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Permit CITY TIGARD PLUMBING PERMIT ml4. DEVELOPMENT SERVICES PERMIT #: PLM2005 -00477 '�J I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/13/2005 PARCEL: 1S12600-00300 SITE ADDRESS: 09306 SW WASHINGTON SQUARE RD ZONING: C -G SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG Project Description: (1) new sink in goldsmiths room. CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: M FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: 1 OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES WASHINGTON SQUARE LLC Description Date Amount BY THE MACERICH COMPANY 9585 SW WASHINGTON SQUARE RD [PLUMB] Permit Fee 10/3/2005 $72.50 TIGARD, OR 97223 [TAX] 8% State Surcharl 10/3/2005 $5.80 Phone : Total $78.30 Contractor: ADDISON PLUMBING 17506 SE RIVER RD. REQUIRED ITEMS AND REPORTS MILWAUKIE, OR 97267 Phone : 503 785 - 1840 Reg #: LIC 151754 • PLM 3 -449PB 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-!: ! hrough OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling ;03-246-6:• 9 or 1-81 344. Issued By: ,. ✓ i�_�,, Permittee Signature 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. Bsiild *ig Fixtures Plumbing Permit Application - Foli OFFICE USE ONLY City of Tigard Rece ived i7 Permit No 13125 SW Hall Blvd., Tigard, OR 97223 r*. l EC � ' Date/By. ����` �� �� ���� d Plan Review Other Permit No Phone: 503.639.4171 Fax: 503.598.1961 +, � \ Date/By. Date/By. cl 'q�'?�' 24- Hour Inspection Line: 503.639.4175 .. -' Date ReadyBy tuns ® See Page 2 for 3 � , I I % Internet: www.ci.tigard.or.us SEP 2 1 _ r, Notified/Method. r , if Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑ New construction CI f 1Fatgthigp For special information use checklist. BUILC DIVISION Description I Qty. I Ea. I Total ❑ Addition /alteration/replacement Other: ' j New 1 - 2 - family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 249.20 ❑ 1- and 2- family dwelling Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi - family SFR (3) bath 399.00 ❑ Master builder Each additional bath/kitchen 45.00 ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: ?SOC. SW tdl4 ibi. Se • 12,641a Catch basin or area drain 16.60 City /State /ZIP: , f yA , a&_ d - p e..-3 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no : Project name: I\g g 1-t&ofike✓ Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street /directions to job site: Manholes 16.60 LlJ -=t_I ( a., Q. V.6.rtJ_ MA 4.0. Rain drain connector 16.60 Sanitary sewer (no. linear ft. • ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: I Lot no: Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no.. Absorption valve 16 60 DESCRIPTION OF WORK 1 Back flow preventer Page 2 A)EA.a 1 Si Ai IC f Ai cis... iw.. I L�B Awh Backwater valve 16 60 Clothes washer 16.60 ,,�,// Dishwasher 16.60 ❑ PROPERTY OWNER ' I �{ITENANT Drinking fountain 16.60 Ejectors/sump 16.60 Name: tfl11`cas, S►Sd & Expansion tank 16.60 Address: Fixture /sewer cap 16.60 City /State /ZIP: Floor drain/floor sink/hub 16.60 Phone: ( ) Fax: ( ) Garbage disposal 16.60 . 0 APPLICANT 21 CONTACT PERSON Hose bib 16.60 Ice maker 16.60 Business name: TL o /S `_I_ ervI geT -44 Interceptor /grease trap 16.60 Contact name: Tn.4.yc., S. n„fJ3 -r-' Medical gas (value: $ ) Page 2 Address' 1,L0 su,3 Th.."2.D,Az wis.) Primer 16.60 _ Roofdrain (commercial) 16.60 City /State /ZIP: �_T 1 ' � �I 4,11.1b � 1 �� ' p Sink/basin/lavatory t 16.60 Phone: ( 55 ?.2.A• SS` 7 I Fax: : ( �l ) Zl 0 • Ss' I Tub/shower/shower pan 16.60 E-mail: Urinal 16.60 CONTRACTOR Water closet 16 60 Business name: -7'D Water heater 16 60 Address: Other: City /State /ZIP: Subtotal Minimum permit fee: $72.50 v50 Phone' ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 ' CCB Lic.: ' mb�: Lic o.: Plan review (25 %ofpermit fee) gn i / i State surcharge (8% of permit fee) 5,130 Authorized si ature� �'� El TOTAL PERMIT FEE 7g • 50 Print name: An! K �. NOT' Date. a . a x- 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 'Permns\PLMF- PermitAppdoe 06/05 440-4616T(10/02/COM/WEB) 7S 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' 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 Sy Water Service - each additional 100' 46.40 ValUatlon' Permit Fee: 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 Fixture or Item Qty. Fee (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 $25,007 A0 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 c specially requested inspections - per hour 72.50 �1; J4 " and including 0.00. Subtotal: $5b,001.007ana up 'fie 'n. $742.00 for the e first first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. Fixture Work: Plan Review for Comple S • Are you capping, adding or replacing fixtures? If "yes", A "complex structure" is defined as an installation of a plumbing please indicate work performed by fixture. Failure to system that meets any of the following criteria. accurately report fixtures could result in increased sewer fees *. Please check all that apply. . 0'4 Any new commercial building. Quanti b r (Fixture) Work Performed %L Fixture Type: Replace ❑ Any new exterior plumbing site utilities. Previous Capped Added Existing ❑ A commercial building with installation, alteration or addition Baptistry/Font of nine (9) or more new or relocated plumbing fixtures. • Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities - Jacuzzi/Whirlpool providing services to human beings. Car Wash - Each Stall ❑ Plumbing installations, alterations or additions.to'£ood service -Drive Thru facilities where new plumbing fixtures, including interceptors, Cuspidor/Water Aspirator are being installed for the food service area. Dishwasher - Commercial ❑ Any new residential building containing three (3) or more - Domestic dwelling units. Drinking Fountain ❑ Any NFPA 13 - D multipurpose fire sprinkler system. Eye Wash Floor Drain /sink - 2" Submit 2 sets of plans with any of the above. -4 „ Car Wash Drain Isometric•or•Riser Diagram • Garbage - Domestic ❑ Isometric or.riser diagram is`required for new buildings Disposal -Commercial three (3) or more stories-in height. - - - Industrial , Ice Mach./Refrig. Drains s ; . Oil Separator (Gas Station) • • - Comments 'regarding fixture work:" Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar/Lavatory 1 a i - Bradley - Commercial - Service Swimming Pool Filter Washer - Clothes *Note: If the fixture work under this permit results in an Water Extractor uner P Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and ' Urinal fees assessed for the sewer increase must be paid before the Other Fixtures: plumbing permit can be issued. I \Bwldtng\Pennits\PLM- PennitApp doc 07/06/05 CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE RECEIVED ADDISON PLUMBING OCT 13 2005 17506 SE RIVER RD. CITY LD NG TIGARD MILWAUKIE, OR 97267 BUILDING DIVISION Plumbing Signature Form Permit #: PLM2005 -00477 Date Issued: 10/13/2005 Parcel: 1S12600-00300 Site Address: 09306 SW WASHINGTON SQUARE RD Subdivision: WASHINGTON SQUARE Block: Lot: Jurisdiction: C -G Zoning: TIG Remarks: (1) new sink in goldsmiths room. Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the plumbing permit to be valid, please have the appropriate individual from your company sign below and return this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building Division. No plumbing inspections will be authorized until this completed form is received OWNER: PLUMBING CONTRACTOR: WASHINGTON SQUARE LLC ADDISON PLUMBING BY THE MACERICH COMPANY 17506 SE RIVER RD. 9585 SW WASHINGTON SQUARE MILWAUKIE, OR 97267 TIGARD, OR 97223 Phone #: Phone #: 503- 785 -1840 Reg #: LIC 151754 PLM 3 -449PB AN INK SIGNATURE IS REQUIRED ON THIS FORM X °6 Signature of Authorized Plumber If you have any questions, please call 503.718.2433. CITY'OF TIGARD � , z. BUILDING DIVISION PERMIT #: PLM2005 -00477 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/13/2005 Phone: (503) 639 -4171 :Veit Inspection Requests (24 Hrs.): (503) 639 -4175 _... 559 INSPECTION WORKSHEET FOR DATE: 11/21/2005 TIME: 8:22A PAGE: 9 SITE ADDRESS: 09306 SW WASHINGTON SQUARE RD CLASS OF WORK: SUBDIVISION: WASHINGTON S E LOT #: TYPE OF USE: PROJECT NAME: ( SSAB JEELE DESCRIPTION: (1) new sink in goldsmiths room. OWNER: WASHINGTON SQUARE LLC, PHONE #: CONTRACTOR: ADDISON PLUMBING PHONE #: 503.785 -1840 Inspection Request Scheduled For: Date: 11/22/2005 Pour Time: 1 Code # Inspection Description Confirm # • Contact # Messa e 399 Plumbing final 022118 -01 503-740-8116 — lf Corrections/Comments/Instructions: • \r ke c 62_S S S U1/4.3.-'}' - o Pa\J---7 C c-5s -�-e- • • • iv 0 __________ rafitiotisoloi • 00046,4w PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED ` + l � /O Inspector: Date: / Phone #: (503) 718- CITY' OF TIGARD . BUILDING DIVISION - - PERMIT #: PLM2005 -00477 13125 SW Hall Blvd., Tigard, OR 97223 V DATE ISSUED: 10/13/2005 Phone: (503) 639 - 4171 + , Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 11/4/2005 TIME: 7:08AM PAGE: 12 SITE ADDRESS: 09306 SW WASHINGTON SQUARE RD CLASS OF WORK: SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE: PROJECT NAME: KASSAB JEWELERS DESCRIPTION: (1) new sink in goldsmiths room. OWNER: WASHINGTON SQUARE LLC, PHONE #: CONTRACTOR: ADDISON PLUMBING PHONE #: 503 Inspection Request Scheduled For: Date: 11/4/2005 Pour Time: Code.# Inspection Description Confirm # Contact # Message 320 Plumbing rough -in 020411 -01 503 -740 -8116 N • Corrections /Comments /Instructions: • • • • • PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED • • fyij Insp ector: Date: / V Phone #: (503) 718- • 1'� CITY OF TIGARD B ULDING DIVISION r ' I. �� PERMIT #: PLM2005-00477 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/13/2005 Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 ° INSPECTION WORKSHEET FOR DATE: 10/18/2005 TIME: 7:10AM PAGE: 8 SITE ADDRESS: 09306 SW WASHINGTON SQUARE RD CLASS OF WORK: SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE: PROJECT NAME: KASSAB JEWELERS DESCRIPTION: (1) new sink in goldsmiths room. OWNER: WASHINGTON SQUARE LLC. PHONE #: CONTRACTOR: ADDISON PLUMBING PHONE #: 503- 7851840 Inspection Request Scheduled For: Date: 10/18/2005 Pour Time: . Code # - • - - - ription Confirm # Contact # Message 305 Plumbing undersla• . 018634 -01 503 - 740 -8116 N Corrections /Comments n'' °: ��•�• CO` I No p V p...a 182Ai) vy'I t 1\ VA' Fs.u—,- • 7 PAS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ C:- L FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED • Inspector: _ Date: n� Phone #: (503) 718- mg •