Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2016-00335
T[G,AR.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/14/2016
Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9364 SW WASHINGTON SQUARE RD R01
Project: Blue Nile Subdivision: None Lot: None
Project Description: TI-Adding(1)sink&(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 Sink 07/13/2016 $25.02
Specifics: 1 ea Water Heater 07/13/2016 $37.52
1 12%State Surcharge- 07/13/2016 $8.70
Type of Use: COM Plumbing
Class of Work: ALT 10 ea Minimum Fee Adjustment- 07/13/2016 $9.96
Type of Const: Plumbing
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 direct que to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By. Permittee Signature: / ,(1—
A
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 Applicat' �►
Building Fixtures
City of Tigard i V N 2 ,3 2016 Received
DaterBy 6 As (4 �J9 Permit No.- Acillo 33 5
11111 13125 SW Hall Blvd..Tigard.OR 97223 Plan Rcvicw
Y Phone: 503.718.2439 Fax: 503 il6C , !e �'3 �(tG i��E;5 Date/By Other Permit No.:6(4A:7-C4-00 3.%la,
t.i c; t�l� Inspection Line 503 639.4175 s t e o e o i Date Ready/By lulls ® See Page 2 for
Internet. www.tigard-or.gov '--' 1 Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction 0 Demolition For special information use checklist
Description I Qty. j Ea. 1 total c
®Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 itfor each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70 Q�
0 I-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78 ,l
❑Accessory building 0 Multi-family SFR(3)bath 500.32 ll???
Each additional bath/kitchen 25.02 6
❑ Master builder 0 Other: I
Fire sprinkler( sq.ft.) Page 2 O
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:9364 SW Washington Square Rd Catch basin or area drain 18.76 O
Drywell.leach line,or trench drain 18.76 '�
City/State/ZIP:Tigard,OR 97223
Footing drain(no.linear(1.: ) Page 2 "s1
Suite/bldg./apt.no.: I Project name:Blue Nile Manufactured home utilities 50.03 P
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 II.:_) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: /3/4 (e).06:200 30o Backllow 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 1 0 TENANT Expansion tank 12.51
Name: 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
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory I 25.02 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail: .
Water closet 25.02
CONTRACTOR
Water healer I 37.52 37.52
Business name:PMS( LLC Water piping/DWV 56.29
Address:21195 NW Evergreen Pkwy Suite 204 Other: 25 02
City/State/ZIP:Ilillsboro,OR 97124 Subtotal
Phone:(503)466-2222 Fax:(503)466-2211 Minimum permit fee: $72.50 -7,4..Co
er - - Plan review (25%ofpermit fee)
CCB I ie.: 158286 Plumbing Lie.no.:34-434PB
i� State surcharge(12%of permit lee)
Authorized signatupk'‘14" / f---.," "7"-' ," `1,---N TO.FAL PERMIT Flit: t ' =J
J Ts permitapplication lication expires if a permit is not obtained within 180 days
Print name: L.anell#tobinson Date:6/23/16after it has been accepted as complete.
*Yee methodology set by Tri-County Building Industry Service Board.
IlHuildn Permits;Pt.Nil`-PcrmitApp doe 1!'01/00 44o-461G't110/02'COWVWCBI
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-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 $23320
Sewer-1st 10(1 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) "f0t21 each additional$100.00 or fraction[hereofto
and including$10,000.00.
Inspection of existing plumbing or for $10001.00 to$25000.00 $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 525.000.00.
Inspections outside of normal business 90.00Thr $25.001,00 to 550.000.00 $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
each additional$100.00 or fraction thereof.
(minimum charge 1/2 hour) . ,
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.
Work Performed: Capped Added Relocate
Please check all that apply.
Baptistry/Font 0 Any nets commercial building with wafer service 2"and
Bath -Tub/Shower greater.except systems designed and stamped by licensed
-Jactifyi/Whirlpool
Car Wash -Each Stall engineer.
-Drive Thru 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial El Medical gas and vacuum systems for health care facilities.
-Domestic D Any multipurpose lire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink Submit 2 sets of plans with any of the above.
Isometric or Riser Diagram
Car Wash Drain
0 Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food
Disposal -Domestic-litod 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/1,as -Non-hiod related 1
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes increase of sewer EDUs,a sewer permit will be issued and
Water Extractor
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C:\I isersdrobinson\Downloads\PLMF__PermilApp(3).doc 7
Location:
Record Type:
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Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
9364 SW WASHINGTON SQUARE RD R01,
TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2016-00335
Don Sylvester
Violation Summary:
Inspector Contractor