Permit CITY TIGARD PLUMBING PERMIT
° . ` COMMUNITY DEVELOPMENT PERMIT #: PLM2007 - 00146
13125 Hall Blvd., Tigard, OR 97223 503.639.4171
DATE ISSUED: 5/8/2007
TIGARD
3 g
PARCEL: 1S12600-00300
SITE ADDRESS: 09469 SW WASHINGTON SQUARE RD A10 ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
PROJECT: MAGGIE MOO'S /AUNTIE ANNE'S
Project Description: Interior fixtures. Other fixture 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: 4 URINALS: GREASE TRAPS:
LAVATORIES: 2 OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
WASHINGTON SQUARE LLC
BY THE MACERICH COMPANY Description Date Amount
9585 SW WASHINGTON SQUARE RD [PLUMB] Permit Fee 4/17/2007 $182.60
TIGARD, OR 97223 [TAX] 8% State Surcha 4/17/2007 $14.60
Phone : Total $197.20
Contractor:
RH KUNSELMAN PLUMBING
15121 NE CLACKAMAS ST.
PORTLAND, OR 97230 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 262 -8337
FAX 503- 257 -6697
Reg #: LIC 154054
PLM 26 -365PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Cede . and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work o st. et within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to ollow les :d. •ted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 -0001 1100. ou ma o•tain copies of
these r r- direct questio s to OUNC by calling 503.246.6699 or 1.800.332.2344.
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Is ed By: I !� ,r"v / 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.
;n._.?, r, - 1 - :r 7, 0, rii ., -
Plumbine Permit Application ti / t FOR OFFICE USE ONLY
City of Tigard APR 2007 // 7/0 7 -./3 Pen- N- - :'IIZtb7 -06 /4,
:� u 13125 SW Hall Blvd, Tigard OR 97223 Plan Revie
• Phone: 503.639.4171 Fax: 503.5a8a R Other Permit No �`�aG / / "� a e
O
r 1 G n I; a Inspection Line 503.639.4175 �,��� V-' 1 fiU _ ; • ® Ready/By I See Page 2 for
Internet: www.tigard -or.gov � 1 T'y" Tf ' T>T(TTLzT • , 6ed/Method / supplemental Information
TYPE OF WORK FEE' SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description f I Qty. I Ea. I Total
X Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (l) bath 249.20
❑ 1- and 2- family dwelling " C ommercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑� Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION
,- 1 Site utilities
Job site address. q6 9 cW lux -cle &i 7D/v $ t Catch basin or area drain 1660
City /State/ZIP: � _, 0 R. r Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: 74. 0 I Project name AA.00 Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
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 fl: ) Page 2
Fixture or item
Tax map/parcel no.: Absorption valve 16.60
77 �,�, d,, DESCRIPTION OF WORK
Back flow preventer Page 2
--y7 '1'�R
f Z ‘f - /24005 lCe...e_$st-Pyl _5 Backwater valve _ 16.60
/65 i 7CA. Pi-./g . Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER f ❑ TENANT Dunking fountain 16.60
Ejectors sump 16.60
Name: Ex i on tank 16.60
Address: Fixtu eweQ .s, I 16.60
City/State/ZIP. Floor drain/floor sink/hub r/ 1 t / 1660
Phone: ( ) Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: Interceptor /grease trap • i. 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State/ZIP. Roof drain (commercial) y� ; 16.60
Phone. ( ) Fax: : ( ) l a . t iin/la'valory / h I 4 ■ 16.60
E-mail: ub/shover/shower pan / 16.60
Urinal 16.60
CONTRACTOR
Water closet 16.60
Business name �G(NS L74 OS( , i T-6--• Water heater 1660
Address: (r Z ( Ii GSA ... Other: Adira
City /Slat P : of i Subtotal
Q i�-"p ( � 7Z 3 . Minimum permit fee $72.50
Phone: 0b3) 3 -7g Fax: q05 )2 7 -66 �Z Residential backflow minimum permit fee: $36.25 /0a '�"
CCB Lic • (5 +0 ''��� 3 O " Plumbing Lic noZ6, � P6 Plan review (25% of permit fee)
Authorized signature: , /// / State surcharge (8% of permit fee) / q, 00 s
me g ' / -- " / / TOTAL PERMIT FEE ' 7 ,
Print na��7 KG v i -_. e- L. Pi Date4. 1 This permit application expirs if a permit is not obta...... wun la
{ {{ 180 days after it has been accepted as complete.
'Fee methodology set by Tn -County Building Industry Service Board.
I \BwldingTamsb1PLM- PamnApp doc 06126/06 440- 4616T(16/77.1COMAVEB?
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 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 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:
$50,001 00 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Fixture Work: Plan Review for Plumbing Installations
Are you capping, adding or replacing fixtures? If "yes", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees *. ❑ Any new commercial building with water service 2" and
Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: Replace engineer.
Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash - Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic
Drinking Fountain Isometric or Riser Diagram
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain/sink -2" that meet the qualifications above.
-3"
-4"
Car Wash Drain Comments regarding fixture work:
Garbage - Domestic
Disposal - Commercial
-Industrial •
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall *Note: If the fixture work under this permit results in an
Sink - Bar/Lavatory Z, increase of sewer EDUs, a sewer permit will be issued and
- Bradley fees assessed for the sewer increase must be paid before the
- Commercial
Service plumbing permit can be issued.
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures.
i \Buddmg\Pamos \PLM- PamitApp doc 0982/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007 -00146
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/8/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 7/2/2007 TIME: 7:02AM PAGE: '16
SITE ADDRESS: 03469 SW WASHINGTON SQUARE RD A10 CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: MAGGIE MOO'S/AUNTIE ANNE'S
DESCRIPTION: Interior fixtures. Other fixture mop sink.
OWNER: WASHINGTON SQUARE LLC, PHONE #:
CONTRACTOR: RH KUNSELMAN PLUMBING PHONE #: 503 -262 -8337
Inspection Request Scheduled For: Date: 7/2/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 051293-01 503 -793 -7888 N
Corrections /Comments /Instructions:
�/ / •
d -
111 P' SS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: vi Date: w ) Phone #: (503) 718 -
CITY OF TIGARD .''
BUILDING DIVISION PERMIT #: PLM2007 -00146 . '
13125 SW Hall Blvd., Tigard, OR 97223 t DATE ISSUED: 518/2007
Phone: (503) 639 -4171 �
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 502502007 TIME: 7:17AM PAGE: '11
SITE ADDRESS: 09469 SW WASHINGTON SQUARE RD A10 CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: MAGGIE' MOO'S /AUNTIE ANNE'S
DESCRIPTION: Interior fixtures. Other fixture mop sink.
OWNER: WASHINGTON SQUARE I_LG, PHONE #:
CONTRACTOR: RH KUNSELMAN PLUMBING PHONE #: 503-262-8337
Inspection Request Scheduled For: Date: 5/2512007 Pour Time:
Code # Inspection Description . Confirm # Contact # Message
320 Plumbing rough -in 049108 -01 503-793-7888 Y
Corrections /Comments /Instructions:
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La„ » -La.+c_ X') vet ,p eo - 1) a4 r - t — :
❑ PASS Xr PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: CTb L,rn_A 1 1 -- Date: S12, l «) Phone #: (503) 718-
Y T R
CITY OF ■IG�A■lD - T
1 ` BUILDING DIVISION A PERMIT #: PLM2007 -00146
13125 SW Hall Blvd., Tigard, OR 97223 , , DATE ISSUED: 5/8/2007
Phone: (503) 639 - 4171
Inspection Requests (24 Hrs.): (503) 639 -4175 , �_: "'f �..
INSPECTION WORKSHEET FOR DATE: 5/11/2007 TIME: 7:01AM PAGE: 72
SITE ADDRESS: 09469 SW WASHINGTON SQUARE RD AlO CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: MAGGIE NMOO'S/AUNTIE ANNE'S
DESCRIPTION: Interior fixtures. Other fixture mop sink.
OWNER: WASHINGTON SQUARE LLC, PHONE #:
CONTRACTOR: RH KUNSELMAN PLUMBING • PHONE #: 503 -262 -8337
1
Inspection Request Scheduled For: Date: 5111 /2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
305 Plumbing underslab 048132 -01 503-793-7888 Y
Corrections /Comments /Instructions:
07- / - , 7 2 ,..e vii ( --- i e.. 2 fe (vi ..."-
c
,
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 1 Date: ` P hone #: (503) 718- ) 0