Permit (116) CITY OF TIGARD PLUMBING PERMIT
2. COMMUNITY DEVELOPMENT Permit#: PLM2018-00448
D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/27/2018
T t G1 8 9 Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9520 SW WASHINGTON SQUARE RD H06
Project: L'Occitane Subdivision: None Lot: None
Project Description: Interior plumbing for TI:Relocating(1)sink and installing(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 09/27/2018 $25.02
Specifics: 1 ea Water Heater 09/27/2018 $37.52
1 12%State Surcharge- 09/27/2018 $8.70
Type of Use: COM Plumbing
Class of Work: ALT 10 ea Minimum Fee Adjustment- 09/27/2018 $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 questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ittee 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. Ap licatio i "�
e d _ '
Building Fixtures �" _ FOR QI•EI( E LSE ONL1
City of Tigard Received .
f`. 41 Permit No.: /21,:///1".--cy i
t; 2 2,201?)?1 Date/By: t/.7`a7�L ;) _ C 1'
L
III
13125 SW Hall Blvd.,Tigard OR 97223 Plan Review
Ig Phone: 503.718.2439 Fax: 503.598.1960Date By: Other Permit No:a,r ! 1_ ) 3j
TIGARD Inspection Line: 503.639.4175 1fl'\1 4 a �� Date Ready/By
, runs 0 See Page 2 for
Intentet tvwti.ti ard-or.gov .V1 1 ifted/Method. f Supplemental Information
TYPE OF Wo LSI fi $ a *;-�D y., � ":;;i', '
❑New construction 0 Demolition For special information use checklist.
----- Description I 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(1)bath 312.70
❑ 1-and 2-family dwelling r4Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
etC- TOB TE INFORMATION AND LOCATION Site utilities:
Job site address: 5 SV1'Washigton Square Road Catch basin or area drain 18.76
City/State/ZIP: Portland,OR 97223 Drywell,leach line,or trench drain 18.76
Footing drain(no,linear ft.: ) Page 2
Suite/bldg./apt.no.:611 Project'tattle:l.'Occitane En Province Manufactured home utilities 50.03
Cross street/directionsto 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 maplparcel no.: Backflow preventer 31.27
DESCRIPTION OF'WORK r ' .,,„ ;t Backwater valve 12.51
Clothes washer 25.02
Plumbing for TI
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER I 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
0'9 APPLICANT ❑ CONTACT: Interceptor/grease trap 25.02
Business name:PMSI 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 1 25.02 25.02
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
E-mail: bsolano@msi-systems.com Urinal 25.02
Water closet 25.02
CONTRACTOR
- ' Water heater f 1;. 1f Ulu-- 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 s ,y-t{
Phone:(503)466-2222 Fax:(503)466-2211 Minimum permit fee: $72.50 /7.).
Plan review (25%of permit fee)
CCB Lie.: 158286 Plumbing Lie.no.:34-434PB
State surcharge(12%of permit fee) es,i 0
Authorized signature:1 . €_ R TOTAL PERMIT FEE al,"10
Print name: Brandy Solano Date: y ^� 'I) This permit application expires if a permit is not obtained within 180 days
i i after it has been accepted as complete.
`Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\PermitsOPLMU-Perm it App.doc 10/01!09 440-4616T(I 0/02/COM/WEB)
'Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Qty. Fee(ea) Total
Site Utilities ,S(141 - Footage:_ : - . Permit Fee: i ik� . :..
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 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 o
Valuation : - Permit Fee: - , r
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) Total
each incadluding
10,$100.00. or fraction thereof,to
h and includmg'$IO,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*.
Quanti�by Fixture lou .:
�� :° - i�` n:Ii�+ '�flT l�t#F �a�t�dl�ttUa
Fixture Type for Reptace1 Plan review is required for any of the following.
Work Performed: Capper Added Relocate
Baptistry/Pant Please check all that apply.
Bath fublShow"er ❑ 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'l'hru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator
as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic a Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OA.R918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
,E, . ' ometr- tofe r=s-er pal is mtmilai U -:
Car Wash Drain
Garbage Domestic-non-fogd
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/Lay -Non-food related I
-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:
M:1Job Files\PMSI Jobs\20243-L'Occitane En Province WA. SQ\City of 'igard Plumbing Permit App.doe
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9520 SW WASHINGTON SQUARE RD H06,
TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2018-00448
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor