Permit CITY OF TIGARD
PLUMBING PERMIT
� �� DEVELOPMENT SERVICES DATE PERMIT #: PLM2005-
ISSUED: 8/10/2 0500256
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1S12600-00300
SITE ADDRESS: 09345 SW WASHINGTON SQUARE RD ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
Project Description: Building fixtures. Other fixtures: 1 drinking fountain, expansion tank and primer.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: M FLOOR DRAINS; 2 TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: 2 OTHER FIXTURES: 3
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 2 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 8/10/2005 $182.60
TIGARD, OR 97223 [PLMPLN] Plan Review 8/10/2005 $45.65
Phone : 503 [TAX] 8% State Surcharl 8/10/2005 $14.60
Total $242.85
Contractor:
MODERN PLUMBING
11120 SW INDUSTRIAL WAY REQUIRED ITEMS AND REPORTS
TUALATIN, OR 97062
Phone : 503- 691 -6166
Reg #: LIC 87906
PLM 34 -250PB
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 rules or direct questions to OUNC by
calling 503 -246 j.99 or - 800 - 332 -2344.
Issued By: . _ - � � % Permittee Signature :1
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.
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93LiS. PA
Building Fixtures - E tV F I 1S /2-G00 -00 _ a
Plumbing Permit Application is FOR OFFICE USE ONLY
City of Tigard i 0 I Date/B // j4 Permit 2i 5 _' 72 ,
13125 SW Hall Blvd., Tigard, OR 97223 Plan Re ew
Phone. 503.639.4171 Fax: 503.598.1960 % ; d p i I i� . Date/By: 6 - b / s
Y (A.) Other Perm NS1, i6,0"5 Of�f�/
24- Hour Inspection Line: 503.639.4175 CITY OF RI a 7 e .J `i Date Ready B 1 '� 0 See Page 2 for
s
Internet: www.ci.tigard.or.us DIN, p �
, , � :Notified/Method Supplemental Information ee B 11 TIT AJ I7�, I1V
TYPE OF WORK - ' . , - -, FEE* SCHEDULE - ' . -
For special information use checklist.
El New construction El Demolition t
Description I Qty Ea I Total
lij Addition/alteration /replacement ❑ Other: 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
El Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45 00
❑ Master builder ❑ Other. 11
Fire sprinkler ( sq. ft.) Page 2 )
' JOB SITE INFORMATION AND LOCATION , 0
Site utilities
Job site address: Catch basin or area drain 16 60
.s SN .J \QA.Nat foci Sp a_
City/State /ZIP c 4, ..0 Og Drywell, leach line, or trench drain 16 60 \;;
T � Footing drain (no linear ) Page 2
Suite/bldg./apt. no. :� = 15 Project name b� ry v 61
ft _ \;
Cross street/directions to job site: e I I Manufactured home utilities 110 00
'� �� n ID • Q Manholes 16 60
Rain drain connector 16 60 1
Sanitary sewer (no linear ft . ) Page 2
Storm sewer (no. linear ft ) Page 2 V ( I
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 Backflow preventer Page 2
�LL.MISt..19 Lx CJ AT7Rp �J 171- 1Ni »T Backwater valve 16 60
F. ? CM Er.31 TuP U005 - C`A 18O Clothes washer 16.60
Dishwasher 16 60
❑ PROPERTY OWNER I ' TENANT
Drinking fountain I 16.60 I �,
.. Ejectors /sump • 16.60
Name: I LL1A.wr, - MA 1 kIG Expansion tank / / 16 60 ib, CIO
Address: ?2..5 O \ J aeo 7 r SS / J E.. Fixture /sewer cap 16.60
I` City/State /ZIP: SJ.v.I F, c. .c , ( J �t / 14 1 0 9 Floor drain/floor sink/hub ✓ * a 16 60 3 3 �'
Phone: (y 15) qO, - 5c6 J Fax: ( 4IS ) 4509 -1$Z.5 Garbage disposal 16.60
*APPLICANT . . ' C ONTACT PERSON Hose bib 16.60
`' Ice maker 16 60
Business namC I4tu1 . ` ), t r:,,33 F , bQ r i S A► I Cl R. Df V . Interceptor /grease trap g 16.60
Contact name: n ,,, gr u - �e . /1 I- 2 Medical gas (value: $ ) Page 2
Address: S' 5 J c r 4 � v f E - g A`V v Primer V 1 16.60 IC ,C 0
City/State/ZIP: ` `�' Roof drain (commercial) 16 60
Phone: 503) 2_19 _ cif ( Fax: : So ) a' Q U Sink/basin/lavatory / 3 16 60 49. 0
- -9 03 L Tub /shower /shower pan 16 60
E -mail:
Urinal 16 60
' _ , - CONTRACTOR - . Water closet ✓ , Zf 16 60 33 ,1,0
Business name: N ft, , ` ,.; V i , `, �, W ater heater V i 16.60 �p.
Address: / Other T / ,_�
Subtotal /2*.ba0
City/State /ZIP: Minimum permit fee $72 50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee $36 25
CCB Lie.: Plumbing Lic. no.: Plan review (25% of permit fee) 4 &J
State surcharge (8% of permit fee)
Authorized signatur:, 4
,_ . te a ► TOTAL PERMIT FEE Act ,„
Print nam. ____A bet-CS I Pore. Date CD � os This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
--lc) N R *Fee methodology set by Tri -County Building Industry Service Board
1 \ Building1Permia\PLMF- PerrnitApp doc 12/03 440- 4616T(10/02/COM/WEB)
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 dram - 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
Storm & Rain Drain - 1st 100' 55 00 Valuation: Permit Fee:
$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 $25,001 00 to $50,000 00 $379 50 for the first $25,000.00 and $1 45 for
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
specially requested inspections - per hour 72.50 and including $50,000 00.
Subtotal: $50,001.00 and up $742.00 for the first $50,000 00 and $1.20 for
each additional $100 00 or fraction thereof
Fixture Work:
Are you capping, moving or replacing existing fixtures? If
"yes ", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees * .
Quantity (Fixture) Work Performed
Fixture Type: - ' Replace
New ' Moved Existing 'Capped Comments regarding fixture work:
Baptistry/Font
Bath - Tub /Shower
- Jacuzzi/Whirlpool
Car Wash -Each Stall
-Drive Thru
Cuspidor/Water Aspirator
Dishwasher - Commercial
- Domestic
Drinking Fountain
Eye Wash
Floor Drain /sink - 2"
-3"
-4"
Car Wash Drain
Garbage - Domestic
Disposal -Commercial *Note: If the fixture work under this permit results in an
- Industrial
Ice Mach./Refng. Drains increase of sewer EDUs, a sewer permit will be issued and
Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the
Rec Vehicle Dump Station plumbing permit can be issued.
Shower -Gang •
-Stall
Sink - Bar/Lavatory
Quantity Total
- Bradley
Commercial Isometric or riser diagram is required if fixture quantity
- Service total is >9.
Swimming Pool Filter
Washer - Clothes
Water Extractor Plan Review
Water Closet - Toilet Plan review is required if fixture quantity total is >9.
Urinal
Other Fixtures:
\Building\Pemuts\PLM- PermiiApp doc 3/03
.
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005 -00256
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/10/2005
Phone: (503) 639 -4171 a.dy i'
Inspection Requests (24 Hrs.): (503) 639 -4175 ... „, I ..
INSPECTION WORKSHEET FOR DATE: 8/12/2005 TIME: 7:06AM PAGE: 20
SITE ADDRESS: 09345 SO/WASHINGTON SQUARE RD CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: POTTERY BARN KIDS
DESCRIPTION: Building fixtures. Other fixtures: 1 drinking fountain, expansion tank and primer.
OWNER: WASHINGTON SQUARE LLC, PHONE #: 503 - 639 -8865
CONTRACTOR: MODERN PLUMBING • PHONE #: 503 - 6166
Inspection Request Scheduled For: Date: 8/12/2005 Pour Time: .
1 Code # Inspection Description Confirm # Contact # Message
305 Plumbing underslab 013473-01 503 -691 -6166 N •
Corrections /Comments /Instructions:
7 - d b o
G�
. /
/ K I
❑ PASS ❑ PARTIAL APPROVAL CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Ins ector Date: 9/p(iii Phone #: (503) 718-
•
•
, CITY OF TIGARD% , 1, ..
BUILDING DIVISION • PERMIT #: PLM2005.00256
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/10/2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 , '_�+�-
INSPECTION WORKSHEET FOR • DATE: 8/16/2005 TIME: 7 :05AM PAGE: 31
SITE ADDRESS: 09346 SW WASHINGTON SQUARE RD CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: POTTERY BARN KIDS
DESCRIPTION: Building fixtures. Other fixtures: 1 drinking fountain, expansion tank and primes.
OWNER: WASHINGTON SQUARE LLC, PHONE #: 503 -639 -8865
CONTRACTOR: MODERN PLUMBING PHONE #: 503691 -6166
Inspection Request Scheduled For: Date: 8/16/2005 Pour Time:
•
Code # Inspection Description Confirm # - Contact # Message
305 Plumbing underslab 013627 -01 503-691 -6166 Y
•
Corrections /Comments /Instructions: •
•
•
•
•
'ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL _ ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 1, Da
ate: Phone #: (503) 718-
•
CITY OF TIGARD
BUILDING DIVISION ' ` PERMIT #: PLM2005-00256
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/10/2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639-4175 _—
INSPECTION WORKSHEET FOR DATE: 9/13/2005 TIME: 7:05AM PAGE: 20
SITE ADDRESS: 09345 SW WASHINGTON SQUARE RD CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: POTTERY BARN KIDS
DESCRIPTION: Building fixtures. Other fixtures: 1 drinking fountain, expansion tank and primer.
OWNER: WASHINGTON SQUARE LLC, PHONE #: 503.639..8865
CONTRACTOR: MODERN PLUMBING PHONE #: 503 - 691 -6166
Inspection Request Scheduled For: Date: 9/13/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 015520-01 503- 691 -6166 N
Corrections /Comments /Instructions:
5 7 —
•
❑ PASS ❑ PARTIAL APPROVAL CANCEL ❑ NO ACCESS
❑ FAIL ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 010.J Date: Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005 -00256
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/10/2005
Phone: (503) 639 -4171 4 gilt
Inspection Requests (24 Hrs.): (503) 639 -4175 W
INSPECTION WORKSHEET FOR DATE: 9/14 /2005 TIME: 7:09AM PAGE: 46
SITE ADDRESS: 09345 SW WASHINGTON SQUARE RD CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: POTTERY BARN KIDS
DESCRIPTION: Building fixtures. Other fixtures: 1 drinking fountain, expansion tank and primer.
OWNER: WASHINGTON SQUARE LLC, PHONE #: 503. 639 -8865
CONTRACTOR: MODERN PLUMBING PHONE #: 503 -691 -6166
Inspection Request Scheduled For: Date: 9/14/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 015651 -01 503 -572 -0020 Y
Corrections /Comments/ Instructions:
%/� ' ��
gA n fa U 0 PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED •
•
v Nc9
Inspector Date17 Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM200S -00256
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: $/1012006
Phone: (503) 639 -4171 In
Inspection Requests (24 Hrs.): (503) 639 -4175 I �..
INSPECTION WORKSHEET FOR _ DATE: 11/9/2005 TIME: 7:09AM PAGE: 9
SITE ADDRESS: 09345 SW WASHINGTON SQUARE RD CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: POTTERY BARN KIDS
DESCRIPTION: Building fixtures. Other fixtures: 1 drinking fountain, expansion tank and primer.
OWNER: WASHINGTON SQUARE LLC, PHONE #: 503-639-8865
CONTRACTOR: MODERN PLUMBING PHONE #: 503 - 691 -6166
Inspection Request Scheduled For: Date: 11/9/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 020856-01 415.298 -7618 N
Corrections /Comments /Instructions:
"/ fr
OZ
tad
ter
- .7/47
i
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: // Phone #: 503 , ( � ) 718-
CITY OF TIGARD
BUILDING DIVISION j °, ' PERMIT #: PLM2005 -00256
13125 SW Hall Blvd., Tigard, OR 97223 • - DATE ISSUED: 8/10/2005
Phone: (503) 639 -4171 c u
Inspection Requests (24 Hrs.): (503) 639 -4175 . ': • '`'f L.
INSPECTION WORKSHEET FOR DATE: . 11/14/2005 TIME: 7:12AM PAGE: 77
SITE ADDRESS: 09345 SW WASHINGTON SQUARE RD CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
. PROJECT NAME: POTTERY BARN KIDS
DESCRIPTION: Building fixtures. Other fixtures: 1 drinking fountain, expansion tank and primer. •
OWNER: WASHINGTON SQUARE LLC, PHONE #: 503-639-8865
• CONTRACTOR: MODERN PLUMBING PHONE #: 503-691-6166
Inspection Request Scheduled For: Date: 11/14/2005 Pour Time:
1
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 021113 -01 503.572 -4411 N
Corrections /Comments /Instructions:
i r --..si _./Ak ' illr_ _ —.....,-. ---- ___ -.0 ,,,, _ __ _
'O i1
//,- a
.
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
'FAIL ' ❑ CALL FOR INSPECTION r ADDITIONAL FEES ASSESSED
I /// I nspector: Date: `' Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005 -00266
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/10/2005
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639 - 4175
INSPECTION WORKSHEET FOR DATE: 11/15/2005 TIME: 7:02AM PAGE: 21
SITE ADDRESS: 09345 SW WASHINGTON SQUARE RD CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: POTTERY BARN KIDS
DESCRIPTION: Building fixtures. Other fixtures: 1 drinking fountain, expansion tank and primer.
OWNER: WASHINGTON SQUARE LLC, PHONE #: 503- 639 -8865
CONTRACTOR: MODERN PLUMBING PHONE #: 503- 691 -6166
Inspection Request Scheduled For: Date: 11/1612005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 • Plumbing final 021306 -01 416.298 -7618 Y
Corrections /Comments /Instructions:
•
M _
g pASS "❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ' ❑ ADDITIONAL FEES ASSESSED
Inspector: /7 (), Dater )1 WO Phone #: (503) 718 -