFTH AVE 33RD FL NEW YORK CITY, NY 10151 PHONE: 503-656-7400 PHONE: FAX: 503-655-0620 FEES Quantity Description Date Amount 1 ea Backflow Preventer 10/21/2015 $31.27 Specifics: 3 ea Fixture/Sewer Cap 10/21/2015 $75.06 1 ea Floor Drain/Floor Sink/Hub 10/21/2015 $25.02 Type of Use: COM 1 ea Ice Maker 10/21/2015 $12.51 Class of Work: ALT 3 ea Sink 10/21/2015 $75.06 Type of Const: 3 ea Lavatories 10/21/2015 $75.06 Occupancy Grp: 1 ea Tub/Shower/Shower Pan 10/21/2015 $12.51 Stories: 1 ea Water Closet 10/21/2015 $25.02 25 Misc Other Fee 10/21/2015 $25.02 1 12%State Surcharge- 10/21/2015 $42.78 Plumbing 3 ea Lavatories 11/19/2015 $75.06 g ea Tub/Shower/Shower Pan 11/19/2015 $112.59 6 ea Water Closet 11/19/2015 $150.12 0 12%State Surcharge- 11/19/2015 $4054 Plumbing 45 Misc Administration Fee 11/19/2015 $45.00 Total 5895.64 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 questio OUNC by calling 503.232.1987 or 1.800.332 2344. Issued By: Permittee Signature: i�rL�F L 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. Plumbing Permit Application Building Fixtures ��l�� • • • ONLY City g Cit of Tigard D+ Received �../ Date/By: Permit No.: L O f a 13125 SW Hall Blvd.,Tigard.OR 97223 e Rv Plan Review r r Phone: 503.718.2439 Fax: 5013-;59&1 �0, PlanDateR v Other Permit No.: Inspection Line: 503.639.4175 / ( L� Dale Ready/13y: loris: ® See Page 2 for Internet: www.tigat-d-oi-.gov / Notified/Method: Supplemental Information TYPE O FEE* SCHEDULE ❑ New construction For special inforata/ion use checklist. Descri tion Qt Ea. Total ❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.f'or each utility connection) CATEGORY OF CONSTRUCTION SFR(I)bath 312.70 ❑ I-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 ❑Accessory g buildin ❑Multi-family SFR(3)bath 500.32 Each additional bath/kitchen 25.02 ❑ Master builder ❑Other: Fire sprinkler(_sq. It.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: D� Catch basin or area drain 18.76 �~ Drywell,leach line,or trench drain 18.76 City/State/ZIP: Footing drain(no.linear It:_) Page 2 Suite/bldg./apt.no.: Project name: Manulactured 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 It:_) Page 2 Water service(no.linear tt.:_) 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 ell, `' t- Dishwasher 25.02 Ga t- A%T-4 Drinking Rbuntain 25.02 Ejectors/sump 25.02 ❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51 Name: Fixture/sewer cap 25.02 Address: Floor drain/floor sink/hub 25.02 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 Contact name: Pruner 12.51 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 CONTRACTOR Water closet 25.02 Water heater 37.52 Business name: Watcr piping/DW V 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal Phone:( ) Fax:( ) Minimum permit fm $72.50 CCB Lic.: Plumbing Lic.no.: Plan review (25%of pennit fee) I State surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE Print name: Date: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fcc methodology set by 7•ri-County Building Industry Service Board. 1\Building\I'ermus\PLNIU-PennitApp.doe 10,01/09 440-4616"1'(1 M21C0\VwH13) 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-I" 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 5233.20 Sewer- 1 st 100' 62.54 7,201 and greater $327.54 Sewer-each additional 100' 37.52 Water Service-1 st 100' 62.54 Medical Gas S stems' Water Service-each additional 100' 37.52 Valuation: Permit Fee: Storm&Rain Drain-1st IW 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$100.00 or traction 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$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 nonnal business 90.00/111• $25,001.00 to$50,000.00 $379.50 for the fust$25,000.00 and S 1.45 for hours(minimum charge-2 horns) each additional S 100.00 or fraction thereof,to Reinspection Fees 90.00/hr and including$50,000.00. Additional plan review for revisions 90.00/111• $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for (mininmm 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*. Plan Review for Plumbing Installations Quantity by Fixture Tv e Plan review is required for any of the following. Fixture Type for Replace/ Please check all that apply. Work Performed: Capped Added Relocate Baptist /Font El Any new commercial building with water service 2"and greater,except systems designed and stamped by licensed Bath: -Tub/Shower engineer. -Jacuzzi/Whirlpool Stall El New exterior plumbing site utilities for any complex structure Car Wash: -Each S Drive tall as defined in OAR918-780-0040. [Im Cus idor/Water Aspirator Medical gas and vacuum systes for health care facilities. Dishwasher: Commercial [I Any multipurpose fire sprinkler system. Domestic El Any complex structure as defined in OAR918-780-0040. Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: 2" 3" Isometric or Riser Diagram 4„ ❑ Isometric or riser diagram is required for new buildings -Car Wash Drain Garbage -Domestic non-food that meet the qualifications above. Disposal: -Dornestic food related -Commercial food related -Industrial food related Ice Mach./Refrig.Drains Comments regarding fixture work: Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower: -Gang -Stall Sink: -Lav/Bar non-food related -Bradley -Com/Serv/Util food related -service *Note: If the fixture work under this permit results in an Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and Washer-Clothes fees assessed for the sewer increase must be paid before the Water Extractor Water Closet-Toilet plumbing permit can be issued. Urinal Other Fixtures: I:\Building\Pcnnits\PLMF_PermitApp.doc 08/04/2011 2 r,a:, 31 A Accumulative Sewer Tally AA Tenant Name: 13mbassy Suites "CRL:DI'I'S'*' S\\iR# N/A Site AddreSS: 9000 S\V/Washington Square Rd PLiA1 # 2015-00363 Parccl#: 1 S126BC01500 Mixture Value Previous Prcviou. Crcclits Capped Fixture fixture Ncw New # value count ca>>ed#s value count added# added value total#s total values Baptistry/font 4 0 0 0 0 0 Bath: -Tub/Shower 4 0 0 0 0 0 - jacuzn/\V/hirl x001 4 0 0 0 0 0 Car Wash: - Fach Stall 6 0 0 0 0 0 Drive through 16 0 0 0 0 0 Cis pidor/\Cuter Aspirator 1 0 0 0 0 0 Dishwasher: -Commercial 4 0 0 0 0 0 Domestic 2 0 0 0 0 0 Drinking Fountain 1 0 0 0 0 0 I?N'c AV/ash 1 0 0 0 0 0 Floor Drain/Sint:: -2 inch 2 0 1 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: D( mcstic(to 3/4 1-I1)) 16 0 0 0 0 0 Commercial (to 5 1-I1)) 32 0 0 0 0 0 Industrial (over 5 HP) 42 0 0 0 0 0 Icc IMaehinc/Refrigerator Drain 1 0 0 1 1 1 1 Living Unit 16 0 0 0 0 0 Oil Sep(Gas Station) 6 0 0 0 0 0 RCC. Vchicic DUMP Station 16 0 0 0 0 0 Showcr: -Gang(per head) 1 0 1 0 0 0 0 Stall 2 0 0 1 2 1 2 Sink: Lav/Bar- Non-Foocl Related 2 0 0 0 0 0 Bradlcv 5 0 0 0 0 0 Com/Scry/Util- Food Related 3 0 0 1 3 1 3 Swimming Pool Filter 1 0 0 0 0 0 \Masher-Clothcs 6 1 0 0 0 0 0 Water I{xtractor 6 0 0 0 0 0 Water Closct -Toilet 6 0 1 6 0 -1 -6 Urinal 6 0 1 6 0 -1 -6 Previous I{DU Count 0 0 Capped I.:DU Crcdit 0 1,C), I.S 0 0 3 14 3 6 0 -8 Current fixture Value -8 divided by 16= -0.500 Current I?DU 1 EDU= $5,100.00 PI"CVIOn'� Fixrurc Value 0 divided by 16= 0.000 PrCV10nS G:DU Change -8 divided by 16= -0.500 over (under) S (2,550.00) Enter EDU Change Here -0.500 * _Round I:DUS to the ilCat'Cat 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: ***C1tED1'fS*** 12/24/15,adding(1)hand sink Authorized Name/Signature: Debbie Adamski Date: 10/21/2015 Building Division Nor: 1'he property owner shall retain the ORIGINAL sewer tally record. I f credits exist,this document will SCI-VC as a voucher which must be submitted to the City of'1'igard Building Division to redeem credits towards future system development charges. I:Aliuildmt;AScwcr'I'allyAScwcr'I';tllyShcct_5100 070115.xISx `' CITY OF TIGARD 1 PLUMBING PERMIT COMMUNITY DEVELOPMENT �� Permit#: PLM2015 00363 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/21/2015 Parcel: 1S126BC01500 Jurisdiction: Tigard Site address: 9000 SW WASHINGTON SQUARE RD Project: Embassy Suites Hotel Subdivision: 2005-035 PARTITION PLAT Lot: 3 Project Description: Plumbing associated with TI of public spaces: Capping(1)2"floor drain,(1)toilets&(1)urinal.Adding(1)ice machine drain&(1)shower stall. Relocating/replacing(1)2"floor drain,(3)lays/hand sinks,(3)food prep sinks& (1)toilet. 11/19/15 Reprint to add:replacement of(3)lays,(9)showers&(6)toilets Contractor: PORTLAND MECHANICAL CONTRACTORS Owner: FO PORTLAND PROPERTY LLC 2000 SE HANNA HARVESTER DR BY WINSTON HARTON HOLDINGS LLC MILWAUKIE, OR 97222 745 FIFTH AVE 33RD FL NEW YORK CITY, NY 10151 PHONE: 503-656-7400 PHONE: FAX: 503-655-0620 FEES Quantity Description Date Amount 1 ea Backflow Preventer 10/21/2015 $31.27 Specifics: 3 ea Fixture/Sewer Cap 10/21/2015 $75.06 1 ea Floor Drain/Floor Sink/Hub 10/21/2015 $25.02 Type of Use: COM 1 ea Ice Maker 10/21/2015 $12.51 Class of Work: ALT 3 ea Sink 10/21/2015 $75.06 Type of Const: 3 ea Lavatories 10/21/2015 $75.06 Occupancy Grp: 1 ea Tub/Shower/Shower Pan 10/21/2015 $12.51 Stories: 1 ea Water Closet 10/21/2015 $25.02 25 Misc Other Fee 10/21/2015 $25.02 1 12%State Surcharge- 10/21/2015 $42.78 Plumbing 3 ea Lavatories 11/19/2015 $75.06 g ea Tub/Shower/Shower Pan 11/19/2015 $112.59 6 ea Water Closet 11/19/2015 $150.12 0 12%State Surcharge- 11/19/2015 $40.54 Plumbing 45 Misc Administration Fee 11/19/2015 $45.00 Total $822.62 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 • a ion -_•ter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090 •u may obtain a copy of the rules or dir: t questions to OU by ca '•g 503.232.1987 or 1.800.332.2344. Issu=d By: ` ,� , Permittee Signature: / 4 • 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. Plumbing Permit Applicniti B AVI(' uilding Fixtures 1IVEP g FOR OFFICE USE ONLY City of Tigard r '21-1'''-) Received Permit No.: Vir 13125 SW Hall Blvd.,Tigard,OR 97223 1 9 Date/By: /I /�j�/S � Xjl S-rilO 43 Plan Review Other Permit No.: Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Inspection Line: 503.639.4175(;11 Y OF 1 l(iit(tt Date Ready/By: furls El See Page 2 for TIGARD y y g Interact www.tigard-or.gov i l % M SION ' Notified/Method: Supplemental Information TYPE O FEE* SCHEDULE ❑New construction 0 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) 1. 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 ❑Multi-family Each additional bath kitchen 25.02 ❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address:9000 SW Washington Square Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP:Tigard,Oregon 97140 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: I Project name:Embassy Suites 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: I 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 modifications in multiple locations Dishwasher 25.02 ACo "I-0 Ex/ s 1// x) 8 r/�tart t Drinking fountain 25.02 Ejectors/sump 25.02 ❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name:Hilton Hotel&Resorts 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 Z APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 Business name:Portland Mechanical Contractors Medical gas(value:$ ) Page 2 Primer 12.51 Contact name:Paul Hettervig Roof drain(commercial) 12.51 Address:2000 SE Hanna Harvester Drive Sink/basin/lavatory 3 25.02 75.06 City/State/ZIP:Portland,Oregon 97222 Solar units(potable water) 62.54 Phone:(503)656-7400 Fax: :(503)656-6374 Tub/shower/shower pan 9 12.51 112.59 E-mail:phettervig@pmc-g.com or cmurray @pmc-g.com Urinal 25.02 CONTRACTOR Water closet 6 25.02 150.12 Water heater 37.52 Business name:Portland Mechanical Contractor Water piping/DWV 56.29 Address:2000 SE Hanna Harvester Drive Other: 25.02 City/State/ZIP:Portland,Oregon 97222 Subtotal 337.77 Phone:(503)656-7400 Fax:(503)656-6374 Minimum permit fee: $72.50 CCB Lic.:151807 lumbing Lic.no.:3-425-PB Plan review (25%of permit fee) _ 4_ State surcharge(12%of permit fee) 40.5 ► Authorized signal : TOTAL PERMIT FEE 378.30 Print name:C of A.Murray Dat•. __•-•:4.■;..c This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. ki (,IJ V‹ *Fee methodology set by Tri-County Building Industry Service Board) eio I:\Building\Permits\PLMU-PermitApp.doe 10/01/09 440-4616T(10/O2/CO /M/WEB) va3. 3i 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- 1'1100' 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 8i 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$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$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: • Other Fixtures: 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 Fixture Type for Replace/ - Plan Review for Plumbing Installations' Work Performe d: Capped Added. Relocate Baptistry/Font Plan review is required for any of the following. Bath -Tub/Shower Please check all that apply. Tub/S ower -Jacuzzi/Whirlpool ❑ Any new commercial building with water service 2"and Car Wash -Each Stall greater,except systems designed and stamped by licensed -Drive Thru engineer. _Cuspidor/Water Aspirator ❑ New exterior plumbing site utilities for any complex structure Dishwasher -Commercial as defined in OAR918-780-0040. -Domestic ❑ Medical gas and vacuum systems for health care facilities. Drinking Fountain ❑ Any multipurpose fire sprinkler system. Eye Wash ❑ Any complex structure as defined in OAR918-780-0040. Floor Drain/sink -2" 3" Submit 2 sets of plans with any of the above. -4" Car Wash Drain Isometric or Riser Diagram Garbage -Domestic-non-food Disposal -Domestic-food related ❑ Isometric or riser diagram is required for new buildings -Commercial-food related _ that meet the qualifications above. -Industrial-food related Ice Mach./Refrig.Drains Oil Separator(Gas Station) Rec.Vehicle Dump Station Comments regarding fixture work: Shower -Gang -Stall 9 Sink/Lav -Non-food related 3 -Bradley -Commercial-food related -Service Swimming Pool Filter Washer-Clothes *Note: If the fixture work under this ermit results in an Water Extractor p Water Closet-Toilet 6 increase of sewer EDUs,a sewer permit will be issued and Urinal fees assessed for the sewer increase must be paid before the H:\Departments\New Div 71 Mech&Plumbing\Projects\Projects- 100002eries\12200-12299JobFolders\12272-7-15 Embassy suites remodel\Permits\City of Tigard-Plumbing Fixture ADA.doc CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit#: PLM2015-00363 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/21/2015 TIGARD Parcel: 1 S126BC01500 Jurisdiction: Tigard Site address: 9000 SW WASHINGTON SQUARE RD Project: Embassy Suites Hotel Subdivision: 2005-035 PARTITION PLAT Lot: 3 Project Description: Plumbing associated with TI of public spaces: Capping(1)2"floor drain,(1)water closet&(1)urinal.Adding(1) ice machine drain&(1)shower stall. Relocating/replacing(1)2"floor drain,(3)lays/hand sinks,(3)food prep sinks&(1)water closet. Contractor: PORTLAND MECHANICAL CONTRACTORS Owner: FO PORTLAND PROPERTY LLC 2000 SE HANNA HARVESTER DR BY WINSTON HARTON HOLDINGS LLC MILWAUKIE, OR 97222 745 FIFTH AVE 33RD FL NEW YORK CITY, NY 10151 PHONE: 503-656-7400 PHONE: FAX: 503-655-0620 FEES Quantity Description Date Amount 1 ea Backflow Preventer 10/21/2015 $31.27 Specifics: 3 ea Fixture/Sewer Cap 10/21/2015 $75.06 1 ea Floor Drain/Floor Sink/Hub 10/21/2015 $25.02 Type of Use: COM 1 ea Ice Maker 10/21/2015 $12.51 Class of Work: ALT 3 ea Sink 10/21/2015 $75.06 Type of Const: 3 ea Lavatories 10/21/2015 $75.06 Occupancy Grp: 1 ea Tub/Shower/Shower Pan 10/21/2015 $12.51 Stories: 1 ea Water Closet 10/21/2015 $25.02 25 Misc Other Fee 10/21/2015 $25.02 1 12%State Surcharge- 10/21/2015 $42.78 Plumbing Total $399.31 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 ollow the - -dopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0091. Yo m-, obtain a copy of the rules or direct•- .n • 9 NC by calling 503.232.1987 or 1.800.332.2344. I Is.ued By: Permittee Signature: • NIM Call 503.639.4175 by 7:00 a.m.for the next available inspection :.te. 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. Plumbing Permit Application Building Fixtures FOR OFFICE USE ONLY RECEIVED of Tigard V VED Received / Permit ,/ 2 ■ 13125 SW Hall Blvd.,Tigard,OR 9722 r Date/By: �(, �� 7 /(�� JG3 I Phone: 503.718.2439 Fax: 503.598. ALIT 2 1 2015 Plan Review Date/By: Other Permit No.: T 1 G A R D Inspection Line: 503.639.4175 Date Ready/By: orris: iii See Page 2 for Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information TYPE OF'i11((�� JNG DIVISION FEE* SCHEDULE ON ['New construction ❑Demolition For special information use checklist Description I Qty. Ea. I Total ®Addition/alteration/replacement ❑Other: New 1-2-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 31 SFR(3)bath , ❑Accessory building ❑Multi-family ■N Each additional bath/kitchen 25.02 O ❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 b JOB SITE INFORMATION AND LOCATION Site utilities: ". . ` Job site address:9000 SW Washington Square Catch basin or area drain 18.76 � Drywell,leach line,or trench drain 18.76 City/State/ZIP:Tigard,Oregon 97140 Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: ( Project name:Embassy Suites 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: Lot no.: Fixture or item: Tax map/parcel no.: 1 St lI /jCO Backflow preventer 1 31.27 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 Plumbing modifications in multiple locations Dishwasher 25.02 1 ('')‘--L. c.- �r` come- '. .. -15-0-- out.- Drinking fountain 25.02 Ejectors/sump 25.02 ❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51 Fixture/sewer cap .^.0 25.02 76-04• Name:Hilton Hotel&Resorts * Floor drain/floor sink/hub 1 25.02 25.02 Address: Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone:( ) Fax:( ) Ice maker 1 a 12.51 12.51 ® APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 Business name: Portland Mechanical Contractors Medical gas(value:$ ) Page 2 Primer 12.51 Contact name:Paul Hettervig Roof drain(commercial) 12.51 Address:2000 SE Hanna Harvester Drive /,�/ /� �- Sink/basin/lavatory 4' 25.02 City/State/ZIP:Portland,Oregon 97222 Solar units(potable water) 62.54 Phone:(503)656-7400 Fax: :(503)656-6374 Tub/shower/shower pan 1 12.51 12.51 E-mail:phettervig @pmc-g.com or cmurray @pmc-g.com Urinal 25.02 Water closet 1 25.02 25.02 CONTRACTOR Water heater 37.52 Business name:Portland Mechanical Contractor Water piping/DWV 56.29 Address:2000 SE Hanna Harvester Drive Other:Soda Machine 1 25.02 ,s.,25.02 City/State/ZIP:Portland,Oregon 97222 Subtotal -113-173'9* Phone:(503)656-7400 Fax:(503)656-6374 Minimum permit fee: $72.50 Plan review (25%of permit fee) 44' CCB Lic.:151807 Plumbing Lic.no.:3-425-PB State surcharge(12%of permit fee) glii 2-}-79 Authorized signat e: TOTAL PERMIT FEE 2Q.3-t6' This permit application expires if a permit is not obtained within 180 days Print name:C A.Murray Date:10/ 015 after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. 1 t146 �3qq. I:A Building A Permits\PLMU-PermitApp.doc 10'01/09 440-4616T(10i02/COMiWEB) 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-1"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 S72.50 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$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$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: Other Fixtures: 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 Fixture Type for Replace/ Plan Review for Plumbing Installations Work Performed: Capped Added Relocate Baptistry/Font Plan review is required for any of the following. Bath Tub/Shower Please check all that apply. -Jacuzzi/Whirlpool ❑ Any new commercial building with water service 2"and Car Wash -Each Stall greater,except systems designed and stamped by licensed -Drive Thru engineer. Cuspidor/Water Aspirator ❑ New exterior plumbing site utilities for any complex structure Dishwasher -Commercial as defined in OAR918-780-0040. -Domestic ❑ Medical gas and vacuum systems for health care facilities. Drinking Fountain ❑ Any multipurpose fire sprinkler system. Eye Wash ❑ Any complex structure as defined in OAR918-780-0040. Floor Drain/sink -2" , 3" Submit 2 sets of plans with any of the above. Car Wash Drain , Isometric or Riser Diagram Garbage -Domestic-non-food Disposal -Domestic-food related ❑ Isometric or riser diagram is required for new buildings -Commercial-food related that meet the qualifications above. -Industrial-food related Ice Mach./Refrig.Drains Oil Separator(Gas Station) Rec.Vehicle Dump Station Comments regarding fixture work: Shower -Gang -Stall Sink/Lav -Non-food related -Bradley -Commercial-food related J1 -Service Swimming Pool Filter Washer-Clothes *Note: If the fixture work under this permit results in an Water Extractor p water Closet-Toilet ` increase of sewer EDUs,a sewer permit will be issued and Urinal fees assessed for the sewer increase must be paid before the H:\Departments\New Div 71 Mech&Plumbing\Projects\Projects- 100001eries\1 2200-12299JobFolders\12272-7-15 Embassy suites remodel\Permits\City of Tigard-Plumbing Fixture Units.doc Accumulative Sewer Tally 111111 II Tenant Name: Embassy Suites **CREDITS*** SWR# N/A II Site Address: 9000 SW Washington Square Rd PLM# 2015-00363 TIGARD Parcel#: 1S126BC01500 Fixture Value Previous Previous Credits Capped Fixture fixture New New # v clue count capped#s value count 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 0 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 0 Dishwasher: -Commercial 4 0 0 0 0 0 -Domestic 2 0 0 0 0 0 Drinking Fountain 1 0 0 0 0 0 Eye Wash 1 0 0 0 0 0 Floor Drain/Sink: -2 inch 2 0 1 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 I IP) 32 0 0 0 0 0 -Industrial(over 5 IIP) 42 0 0 0 0 0 Ice Machine/Refrigerator Drain 1 0 0 1 1 1 1 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 1 _ 2 1 2 Sink: -Lav/Bar-Non-1;0°d 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 1 6 0 -1 -6 Urinal 6 0 1 6 0 -1 -6 Previous EDU Count 0 0 Capped EDU Credit 0 TOTALS (1 0 3 14 2 3 -1 -11 Current Fixture Value -11 divided by 16= -0.688 Current EDU 1 EDU= $5,100.00 Previous Fixture Value 0 divided by 16= 0.000 Previous EDU Change -11 divided by 16= -0.688 over (under) $ (3,519.00) Enter EDU Change Here -0.690 * *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 Adamski Date: 10/21/2015 Building Division Note: The property owner shall retain the ORIGINAL 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\SewerTallySheet_5100_070115.xlsx City of Tigard • COMMUNITY DEVELOP:\fENT DEPART:\IF.NT ■ Request for Permit Action 13125 SW Hall Blvd. • 'Tigard, Oregon 97223 • 503-718-2439 • www.tigard-ongov TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard, OR 97223 Phone 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov FROM: ❑ Owner ❑ Applicant ❑ Contractor City Staff Check(✓)one REFUND OR Name: INVOICE TO: ledi,;dn,l) 0 2rt RtiSlj f elfq Nt�A L Co N ST Q�j Mailing Address: o2o6o df_ 14jjJt3Il t{AE�EhTE2�Q. City/State/Zip: Phone No.: '503' to'F&- 7"100 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): ❑ CANCEL/VOID PERN11TAPPI.ICA'TION. REFUND PERMIT FLANS (attach copy of original receipt and provide explanation below). ❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit #: LH 3D15 -00 3(a3 Site Address or Parcel #: 9/000 eW LO'eF 51♦1 IJChTo/j 6Q Subdivision Name: Lot#: EXPLANATION: �l �Yt„�ij CRSFy OJ g2 CJtf0k AMOu/JTHope-E TgrJ Pf-p-i1 t-F 1=£fs. Signature: OL Date: Print Name: E gf At)AMSf.L Rctund Police 1. The cin°'s Communin Development Director,Building Official or()01 Fogineer mai authorise the refimd of. • .Ane fee which was crroneouslll paid or colluded. • Not more than 80°4,of the application or plan rcvicw fee when an application is withdrawn or cmccicd before rcvicw effort has been expended. • Not more than 80"%of the application or permit fee for issued permits prior to ane inspection rcyucsr¢. 2. .All refunds will be returned to rhe original pacer in the form of it check via US postal service. 3. Please allow 3-4 week_= for processing refimd rceluusts. Route to Sys Admin: Date T /S Route to Records: Date Refund Processed: Date i (o Bh Invoice Processed: Date B Permit Canceled: Date B- Parcel Ta _ldded: I Date B\ 1:ABuddmgV DormsARvyl'cnnic Act1un_092i 4.doc City of Tigard January 21, 2016 Portland Mechanical Contractors 2000 SE Hanna Harvester Dr. Milwaukie, OR 97222 Re: Permit No. PLM2015-00363 Dear Applicant: The City of Tigard has processed a refund for overpayment of permit fees on the above referenced permit for the following: Site Address: 9000 SW Washington Square Rd Project Name: Embassy Suites Job No.: N/A Refund: ® Check#219886 in the amount of$73.02. ❑ Credit card "return" receipt in the amount of$ ❑ Trust account"deposit" receipt in the amount of$ Notes: Refund overpayment of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, Dianna Howse Building Division Services Coordinator Enc. I:\Buitdine\Refun,PAg��X,kKy�b,'0,T�pr6 /,Q(;€gon 97223 • 503.639.4171 TTY Relay: 503.684.2772 0 www.tigard-or.gov City of Tigard Accela Refund Request This form is used for refund requests of land use, development engineering and building permit application fees. Receipts, documentation and the Request for PermitAttion form (if applicable) must be attached to this request form. Refund requests are due to Accela System Administrator by each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts Payable %-,U route refund checks to Accela System Administrator for distribution to applicant. PAYABLE TO: Portland Mechanical Contractors DATE: 1/14/2016 2000 SE Hanna Harvester Dr. Mihvaukie, OR 97222 REQUESTED BY: Dianna Howse DEB TRANSACTION INFORMATION: Receipt#: 401227 Case #: PLN12015-00363 Date: 12/24/2013 Address/Parcel: 9000 SW W ashington Sq Rd Pay Method: Check Project Name: Embassy Suites EXPLANATION: Refund over payment amount Paid on permit fees. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Buildin Pen-nit Fee Example: 2300000-43104 $Amount Cash Over 100-0000-43001 $73.02 TOTAL REFUND: $73.02- APPROVALS: 73.02APPROVALS: SIGNATURES DATE: If under $5,000 Professional Staff lTy� If under$12,500 Division Manager If under$25,500 Department Manager If under$50,000 City Manager If over $50,000 Local Contract Review Board FOR TIDEMARK SYSTEM ADMINISTRATION USE ONL Case Refund Processed: Date: / 1/ / By: I:\Building\Refunds\RefundRequcstdnc 09/01/2010