Permit C ITY OF TIGARD PLUMBING PERMIT
P ERMIT #: PLM2005 -00508
'+Yl DEVELOPMENT H BMENg Tigard, 6 39 -4171 DATE ISSUED: 9/30/2005
— 13125 PARCEL: 1S12600-00300
SITE ADDRESS: 09378 SW WASHINGTON SQUARE RD ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
Project Description: Plumbing fixtures.
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: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 1 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 9/30/2005 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcharp 9/30/2005 $5.80
Phone : Total $78.30
Contractor:
D P PLUMBING /DARREN T PLACEK
15825 NE SPRINGBROOK RD REQUIRED ITEMS AND REPORTS
NEWBERG, OR 97132
Phone : 537 - 9492
Reg #: LIC 110612
PLM 36 -70PB
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
req y• • • follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
9 - 0001 -0010 t ough • R 952 - 0001 -0100. You may obtain copies of these rule r direct questions to OUNC by
Iling 50 246 -66.9 /: fie-332-2344.
I sued B _ / !� Permittee Signature;, a/NA. ilt4
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.
Building Fixtures
g is
Plumbing Permit Applica 11 t' i. -.CE1 ED FOR OFFICE USE ONLY
City of Tigard Received R ,I , Permit No Ot 5eg
13125 SW Hall Blvd., Tigard, OR 97223 SEP 3 t 01 Plan Revie •
Phone: 503.639 4171 Fax: 503.598 1960 Ga , 1,., c1\ p ate /B Other Permit Noti , Z a .0
24- Hour Inspection Line: 503.639.4175 CITY Y - i Date Ready/By Jun, ® See Page 2 for .0 /
Internet: www.ci.tigard.or.us Y 1 . -1 -1-. Notified/Method: Supplemental Information
TYPE ING DIVISION FEE* SCHEDULE
For special information use check list.
�J�lew construction ❑ Demolition
Description I Qty. I Ea. I Total
❑ Addition /alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 249.20
❑ I - and 2- family dwelling [PI Commercial /industrial SFR (2) bath 350 00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45 00
0 Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address. q 3 i7 $ s w lAlastftlick 3 o ur Rd Catch basin or area drain 16.60
City /State /ZIP: G f Drywell, leach line, or trench drain 16.60
Suite /bldg /apt. no. Rob I�e � A 1 r t U I Project name: D clot Footing drain (no. linear ft. ) Page 2
4 � �(01 Manufactured home utilities 110.00
Cross street /directions to job site: Manholes 16.60
Mid Rain drain connector 16.60
,4ij 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
Back flow preventer Page 2
TI C i'cSistOOM- Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I 0 TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name. 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
Hose bib 16.60
C' ❑ APPLICANT ❑ CONTACT PERSON
Ice maker 16.60
Business name: Interceptor /grease trap 16.60
Contact name Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State/ZIP Roof drain (commercial) 16.60
Phone:( ) Fax..( )
Sink/basi av atory • ' 16.60
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 1 16.60
-
Business name: 49p (PJ Jjj Q 44, Water heater 1 16.60
Address: ISSZ-S i 3,ik Iryim04 Other I Subtotal
City /State /ZIP: /1 14 9 3 Z _
■ `� I" M in i mum perm fee. $72.50
Phone ( ) S7 .- O qq Fax: ( ) S3g • y�06 Residential backFlow minimum permit fee: $36.25
CCB Lic.: 1 I t ? e *f 7 Plumbing Lic no.: s.6-70 pR Plan review (25% of permit fee)
/ State surcharge (8% of permit fee) s
Authorized signature: 1 ) O 1°
M il� TOTAL PERMIT FEE 1 g .3o
Print name. Apr(0, pivti Date: q / -- This permit application expires if a permit is not obtained within
! l 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
i. \Butldmg\Permtts\PLMF- PermitApp doc 06/05 4404616T( l0/02/COM/WEB)
Plumbin! 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 $1 15.00
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: 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
Commercial Back Flow Prevention Device 46.40
including
148. i0 for the first $10,000 to $25,000.00 $148.50 for the first $10,000 00 and $1 54 for
Residential Back Flow 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, 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.
Quantity by (Fixture) Work Performed ❑ Any new commercial building.
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 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
Eye Wash ❑ Any NFPA 13 - D multipurpose fire sprinkler system.
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 -Ba ay)
-Brad ey
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes *Note: If the fixture work under this ermit results in an
Water Extractor 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 \Bwldmg\PermilswLM- PermlApp doc 07/06/05
CITY OF TIGARD Q/
'
BUILDING DIVISION PERMIT #:/ `- mO?
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 0 6
Ph (503) 639 -4171 i 1 y
Inspection Requests (24 Hrs.): (503) 639 -4175 . "'' I..
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: q 3 g "' ' g D. CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:,..57 O'f - 9 iii..icii
Inspection Request Scheduled For: Date: 10/ Pour Time:
Code # Inspection Description Confirm # Contact # Message
Corrections /Comments /Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: Phone #: 503
P � 1 U
- � ) 718 -
,
CITY OF TIGARD
BUILDING DIVISION . - PERMIT #: PLM2005 -00508 j
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/30/2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 ..' IL.
INSPECTION WORKSHEET FOR DATE: 11/10/2005 TIME: 7:02AM PAGE: 8
SITE ADDRESS: 09378 SW WASHINGTON SQUARE RD CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: DUCK SHOP
DESCRIPTION: Plumbing fixtures.
OWNER: WASHINGTON SQUARE LLC, PHONE #:
CONTRACTOR: D P PLUMBING /DARREN T PLACEK PHONE #: 537 -9492
Inspection Request Scheduled For: Date: 11/10/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 020977 -01 503 -519 -7448 N
Corrections /Comments/ Instructions:
i l
RASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 11 Date: ho i 0 0 Phone #: (503) 718-