Permit 114 CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit PLUMBING
PLM2011 -00100
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/31/2011
Parcel: 151260000300
Jurisdiction: TIGARD
Site address: 9633 SW WASHINGTON SQUARE RD FC04
Project: Braganza Tea Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project Description: Interior plumbing for TI.
Contractor: PMSI LLC Owner: PPR WASHINGTON SQUARE LLC
21195 NW EVERGREEN PKWY #204 2235 FARADAY AVE STE #0
HILLSBORO, OR 97124 CARLSBAD, CA 92008
PHONE: 503 - 466 -2222 PHONE:
FAX: 503- 466 -2211
FEES
Quantity Description Date Amount
2 ea Sink 03/31/2011 $50.04
Specifics: 1 ea Water Heater 03/31/2011 $37.52
1 12% State Surcharge - 03/31/2011 $10.51
Type of Use: COM Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $98.07
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: � mittee Signature:
Call 50 .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.
Mar. 30. 2011 4:24PM No. 2555 P. 2
Plumbing Permit Application -
Building Fixtures Blvd., Tigard, OR 97 , \1 Received
11 13125 SW F . Lott w ICL USE ONLY
City of Tigard ,G )
� ., r A Pian Review- `� ,)'- Permit No.: /J ,/
BA 2L3 aA f•-• \ Der y:
i : Phone; 503. 718,2139 Fax: 503:598.1960 Q�`� Date/By: OtherPcrmitNo.: �J,� / - �'�
Inspection Line: 503.639.4175 ``,, `�j Date Ready/Sy: lurlr See Page i for
TLGAttll Internet: www.tigard - or.gov i ∎ P \` Noufiedfvieihod: ' w� Supplemental Information
❑ New construction 0 Demolition For special In /orinallon use checklist.
Description I Qty. I E . I Total
® Addition/alteration/replacement ❑ Other; New 1- 2- family dwellings (includes 100 ft. for each utility connection)
: ?'3777,:_:= ;- _.---- __ - -:=----- :_ .. - - ---------_ =, ,r:: ,.«�_.-- x___- SFR (1) bath 312.70
❑ 1- and 2- family dwelling a Commercial/industrial SFR (2) bath 437.78
SFR (3) bath 500 - 32
❑ Accessory building ❑ Multi - family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
•. _ _ l•w~ _ ' ._j.•, ly_ L,Q. �,yd1j' 4 T -°rir. Site utilities!
:. .._. . � �� - ..., 7777- �.. _.+r.,,...� , ., ._. : ....- .. ,��,5
J ob s a 9 W W ash i ngton Square Rd
Catch basin or arca drain 18.76
City /State/ZIP: Tigard, OR 97233 Drya'CII,1COCh line, or trench drain 18.76
Footing drain (no. linear ft.: ) Page 2
_Suite/bldg. /Apt. no.; FC-04 I Project name: Braganza Tea 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: I Lot no.: Fixture or item:
Tax map /parcel no.; Back00w preventer 31.27
_ A.YY __,_.... .. ` °4 . ' e! (4: i; ,.. - _ :r .:c::__ r" Backwa valve 12.51
°. r k nom -= = s
7777 _ _
:,r.._ -. -._ kY?' - = =s -1. Clothes washer 25.02
Plumbing for tenant improvement - Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
��� or -.r• _ +".r = -= -77 -_:_c i . e- _
' <S � ? -L - � 3� :'=,F, .' 7� =a l E xpansion tank 12.51
- 7777
- ��� _- �.:_,_
,.:: :. -� .:- 7777 .....,
Hanle Fixturc/sewcr cap 25.02
Floor drain/floor sink/htib 25.02
Address: Garbage disposal 25.02
City /State /ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) lee maker 12.51
- . . . , ` . . . 7777 � f rr") . `P Ii Interceptor /grease trap 25.02
- 7777 - n - � :
. - 7777 .......... ..
Business name: Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: Roof drain (commercial) 12.51
Address: Sinklbasin/lavatory 2 . 25.02 50.04
City/Statc/ZIP: Solar units (potable water) 62.54
Phone: ( ) Pax:: ( ) Tub /shower / showcr pats 12,51
E-mail: Urinal 25,02
- - - „v.. a .v+i: r t .., . <«.. :
. = 77 77 .. � �- Water closet 25.02
:_:_:_:,•.�_ 22:.77--- s- �:: �_ � ,,_..._.:
=- 77 �-- - • - 7777 77 77 - -� 77 -
7 - . ".::":" . .::-"-: - ..:: 1-7 .77....'..".--4% ... ... 77 1Qtt_.. _ _- .=._rr,• _''..:.t.:s= _
- - - -: .7777 ------- - - � a .;.:n' :_.. '�... _
-. -_77_...- --
- - • =• -- -- Water heater 1 37,52 37.52
Business name: PMS1 LLC Water 1p Y 111 VW 56.29 -
P
Address: 21195 N'%V Evergreen Pkwy Suite 204 Other: 25.02
City /State /ZIP: Hillsboro, OR 97124 Subtotal _ 87.56
Phone: (503) 466 -2222 Fax: (503) 466 -2211 Minimum permit fee: $72.50
Plan review (25% of permit tee)
CCB Lie.: 158286 ' Plumbing Lic, no.: 34 -434PB • / State surcharge (12 %ofpermit fee) 10.51
Authorized signature; ,/,,,,,,,,m PERMIT FEE 98.07
Print name: Lunen Robinson Date; 3/30/11
Tbls permit application expires If a penult is not obtained within 180 days
atter It bas been accepted as complete.
'Fee methodology set by 'I'd-County Building Industry Senior Board.
I:\ Iiuii ding\PermiuOPLattf- PermilApp.doc 10/01/09 - 40- 16I6T(10/02/COM(Wda)
Mar. 30. 2011 4:24PM No. 2555 P, 3
Piuinbingermit Application. - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
- 17191 :_ I� OfA l�I F - =_ '�` -
µ.ms .:. - - -� - ....:.. {�"� ���ii ±�> � .... ,_x - - -ti ' �-��..:_
Footing drain - l 100' 50.03 010 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 �•- :- :- --- �-=- _-- _ -. --- '0,M> +�� �:� ••�w• :�• :�.__r_ :_m- =:-�;� t .�- :.. -. -.:_
-
St 8t Rain Drain -1st 100' 62.54 .Y�tuiaiTQaix. _- Yee, __ -___ -_ ?;,r
$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
? each additional 5100.00 or fraction thereof, to
_( tl►er_ ps a t o or Fees = L 21 i CGS 16 s 0 0 , 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 525.001.00 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 - i/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 *, p
r. t :,. pusutlt by Rizhtre pc ___ syieFir.. - - ta71 .....
�' � �. •... � . fir- :P'Xiuni:>�iu�g`xaliis �iuri
1?lr<utre Type for r >: xepl ■cei ; Plan review is required for any of the following.
Work'Performed. - ..., ,..Capped, -. Added : ,- Rclocat r°
Baptistry/Font Please check all that apply.
-Tub/Shower ❑ Any new commercial building with water service 2" and
Bath
-Jacuzzi/Whirlpool Tub /S greater, except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
- Drive TM ❑ 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 _ ❑ Any multipurpose fire sprinkler system.
Drinkin _ Fountain ❑ Any complex structure as defined in OAR918- 780 -0040.
Eye Wash
Floor Drain/sink - 2" Submit 2 sets of plans with any of the above.
- 3"
Car n Wash Drain ❑ I or riser diagram is required new - Domestic - nonfood _ � d f w bildin s q buildings
- Domestic-food related that meet the qualifications above.
- Comntereial -food related
- InduSlriA1 -food related
Ice MachiR.efrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang -
-Stall
Sink/Lay -Non -food related
- Bradley
- Commercial -food related 2
- Service -.
Swimming Fool Filter *Note: If the fixture work under this permit results in an
Washer - Clothes increase of sewer I�DTJs a sewer permit will be issued and
Water Extractor p
Water Closet - Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures;
http: / /wvuw.tigard- or.gov /eiry hal ( departments /cd /docs/PLMF- PennitApedoc