Permit CITY OF TIGARD PLUMBING PERMIT
11 COMMUNITY DEVELOPMENT Permit #: PLM2011 -00023
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/20/2011
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9637 SW WASHINGTON SQUARE RD FC -6
Project: Sbarro Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project Description: Water heater replacement.
Contractor: ANYTIME PLUMBING & DRAIN CLEANING Owner: PPR WASHINGTON SQUARE LLC
3333 NW 35TH AVE, BLDG 6 2235 FARADAY AVE STE #0
PORTLAND, OR 97210 CARLSBAD, CA 92008
PHONE: 503 - 432 -8275 PHONE.
FAX: 971 - 255 -1965
FEES
Quantity Description Date Amount
1 ea Water Heater 01/20/2011 $37.52
Specifics: 1 12% State Surcharge - 01/20/2011 $8.70
Plumbing
35 ea Minimum Fee Adjustment - 01/20/2011 $34.98
Type of Use COM Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
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 50 232.1987 or 1.800;
Issued Byv 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.
Jan. 19, 2011 11:37AM No. 6005 P. 2
Plul>tnbin Permit A licatio c,EIVED
Building Fixtures Don (WI"ICE USE ()Nix
City of Tigard Received /� PennitDio -:
n 13125 SW Hall Blvd., Tigard, OR 97223 JA N 19 7011 DateB : ii 1 / jiff P are I I ` duo
' Phone: 503.639.4171 Fax: 503.59 D ie/B eviaw
Oilier Pennit No.:
Inspection Line; 503.639.4175
1 I Y OF TIGARD 1°e`
TiGAIU Date RcadyBy: r See Page2
Internet: www.tigerd- o r.gov BUILDING : S
G D Notified/Met 1 tal Information
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DIVISION Supplemental �
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❑ New construction ❑ Demolition For special inforntarlmr use checklist
Description I Qty. I Ea. 1 Total
Addition/altcration/replacement ❑ Other New 1- 2- family dwellings (includes 100 ft. for each utility connection)
5 .+: ,". , .,�1., - ti ` , 9' d TEb. 0 CQ�1 T l ' CT�[O l 1 ,.. SFR (1) bath 312.70
LI 1- and 2- family dwelling j( Commereial/industrial SFR (2) bath 437.78
Li Acoessory building ❑ MUlti- (family SFR (3) bath 500,32
Each additional bath/kitchen 25.02
❑ Master builder ' ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
: ° : :, '46B' • S1 1✓ T4S4MATTOTelhfD'LOCATIONr- Site utilities:
Job site address: q Ip p N Catch basin or area drain 18.76
City /State /ZIP; I �i ` rJ Drywell, leach line, or trench drain 18.76
' n. a Footing drain (no. linear ft.; ) Fags 2
Suite/bldg. /apt, no.: • Project name; { S WED Manufactured home utilities 50.03
Cross street/directions to job site; Manholes 18.76
Q S U- R � S L I N F O D b COA ? f � I., C _ Rain drain connector 18.76
,A' 11 II di) ` 0 i 4 V A (/. rf A 1 1� ,1 Sanitary sower (no. linear ft.: , ) Page 2 .
Storm sewer (no, linear ft.: _) Page 2
Water service (no. linear ft.: _) Page 2
Subdivision: 1 Lot n0.: Fixture or Item: .
Tax map /parcel no.: i 03 0 0 13ackflow preventer 31.27
• ' n/ � �,/ .' n DiEscru I YTION ot. wORI[ : t � ry1 ' p LEI LI N Backwater valve 12.51
I �4A(I W WATER I-IC4 t f,R, IN DN..0 (j Clothes washer 25,02
' Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
"' ^ 1 . PROPERTY OWNER TENANT Expansion tank 12.51
Name: S bfrIZ RD Pixture /sewer cap 25.02
�Ip Y SW YVASF r t'J SOI4 /' „ Fioordrain/floorsink/hub 25,02
Address: ' y ` "r ' _ l V�
Garbage ‘ disposal 25.02
City /State /ZIP: fl 4 A, Rb , n I. __ ,_� J Hose bib 25.02
Phone: (Sa) (0 j,11 if ill Fax: ( ) Ice maker 12.51
. 0 APPLICANT . ❑ C ONTACT' PERSON Interceptor /grease trap 25.02
Business name: AN - r( M E P M F3i Nti .l IV I IV � I A N (Alt/ Medical gas (value: $ ) Page 2
Contact name: Asti-14)f I +
M ` i v( Primer 12.51
'^/ Hoof drain (commercial) 12.51
Address: _ '9 JY Y1 '(1� ��/ �� Lp� b it,/ G Sink/basin /lavatory 25.02
City /State/ZIP: Ep pj LAN -p , 0 f?._ ' •171 p Solar rmita (potable water) 62,54
Phone; (5V 2 ,. $2f s Fax: : (o3 I) j r I q Lt d Tub /shower /shower pan 12.51 •
E -mail: I N ( i.t F , b_u/Ym1 '. u C Urinal 25 -02
.M.,..::,,. '!a r'r G Water closet 25.02 •
; COMM/ TOIR
Water heater 1 37.52 1, `S2.
Business name; A i E pi4frneyi {- b N C1 /tN(NLt Water pipingfDWV 56.29
Address: N w � 11i A 01.1PL7 (,. Other: 25.02 - M
City/State /ZIP: po I2. f IAN ) 1 OK- 4-12/ 0 Subtotal
$72.50 it fee: $72
erm .
P ne: 60 '3 )4 7 r 9Z� Fax; (41 I) 265- 1 0 S Minimum p 12, i
�1 Plan review (25% of permit fee)
CCE Lie.: II ( it ! f I1,2,, Plumbing Lic. no.: p j $r� i-�
w State surcharge (12% of permit fee) '( D
Authorized signature: .' 1 / .1 7//1/1 TOTAL PERMIT FEE I ,
Print name; iti5 I,LC / � ( Date: l' I This permit application expires if a permit la not obtained within 180 days
" ( after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
I: 1Builditgemii ,\PLhtU- PerniitAgf,doo 10/01819 440- 4616T(10 /02/C0M/wEE)