Permit (70) CITY OF TIGARD PLUMBING PERMIT
2J COMMUNITY DEVELOPMENT Permit#: PLM2017-00243
T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/20/2017
Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9538 SW WASHINGTON SQUARE RD H14
Project: Nespresso Subdivision: None
Project Description: Relocate/replace(1)expansion tank,(1)2"floor drain,(4)sinks/lays,(1)utility sink,(1)water closet&(1)water Lot: None
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 Expansion Tank 06/20/2017 $12.51
Specifics: 1 ea Floor Drain/Floor Sink/Hub 06/20/2017 $25.02
Type of Use: COM 4 ea Sink 06/20/2017 $100.08
Class of Work: ALT 1 ea Lavatories 06/20/2017 $25.02
1 ea Water Closet 06/20/2017 $25.02
Type of Const:
1 ea Water Heater 06/20/2017 $37.52
Occupancy Grp:
Stories: 1 12%State Surcharge- 06/20/2017 $27.02
Plumbing
Total $252.19
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:
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 RECEIVED FOR OFFICE ESE ()NEN'
City of Tigard Received
DDate/By: w L
'1 /7
Permit Na.. /....11(96/7-00,; (43
IN . 13125 SW Hall Blvd.,Tigard,OR 97223 1 9 2017
Plan Review
Date/By:Phone: 503.718.2439 Fax: 503.598.196 Other Permit
,
dUN ('- a0 /
Inspection Line: 503.639.4175
l'IGARD Internet: WWW.tigard-or.gov CITY OF TIGARu Date Ready/By: n, (CliJur . El See Page 2 for
NG DIVISE•wotified/Method: olti/7 b Supplemental Information
TYPE OF W ' - "' '' '', '' ,
i .
0 New construction 0 Demolition r i' i( For special information use checklist
DescriFEESCHEDULE
ption I Qty. I Ea. I Total
he Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 II.for each utility connection)
, -
CATEGORY OF CONSTRUCTION ' ' SFR(1)bath 312.70
0 I-and 2-family dwellingP'4' Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
0 Master builder 0 Other:
Fire sprinkler( sq.R.) Page 2
- 43 CA JOB SITE INFORMATION AND LOCATION ' ' Site utilities:
ifi
Job Si e address:?_505' W Washington Square Road Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Portland,OR 97223
Footing drain(no.linear(I.: ) Page 2
Suite/bldg./apt.no.:14 13,)4 is- Project name:Nespresso
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.: Backflow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
. „
Clothes washer 25.02
Plumbing for Ti
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
1 0 TENANT - '', , Expansion tank
PROPERTY.OWNER - ,
, 1 12.51 12.51
Fixture/sewer cap 25.02
Name:PPR Washington Square LLC
Floor drain/floor sink/hub I 25.02 25.02
Address:PO Box 847
Garbage disposal 25.02
City/State/ZIP:Carlsbad,CA 92018
Hose bib 25.02
Phone:( ) Fax:( ) Ice maker - 12.51
0 APPLICANT ' g.: CONTACT PERSON , Interceptor/grease trap 25.02
Business name:PMS1 LLC Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: Brandy Solano
Roof drain(commercial) 12.51
Address:21195 NW Evergreen Pkwy.,Ste.204
Sink/basin/lavatory 5 25.02 125.10
City/State/ZIP:Hillsboro,OR 97124 Solar units(potable water) 62.54
Phone:(503)466-2222 Fax:;(503-)466-2211 Tub/shower/shower pan 12.51
Urinal 25.02
E-mail:bsolanoin)tnsi-systems.com
Water closet CONTRACTOR
t 25.02 25.02
Water heater
1 37.52 37.52
Business name:PMSI LLC
Water piping/DWV 56.29
Address:21195 NW Evergreen Pkwy.,Ste.204 Other: 25.02
City/State/ZIP:Hillsboro,OR 97124
- ___,
Subtotal 225.17
Phone:(503)466-2222 Fax:(503)466-2211 Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lie.:158286 Plumbing Lic.no.:34-434PB
t s7
Authorized signature: State surcharge(12%of permit fee) 27.02
N.._ A
TOTAL PERMIT FEE 252.19
Print name:Brandy Solano Date:6/16/17 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\Budding\Permits,PLN4U-PermitApp doc !WO I/09 440-4616T(i 0/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Util hies 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 $233.20
Sewer-1st 100' 62.54 7,201 and vreater $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
s
Clthlr It1tS eetionor Fees''' Fee(ea,), Total each additional$100.00 or fraction thereof,to
pand 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:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If i"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 anyof the following.
Work Performed: Capped' Added Relocate it
Baptistry/Font Please check all that apply.
Bath fublShawer
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 Thru ❑ 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 OA.R918-780-0040.
Eye Wash
Floor Drain/sink -2" 1 Submit 2 sets of plans with any of the above.
-3„
Car Wash Drain Isometric Or Rser-Diagram
Garbage Domestic-non-food
0 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./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related 4
-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 1 fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
M:\Job Files\PMSI Jobs\20150-Nespresso\City of Tigard Plumbing App.2oc
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9538 SW WASHINGTON SQUARE RD H14,
TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2017-00243
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor