Permit CITY TIGARD PLUMBING PERMIT
l DEVELOPMENT SERVICES PERMIT #: PLM2003 -00426
., I— 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/9/03
SITE ADDRESS: 09530 SW WASHINGTON SQUARE RD H -10 PARCEL: 1S126C0 01107
SUBDIVISION: WASHINGTON SQUARE ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
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: 3
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Plumbing tenant improvement, other fixtures are (1) expansion tank, (1) primer & (1) drinking fountain.
FEES
Owner:
Description Date Amount
PPR WASHINGTON SQUARE LLC
BY THE MACERICH COMPANY [PLMPLN] Plan Review 9/8/03 $33.20
9585 SW WASHINGTON SQ. RD. [PLUMB] Permit Fee 9/8/03 $132.30
PORTLAND, OR 97223 [TAX] 8% State Tax 9/8/03 $10.63
Phone : Total $176.63
Contractor:
KEEFER PLUMBING INCORPORATED
PO BOX 562
HILLSBORO, OR 97123 REQUIRED INSPECTIONS
Rough -in Insp
Phone : 503 640 - 7451 Top -out Insp
Reg #: LIC 65481 Final Inspection
PLM 34 -94pb
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
Issued By: � � Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Building .t ixtures
Plumbing Permit App FOR OFFICE USE ONLY
�� Received Plumbing
Date/By: '/ 0 ' 0 Permit No.: (.1700,--f}" 2 '
Cl of Tigard
Planning Ap.roval Sewer
City g an Date/By: Permit No.: o%03- 19
13125 SW Hall Blvd. Plan Review Other /� (� 22
Tigard, Oregon 97223 Date/By: Permit No.1l/G(1���f J
Phone: 503- 639 -4171 Fax: 503 -598 -1960 too Post Land Use
OY' � +��
Internet: www.ci.tigard.or.us . i e I I Date/By. Case No.:
Contact Juris.: ® See Page 2 for
` -
24 -hour Inspection Request: 503- 639 -4175 - Name/Method: Supplemental Information.
TYPE OF WORK FEE* SCHEDULE (for special information use checklist)
New construction ❑ Demolition Description Fee(ca.) Total
. A ddition/alteration/replacement ❑ Other: N ew 1 - & 2 - family dwellings
CATEGORY OF CONSTRUCTION (includes 100 ft for each utility connection)
El 1 & 2- Family dwelling Commercial/Industrial SFR (1) bath 249.20
SFR (2) bath 350.00
['Accessory Building ❑ - Multi - Family SFR (3) bath 399.00
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00
JOB SITE INFORMATION and LOCATION Fire spnnkler - sq. ft.: Page 2
Job site address: 1 6 0 LO u)4__ii S'0 441 Site Utilities
Suite #: Bldg. /Apt. #: Catch basin/area drain 16.60
Project Name: / � - Co u.. ,-fie„ S .re Fo ra line/trench . linear drain 16.60 Page
�� � Footing drain (no. liar ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60 '
Sanitary sewer (no. linear ft.) Page 2
Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2
Tax map /parcel #: Water service (no. linear ft.) Page 2
DESCRIPTION OF WORK. Fixture or Item
Absorption valve 16.60
.-- ,1.J S4 Q-9-- 1 ) W u.A0 �- r� � CM _ Backflow preventer Page 2
LL.) `�
L lkip Backwater valve 16.60
1 Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60 /6. 60
Ejectors/sump 16.60
Name: Expansion tank / 16.60 /6. 6
Address: Fixture /sewer cap 16.60
City/State/Zip: oor dra' floor sink/hub ,2" ! 16.60 /( (o
Garbage disposal 16.60
Phone: Fax: Hose bib 16.60
❑ APPLICANT ❑ CONTACT PERSON Ice maker 16.60
Name: (Gem(e ..- 0 U6 .
., Interceptor /grease trap 16.60
Address: p. o e-a.a -,, S c'Z Medical gas - value: $ Page 2
City /State /Zip: (-4.. - (I , ( ry 6r 47 (Z Primer / 16.60 /!o. ��
1 .f drain (commercial) 16.60
Phone: 4 ;03 -1.0 0 k-4 Fax: e,3 fc.(R- S`cic, ( ar .asi avatory d- 16.60 3B . at
E -mail: ub /shower showe ppan 16.60
CONTRACTOR Urinal 16.60
Business Name: Ke ,., (k. ,Lr
Water closet 16.60 /6, (/ . dh (oU
� ; � Water heater o-
Q 16.60 � . v
Address: 0 L Other: 1
City /State /Zip: t s ( ( 6-,- ei '112,' Other:
Phone: �� ? LIS1 Fax: 3 - 6 Li i •Scr4,/ Plumbing Permit Fees*
CCB Lie. #: Lc CU k Plumb. Lic. #: AL.( -R
Subtotal $
Lti `1 -1C1 -� Minimum Permit Fee $72.50 $ �{ a
Authorize , t/� �� Residential Backflow Minimum Fee $36.25 /°'
uth
Sign 1 �( _ ' I .,„ 1. .� Date: / Plan Review (25% of Permit Fee) $ ,6' . 9-0
_0_Q
e State Surcharge (8% of Permit Fee) $ / • l0 3
(Please print name) TOTAL PERMIT FEE $ /1(0 • 6, 3
Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or
180 days after it has been accepted as complete. riser diagram for plan review.
*Fee methodology set by Tri -County Building Industry Service Board.
i:\Dsts\Permit Forms\PlmPermitApp.doc 01/03
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 77009 $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 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
additional $100.00 or fraction thereof, to and
Fixture or Item Qty. Fee (ea) Total 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 by (Fixture) Work Performed Comments regarding fixture work:
Fixture Type: Replace
New Moved Existing Capped
Baptistry/Font
Bath - Tub /Shower
- Jacuzzi/Whirlpool
Car Wash -Each Stall
-Drive Thin
Cuspidor/Water Aspirator
Dishwasher - Commercial
- Domestic
Drinking Fountain /
Eye Wash
Floor Drain/sink - 2" r
- 4"
Car Wash Drain
Garbage Domestic *Note: If the fixture work under this permit results in an
Disposal - Commercial increase of sewer EDUs, a sewer permit will be issued and
- Industrial fees assessed for the sewer increase must be paid before the
Ice Mach. /Refrig. Drains plumbing permit can be issued.
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar /Lavatory /
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet /
Urinal
Other Fixtures:
is \Dsts\Permit Forms\PlmPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
. BUILDING (--. Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
c0/2.2_ BUP
Received ¶.11 h -14 Date Requested /O/ AM PM BUP
Location OQ ( Q UI/G>'.5k • S i 'L Suite /4 — 10 MEC
Contact Person ) 660 —74 e -17 . 3 —
Contractor 1 ywy - Ph ( ) SWR
BUILDING . Tenant/Owner 4JYQ 4t
CO fO / - 5 ELC
Footing
ELC
Foundation
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other: ' _ = - - - -
Final
FAIL
;earn
- "Under Slab
Rough -In
Water Service
Sanitary Sewer •
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan \I
• . •
PART FAIL
ANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm •
Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA / 6? 3 /03 l �.�,
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
•