Permit (56) Ph Ili
CITY OF TIGARD
PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2016-00284
T f C'Afi D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/06/2016
Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9647 SW WASHINGTON SQUARE RD FC09
Project: Charley's Philly Steaks Subdivision: None Lot: None
Project Description: Cap(1)2"floor drain. Add(1)ice maker drain, (1)non-food sink&(1)food related sink. Replace/relocate(2)
non-food sinks.
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 Fixture/Sewer Cap 06/03/2016 $25.02
Specifics: 1 ea Ice Maker 06/03/2016 $12.51
4 ea Sink 06/03/2016 $100.08
Type of Use: COM 1 12%State Surcharge- 06/03/2016 $16.51
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $154.12
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 questi o OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued I ' � � I; Permittee Signatur :
VV V--►'L�
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: 05/31/2016 19:39 #430 P.001/002
Plumbing Permit Applic li} EIV
Building Fixtures 1[��11��9�....
CI Of Tigard AAAA����// a y Received t permit No �/
N 41 13125 SW Hallll131vd.,Tigard,OR t47T?p3 3 1 1 DaterRy: G l& 1,.,_,.+ EA-1! t t0'O6)o�a 7
Phone: 503.718 2439 Fax. 503598.1960. Plan Review
: t1 � Other Permit No O , -7
DaFe/By ���`/'''�jp-�I
Inspection line: 503.639.41751 l y 01 i(yA\1� Date Read By / ). .. ® See Page 2 for
TIC ARD y,
Internet. www.tigard-or goy [ g®� Noutied Method L f fU ��.•�JJ Supplemental information
'. TYPE' H.R1siN DIVISION' .. .614041, ,0244. FEET'SCkl<EDULE
For special in armation use checklist.
❑New construction 0 Demolition 'O
---- Description Qty. Ea. Total
®Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 II.for each utility connection)
CATEGORY OE CONSTRUCFION SFR(1)bath 312.70 •-
❑ I-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.7R
SFR(3)bath 500.32 1
❑Accessory building ❑M
Multi-family - ----- - Each additional bath/kitchen 25.02 O
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 4
. . JOB SITE INFORMATION AND LOCATION Site utilities: �l
Joh site address:9647 SW Washington Square Rd Catch basin or area drain 18.7644
--W` -- 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.: Project name:Charley's Philly Steaks Manufactured home utilities 50.03
Cross strect/directions to job site: Manholes ` --- _� --
Rain drain connector 18.76
Sanitary sewer(no.linear II.:_) Page 2
__
Storm sewer(no.linear ft.. ) Page 2
_-_ Water service(no.linear Ii.:_) Paee 2
Subdivision: lot no.: Fixture or item:
Tax map/parcel no.: .25 /01.4 0003 3DD Backflow preventer 31.27
DESCRIPTION OF.WORK Backwater valve 12.51
Clothes washer 25.02
Plumbing for tenant improvement
Dishwasher 25.02
Drinking fountain 25.02 -.
Ejectors/sump 25.02
PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Fixture/sewer cap I 25.02 25.02
Name:
Floor drain/floor sink/hub 25.02
Address: - Garbage disposal 25.02
City/State/ZIP: I lose bib 25.02
Phone:( ) Fax:( ) Ice maker 1 12.51 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
.
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: -
�.-- Roof drain(commercial) 12.51
Address: --- Sink/basin/lavatory 4 25.02 100.08
City/State/ZIP: Solar units(potable water) -�- 6254
Phone:( ) Fax: :( I Cub/shower/shower pan 12.51 `
- -1
E-mail Urinal -- 25,02
Water closet 25.02
CONTRACTOR
-
Water heater 37.52
Business name:PMSI EEC Water tin UWV 5629
Address:21195 NW Evergreen Pkwy Suite 204 Other: 25.02
City:/State/ZIP' Hillsboro,OR 97124 - - - Subtotal-II 2,-;'1, L:t
Phone:(503)466-2222 Fax:(503)466-2211 Minimum permit lee: $72.`50 {
CCB Lie.: 158286 Plumbing l ie,no.:34-434PB I Plan review (25%ofpemlit fee)
- i State surcharge(12%of permit tee) IU S
Authorized \,,e._ lb-:>1 /4zv [ TOTAL PERMIT FEE
Print name:I.anell Robinson Date:5/31/I6 l This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
`Fee methodology set by 1 ri-County Building Industry Service Board.
I\Bui1dingrPermits',P1.51)-Pcrmu App doe 10')11)X1 440-40101(IO;uZICO\t`WF.I3)
From: 05/31/2016 19:39 #430 P.002/002
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
-Site. .. Qtr. . .l ee;(ea} Total qulare Foota e: Permit'Fee:
Footing drain-I 100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 r 2.001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.547 X01 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
Storm&Rain Drain-1st 100' 62.54 Valuation. Permit'Fee:
$1.0010$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 1
Other Insections or Fees` QtY. )Fee;(ca) ,Total each additional$100.00 or fraction thereof,to
I► 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 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*.
Quantity by Fixture Type 'Plan.Review for Plumbing Installations
Fixture Type for Replace! Plan review is required for any of the following.
work Performed: Capped;, Added Relocate
Baptistry/Font Please check all that apply.
Bath Tub/Shower El 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 Thru ❑ 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 0 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"
4.. .Isometric or Riser Diagram
Car Wash Drain
Garbage Domestic-non-food ❑ Isometric or riser diagram is required for new buildings
Dis tsI -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/l.av -Non-food related I 2
-Bradley
-Commercial-food related 1
-Service
Swimming Pool Filter *Note: If the 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 fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures
C:AUsersi.IrobinsonADownloads\PLMI" PerntitApp(1).doc '7
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
9647 SW WASHINGTON SQUARE RD FC09,
TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2016-00284
Don Sylvester
Violation Summary:
Inspector Contractor