Permit CITY OF TIGARD
PLUMBING PERMIT
„
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00405
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/15/2008
PARCEL: 1 S 126CA -01000
SITE ADDRESS: 09009 SW HALL BLVD 142 ZONING: C - G
SUBDIVISION: WASHINGTON CIRCLE PLAZA LOT: JURISDICTION: TIG
PROJECT: SUSHI HANA
Project Description: TI - Install (2) sinks and (1) water heater.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 2 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
WASHINGTON SQUARE PLAZA
BY THE CAFARO COMPANY Description Date Amount
P 0 BOX 422 [PLUMB] Permit Fee 10/15/200E $72.50
FLORHAM PARK, NJ 07932 [TAX] 12% State Surch 10/15/200E $8.70
Phone : Total $81.20
Contractor:
FAR WEST PLUMBING
PO BOX 597
ESTACADA, OR 97023 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 318 -5148
Reg #: LIC 78959
PLM 3 -246PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rul-; or •i questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Iss ed By: i ) / / Permittee Signature J V
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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 4 fl FOR : OFFICE USE ONLY
City of Tigard Received Date /By: ( /,5 D ' Permit No.: 0 N � e5/ - q 13125 SW Hall Blvd., Tigard, OR 97223 /� �,,�
Phone: 503.639.4171 Fax: 503.598.1960 Date /By:
Other Permit Noyu j
' Inspection Line: 503.639.4175 y
• T I G A R D Date Ready /By: luris. Fa See Page 2 for
Internet: www.tigard- or.gov Notified/Method. Supplemental Information
_ - , , ;' TYPE OF • W ORK F ' . ' y FEE* ' ULE `
SCHED. ' . l'
❑New construction ❑Demolition For special information use checklist
Description I Qty. I Ea. Total
❑ Addition/alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
' Re° '-' 'CATEGORY OF :CONSTRUCTION, '.' SFR (1) bath 249.20
❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350 00
❑ Accessory building III Multi-family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB: - SITE , INFORMATION AND L(iCATI0N 3 . F ' a S ut
Job site address: Cr QQ R SlA) Ho.)) g) v ! al- ) 14- . Catch basin or area drain 16.60
City /State /ZIP: t-t - "� 6.'rj 0� q -722 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: 8 Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no. linear ft.: _) Page 2
Subdivision: Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
;, �. = . DESCR�', ION,`F O W Absorption valve 16.60
OR ,�' r,`, a:,. Backflow preventer Page 2
'r Z Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
. - . Drinking fountain 16.60
` .` ` uPROPERTY;.OWNER _ . - . p TE : `
" Ejectors /sump 16.60
Name: 314 f 11 n I-Try/ Expansion tank 16.60
Address: (4 . 1 q,- 51ti 13 f Si 1 L- Fixture /sewer cap 16.60
City /State /ZIP: 'Tr fg C�' c! 2. j� Floor drain/floor sink/hub 16.60
Phone: (•a g3 ) 4p � / -3 .J,s t Fax: ( ) Garbage disposal 16.60
',,[(APPLICANT' ❑ " ° CONTACT, ' PERSON ' t
16.60
:,` ` .,.'_ a' ��... Hose bib Ice maker 16.60
Business name: S (itch t F?c.i'1 U
Interceptor /grease trap 16.60
Contact name: Tv' o n l_rh Medical gas (value: $ ) Page 2
Address: 1 Li' Ca- 5Q 1) ,� P L. Printer 16.60
'
City /State /ZIP: I -6t^ c 1 p q7221- Roof drain (commercial) 16.60
Sink/basin/lavatory - 16.60
Phone: (S-4-3) I - 3 q SThe Fax: : ( ) Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR .. ' - , �= `, Water closet 16.60
Business name: , 4g GvCSr /9Z../Y44 % Water heater I 16.60
Address: p g 5"97 Other:
/0 Subtotal
City /State /ZIP: �S.,CGa.e(� ejafle__ .F7a 2 3
Minimum permit fee: $72.50 c/
Phone: (a,3) G 3O - j -v-/ 0 Fax: ( ) Residential backflow minimum permit fee: $36.25 (
CCB Lic.: D 7 69 .7S °1 Plumbing Lic. no.: _3'3r' .jie Plan review (25% of permit fee) 43.--
Authorized signature: State surcharge (12% of permit fee) eg -76
TOTAL PERMIT FEE
•
Print name O 0, J4 (..... Date/0,3 /a,)- This permit application expires if a permit is not obtaine within
180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
1. \ Building \Permits\PLMF- PermitApp.doe 12/27/06 440- 4616T(I0/02 /COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Qty. Fee (ea): Total.. Sg ia a re F oota g e ' t Per>liaat'
=Site 'Ut4ies - , w •
Footing drain - 1' 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160 00
3,601 to 7,200 $220.00
Sewer - 1st 100' 55.00 7,201 and greater $309.00
Sewer - each additional 100' 46 40
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40
Valuation:';, y . ` .
Storm & Rain Drain - 1st 100' 55.00
$1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
(ea Total additional $100.00 or fraction thereof, to and
including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50.for the first $10,000.00 and $1.54 for
Residential Backflow Prevention Device each additional $100 00 or fraction thereof, to
(minimum permit fee $36.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 $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
Inspection of existing plumbing or
and including $50,000.00.
specially requested inspections - per hour 72.50
Subtotal: $50 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof
Commercial Fixture Work: Plan Rev iew for Plumbin Installations
Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees * . ❑ Any new commercial building with water service 2" and
Quantltyby (Fixture) Work Performed, , greater, except systems designed and stamped by licensed
Future Type:'- ` . : , Replace- en g
ineer.
„ ,. ,.,., • - ''eri�us - Capped` x Added - Existink;' ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font '\ as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
-Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic
Drinking Fountain
Isometric�or 'Rse"r.°`Diagra>tn
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain /sink - 2" that meet the qualifications above.
-4"
Car Wash Drain
Garbage -Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar /Lavatory
- Bradley *Note: If the fixture work under this permit results in an
- Commercial \ increase of sewer EDUs, a sewer permit will be issued and
- Service assessed for the sewer increase must be paid before the
Swimming Pool Filter I plumbing permit can be issued.
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
i:\Building\Permits\PLM- PermitApp doc 12/27/06
• CITY OF TIGARD ,.
BUILDING DIVISION PERMIT #: PLM2008-00405
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: ion r.
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175 /A0 4 - 11600 ' l
Alsi- 'il
INSPECTION WORKSHEET FOR DATE: 11/1912008 TIME: 7:02AM PAGE: 36
SITE ADDRESS: 09009 SW HALL BLVD 142 CLASS OF WORK:
SUBDIVISION: WASHINGTON CIRCLE PLAZA LOT #: TYPE OF USE:
PROJECT NAME: SUSHI HANA
DESCRIPTION: TI - Install (2) sinks and (1) water heater,
OWNER: WASHINGTON SQUARE PLAZA, PHONE #:
CONTRACTOR: FAR WEST PLUMBING PHONE #: 503-310-5148
Inspection Request Scheduled For: Date: 11/19/2008 Pour Time:
Code # lInspection Description Confirm # Contact # Message
399 Plumbing final 078225-01 -503-318-5148 N
Corrections/Comments/Instructions:
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L l i al ' 'ASS fl PARTIAL APPROVAL El CANCEL NO ACCESS
-
FAIL I I CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
\ ( - 4
Inspector: Date: c/ _ kikA,CVILI
Phone #: (503) 718-2)4
CITY OF TIGARD _
BUILDING DIVISION PERMIT #: PL1 21013•(10405
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1oi15f300a
Phone: (503) 639- 4171
Inspection Requests (24 Hrs.): (503) 639 -4175 Il12 Y f >,,
p
INSPECTION WORKSHEET FOR DATE: 1/11312008 TIME: 7:00Am PAGE: 3
SITE ADDRESS: 09009 SW HALL BLVD 142 CLASS OF WORK:
SUBDIVISION: WASI1INGTCN CIRCLE PLAZA LOT #: TYPE OF USE:
PROJECT NAME: SUSHI HANA
DESCRIPTION: TI - Install (2) sinks and (1) water heater.
OWNER: WASHINGTON SQUARE PLAZA, PHONE #:
CONTRACTOR: FAR WEST PLUMBING PHONE #: 503-318-5148
x148
Inspection Request Scheduled For: Date: 11/13/2308 Pour Time:
Code # inspection Description Confirm # Contact # Message
399
. \ t )., Plumbing final 078048 01 503-318 N
Corrections/Comments/Instructions: f � -
/ ?i AL �'
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PASS ( I PARTIAL APPROVAL fI CANCEL n NO ACCESS
\''PAIL ❑ CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
4 Inspector: �° Date: 4 1/ Phone #: (503) 718-
CITY OF TIGARD „.
BUILDING DIVISION ,,,,_- ‘. . ,, .
PERMIT #: PLM200800405
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/15/2008
Phone: (503) 639-4171 I! , i It\
Inspection Requests (24 Hrs.): (503) 639-4175 W IL
INSPECTION WORKSHEET FOR DATE: 11/12/2008 TIME: 7 PAGE: 19
SITE ADDRESS: 09009 SW HALL BLVD 142 CLASS OF WORK:
SUBDIVISION: WASHINGTON CIRCLE PLAZA LOT #: TYPE OF USE:
PROJECT NAME: SUSHI HANA
DESCRIPTION: TI - Install (2) sinks and (1) water heater.
OWNER: WASHINGTON SQUARE PLAZA, PHONE #:
CONTRACTOR: FAR WEE-3 PLUMBING PHONE #: 503-31B-5148
Inspection Request Scheduled For: Date: 11112/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 077966-.01 503-318-5148 N
Corrections/Comments/Instructions:
A 1 CC—(2-r-Y - ipl /. ('-'() CAL4
n PASS El PARTIAL APPROVAL fl CANCEL NO ACCESS
X FAIL 0 CALL FOR INSPECTION fl ADDITIONAL FEES ASSESSED
Inspector: 011flekk.....ic \A- Date: t 1 1 t9.__t 0 Phone #: (503) 718-
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CITY �����7N��������
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BUILDING DIVISION �-` l�� ^ � " ^ PERMIT ~�~°"~~~°""~~° ~�~~"~~"~~"~ r - #: pLhA200B-00406
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10y16/2008
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 638'4175 a�;161' AL
INSPECTION WORKSHEET FOR DATE: TIME: PAGE: � . 10/21/2008 � 7:00AM � 37
SITE ADDRESS: 09009 CLASS � SW HALL8LV [) 142 �
SUBDIVISION: LOT TYPE � VVASi|NGT{}N(�|F�C1EPLAZA #: �
PROJECT NAME: � 5QSHUHANA
DESCRIPTION: � T|' Install (2) sinks and (1) water heater.
PHONE OWNER: � PHONE #:
V�SM|N�9TDMSQUARE PL��` �
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CONTRACTOR� WEST F�RESTPLUkd��N/� 503-31B-514B
Inspection Request Scheduled For: Date: 102112008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough-in 076967-01 603-35B-8464 N
Corrections/Comments/Instructions:
.
•
.
�� PASS �� PARTIAL APPROVAL �� CANCEL �� NO ACCESS
�� �� . / / ��
I I FAIL [l CALL FOR INSPECTION ri ADDITIONAL FEES ASSESSED
Inspector: Date: |[]12-1 1.3E1 Phone #: (503) 718-