Permit (54) CITY OF TIGARD PLUMBING PERMIT
N ,:
, ...- COMMUNITY DEVELOPMENT Permit#: PLM2019-00117
T I G.AR.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/21/2019
Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9339 SW WASHINGTON SQUARE RD T11
Project: Amerisleep Subdivision: None Lot: None
Project Description: Interior plumbing for TI: Relocating(2)sinks and(1)water closet; 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
2 ea Sink 03/21/2019 $50.04
Specifics: 1 ea Water Closet 03/21/2019 $25.02
1 ea Water Heater 03/21/2019 $37.52
Type of Use: COM 1 12%State Surcharge- 03/21/2019 $13.51
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $126.09
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.
l
Issued By: 'Ste'_ Permittee Signature: tr7
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 . te)F1�l(.E USE C'SLY
CityofT1 and RECEIVED Received /``� Permit No.. �� � ��y�/
� Date/By: r'� �'' ' W`/7
II r 13125 SW Hall Blvd..Tigard.OR 972 ,� Plan Review
2 Phone: 50 718 2439 Fax: 503.598 1 2019 DatelBy Other Permit No.'
/ FA 'LV J�Isi1
TIGARD InspeL.ction I the 503 639 1175 Date Ready/By• Juns Et See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: •#Ba Supplemental Information
TYPE OF Ilailit.DING DIVISION FEE`' SCHEDULE
0 New construction 0 emo
Dlition For special information use checklist.
Description I Qtv. I Ea. I Total
fr.Additionialteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
SFR(2)bath 437.78
CI1-and 2-family dwelling E Commercial/industrial SFR(3)bath 500.32
❑Accessory building 0 Multi-family Each additional bath/kitchen 25.02
0 Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Catch basin or area drain I 8.76
Job site address:9339 SW Washington Sq.Rd.
_._ Drywell,leach line,or trench drain 18.76
City/State/ZIP:Portland,OR 97223 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.:TI I Project name:Amerisleep 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 It.: ) Page 2
Subdivision: l.ot no.: Fixture or item:
Backflow preventer 31.27
Tax map/parcel no.: 12.51
Backwater valve
DESCRIPTION OF WORKClothes washer 25.02
Plumbing for TI Dishwasher 25.02
Drinking fountain 25.02
EjectorsJsump 25.02
0 PROPERTY OWNER ❑
TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name: Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
12.51
Phone:( ) Fax:( ) Ice maker25.02
►i4 APPLICANT 0 CONTACT PERSON Interceptor/grease trap
Medical gas(value:$ ) Page 2
Business name:PMSI LL(' Primer 12.51
Contact name:Brandy Solaro Roof drain(commercial) 12.51
Address:21195 NW Evergreen Pkwy.,Ste.204 Sink/basin/lavatory 2 25.02 50.04
City/State/IIP: Hillsboro,OR 97124 Solar units(potable water) 62.54
____._ .__.. -•
Phone::(503)466-2222 t Fax::(503)466-2211 Tub/shower/shower pan 12.51
Urinal 25.02
E-mail:bsolano(a msi-systems.cont Water closet 1 25.02 25.02
CONTRACTOR ^ Water heater 1 37.52 37.52
Business name:PMSI Elk Water piping/DWV 56.29
Address:21195 NW Evergreen Pkwy.,Ste.204 Other: 25.02
Subtotal 112.58 11
City/State/ZIP:Hillsboro,OR 97124 -
Fax:(503)466-2211 Minimum permit fee: $72.50
Phone:(503)466-2222 Plan review (25%of permit fee)
CCB Lie.:158286 Plumbing l,ic.no.:34-434PB
State surcharge(12%of permit fee) 13.51
Authorized signature......4 4C� TOTAL_PERMIT FEE 126.09
v....•.4. ' -"" +4This permit application expires if a permit is not obtained within 180 days
Print name:Brandy Solano m Date:3/18/19 I after it has been accepted as complete.
*fee methodology set by Tri-County Building Industry Service Board.
I 3suildFlrglPermils\t'Lre1lJ•PermeApp.doe 10/01/09 440.46161(10/02'COM/WES)
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Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
e e
Site Utilities Qty. re( a) 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 $233.20 ____________
Sewer-1st 100' 02.54 7,201 and greater $327.54
Sesser-each additional 100' 37.52
Water Service-1st 100 62.54 Medical Gas Systems:
Water Service-each additional I Ott' 37.52
Valuation; ,,‘,,. " Permit Fee:
Storm&Rain Drain-I st IMF 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
Qty, Fee(ea) Total
Other Inspections or Fees . , 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 ineludinm $25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 Mr the first$25,000.00 and$1.45 for
hours t 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*.
Quantiy by Fixture Type ilia Review for Plumbing Installations ' 1
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 new commercial building with water service 2"and
Bath -Tub/Shower
Jacuzzi/Whirlpool 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 , 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.
. ... ,.
Iionietrie:Oritiser Diagram
Car Wash Drain
0 Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-Mod
Disposal -Domestic-fixmd related that meet the qualifications above.
-Commercial-food related
-Industrial-food related _
Ice Maeh./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall -
Sink/Lay -Non-Mod related I
-I3radley
-Commercial-Mod related ....
-Service I
Suimmine Pool Filter . *Note: lithe 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:t.lob Files\PMSI Jobs\20278-AmerisleepTity of Tigard Plumbing PerMit App.doc