Permit (52) II ---
It CITY OF TIGARD
PLUMBING PERMIT
8 COMMUNITY DEVELOPMENT Permit#: PLM2016-00141
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/23/2016
Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9569 SW WASHINGTON SQUARE RD B04
Project: Godiva Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Adding(1)clothes washer,(2)2"floor drains,(5)3"floor drains,(1)ice maker,(1)grease trap,(1)primer,(2)lays,
and(3)food prep sinks. Replace/relocate(1)lay,(1)service sink and(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
1 Quantity Description Date Amount
1 ea Clothes Washer 03/21/2016 $25.02
Specifics: 7 ea Floor Drain/Floor Sink/Hub 03/21/2016 $175.14
1 ea Ice Maker 03/21/2016 $12.51
Type of Use: COM 1 ea Interceptor/Grease Trap 03/21/2016 $25.02
Class of Work: ALT
1 ea Primer 03/21/2016 $12.51
Type of Const: 4 ea Sink 03/21/2016 $100.08
Occupancy Grp: 3 ea Lavatories 03/21/2016 $75.06
Stories: 1 ea Water Heater 03/21/2016 $37.52
1 12%State Surcharge- 03/21/2016 $55.54
Plumbing
Total $518.40
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 y: Permittee Signature: r
I i /LJ..A&...' p► t-SLI/// (>>/l cs--,_
Call 503.639.4175 by 7:00 a.m.for the next available inspecti•n 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 R�
Cl of Tigard � D Received Permit No.: /
13125 SW Hall Blvd..Tigard,OR 97 Date/By: l� I t.J`le 1(Q'DD/4//
Plan Review111 a/�
ft Phone: 503.718.2439 Fax: 503.59 15 20 DateByc Other Permit No. e 2 for Dt0
I 1 i, I; Inspection Line: 503.639.4175 C17'`, _ 16 Date Ready/By: p// loris 0 See Page 2 for
Internet: www.tigardor.goe I �w♦' ] Notified/Method: �Or� n (l�J Supplemental floe; ation
%4 G Q Ge�L1 FEE* SCITEDUIE -b
TYPE OF w
❑New construction ❑Demolition �N For special information use checklist.
Description 1 Qty. 1 Ea. 1 Total k
®Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) ,,,
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70Ul
o I-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
0 Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 n
JOB SITE INFORMATION AND LOCATION Site utilities: o`
Job site address:9569 SW Washington Square Rd Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97223
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name:Godiva 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.: /5/,7c€ OOO D 300 Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer I 25.02 25.02
Plumbing for tenant improvement
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER ( ❑1no/ANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 7 25.02 175.14
Address: Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) I Fax:( ) Ice maker 1 12.51 12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 1 25.02 25.02
Business name: Medical gas(value:S ) Page 2
Primer 1 12.51 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 7 25.02 175.14
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 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 462.86
Phone:(503)466-2222 l Fax:(503)466-2211 Minimum permit fee: $72.50
(
CCB Lic.: 158286 () Plumbing Lic.no.:34-434PB Plan review (25%of permit fee)
f', State surcharge(12%of permit fee) 55.54
Authorized signatt (-1A/1),21 M"71 ^,„ TOTAL PERMIT FEE 518.40
/ This permit application expires If a permit is nut obtained within ISO days
Print name:Lanell Robinson Date:3/15/16 after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I.Building-Permits PLMU-PermitAppdoc 1001419 440-4616T(10O2,COM'WEB)
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' 'PermitFee:
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) Tom' 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$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-112 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 Capped Added RR
Work Performed: Capped Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath -Tub/Shower 0 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 0 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" 2 Submit 2 sets of plans with any of the above.
5
4" Isometric or Riser Diagram
Car Wash Drain
0 Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food 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
Shower -Gang
-Stall
Sink/Lav -Non-food related 2 1
-Bradley
-Commercial-food related 3
-Service 1
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes 1
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:\Users\Irobinson\Downloads\PLM F_PermitApp.doc 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
9569 SW WASHINGTON SQUARE RD B04,
TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2016-00141
Don Sylvester
1. Corrections are complete, plumbing final approved.
Violation Summary:
Inspector Contractor