Permit (175) t. CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2017-00294
and OR 97223 503.718.2439
13125 SW Hall Blvd., Ti Date Issued: 07/27/2017
T[t�r'�I.1? 9
Parcel: 1 S 134BC00300
Jurisdiction: Tigard
Site address: 12284 SW SCHOLLS FERRY RD
Project: Cyclebar Subdivision: None Lot: None
Project Description: Adding(2)2"floor drains, (4)shower stalls, (2)lays&(2)clothes washers. Replacing/relocating(1)4"floor drain,
(4)lays, (3)water closets&(1)urinal. Installing(1)backflow preventer&(1)water heater.
Contractor: PMSI LLC Owner: FW OR-GREENWAY TOWN CENTER LLC
21195 NW EVERGREEN PKWY#204 PO BOX 790830
HILLSBORO, OR 97124 SAN ANTONIO,TX 78279
PHONE: 503-466-2222 PHONE:
FAX: 503-466-2211
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 07/24/2017 $31.27
Specifics: 2 ea Clothes Washer 07/24/2017 $50.04
3 ea Floor Drain/Floor Sink/Hub 07/24/2017 $75.06
Type of Use: COM 6 ea Lavatories 07/24/2017 $150.12
Class of Work: ALT 4 ea Tub/Shower/Shower Pan 07/24/2017 $50.04
Type of Const:
1 ea Urinal 07/24/2017 $25.02
Occupancy Grp: 3 ea Water Closet 07/24/2017 $75.06
Stories:
1 ea Water Heater 07/24/2017 $37.52
1 12%State Surcharge- 07/24/2017 $59.30
Plumbing
Total $553.43
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 q tions to ` NC by calling 503.232.1987 or 1.800.332.2344.
Issued B • / ,_a• . 1 Permittee Signa re: 4 •
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
W 4:4,'".1r TvEili
Building Fixtures
FOR OFFICE I . .
'SE ON1,1
' ' ' ' - .'•-,, :.'s V
City of Tigard Received ..7 du 1,
Date/By: ' o'''' i I
Permit No.: t el ipte/7-Do.2.91. p
14 NI 13125 SW Hall Blvd.,'Tigard,OR 97223A A ,
Plan Review
1 II Phone: 503.718.2439 Fax: 503.598. M 2017 Date/By: Other Permit No,:Su, .94,17_06.we
. Inspection Line: 503.639.4175
ft
TIGARD Date Ready/By: lurk El See Page 2 for
Internet: www.tigard-or,gom, r .k off'TIGARD Notified/Method: Supplemental Information
'
TIPS'4i ,' FEE* scRONI.
' ' n
0 New construction 0 Demolition For special information use checklist. CI
Description 1 Qty. I Ea. I Total ..
Addition/alteration/replacement 0 Other: New I-2-family dwellings(includes 100 ft.for each utility connection)
gm
All, CATEGORY OF CONSTRUCTION ':, -;'‘ - - SFR(1)bath 312.70
0 1-and 2-family dwelling I1Womn iercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building 0 Multi-tbmily
Each additional bath/kitchen 25.02
0 Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
49B SITE INFORMATION AND LOCATION ' '' Site utilities:
Catch basin or area drain 18.76
Job site address: IDDF)i 54,0 3,.._L.,„:„II cF...,,",..,r ‘2,,,,,..„ci
Drywell,leach line,or trench drain 18.76
City/State/ZIP: --i. ck,,,, q 7))1
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.n,, a Project name: , .. 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.: /5 134/6e,ea 300 Backflow preventer 1 31.27 30/
Backwater valve 12.51
DESCRIPTION OEWORK
Clothes washer 1--- 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25,02
.,...., ,, ,, ,,11d.***Kry OWNER 1 .':.::„.. 0 1,LNANT , Expansion tank 12.51
Fixture/sewer cap 25.02
Name:
Floor drain/floor sink/hub 3 25.02 7 -, oc,
Address:
Garbage disposal 25,02
City/State/ZIP:
Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
:414-, : . pucANT, '' - 'tt-corsrfjcy pERg6a;i Interceptor/grease trap 25.02
Business name: rsi: LL ..
Medical gas(value:$ ) Page 2
iyi
Primer 12.51
Contact name: „. ,.,A
r) Roof drain(commercial) 12.51
Address: . 1 0 ,-- . tit...) .t.i , J14,)„, -4_0, DC'', ' Sink/basin/lavatory (..6 25.02
City/State/ZIP: . ) e 9--i 3 Solar units(potable water) 62.54
Phone:(S---03 )Litr,c,) -,)>,),) Fax::(sr.)-3)4)&746-,--4)) Tub/shower/shower pan
ti 12.51 S-0,otl
Urinal
1 25.02
E-mail: 0T.,,:, (:,:.4) im -, - 5, ,s,' .3Water closet.,
icoNTRAcToR,,'':!' 3 25.02 ei c
Water heater 1 37.52 3)
Business name: eiY)st 4.1_i..., Water piping/DWV 56.29
Address: i N s-- „„Qi.,,,) ti, ..„2„,,....„. pk, ,, 3 Other: 25.02
City/State/ZIP: A 110 6(.:Z et)i y Subtotal
Minimum permit fee: $72.50
Phone:(Srp„.)ill 46-)..)),-1, Fax:(S6,3 )t./64, Dir I
Plan review (25%of permit fee)
CCB Lie.: )r•.3-8,-,),sk„, Plumbing Lie.no.: 39-.4/311 eL
State surcharge(12%of permit fee) 5.9,36
Authorized signature: A1 j„.„. c .0_ , , TOTAL PERMIT FEE
,1/4,
Print name: ik 0 d, .c.„.„..,1 - Date: r--/-1,1 _/7 This permit application expires if a permit is not obtained within 186 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I tflui Id ingTerrnitslPLMU-Permit App.doc 10/01/09 440-4616T(I 0/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2- Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities cttY- Fee(ea) Total Square Footage: Permit Fee:
Footing drain-i"I00' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $16969
3,601 to 7,200 5233.20
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
Storm&Rem Drain-1st 100' 62.54 Valuation: Permit Fee: ` "
51.00 to 55,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5.001.00 to$10,000.00 • 572.50 for the first$5,000.00 and$1.52 for
fi each additional$100.00 or fraction thereof,to
O e Inf p tions`or Fees Fee tea) Total and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first 510.000.00 and$1.54 for
which no fee is specifically indicated 90,00/hr cach 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 550.000.00 5379.50 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 lbr 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*.
Quaatly by Fixture Type Plan Review for Plumbing Installations i'ut
Fixture Type for Replace/ Plan review is required for anyof the following.
Work Performed: Capped Added Relocate Please check all hate I
Baptistry/Font apply.
Bath Tub/Shawer 0 Any new commercial building with water service 2"and
-lacurzi/Whhlpool 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 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.
3', (
4.. - 1 Isometric or Riser Diagram
Car Wash Drain �'
Garbage Domestic—non-fnrxl
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 1.
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang ,
-Stall
Sink/Lav -Non-food related 4 4•., . 4
-Bradley
-Commercial-food related
I -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-Toilet1 fees assessed for the sewer increase must be paid before the
Urinal 1 I plumbing permit can be issued.
Other Fixtures:
M.\Brandy\Forms\Permit Apps\City of Tigard Plumbing doe 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12284 SW SCHOLLS FERRY RD, TIGARD,
OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2017-00294
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . Plumbing final - approved
2. 1/2" Watts DC,model LF007QT, serial# 33154, for water dispenser, located under
water dispenser, - ok with test
Violation Summary:
Inspector Contractor