Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005 -00286
III 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/30/2005
PARCEL: 1S12600-00300
SITE ADDRESS: 09410 SW WASHINGTON SQUARE RD K -11 ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
Project Description: Plumbing TI, moving (1) lay, (1) water closet & (1) floor drain. Adding (1) mop sink.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: M FLOOR DRAINS: 1 TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 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 6/28/2005 $83.00
TIGARD, OR 97223 [TAX] 8% State Surchar! 6/28/2005 $6.64
Phone : Total $89.64
Contractor:
MODERN PLUMBING
11120 SW INDUSTRIAL WAY REQUIRED ITEMS AND REPORTS
TUALATIN, OR 97062
Phone : 503 691 - 6166
Reg #: LIC 87906
PLM 34 -250PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by
calling 503 - 246.99 or 1- 800 - 332 -234
Issued By: AP , , �� /, Permittee Signature SnA
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
06/27/2005 18:42 5036916771 MODERN PLUMBING PAGE 02
10/1212004 1.5:34 FAi 5035981960 CITY OP TIGABD IA 003
P)sllnbing Perm 4 ^ 1 . I !V E FOR OfFIrF. USE ON1.1
City of Tigard - Q °aw cm► d , ■ "
13125 sw Ilan t�vd.. Tigard, OR 97273 JUN. 28 2005 Pla Review
r ,
Other PermitNa : (A - D i / g
Phase: xour� e%a�%,n o 503-598-1M0 1 1T OF T .- ' __I ' �'" Ili Sae z�
lbteR ®dyldY oppkmental Information w
et wwcl- tlgard.or us i IM DM "' NatiedlMedrod: S � ,.,t
} 7 . 1i. • -il a' I ,'{I �IO i^ ;1•1•x ` I.P3:''. • . `' t : ':,,:, r a . .r . :ai ,. a .. %IV' '. '; I• • . l•' 7:.
;:i, • .i • , 11 r• •:1 :11 10 1 • I.
.,
❑ New coextrttction ' 0 Demolition
Par special ernrrtROlt u8e cAackf
Total
PA: ' I ailtoNsltennion /tepiaaemerlt 0 Other No L. y.family dwellings (includes 100 ft foreaeh utility connection)
r I 1•, I 1 `QRI u.. is ` . • ' ' ' ''ES SIR b ath 249.20
11 iVI li:dat;$
!. , ., , •x _ '' i �' I., o i ,2 ��: i i , 4, �:I4,,,• S,,,S'e •; 1 () 350.
SFR (2) bath 00
CI 1- and 2- fatnilydvtrelliaS rXComm,aeielKrrtreRtriel •
SFR (3) bath w 399.00
❑ Accessary ❑ Mn1ti` family 45.00 `
Each additional bathlldlchcn
❑ ?Amor balkier [l Other: -
A Fut am 161= - eq. ft) 2
. ' ' 'S d�n�� 7- . •. r1 -'a rr II'In YI' '.
1..,.:.
�I���`:��Fy5C�6 �1..• I ° 7 ,. ,' , 4 ' nr1 { t i lA4 i .' ?iry�irQ'I'�•F�x.9'r ll.i 1. Site lislllt189
Job site e►ddelxt _ r3 � 1 'ri _ r,i Cas basin or at drain i 6.60 •
,I : a ra o l2 . - _ ell, leach fine, or trench drain - 16,60
Footing dodo (no.linear R: Page 2
SnitabItIg./apt no.: `� 1 \ Nedectulnic: L. p
AdoevCaotul'od Horne utilities � 110.00
Crow stater/directions to job sites Manholes 1640
160 I Ian drain connector 16.60
Sanitary sewer (no. linear f).: ) Paplr 2
Storm sewer (no. linear :R.: _, Page 2
Subdivisions Lot 00.: Weer service (ne. tinAS1 it _ Rase 2
bIxture or Item
Tex mspipmcel no -: Absetpliotl valve t b.60
� . 1 � '� . it r " „ - , ���'
4 , • j'- *.i' . .u�� : ul•:I' : � ** } ' I'lll • r'r, i p 2
sk •f� � •:i: ;�'7:i , "� � 6 • �, R� '. . •�F: •: �'f :1;. . , ;r' 1 Ba Ckflrnw p�cntsr �
i • Backwater valve • IIIIIII 16.60
Clothes amber _ 16.60
Dishwasher 16.60
. a,.v : . , 1 .I . F ' = x gq : _Dranki...Plinking #hlmtdn 16.60 • tt
ormols ' i' I. ,. • : ,� • • • .' ;' ., I, l ' 1: a 'i'•''':: i��l�,ie ,, '. 4 ", ..:2 $':', o Ejectors/Soul, 10.60
Name: _ *
MIIMIT Itemmthen tank 16-60
Address • Fixturesewer cap 16.60
City/State/MP: Floor druie/tloor atnklhab 1 - 16.60 J l 4 0
Garbage disposal 16.60 •
Phnom ( ) Ir a Fox; ( ) �} g �1oaa MD 16.60
ii;V E! �.NI! h�,' 'I�A 9J ��'I� m f r '' • • .�+; ®, • II -I ` Yil � ��i ,�iDl'� rN maker .
: L 'l. ''I}k.L I M'1dR'1 �7r o rr .11 r"i 1 : liItl r ; 1 lIce bib 16.60 IN
Rusin mane: Interceptorlgrease ono t6.60
Contact nano: Medical gas (value: S ) MIE PaSc 2
Primer 16.60 -
Address; ^ Rod drain (commercial) _ 16.50 MIS
Cityl fZlF: Sink/basin/lavatory 1103 16,60
Piton: ( ) P'ax:: ( ) 7ublshoweNDhewer pan 16.60 IIM
E-mail: Urinal 16.
{ . ,•,,: . ' I ]: �. '' 5'. I' "� 4'li: lF` �_ iv 16.60 1;.: b0
�TJ( "L : .,•,I4� .. �'r^ '.4.1 •ti ' ' .';Ii, iV �, h•".,. " WR6Crc106et
'' � w ►:i , . i • • • , �,' , ' - , 'i.`c.�P'i ;I ;�'><,111�4 t�� � .. � i`N. ",t' TI�'�' � � - - ��i
Water barter 11•1 16
Ate: 0 1 1'1a u .. 1 ahem
Subtotal 7 .0
city/smmrrr: '1 tea \ a`1`r I( ► • I 70(02 Nflnurmlm permit tea 372.50
Phone: (56 (o / I - Co 1 (p Rol: (553) (p c r 1 C.7 _ Residential bncidlow minimum • wash foe: 536.25
CC& T..i Plum ' , tic_ nn._ 4- _ a$ r Plea review (25% of permit fan)
al, wtnnerge ill% or permit *0 MINI'
Authorized signature: 1 �_' / i TOTAL PERMIT FES MIMI
a � �
n ma�
t Qr r . Cl
c' WL'a' G C C [. /- % / am CO-2 7.4 . s" y This permit app rcatton Eltpirea if e permit Is Us obtained within
1110 days after it bas been aee4MM as complete.
*Fee methodology set by T i..County Building industry Service Board.
L•1Buarmg1Pinv. rtrr-1l..BenitApp.doo 12/03 440.46167(rWhiA:12tdJaVGO)
CITY OF TIGARD
BUILDING DIVISION - �" - PERMIT #: PLM2005 -00286
h 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 613012005
Phone: (503) 639-4171 0 ,� �iA
Inspection Requests (24 Hrs.): (503) 639 -4175 s__..
, INSPECTION WORKSHEET FOR DATE: 8/15/2005 TIME: 7:05AM PAGE: 1
SITE ADDRESS: 09410 SW WASHINGTON SQUARE RD K - 11 CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
'PROJECT NAME: LEGO
DESCRIPTION: Plumbing TI, moving (1) lav, (1) water closet & (1) floor drain. Adding (1) mop sink.
OWNER: WASHINGTON SQUARE LLC, PHONE #:
CONTRACTOR: MODERN PLUMBING PHONE #: 503- 691 -6166 '
•
Inspection Request Scheduled For: Date: 8/15/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 013553 -01 503-968 -8242 N
Corrections /Comments /Instructions:
•
I .
L ,
. w e_ , . r
i •
, .
. .
. .
• ,
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Dat Phone #: (503) 718-