Permit (106) PLUMBING PERMIT
CITY OF TIGARD
'! * ; COMMUNITY DEVELOPMENT Permit#: PLM2016 00080
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/18/2016
Parcel: 131260000300
Jurisdiction: Tigard
Site address: 9368 WASHINGTON SQUARE RD R03
Project: Papyrus Subdivision: None Lot: None
Project Description: Adding(1)service sink and(1)water heater for TI.
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 Sink 02/18/2016 $25.02
Specifics: 1 ea Water Heater 02/18/2016 $37.52
1 12%State Surcharge- 02/18/2016 $8.70
Type of Use: COM Plumbing
Class of Work: ALT 10 ea Minimum Fee Adjustment- 02/18/2016 $9.96
Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
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 directs.- ions • •UNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Sign.' _, /
.4i iii
Call 503.639.4175 by 7:00 a.m.for the next available inspecti• 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: 02/11/2016 00:39 #406 P.001/002
Plumbing Permit Application
Building Fixtures RECEIVEDJli ((ex3
City of Tigard Date/By. / PermitNo.
■ 13 25ne SW Hall Blvd.,Tigard,O50 lib ig 12016 Plan Review l(p-v l
I Phone: 503.7182439 Fax: 503
lib Date/By: Other Permit No.5�K,btO
Inspection Line: 503.639 4175 Date Read/B lura: ®See Pa e 2 for
i Ili q It U Internet: www.ti rd-or. ovCITY OF TI Ready/By: / f /�/_/ G
1'a g 7 Notified/Melhod: ((( [ r!+l Supplemental Information
ARD. ... . . _ .;
TYPIC DIVISION LJ` FEE" SCHEDULE
i,� For special information use checklist
❑New construction 0 Demolition
Description ( Qty. I Ea. I Total
®Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
❑ 1-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler(_sq.ft.) Page 2
93(-P(g JOB SITE INFORMATION AND LOCATION Site utilities:
Job site addressSW 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 LA
Suite/bldg./apt.no.: Q,; I Project name:Papyrus Manufactured home utilities 50.03 t./N1
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 fl.:_) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: /66/,96 0 5:20 Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Plumbing for tenant improvement
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER I i ID TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02,T
Floor drain/floor sink/tub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
0 APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51 I
Address: Sink/basin/lavatory 1 25.02 25.02 I
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater I 37.52 37.52
Business name:PMSI LLC
Water piping/DW V 56.29
Address:21195 NW Evergreen Pkwy Suite 204 Other: 25.02
City/State/ZIP:Hillsboro,OR 97124 Subtotal 62.54
Phone:(503)466-2222 Fax:(503)466-2211 Minimum permit fee: $72.50 !72.50
CCB Lic.:158286 ) ' Plumbing Lic.no.:34-434P13 Plan review (25%of permit fee)
,) State surcharge(12%of permit fee) 8.70
Authorized Signa r � r 1, -A,A TOTAL PERMIT FEE 81.20
Print name:Lantli Robinson Date:2/10/15 This permit application expires if a permit is not obtained within 186 days
after it has been accepted as complete.
'Fee methodology set by Tri-County Building Industry Service Board.
I,Huildmg`.Permit,,PLMU•PcrmitApp.doe 10.01 09 440.4616T(10 02'COM WEB)
From: 02/11/2016 00:39 #406 P.002/002
Plumbing Permit Application - City of Tigard
Page 2- Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Q Fee<�) 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$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
Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
Other Inspections or Fees 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$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*.
Quandty by Fixture Type Plan Review TOr Plumbing Installations
Fixture Type for Replace/ Plan review is required for any of the following.
Work Performed: Capped Added Relocate
Baptistry/Font Please check all that apply.
Bath TublShower ❑ 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 Thm •
❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" L Submit 1 sets of plans with any of the above.
-3"
Isometric or Riser Diagram
Car Wash Drain 0 Isometric or riser diagram is required for new buildings
Garbage -Domestic--non-food
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
-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 fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C:\Usersllrobinson\Downloads\PLMF_PennitApp(3).doc 2