Permit ;...-
C ITY OF TIGARD PLUMBING PERMIT
l� DEVELOPMENT SERVICES PLUMBING
PLM2006 -00031
el DATE ISSUED: 1/25/2006
1 3125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1S12600-00300
SITE ADDRESS: 09581 SW WASHINGTON SQUARE RD B8 ZONING: C - G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
Project Description: Sony Style. Replace (1) lay, (1) water closet.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: M FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: 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
BY THE MACERICH COMPANY Description Date Amount
9585 SW WASHINGTON SQUARE RD [PLUMB] Permit Fee 1/25/2006 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcha 1/25/2006 $5.80
Phone : Total $78.30
Contractor:
MODERN PLUMBING
11120 SW INDUSTRIAL WAY
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503 -691 -6166
FAX 503 -691 -6771
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 -6699 or 1- 800 - 332 -2344.
•
Issued By: Permittee Signature: / _ / ■ 7.
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that , - i n ess day. /
This permit card shall be kept in a conspicuous place on the job site un it completion of the project.
Approved plans are required on the job site at the time of each inspection.
`i.Builfding Fixtures •
Plumbing Permi Ap t T 1t.� t EIVED E® 1 OIt OFFICE USE ONLY
City of Tigard -06 z- Perm N. U Lev • - dap 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 / / , >< 1�C, i ;\ Date
CITY OF TIOA' , Daze Ready/By: Other Permit No.:
I �
24 - Hour Inspection Line: 503.639.4175 � ®See Page 2 for
Internet: www.citigard.or.us 1,
BUILDING DIVISION Noufied/Method � °g U Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ Nstruction ❑ Demolition For special information use checklist
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 CONS�TR _ SFR(1)bath 249.20
p
❑ 1- and 2 -family dwelling commercial /industrial SFR (2) bath 350.00
❑ 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 j� Site utilities
Job site address: O `` r )9 ( \ IJ w�� yl � � ,( Catch basin or area drain 16.60
City /State/ZIP: i � � �'7, • °� Drywell, leach line, or trench drain 16.60
S Footing drain (no. linear ft. ) Page 2
Suite/bldg./apt. no. R3,- � Project name: C ( D ts-
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 ft.: ) Page 2
Fixture or item
Tax map/parcel no.: Absorption valve 16.60
�, . DESCRIPTION O l Back Flow preventer Page 2
e �Wl rJ, ,, l ,c, "-rile e -Q-x ( Ti l ✓L Backwater valve 16.60
�, Clothes washer 16.60
Dishwasher 16.60
'❑ PROPERTY OWNER I "TENANT Drinking fountain 16.60
Ejcctors/sump 16.60
Name: �A C ��/� l �, i v1C Expansion tank 16.60
Address: , t Q - - v - `, ` v l Fixture /sewer cap 16.60
City /State /ZIP: j7 av c „ t�, il.tr D / 1,2S to n Floor drain/floor sink/hub 16.60
Phone: ( Dj ) -ism J Fax: ( ) J J Garbage disposal 16.60
Hose bib • 16.60
PLICANT ❑ CONTACT PERSON
Ice maker 16.60
Business name: U `+P/ ./1 t*YU � PM Interceptor /grease trap 16.60
Contact name: p `�,
I ' 1 Medical gas (value: $ ) Page 2
Address: / p/ � � `-- Primer 16.60
C ity/State/ZIP: I ,ek e , . f Roof drain (commercial) 16.60
��`fff""""'�" III V!/Lv l ,,(' Sink/basin/lavatory / 16.60
Phone: • - l-( Fax: : (✓z) V/ - i
Tub /shower /shower pan 16.60
E-mail : &O (t A Urinal 16.60
\. - CONTRACTOR Water closet / 16.60
Business name: t y 1 k, Lei, ���{� V � ( Water heater 16.60
Address: t Y A�Ce�� o Other:
Subtotal
City /State /ZIP: Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee. $36.25
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
/ / State surcharge (8% of permit fee)
Authorized signature: I TOTAL PERMIT FEE
Print name: ar�t e '
� Date: �if 23 This permit application expires if a permit is not obtained within
� ' " 180 days after it has been accepted as complete.
Or / *Fee methodology set by Tri-County Building Industry Service Board.
i \Bwlding\Pennits\PLMF- PennitApp doc 06/05 440- 4616T(IW02/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
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 Val11at10D• 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
Q ty. Fee (ea) Total additional $100.00 or fraction thereof to and
Fixture or Item 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 0 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 buildin ,
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. . '
❑ A
Dishwasher -Commercial g
a Any new residential building containing three (3) or more
- Domestic _ dwelling units. .
Drinking Fountain
Eye Wash ❑ Any NFPA 13 -D multipurpose fire Eye 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 - 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. ,
i \Buiidmg\Pennns\PLM- PermitApp doc 07/06/05
/ I Y OF TIGARD T O CARD -- /DL,iii
BUILDING DIVISION PERMIT #:206. — POO 3/
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 Ah A
Inspection Requests (24 Hrs.): (503) 639 -4175 . ^'I �..
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: ST/ ii) /4 • S r CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 3 -2.-3-6 6 Pour Time: /T , iv ,
Code # Inspection Description Confirm # Contact # Message
39q , � " � Ol - ? ( J C
Corrections /Comments /Instructions: /
C 15 S �nh L
,/
kini ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: /11 v � - Date: - o I r Phone #: (503) 718-
-- — �