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Permit C ITY OF TIGARD PLUMBING PERMIT l� DEVELOPMENT SERVICES PERMIT #: PLM2005 -00290 . 111- � �' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED. 8/10/2005 PARCEL: 1S12600-00300 S12600 -2600 - 00300 SITE ADDRESS: 09367 SW WASHINGTON SQUARE RD ZONING: C -G SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG Project Description: Plumbing TI. Other fixtures: (1) drinking fountain, (1) expansion tank, (1) grease trap, & (1) primer. CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: M FLOOR DRAINS; 3 TRAPS: STORIES: WATER HEATERS: 3 CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: 4 URINALS: GREASE TRAPS: LAVATORIES: 2 OTHER FIXTURES: 4 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 $282.20 TIGARD, OR 97223 [PLMPLN] Plan Review 8/10/2005 $70.55 Phone : 503-639-8865 [TAX] 8% State Surcharl 8/10/2005 $22.58 Total $375.33 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 -246-6 9 or 1- 800 - 332 -2344. Issued By: 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. 3 C77, Uw wo,,et,, Rd, • Plumbing Permit Application FOR OFFICE USE ONLY City of Tigard (, -1 � Received 13125 SW Hall Blvd., Tigard, OR 97223 e/By �I' 1 a. t i - 00 / Plan Revie Phone: 503.639.4171 Fax: 503.598.1960 JU ,' /' d >. p Other Permit No.•y, s �/' 24- Hour Inspection Line: 503.639.4175 `` 20 r �1 ° .1 I y 7 / 7 / 0 n- Or G�/Y _ __ Date Ready/By. O S � I See Page 2 for Internet: www.ci.tigard.or.us �, `� r.r, tn Notified/Method 7 i upplemental Information TYPein' z 9 C2tP -�11 _ FEE* SULE ❑ New construction ❑ t ioit° `� - F or special information use checklist. Description I Qty. I Ea. I Total RI Addition %alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 249.20 ❑ I- and 2- family dwelling fg Commercial /industrial SFR (2) bath 350.00 El 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. 93 b7 5 k dJ c j e jrl n c iimis e d . Catch basin or area drain 16.60 City /State/ZIP: , 0L 17 j3 ` £ 4 / 5) Drywell, leach line, or trench drain 16.60 7 ` Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: Project name: O�/l10/!T1 S- SOrio�k SO Manufactured home utilities 110.00 Cross street/directions to job site: Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.4 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 Back flow preventer Page 2 Phofi 14 IVlq 1, 4-1VA I ' ki S 7 4j � Backwater valve 16.60 �J 4 y. .-- 6...u p JJ n j Clothes washer 16.60 J) ��� o� � �� J Dishwasher 16.60 , J ❑ P PERTY OWNER G,.I// / � I . TENANT Drinking fountain 16.60 ' � te7 Name: WI `b 3 - SD)) tY1A_ Ejectors/sump 16.60 �� � 6h 5 �� j , PLC • J Expansion t tan ank I 16.60 1 ( b ' Address: ,S'1 1667 t C ' G Qr' 44144 G Z Fixture /sewer cap 16.60 J i) City/State /ZIP: 5,611.41 FAMG1 S CO G4 9 V`)t Floor drain/floor sink/hub 3 16.60 in. $O Phone: (WI S) a 54 1 Fax: (S<Is) Z3d'` 3 ti,/ Garbage disposal 16.60 El APPLICANT ❑ CONTACT PERSON Hose bib 16.60 do d. Ice maker 16.60 Business name: Sh / d y °LI/did do Z) € • erceptor /grease trap I 16.60 ) 0 Contact name: J .1j " (/ by- Medical gas (value: $ ) Page 2 Address: SD 4' liS.J ` , & 4y • 14/4 / Primer / 16.60 City /State/ZIP: O, Gam O 4 R'7 ( f 7 Roof drain (commercial) 16 60 .,3 j , 3 / Sink/basin/lavatory 6 4 o, 1660 "9. lob Phone: (spa) .9 „C / 2 Fax: (� 3) L 7 aL / D •-9� f ,- Tub /shower/shower pan 16.60 E -mail: Ar @ 4 shot h, • c d) ' _ Urinal 16.60 4 CONTRACTOR Water closet 1- 16.60 3 Business name: fri� /,�� p j� Water heater 16.60 yet • BO Address: X SW ��e / ;GC . �f/J ri'�c -� Other: City /State/ZIP: K.i- C./ /c- 7 Subtotal • ga� , e� Minimum permit fee: $72.50 Phone: (g)7 ) t / - (, / (e6 Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lic.: / Plumbing Lic. no.: Plan review (25% of permit fee) .�0 // State surcharge (8% of permit fee) , IA 1 5� Authorized signature: . I' TOTAL PERMIT FEE 3 75 . 3 Print name:, ^ Date:4/ 15 This permit application expires if a permit is not obtained within Qom\ L� ` 1 s 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. i \Building\Per mns\PLM- PennitApp doc 06/05 440 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 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 • 0✓ 3,601 to 7,200 $220.00 Sewer - 1st 100' 55.00 cS 7,201 and greater $309.00 Sewer - each additional 100' I 46.40 14, Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 Valuation: 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 $25,001.00 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 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. Fixture Work: Plan Review for Complex Structures Are you capping, moving or replacing existing fixtures? If A "complex structure" is defined as an installation of a plumbing "yes", 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. Quantity by (Fixture) Work Performed ❑Y new commercial building. Fixture Type: Replace ❑ Any new exterior plumbing site utilities. • New Moved Existing Capped ❑ 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 food 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. -3" -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 Oil Separator (Gas Station) Comments regarding fixture work: Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar/Lavatory - Bradley • -Commercial - Service Swimming Pool Filter Washer - Clothes *Note: If the fixture work under this permit results in an ' Water Extractor 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. \Bwlding\Pennits\PLM- PennitApp doc 3/03 I CITY OF TIGARD BUILDING DIVISION PERMIT #: PLM2005 -00290 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/10/2005 Phone: (503) 639 -4171 VA �l Inspection Requests (24 Hrs.): (503) 639 -4175 _.. INSPECTION WORKSHEET FOR DATE: TIME: PAGE: 9/23/2005 7:07AM 29 SITE ADDRESS: CLASS OF WORK: SUBDIVISION: 09367 SW WASHINGTON SQUARE RD LOT #: TYPE OF USE: PROJECT NAME: WASHINGTON SQUARE DESCRIPTION: 1NiLLIAMS SONOMA Plumbing TI. Other fixtures: (1) drinking fountain, (1) expansion tank, (1) grease trap, & (1) primer. OWNER: WASHINGTON SQUARE LLC, PHONE # : 503639.8865 CONTRACTOR: MODERN PLUMBING PHONE #: 503-691 -6166 Inspection Request Scheduled For: Date: 9/23/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 320 Plumbing rough -in 016482 -01 503.572-0020 Y Corrections /Comments/ Instructions: . i .I i / ' / AWAIMIPv/ f, GI dl."7"-40,7 i// /ft./ ii 0 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS • FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: , Phone #: (503) 718 - . 1 CITY OF TIGARD BUILDING DIVISION t PERMIT #: PLM2006-00290 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/10/2005 Phone: (503) 639 -4171 �a • Inspection Requests (24 Hrs.): (503) 639 -4175 - -,,��` . INSPECTION WORKSHEET FOR DATE: 11/15/2005 TIME: 7:02AM PAGE: 22 SITE ADDRESS: 09367 SW WASHINGTON SQUARE RD CLASS OF WORK: SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE: PROJECT NAME: WILLIAMS- SONOMA DESCRIPTION: Plumbing Ti. Other fixtures: (1) drinking fountain, (1) expansion tank, (1) grease trap, & (1) primer. OWNER: WASHINGTON SQUARE LLC, PHONE #: 503 -639 -8865 CONTRACTOR: MODERN PLUMBING PHONE #: 503 - 691 -6166 Inspection Request Scheduled For: Date: 11/15/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 021305 -01 415.254 -7840 Y Corrections /Comments /Instructions: - ffffffAMIT( - AIIMIMW ,J9 ..._....... , , i /ice. ce. _.�t « . 1 _ (_ - 1 t f∎ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: , / Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: PLM2005 -00290 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/10 /2005 Phone: (503) 639 -4171 � i . Inspection Requests (24 Hrs.): (503) 639 -4175 — ."6i �_ INSPECTION WORKSHEET FOR DATE: 11/9/2005 TIME: 7:09AM PAGE: 48 SITE ADDRESS: 09367 SW WASHINGTON SQUARE RD CLASS OF WORK: SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE: PROJECT NAME: WILLIAMS- SONOMA DESCRIPTION: Plumbing Tl. Other fixtures: (1) drinking fountain, (1) expansion tank, (1) grease trap, & (1) 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 395 Misc. inspection 020822 -01 503 -572 -2179 Y Corrections /Comments /Instructions: A. , ANPIIMAIIMT.,,,, -6- i 4.1 7 AI - _i - /am/ � j r IlPASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspect � ,� Date: �� 0--- Phone #: (503) 718- CITY OF TIGARD , A BUILDING DIVISION PERMIT #: PLM2005-00290 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/10/2005 Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 -' I INSPECTION WORKSHEET FOR DATE: 10/7/2005 TIME: 7:05AM PAGE: 28 SITE ADDRESS: 09367 SW WASHINGTON SQUARE RD CLASS OF WORK: SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE: PROJECT NAME: WILLIAMS-SONOMA DESCRIPTION: Plumbing TI. Other fixtures: (1) drinking fountain, (1) expansion tank, (1) grease trap, & (1) primer. OWNER: WASHINGTON SQUARE LLC, PHONE #: 503.639 -8865 CONTRACTOR: MODERN PLUMBING PHONE #: 503 -691 -6166 Inspection Request Scheduled For: Date: 10/7/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 320 Plumbing rough -in 017746 -01 503 -572 -2179 Y Corrections /Comments /Instructions: PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS 111 FAIL FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: M Date: /1) Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: PLM2005 -00290 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/10/2005 Phone: (503) 639 -4171 ■ a, qnt ` Inspection Requests (24 Hrs.): (503) 639 -4175 !+� ^'I L. INSPECTION WORKSHEET FOR DATE: 8/23/2005 TIME: 7:05AM PAGE: 1 SITE ADDRESS: 09367 SW WASHINGTON SQUARE RD CLASS OF WORK: SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE: PROJECT NAME: WILLIAMS- SONOMA DESCRIPTION: Plumbing TI. Other fixtures: (1) drinking fountain, (1) expansion tank, (1) grease trap, & (1) primer. OWNER: WASHINGTON SQUARE LLC, PHONE #: 503 - 639-8865 CONTRACTOR: MODERN PLUMBING PHONE #: 503 - 691 -6166 Inspection Request Scheduled For: Date: 8/23/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 395 Misc. inspection 014119 -01 415 - 254 -7840 Y Corrections /Comments /Instructions: "ra..,co T A, ,„, Go‘A ✓ w4,- 41 -‘01- o p,. -mac, - r-e. --' ❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: Phone #: (503) 718- CITY OF TIGAR BUILDING DIVISION • ` PERMIT #: PLM2005 -00290 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/10/2005 Phone: (503) 639 -4171 h . 1 ei iri �' j Inspection Requests (24 Hrs.): (503) 639 -4175 - `'I .. • INSPECTION WORKSHEET FOR DATE: 8/16/2005 TIME: 7:05AM PAGE: 30 SITE ADDRESS: 09367 SW WASHINGTON SQUARE RD CLASS OF WORK: SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE: PROJECT NAME: WILLIAMS- SONOMA DESCRIPTION: Plumbing TI. Other fixtures: (1) drinking fountain, (1) expansion tank, (1) grease trap, & (1) primer. OWNER: WASHINGTON SQUARE LLC, PHONE #: 503.635.8865 CONTRACTOR: MODERN PLUMBING PHONE #: 503 - 691 -6166 Inspection Request Scheduled For: Date: 8/1612Q05 Pour Time: Code # Inspection Description Confirm # Contact # Message 305 Plumbing underslab 013628.01 503-691 -6166 Y Corrections /Comments /Instructions: rtA PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: DateDV L 7e.1 Phone #: (503) 718- CITY OF TIGARD - - BUILDING DIVISION ;_ PERMIT #: PLM2005 -00290 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/10/2005 Phone: (503) 639 -4171 ���,e, ,W � , Inspection Requests (24 Hrs.): (503) 639 -4175 4 'I INSPECTION WORKSHEET FOR DATE: 8/15/2005 TIME: 7 :05AM PAGE: 51 SITE ADDRESS: 09367 SW WASHINGTON SQUARE RD CLASS OF WORK: SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE: PROJECT NAME: WILLIAMS- SONOMA DESCRIPTION: Plumbing TI. Other fixtures: (1) drinking fountain, (1) expansion tank, (1) grease trap, & (1) primer. OWNER: WASHINGTON SQUARE LLC, PHONE #: 503-639-8865 CONTRACTOR: MODERN PLUMBING PHONE #: 503- 691 -6166 Inspection Request Scheduled For: Date: 8/15/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 305 Plumbing underslab 013537 -01 503-691 -6166 Y Corrections /Comments /Instructions: __,_59- '"s 7-2,- 00.4 P aw("9 ,_ c„ /en // /... - /. .fit L.... ❑ PASS 0 PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: 4. I Phone #: (503) 718-