Permit (21) !j 4
¢4 41
PLUMBING PERMIT
,, CITY OF TIGARD �'�', ! -r I
COMMUNITY DEVELOPMENTlig
Permit#: PLM2017 00166
Date Issued: 05/03/2017
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9591 SW WASHINGTON SQUARE RD B10
Project: Victoria's Secret Subdivision: None Lot: None
Project Description: TI-Replace(1)drinking fountain,(1)expansion tank,(3)floor drains,(1)sink,(3)lays,(2)water closets,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:
PHONE: 503-466-2222
FAX: 503-466-2211
FEES
Quantity Description Date Amount
1 ea Drinking Fountain 05/03/2017 $25.02
Specifics: 1 ea Expansion Tank 05/03/2017 $12.51
3 ea Floor Drain/Floor Sink/Hub 05/03/2017 $75.06
Type of Use: 1 ea Sink 05/03/2017 $25.02
Class of Work: 3 ea Lavatories 05/03/2017 $75.06
Type of Const: 2 ea Water Closet 05/03/2017 $50.04
Occupancy Grp: 1 ea Water Heater 05/03/2017 $37.52
Stories: 1 12%State Surcharge- 05/03/2017 $36.03
Plumbing
Total $336.26
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 OUNCCGA
by calling 503.232.1987 or 1.800.332.2344.
Issued By: . ' ' + r _ Permittee Signature: N 1' c=/e,97o J
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.
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2017-00166
Date Issued: 05/03/2017
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S 1260000300
Jurisdiction: Tigard
Site address: 9591 SW WASHINGTON SQUARE RD B10
Project: Victoria's Secret Subdivision: None Lot: None
Project Description: TI-Replace(1)drinking fountain,(1)
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 Drinking Fountain 05/03/2017 $25.02
Specifics: 1 ea Expansion Tank 05/03/2017 $12.51
3 ea Floor Drain/Floor Sink/Hub 05/03/2017 $75.06
Type of Use: 1 ea Sink 05/03/2017 $25.02
Class of Work: 3 ea Lavatories 05/03/2017 $75.06
Type of Const: 2 ea Water Closet 05/03/2017 $50.04
Occupancy Grp: I ea Water Heater 05/03/2017 $37.52
Stories: 1 12%State Surcharge- 05/03/2017 $36.03
Plumbing
Total $336.26
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: Permittee Signature: IN 4/y ,,erz77o
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 Applica! ; CE!
yip
Building Fixtures 6 FOR OFFICE, LSF ONLY
City of Tigard APR 201? Received �3 /� 4_.r Permit No/ L/y ,020/7 0/ 6,
13125 SW Hall Blvd.,Tigard.OR 97223 Plan RReyv:
iew
Phone: 503.718.2439 Fax: .
74
iorroF TIG.ARD Date/By: Other Permit .,a/'0/7- Oo?
TIGARD Inspection Line: 503.639.4175 Date Ready/By: runs SI See Page 2 for
Internet: www.tigard-or.gov T Notified/Method: Supplemental Information
BUILDS DWISIO
TYPE'OF WORK 1 *,S DULE ';
❑New construction 0 Demolition Far special information use checklist.
Description I Qty. I Ea. I Total
Addition/alteration/replacement 0 Other: New l-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF coNsmucTIoN SFR(1)bath 312.70
❑ I-and 2-family dwelling %Commercial/industrial SFR(2)bath 437.78
❑Accessory building ❑Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOE SITE INFORMATION AND LOCATION. Site utilities:
Catch basin or area drain 18.76
Job site address: 9.5 ", �,.,) 1.0:t.54";t 5.-,,
,, / ( Drywell;leach line,or trench drain 18.76
City/State/ZIP: s 9 5v
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: �i 0 ✓frojectname: V -.1„a. S, 1. ij 9 17 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.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
+ r A5 . de-„,,........-1- : "'n Pr c+ ,,,a...rti; " Dishwasher 25.02
Drinking fountain t / 25.02 94-,02
Ejectors/sump 25.02
0 PROPERTY OWNER ❑ TENANT Expansion tank '1 12.51 Ji
Fixture/sewer cap 25.02
Name:
LIS 1"C cr al- C Floor drain/floor sink/hub '3, ./ 25.02 9s-.04
Address: L 4, h Garbage disposal 25.02
City/State/ZIP: LBtt,�,,,,.,.gy *,t O ..ti_.,), sO Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
❑ APPLICANT 0 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 ,g LgiS q ✓ 25.02 /60 0
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet V 25.02 TO.Oki
CONTRACTOR
Water heater } 37.52 37,s"y
Business name: pltyl ..4_ LL.G. Water piping/DWV 56,29
Address: j)i' /jam f(0.4„..„.4.v"¢k.,x .4....? , '�d y Other: 25.02
City/State/L1P: IA..;a s ,r,, .,,, Oz. 97C Subtotal 0.?3
Phone:( ,73) iir" ).). Fax:(SO 3 )y4G,'J21/ Minimum permit fee: $72.50
p Plan review (25%of permit fee)
CC B Lie.: ) <)f'. G `Plumbing Lie.no.:.39.tt3t j I State surcharge(12%of permit fee) X..03
Authorized signature: 1 „,, ,„;'WAC -, TOTAL PERMIT FEE 1✓
Print name: _ Date: / This permit application expires if a permit is not obtained within 0 days
(� ttC S��g�..gr9 (r''�7 after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I.V3uildingPermits\PLMU-PermitApp.doe 10/01/09 440-4616T(I0/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site utilities °V. Pee(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 $169.69
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
I ion: F •
Storm&Rain Drain-1st 100' 62.54 Vaua Permit ee:
$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
Other Inspections or Feestee each additional$100.00 or fraction thereof,to
p Qty, (ea) Total
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
Please check all that apply.
Baptistry/Font
Bath Tub/Shower
0 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 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 I ,/ 0 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.
Isometric OrRiser.Diagram
Car Wash Drain
0 Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food q
Disposal -Domestic-food related that meet the qualifications above.
-Commercial--food related
-Industrial-food related
Ice Mach.IRefrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/l.av -Non-food related 3 .7 (_?-vs
-Bradley
-Commercial-food related
-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:
M:1Brandy\Forms\Permit Apps\City of Tigard Plumbing.doc 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9591 SW WASHINGTON SQUARE RD B10,
TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2017-00166
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . 1/2" RP device, watts LF009QT, serial # 131256, located by floor drain on wall by
bathrooms - approved with test.
Violation Summary:
Inspector Contractor