Permit (63) CITY OF TIGARD PLUMBING PERMIT
a 2 '- COMMUNITY DEVELOPMENT Permit#: PLM2017 00222
T t GA D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/13!2017
Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9710 SW WASHINGTON SQUARE RD F01
Project: Untuckit Subdivision: None Lot: None
Project Description: Interior plumbing for TI:Adding(1)2"floor drain,(1)sink,and(1)water closet; Installing(1)water heater and(1)
water meter.
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 Floor Drain/Floor Sink/Hub 06/13/2017 $25.02
Specifics: 1 ea Sink 06/13/2017 $25.02
1 ea Water Closet 06/13/2017 $25.02
Type of Use: COM 1 ea Water Heater 06/13/2017 $37.52
Class of Work: ALT 25 • Misc Other Fee 06/13/2017 $25.02
Type of Const: 1 12%State Surcharge- 06/13/2017 $16.51
Occupancy Grp: Plumbing
Stories:
Total $154.11
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 ork is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to ollhw the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-00•x. ou 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:
..,..-...1-i-..,.....-- ——a l "Is.
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 Application - j (26? , -)-0 / I7_
Building Fixtures RECEIVED FOR OFFICE USE ONLY
City of Tigard Received
Permit No. Of_ALI 17- - A 4,
II 4 13125 SW Hall Blvd.,Tigard,OR 97M 6 2017 Date/By: /Plan 7 4,,jza,
. x Phone: 503.718.2439 Fax: 503.5911960 Daie/RBevv.iewOilier Permit No.: of, i _ i(1 i,---
TIGARD Inspection Line: 503.639.4175
CITY OF TIGARD Date Re.ady/f3y: itsris- Ed See l'a'gc2 for
Internet: ‘VWW.tigard-or.gov
Notified/Method: '7,* .ct,„ Supplemental Information
pc 09NZING DIVISION , ,
Ty FEE* scitEDELE
0 New construction I 0 Demolition For special information use checklist.
C Additiori/alteration/replacetnerit 0 Other:
Description i Qty. 1 Ea. L Total
New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
0 I-and 2-family dwelling "'4 Comniercial/iridustrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
0 Master builder 0 Other:
Fire sprinkler( sq.(t.) Page 2
alrIAB SITE INFORMATION AND LOCATION , Site utilities:
IJob site addres .....U8',- 4 Washington Square Road Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Portland,OR 97223
Footing drain(no.linear ft.: ) Page 2
Suite/bldg/apt,no.:FOI I Project name:UN1'IlCKit
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: 1 Lot no,: Fixture or item:
"fax map/parcel no.:
Back flow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
Clothes washer 25.02
Plumbing for'El
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
U
,-, „•PROPERTY OWNER 1 0 TENANT Expansion tank 12.51
Name:
Fixture/sewer cap 25.02
Floor drain/tloor sink/hub I 25.02 25.02
Address:
Garbage disposal 25.02
City/State/Z1P:
Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
0 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 ,....'"' 25.02 25.02
City/State/ZIP: Ilillsboro,OR 97124
Solar units(potable water) 62.54
Phone:(503)466-2222 f Fax::(503)466-2211 _ Tub/shower/shower pan 12.51
Urinal In 25.02
E-mail:bsolano(n)msi-systems.eom
......____
Water closet I 25.02 25.02
CONTRACTOR
Water heater 1 37.52 _2,5412-3),51,
Business name:1)NISI LEC
Water piping/I)WV 56.29
Address:21195 NW Evergreen Pkwy.,Ste.204 Other Water Meter I 25.02 25.02
City/State/ZIP:Ilillshoro,OR 97124 Subtotal
................„.___.........._ . ...... ........._.......,..........................__..........
Phone:(503)466-2222 Fax:(503)466-2211
_ Minimum permit fee: $72.50
.......... ........ ........,.
Plan review (25%of permit fee)
CCB Lie.: 158286 Plumbing I.ie.no.:34-434P8
State surcharge(12%of permit fee)
Authorized signaturc:,--4
TOTAL.PERMIT FEE
:a 4, .A AO*. /•?Pir%#
Print name:Brandy Solana Date:6/2/17 1 This permit application expires if a permit is not obtained within1130 days
I
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I'‘BuildingsiPerniitstal..hl II-Permit App doe 10/01/09 440-4014'R I0/02/COM/Wt
s ' Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee teat Total Square Footage: Permit Fee:
Footing drain-1" 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
Sewer-each additional 100' 7,201 and greater $327.54
37.52
Water Service-Ist 100' 62.54
Water Service-each additional 100' 37.52 Medical Gas Systems:
storm&Rain Drain•1st 100' 62.54 Valuation: Permit Fee:
Storm&Rain Drain-each additional 100' $1.00 to$5,000.00 Minimum fee$72.50
37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Qty Fee tea) Total
Other Inspections or Fees each additional$100.00 or fraction thereof,to
Inspection of existing plumbing or for and including$10,000.00.
$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
Inspections outside of normal business 90.0Ofl,r and including$25,000.00.
hours(minimum charge-2 hours) $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
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
Plan review is required for any of the following.
Work Performed: Capped Added Relocate
Baptistry/Font Please check all that apply.
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 ❑ Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" 1 ✓ Submit 2 sets of plans with any of the above.
-3„
4
Car Wash DrainIsometric or Riser Diagram
Garbage Domestic--non-food 0 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 Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related 1 is'-.
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter
washer-Clothes *Note: If the fixture work under this permit results in an
Water Extractorincrease of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet I y'` fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
M:ABrandy\Forms\l'ermit Apps\Cify of Tigard Plumbing.doc 2
Accumulative Sewer Tally
IN ■
Tenant Name: UNTUCKIT SWR# 2017-00188
C�tR3 Site Address: 9710 SW WASHINGTON SQUARE R PLM# 2017-00222
Parcel#: 1 S1260000300
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 0 1 2 1 2
-3inch 5 0 0 0 0 0
-4inch 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:
-Lay/Bar-Non-Food Related 2 0 0 1 2 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 0 1 6 1 6
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 3 10 3 10
Current Fixture Value 10 divided by 16= 0.625 Current EDU 1 EDU= $5,300.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 10 divided by 16= 0.625 over (under) $ 3,339.00
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:
Authorized Name/Signature:BRANDEN TAGGART X2449 Date: 6/7/2017
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_5300_070116.xlsx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9710 SW WASHINGTON SQUARE RD F01 ,
TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2017-00222
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor