Permit (120) 71 CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2019-00263
Date Issued: 06/27/2019
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9561 SW WASHINGTON SQUARE RD B02
Project: Abercrombie Kids Subdivision: None Lot: None
Project Description: Interior plumbing for TI:Capping(1)2"floor drain,(1)sink,and(1)water closet;Relocating(1)2"floor drain,(2)
sinks,and(1)water closet; Installing(1)expansion tank 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 Expansion Tank 06/27/2019 $12.51
Specifics: 3 ea Fixture/Sewer Cap 06/27/2019 $75.06
1 ea Floor Drain/Floor Sink/Hub 06/27/2019 $25.02
Type of Use: COM 1 ea Sink 06/27/2019 $25.02
Class of Work: ALT 1 ea Lavatories 06/27/2019 $25.02
Type of Const: 1 ea Water Closet 06/27/2019 $25.02
Occupancy Grp: 1 ea Water Heater 06/27/2019 $37.52
Stories: 1 12%State Surcharge- 06/27/2019 $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 503.232.19874r tRf10. 32.2344.
Issued By: Permittee-Signature:
•�/! r�L.d. _ . . iL, _ - AP-
r 'I,
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.
Plainbin2 Permit Application ''--
Building Fixtures ,i't 'y 2 7 2019
Cityof Tigard Received
g t ',Date/B Permit No..
71
i 13125 SW Hall t3Ivd t igard,OR 97223 Ilan Review
Phone: 503.718.2439 Fax: 503.598.196(1.i . _ '-1‘•
Date.By Other Permit No.6 4g0 iE--a* i /
"CI G A R D Inspection Line: 503 639 4175 Date Ready/By: s 0 See Page 2 for
Internet: www.tigard-or.gov Notified/Method. Supplemental Information
TYPE OF WORK _ - .-. FEE* SCHEDULE
0 New construction ❑ Demolition ____ For special information use checklist
Description j Qhs. .1 Ea. I loud
®Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
❑ 1-and 2-family dwelling 'XI Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family ?5 02
Each additional bath/kitchen
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:9561 SW Washington Square Road,Space BOA
Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97223 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.:BOA I Project name:Abercrombie Kids#21972 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.: /57Ct.x. 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
0 PROPERTY OWNER ( 0 TENANT Expansion tank I 12.51 12.51
Fixture/sewer cap 3 25.02 75.06
Name:
Floor drain/floor sink/hub i 25.02 25.02
Address: Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
gl APPLICANT 0 CONTACT PERSON 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 2 25.02 50.04
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:bsolano@msi-systems.com
Water closet 1 25.02 25.02
CONTRACTOR 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 State surcharge(12%of permit fee) 27.02
Authorized signature: S'il(0"---A-4J TOTAL PERMIT FEE 252.19
Date:6/25/19 This permit application expires if a permit is not obtained within ISO days
Print name:Brandy Solanaafter it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:/Buitdins/PermitsWPLMU-PermitApp doe 10/01/09 440-46I6T(t0/02/COMRPEB)
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- I' 100" 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2.001 to 3,600 $169.693,601 to 7,200 _$233.20
Sewer- 1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 1001 37.52
Water Service- I st 100' 6254 Medical Gas Systems:
Water Service-each additional 1110' 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
Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
Other Inspections or Fees 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 91).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 lied
Work Performed: Capped Added Relocate Plan review is required for any of the following.
Please check all that apply.
Baptistry/font
-Tub/Shower 0 Any new commercial building with water service 2"and
Bath -
-Tub/S
-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 -2 I I Submit 2 sets of plans with any of the above.
-3"
a:. ) 0)�`f 'it- RiserDittgranr ------
Car Wash Drain 0 Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food
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 I I
-Bradley
-Commercial-food related
-Service I
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
WaterCloset-Toilet 1 1 fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
Mob Files\PMSI Jobs120298-.Abercrombie Kids#21972\City of Tigard2Ptumbing App.doc
I
Accumulative Sewer Tally
ill
Tenant Name: ABERCROMBIE KIDS SWR# N/A
TIGARD Site Address: 9561 SW WASHINGTON SQUARE RD PLM# 2019-00263
Parcel#: 1S 1260000300
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s value count added# added value total#s total values
Baptisery/Font 4 0 0 0 0 0
Bath: -Tub/Shower 4 0 0 0 0 0
-Jacuzzi/Whirlpool 4 0 0 0 0 0
Car Wash: -Each Stall 6 0 0 0 0 0
-Drive through 16 0 0 0 0 0
Cuspidor/Water Aspirator 1 0 0 0 0 0
Dishwasher: -Commercial 4 0 0 0 0 0
-Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 1 2 0 -1 -2
-3 inch 5 0 0 0 0 0
-4 inch 6 0 0 0 0 0
-Car Wash 6 0 0 0 0 0
Garbage Disposal:
-Domestic(to 3/4 HP) 16 0 0 0 0 0
-Commercial(to 5 HP) 32 0 0 0 0 0
-Industrial(over 5 HP) 42 0 0 0 0 0
Ice Machine/Refrigerator Drain 1 0 0 0 0 0
Living Unit 16 0 0 0 0 0
Oil Sep(Gas Station) 6 0 0 0 0 0
Rec.Vehicle Dump station 16 0 0 0 0 0
Shower: -Gang(per head) 1 0 0 0 0 0
-Stall 2 0 0 0 0 0
Sink:
-Lav/Bar-Non-Food Related 2 0 1 2 0 -1 -2
-Bradley 5 0 0 0 0 0
-Com/Sery/Util-Food Related 3 0 0 0 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer-Clothes 6 0 0 0 0 0
Water Extractor 6 0 0 0 0 0
Water Closet-Toilet 6 0 1 6 0 -1 -6
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 3 10 0 0 -3 -10
Current Fixture Value -10 divided by 16= -0.625 Current EDU 1 EDU= $5,650.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -10 divided by 16= -0.625 over (under) $ (3,559.50)
Enter EDU Change Here -0.630 *
*Round EDUs to the nearest 1/100th: a count ending in.005 shall be rounded up to.01,and a count ending in.014 or less shall be rounded down to.01.
Notes: ***CREDIT***
Authorized Name/Signature: BRANDEN TAGGART X2449 Date: 6/26/2019
Building Division
Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist,this document will serve as a voucher which must be
submitted to the City of Tigard Building Division to redeem credits towards future system development charges. _ ,
I:\Building\Sewer Tally\SewerTallySheet_5500_070118.xlsx