Permit q CITY OF TIGARD PLUMBING PERMIT
1111 COMMUNITY DEVELOPMENT Permit #: PLM2012 -00043
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/29/2012
Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9573 SW WASHINGTON SQUARE RD B06
Project: The Limited Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: Water piping, install 3/4" water line for new tenant space.
Contractor: PMSI LLC Owner: PPR WASHINGTON SQUARE LLC
21195 NW EVERGREEN PKWY #204 BY THOMSON PROPERTY TAX SERVICES
HILLSBORO, OR 97124 ATTN HILARY RAYMOND
2235 FARADY AVE, STE 0
CARLSBAD, CA 92008
PHONE: 503 - 466 -2222 PHONE:
FAX: 503- 466 -2211
FEES
Quantity Description Date Amount
1 ea Water Piping /DWV 02/29/2012 $56.29
Specifics: 1 12% State Surcharge - 02/29/2012 $8.70
Plumbing
Type of Use: COM 16 ea Minimum Fee Adjustment - 02/29/2012 $16.21
Class of Work: ALT
Plumbing
Type of Const:
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 tification - .ter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or ect questions to O .y cdlin. 503.232.1987 or 1.800.332.2344.
Is ed By: , et Permitter 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.
From: 02/29/2012 12:46 #149 P.002/003
Plumbing Permit Application
Buildin Fixtures A <<191 FOR OFFICE USE ONLY
City of Tigard � � Received 9ffreli � , A -o0C4 ,,
a 13125 SW Hall Blvd., Ti rd, Date/
C Phone: 503.718.2439 Fax: 50 5 960 ,` 4 '... , � Plan Other Permit No.: 4//
C
Inspection Line: 503.639.4175 ` y
T I G A R D O O� Dat R eady /By. Arms I El See Page 2 for
Internet: www.tigard- or.gov Notified/Method Supplemental laformadon
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❑ New construction ❑ Demo* . n For special information ase checklist
Description 1 Qty. I Ea I Total
IS Addition/alteration/replacement ❑ Other. New 1- 2- family dwellings (includes 100 ft. for each utility connection)
. _lW SFR (1) bath 312.70
❑ 1- and 2- family dwelling ® Commercial/industrial SFR (2) bath 437.78
❑ Accessory building ❑ Multi- family SFR (3) bath 50032
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other. Fire sprinkler ( sq. ft.) Page 2
07 •_ -- _a R 3 --e1V --- -1Dir -' _ - -� Site utilities:
Job site address: 9585'SW Washington Square Rd _ Catch basin or area drain 18.76
Drywall, leach line, or trench drain 18.76
City / State/ZIP: Tigard, OR 97223
Footing drain (no. linear R: _) Page 2
Suite/b]dgJapt no.: B06 Project name: The Limited
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 R: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
;�_:_:; _ __ ��- sY'._- 12.51
= = == _ - - q' •: =:ffrET O =- -•s = '- r :e: r -. B valve
s. 3r �Q - • .�. •rrr- .= sr�nnm v . arc •
:._ 'i :.∎ 4 w.iciie ._ -- _E _rte .., =1: , •r-, , ,,- rT_.= "r"= ^: - -� '
Clothes her 25.02
Install 3/4" water line from existing line in ceiling to new T1 space Dishwasher 25.02
Thinking fountain 25.02
• . Ejectors/sump 25.02
- * `
= - Expan 12.51
QUe�� �e=, :.. - sion tank
Name: Fixture/sewer cap 25.02
-Address: Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
Y fi yiiiA r .lt i' =' r_: 4 Interceptor/grease tap 25.02
Business name: Medical gas (value: $ ) Page 2
Contact name:
Primer 12.51
Roof drain (commercial) 12.51
Address: Sink/basin/lavatoty 25.02
City/ State /ZIP: Solar units (potable water) 62.54
Phone: ( ) I Fax:: ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
_-. - __.__. _ .. ? . 4 : =:= n,: r -- ---- --� a Water closet 25.02
'=e_' ` -= 4ir'i 5d '.111g:g ^_. � a - max-. r,
r Water heater 3752
Business name: PMSI LLC Water piping/DWV 1 56.29 56.29
Address: 21195 NW Evergreen Pkwy Suite 204 Other 25.02
City/ State/ZIP: Hillsboro, OR 97124 Subtotal
Phone: (503) 466 exit 12 Fax: (503) 466 -2211 Minimum permit fee: $72.50 72.50
I Plan review (25% of permit fee)
CCB Lic.: /y /�/ Pluml�ng Lic, no.: 34 -434PB State surcharge permit )
,01)014,1r,‘ r g e (1 2% of rtnit fee 8.70
Authorized sigoa TOTAL PERMIT FEE 81.20
I V
Print name: Lanell obinson I Date: 2/29/12 This permit application expires if a permit Is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board
L•\ BuidwglPermitsRPtiv4U- PemmAppda 1 0/01/09 440- 46161110/02/COM/WEB)
From: 02/29/2012 12:47 #149 P.003/003
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: :
,...__ , W ... _.. Fire Suppression terns.
Residential ��- ire S ��__�,- ..........�_
est a ssion s
F•dGT.�13.M- ;�yai±a.iL.�; �'t� .� :. -i �'. � r�- -m. =. -_ - +5 =s��c �q � _,• ,Q ':�•�'_- ta- c. - °w�_
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
Sewer - 1st 100' 62.54 3,601 to 7,200 $233.20
7,201 and greater • $327.54
Sewer - each additional 100' 37.52 -
Waterservice - 1st 100' 62.54 Medical Gas Systems:
Water Service - each additional 100' . 37.52 - ..
Storm & Ram Drain - I st 100' 62.54 ' '-
$1.00 to $5,000.00 Minimum fee $7250
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 $100.00 or fraction thereof, to
;4
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
(minimum charge —1/2 hour) each additional $100.00 or fraction thereof to
and including $25,000.00.
Inspections outside of normal business 90.00/hr r $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 90.00/1u $50,001.00 and up $742.00 for the first $50,000.00 and $120 for
(minimum charge — 1/2 hour) each additional $100.00 or fraction theteo£
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*.
r..a . im - 1'_:: - i i ' ?__.
ant—, _- - t _ ( r f°°` °
-:4 t(FL ' p0?f11 •r.- -^ -3- ^- i -"._•� > ;��'.y,"�_. : c„ �f•:, ^,�vr p.: - -.. . _.__� -._�_ b::_
•fir �z. __
_: rk a tirJfoe . Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
Bath - Tub /Shower ❑ My new commercial building with water service 2" and
- Jacuzzi/Whirlpool greater, except systems designed and stamped by licensed
Car Wash - Each Stall engineer.
Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator
Dishwasher - Commercial ❑ Medical gas and vacuum systems for health care facilities.
- Domestic ❑ Any multipurpose fire sprinkler system.
Drinking 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 Wash Dram
Garbage -Domestic —non -food ❑ 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 MachJRefrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sinlr/Lav - Non -food related
- Bradley •
- Commercial -food related
-Service
Swimming Pool Filter
Washer - Clothes *Note: If the fixture work under this permit results in an
Water Extractor increase of sewer EDUs, a sewer permit will be issued and
Water Closet - Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
C:\ Users\ lrobinson \Downloads\PLMF- PermitApp.doc 2