Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2017-00280
TR ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/26/2017
Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9632 SW WASHINGTON SQUARE RD G09
Project: Bath&Body Works Subdivision: None Lot: None
Project Description: Replace/relocate(1)drinking fountain,(2)2"floor drains/floor sink/tub,(4)sink/basin/lavatories,(1)water closet,
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
Quantity Description Date Amount
1 ea Drinking Fountain 07/20/2017 $25.02
Specifics: 2 ea Floor Drain/Floor Sink/Hub 07/20/2017 $50.04
4 ea Lavatories 07/20/2017 $100.08
Type of Use: COM 1 ea Water Closet 07/20/2017 $25.02
Class of Work: ALT 1 ea Water Heater 07/20/2017 $37.52
Type of Const: 1 12%State Surcharge- 07/20/2017 $28.52
Occupancy Grp: Plumbing
Stories:
Total $266.20
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 q . •UNC by calling 503.232.1987 or 1.800.332.2344.
Issu d By: / / Permittee Sign• ure:
,o graVIZI
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.
Plumbin2 Permit Application
Building Fixtures
USE ()NL.N
FOROFFICE ,
RECEIVE])
City of Tigard Received
Date/By: 7//7/// ' /4 Permit No li/44,10,7t0/7..6104.7 j
. a 13125 SW Hall Blvd.,Tigard,ORWiN3 i 9
74
?0 1 t..--t
Plan Review 44
: I Phone: 503.718.2439 Fax: 503.
Date
59W I-9601 ti Other Permit No.:641Pc9,0/7-e/O ,2
/By:
Inspection Line: 503.639.4175
TII.;ARI) Date Ready /17,/7,6 Jeri,
SF6O p8peleemP aegneta21 for a t i on
Internet: www.tigard-or.gov C
'ry OF TIGAlti)
®G rilvisit,IN - ,-FEE* SCIIEDULE
mation
Fa use checklist
0 New construction D Demolition special informs
Description I Qty. I Ea. Total
Addition/alteration/replaceznent E3 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION ' -' :' ,--- SFR(1)bath 1 312.70
-,'- -
SFR(2)bath II 437.78
0 I-and 2-family dwelling ,aCommercial/industrial
SFR(3)bath 500.32
El Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
0 Master builder 0 Other: Fire sprinkler( sq.II.) Page 2
'1 '.
'A:1 11140f1 SITE liNPORMATION AND LOCATION' '', Site utilities:
'',- '.$,',.''', ', - ''
Catch basin or area drain 18.76
Job site address: 04..5.E5S-"°- 5i:,..„) 14.11.„,,,.,.„,„,L,,, .,,C,:', e,,,, l
_ i
', Drywell,leach line,or trench drain .1111111 18.76
City/State/ZIP: c,,',)f-1,),-4. ..,,I f....3:: q -7 a.....>
4,..- Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.:cr,(2)CA I Project name:1,2 ,' „A-LA ,j. Kc,,.._ i -. 4,f L..c.,, 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
,,,:;,„,,,i,,,A4,4,.. , ,' oEscatvrioN OF WORN.
z Clothes washer , 25.02
TT.- (4LI, k t Pi-ft a g_4-i t 1,-Y rs og--
_.,_ Dishwasher 25.02
,,e, C im-x)6es "72) Ebc., 15) Drinking fountain 1 25.02 X.,,,c)'),.....
Ejectors/sump 25.02
915,.*jiiio-iiticry OWNER ,,,, ,,, , ,„ k ,' Q TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name: ).P., tkic 3(.4,,,,,,, ,4,,cf....
- 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
PLICANT , '.,, ,:,,'„' ,' CI CONTACT PERSON,,',:"',11:,!' Interceptor/grease trap 25.02
Medical gas(value:S ) Page 2
Business name: ern 5 j_s I L.c:--'
Primer 12.51
Contact name: 6 r,o, ..,:.., C.). t k.' Roof drain(commercial) 12.51
Address: :) ci - i6) c: . k si, ao Li Sink/basin/lavatory Li 25.02 I()0,06
City/State/ZIP: 4,)/56,..,,,..„, 0 P..,.. 9'7/.2 ut Solar units(potable water) 62.54
Phone:(cc>1))LIG,. . Fax::(c3) 1/6,6, .)5,,,? Tub/shower/shower pan 12.51
Urinal 25.02
E-mail: ),.....,,,,,,,,4010_v, 0 e3„,,,) iris,i - s s 4 t t,4..-t
1,...; a.'''4„4,`,3- --
Water closet % 25.02 ,...)c)0'3_
Water heaterf 37.52 3),.
Business name: P)ir, S y L i_ci, Water piping/DWV 56.29
Address: -)1 I Ci s- „dr)v) ')> , , Other: 25.02
City/State/ZIP: to:11 s.L , 6,;?..._ ci--ze 2,y
- Subtotal 3,37,toe)
Minimum permit fee: $72.50
Phone:(St.) ) v cot , ,)..2,) _„.. Fax:(ct 1.) vte,„„ti,,))./i
Plan review (25%of permit fee)
CCB Lic.: / s-F). Plumbing Lie.no.: 33/4.1..kit'')).1Pt.; State surcharge(12%of permit fee) ').8,sp,...._
, Authorized signature: ., C::;t k. 7/i/2-0
TOTAL PERMIT FEE D6itt,1E)
This permit application expires if a permit is not obtained within 180 days
Print name: Date: r7-j)
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I 1 Building1Permits\PLIVIL1-PermitApp doe 10/01/09 440-46167(10/02(COMAVEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site:t ities City. Fee'tea) Total Square;;Footage: Permit Fee: ,ii�;l:r
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 $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
Cit leil"- tions or Fees QY, Fee(ea) Total ' 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-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*.
Quantity by Fixture Type Plan Review for Plumbing Installations' °:
Fixture Type for r Plan review is required for anyof the following.
WorkFerformied, Capped Added , ((locate g
Baptistry/Font Please check all that apply.
Bath fub/Shower
0 Any new commercial building with water service 2"and
Jacurzi!Whirlpoul greater,except systems designed and stamped by licensed
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 0 Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain It 0 Any complex structure as defined in OAR918-780-0040.
Eye Wash
� Floor Drain/sink -2" 01._ Submit 2 sets of plans with any of the above.
-3,'
e i'{ Isometric ori EEiser Diagram,'''.' i',1'11':, 11 r.
Car Wash Drain
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
-Bradley
-Commercial-food related
-Service
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 I - fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
M:\Brandy\FormslPermit Apps\City of Tigard Plumbing.doc 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9632 SW WASHINGTON SQUARE RD G09,
TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2017-00280
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor