Permit Support Document ' 'z PLUMBING PERMIT
CITY OF TIGARD Iv TI
11 ''> COMMUNITY DEVELOPMENT /y Z'' , J,// Permit#: PLM2019-00400
Date Issued: 10/28/2019
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S126BC01506
Jurisdiction: Tigard
Site address: 9020 SW WASHINGTON SQUARE RD
Project: One Embassy Centre Subdivision: None Lot: None
Project Description: Plumbing for Commons area associated with TI:Adding(1)drinking fountain, (1)2"floor drain/sink, (2)shower
stalls, and(1)water closet; Relocating(1)sink; Installing(1)expansion tank and(1)water heater. 12/24/2019:
REPRINT to add(1)dishwasher,(1)2"floor drain,(1)ice maker,(1)non-food sink,and(1)water heater.
Contractor: PMSI LLC Owner: TOWMAN ONE EMBASSY CENTRE LLC
21195 NW EVERGREEN PKWY#204 BY TOWMAN LLC
HILLSBORO, OR 97124 25425 BASCOM AVE STE 230
CAMPBELL, CA 95008
PHONE: 503-466-2222 PHONE: 503-294-0400
FAX: 503-466-2211
FEES
Quantity Description Date Amount
1 ea Drinking Fountain 10/25/2019 $25.02
Specifics: 1 ea Expansion Tank 10/25/2019 $12.51
1 ea Floor Drain/Floor Sink/Hub 10/25/2019 $25.02
Type of Use: COM 1 ea Sink 10/25/2019 $25.02
Class of Work: ALT 2 ea Tub/Shower/Shower Pan 10/25/2019 $25.02
Type of Const: 1 ea Water Closet 10/25/2019 $25.02
Occupancy Grp: 1 ea Water Heater 10/25/2019 $37.52
Stories: 1 12%State Surcharge- 10/25/2019 $21.02
Plumbing
1 ea Dishwasher 12/24/2019 $25.02
1 ea Floor Drain/Floor Sink/Hub 12/24/2019 $25.02
1 ea Ice Maker 12/24/2019 $12.51
1 ea Sink 12/24/2019 $25.02
1 ea Water Heater 12/24/2019 $37.52
0 12%State Surcharge- 12/24/2019 $15.01
Plumbing
Total $336.25
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:
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
Building Fixtures RECEIVE _
FOR OFFICE USE ONLY
City of TigardDEC12 2019 Received ._._ ��Qh`-/�C7
: icn»itNo_ ,
13125 SW Hall Blvd.,Tigard,OR 97223 Dale/By: z j�(v / / •l 1
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 CITY OF TIGARDIII
DateBy Other Periscier cPti/f-es
TIGARD Inspection Line: 503.639.4175 BUILDING DIVISION<lateReady/ey: Juris See Pagc2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction 0 Demolition For special information use checklist
Description I Qty. I Ea. I Total
®Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
❑ I-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
0 Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:9020 SW Washington Square Road Catch basin or area drain 18.76
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:Embassy Center Commons Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
• r` Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Plumbing for TI P 11Q., _l
Clothes herwas25.02
(� '�jay,}p�--t / ,71\ '� ��+'t t� � Dishwasher I 25.02 25.02
PL L In r)-O) 1 - On y O(%� U Drinking liwntain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER l 0 TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub I 25.02 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) I Fay:( ) Ice maker 1 12.51 12.51
®
APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:PA1SI 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 I 25.02 1 25.02
City/State/ZIP:Hillsboro,OR 97124 Solar units(potable water) 62.54
Phone:(503)466-2222 Fax::(503)466-2211 Tub/shower/shower pan 12.51
E-mail:bsolano@msi-systems.com Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater I 37.52 37.52
Business name:PMSI LLC Water piping/DWV 56.29
Address:21195 NW Evergreen Pkwy.,Ste.204 Other: 25.02
City/State/ZIP:Hillsboro,OR 97124 Subtotal 125.09
Phone:(503)466-2222 Fax:(503)466-2211 Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lie.: 158286 Plumbing l.ic.no.:34-434PB
State surcharge(12%of permit fee) 15.01
Authorized signature: L-6(lLtrtSc [h _o. TOTAL PERMITFEE 140.10
Print name:Brandy Solano Date: 12/11/19 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.
I-\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-40109110:02tUOM/Wt:B)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(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
Valuation: Permit Fee:
Storm&Rain Drain- 1st 100' 62.54 $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 Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
p 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
Work Performed: Capped Added Relocate yany of the following.
Baptistry/Font Please check all that apply.
Bath Tub/Shower
D Any new commercial building with water service 2"and
Jaeu�zi/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 0 Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose lire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR9I8-780-0040.
Eye Wash
Floor Drain/sink -2" 1 Submit 2 sets of plans with any of the above.
-3„
Isometric or Riser Diagram
Car Wash Drain
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 I
-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:Vob Files\PMSI Jobs\Waiting on Contracts\Embassy Center Phase 2 Cge Area\City of Tigard Plumbing permit app.doc
■
Accumulative Sewer Tally
g Tenant Name: ONE EMBASSY CENTRE SWR# 2019-00288_REV
TIGARD Site Address: 9020 SW WASHINGTON SQUARE RD PLM# 2019-00400
Parcel#: 1S 126BC01506
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 1 2 1 2
Drinking Fountain 1 0 0 1 1 1 1
Eye Wash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 0 2 4 2 4
-3 inch 5 0 0 0 0 0
-4 inch 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 2 4 2 4
Sink:
-Lay/Bar-Non-Food Related 2 0 0 1 2 1 2
-Bradley 5 0 0 0 0 0 __
-Com/Serv/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 8 19 8 19
Current Fixture Value 19 divided by 16= 1.188 Current EDU 1 EDU= $5,800.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 19 divided by 16= 1.188 over (under) $ 6,902.00
Enter EDU Change Here 1.190 *
*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: Dianna Howse Date: 12/16/2019
Building Division
rote: 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:ABuilding\Sewer Tally\SewerI'allySheet_5800_070119.xlsx