The URL can be used to link to this page

Permit • CITY OF TIGARD PLUMBING PERMIT PERMIT #: PLM2002 -00060 ' DEVELOPMENT H Hall SERVICES CS ) 639 -4171 DATE ISSUED: 2/22/02 SITE ADDRESS: 09619 SW WASHINGTON SQUARE RD L -4 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: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: 0 URINALS: GREASE TRAPS: LAVATORIES: 1 OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: 1 WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Cap 3 fixtures. 1 lay., 1 water closet, 1 2" floor drain. FEES Owner: • Type By Date Amount Receipt PPR WASHINGTON SQUARE LLC PRMT CTR 2/22/02 $72.50 27200200000 X 21545 5PCT CTR 2/22/02 $5.80 27200200000 SEATTLE, WA 98111 Total $78.30 Phone 1: Contractor: EURO PLUMBING 2012 SE BLAIRMONT DR VANCOUVER, WA 98683 REQUIRED INSPECTIONS Phone 1: 360 - 882 -8199 Insp existing /capped fixtures Reg #: PLM 37 -486PB Final Inspection LIC 141361 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 -0080. You may obtain copies of these rules or direct questions to OUNC by calFng •03) 246-1• Issued B L0 / ,a Permittee Signature: a w Call (503) 639 -4175 by 7:00 P.M. for an inspection need -d thext business day 1 Plumbing Permit Application . / 2 F Date received Permit no. L/✓l .)e../0 - Ok '= -, Cil of Tigard d' 1 i Sewer permit no.: Building permit no.: Address: 13125 SW Hall Blv Tigard, OR 97223 CiryofTigard Phone: (503) 639 - 4171 Project/appl.no.: Expire date: Fax: (503) 598 - 1960 Date issued: Bytj?v I Receipt no.: Land use approval: Case file no.: Payment type: y TYPE OF PERMIT ❑ 1 & 2 family dwelling or accessory ,tommercial/industrial ❑ Multi- family ❑ Tenant improvement ❑ New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other: JOB SITE INFORMATION FEE SCIIEDULE (for special information use checklist) Job address: 15- e , .5... 1,04 -ll ki , c a. 2b , Description Qty. Fee(ea.) Total Bldg. no.: Suite no.: New 1- and 2- family dwellings only: (includes 100 ft. for each utility connection) Tax map /tax lot/account no.: SFR (1) bath Lot: . Block: Subdivision: SFR (2) bath Project name: \i( J , - )0 )1/1/`- SFR (3) bath City /county: I ZIP: Each additional bath/kitchen Description and location of work on�is: — Site utilities: ^/� ` , tom f- um_ Catch basin/area drain Est. date of completion/inspection: ` Drywells/leach line /trench drain PLUMBING CONTRACTOR Footing drain (no. lin. ft.) Manufactured home utilities - Business_name= j - - - _ -- . = Manholes Address: b r< . gM • Rain drain connector City: A • i i' State: if . . ' Sanitary sewer (no. lin. ft.) Phone: AWYAIDIMMIM1111. E -mail: Storm sewer (no. lin. ft.) CCB no.: '( 3 ('/ Plumb. ■ b r'g. no:. ; , - . 4 y, Water service (no. lin. ft.) City/metro lic. no.: Fixture or item: Contractor's representative signature: �V - Absorption valve Print name: t/ Back flow preventer Backwater valve CONTACT PEI:SON Basins/lavatory Name: Clothes washer Dishwasher Address: Drinking fountain(s) City: I State: I ZIP: Ejectors/sump Phone: Fax: E -mail: Expansion tank OWNER Fixture/sewer cap r;. Floor drains/floor sinks/hub Name (print): Garbage disposal Mailing address: Hose bibb City: I State: I ZIP: Ice maker Phone: I Fax: I E -mail: Interceptor /grease trap Owner installation/residential maintenance only: The actual installation Primer(s) will be made by me or the maintenance and repair made by my regular Roof drain (commercial) employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s) ( aCt Owner's signature: ' Date: Sump Tubs/shower /shower pan Urinal Name: Water closet ( Address: Water heater City: State: ZIP: Other: jvj -o-,u. itAii, / Phone: Fax: E -mail: Total / Not all jurisdictions accept credit cards, Please call jurisdiction for more information. Notice: This permit application Minimum fee $ ti a ❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $ Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ S- c(d Ex TOTAL $ Name of cardholder as shown on credit card accepted as complete. $ 17 Cardholder signature Amount 440-4616 (6/00/COM) • • / PLUMBING PERMIT FEES: 1 • . PRICE TOTAL New 1 and 2- family dwellings only: FIXTURES (individual) ,QTY ,• (ea) AMOUNT (Includes all plumbing fixtures In PRICE TOTAL Sink %. 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT Lavatory 16.60 for each utility connection) / One (1) bath $249.20 Tub or Tub /Shower Comb. 16.60 Two (2) bath - $350.00 Shower Only 16.60 Three (3) bath $399.00 Water Closet / 16.60 SUBTOTAL Urinal 16.60 8% STATE SURCHARGE Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL Garbage Disposal 16.60 TOTAL Laundry Tray 16.60 ing Ma ine 16.60 FloorDraiNFl r Sink 2" 16.60 3" 166.660 0 PLEASE COMPLETE: 4" 16.60 Water Heater 0 conversion 0 like kind 16.60 Quantity by Work Performed Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/ permit. Ca ed MFG Home New Water Service 46.40 Sink MFG Home New San/Storm Sewer 46.40 Lavatory Tub or Tub /Shower Hose Bibs 16.60 Combination Roof Drains 16.60 Shower Only X Drinking Fountain 16.60 Water Closet / X Urinal Other Fixtures (Specify) 16.60 Dishwasher Garbage Disposal Laundry Room Tray Washing Machine Floor Drain /Sink: 2" / k Sewer - 1st 100' 55.00 g• Sewer - each additional 100' 46.40 4" Water Service - 1st 100' 55.00 Water Heater Water Service - each additional 200' 46.40 Other Fixtures (Specify) Storm & Rain Drain - 1st 100' 55.00 Storm & Rain Drain - each additional 100' 46.40 Commercial Back Flow Prevention Device 46.40 Residential Backflow Prevention Device' 27.55 Catch Basin 16.60 Inspection of Existing Plumbing or Specially 62.50 Requested Inspections per/hr COMMENTS REGARDING ABOVE: Rain Drain, single family dwelling 65.25 Grease Traps 16.60 QUANTITY TOTAL Isometric or riser diagram is required if � �� Quantity Total is > 9 *SUBTOTAL 8% STATE SURCHARGE **PLAN REVIEW 25% OF SUBTOTAL Required only If fixture qty. total is > 9 TOTAL $ ,/ * Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow Prevention Device, which is $36.25 + 8% state surcharge ** All New Commercial Buildings require 2 sets of plans with Isometric or riser diagram for plan review. is \dsts \forms\plm - fees.doc 12/26/01 Accumulative Sewer Tally Tenant Name:Pottery Barn This SWRia NA Site Address:9619 SW Washington Sq. This PLM# 2002 -00060 . Fixture Value Previous Previous Credits Capped Fixture Fixture New New # value capped off value added added total total count " off #s count # value #s values Baptisery/Font 4 0 0 0 0 0 Bath - Tub /Shower 4 0 0 0 0 0 - Jacuzzi/Whirlpool 4 0 0 0 0 0 Car Wash - Each Stall 6 0 0 0 0 0 - Drive through 16 0 0 0 0 0 Cuspidor/Water Aspirator 1 0 0 0 0 0 Dishwasher - Commercial 4 0 0 0 0 0 - Domestic 2 0 0 0 0 0 Drinking Fountain 1 0 0 0 0 0 Eye Wash 1 0 0 0 0 0 Floor Drain /Sink - 2 inch 2 0 1 2 0 -1 -2 - 3 inch 5 0 0 0 0 0 - 4 inch 6 0 0 0 0 0 - Car Wash Drn 6 0 0 0 0 0 Garbage Disposal - Domestic (to 3/4 HP) 16 0 0 0 0 0 - Commercial (to 5 HP) 32 0 0 0 0 0 - Industrial (over 5 HP) 48 0 0 0 0 0 Ice Machine /Refrigerator Drain 1 0 0 0 0 0 Oil Sep (Gas Station) 6 0 0 0 0 0 - - Rec. Vehicle Dump station 16 0 0 0 0 0 Shower - Gang (per head) 1 0 0 0 0 0 - Stall 2 0 0 0 0 0 Sink - Bar /Lavatory 2 0 1 2 0 -1 -2 - Bradley 5 0 0 0 0 0 - Commercial 3 0 0 0 0 0 - Service 3 0 0 0 0 0 Swimming Pool Filter 1 0 0 0 0 0 Washer - Clothes 6 0 0 0 0 0 Water Extractor 6 0 0 0 0 0 Water Closet - Toilet 6 0 1 6 0 -1 -6 Urinal 6 0 0 0 0 0 Previous EDU Count 1.44 23.04 23.04 Capped EDU Credit 0 TOTALS 0 23.04 3 10 0 0 -3 13.04 Current Fixture Value 13.04 divided by 16 = 0.8 Current EDU 1 EDU = $2,300.00 Previous Fixture Value 23.04 divided by 16 = 1.4 Previous ED Change -10 divided by 16 = -0.6 over (under) $ 1,380.00, CQElp lT'7JE Enter EDU Change Here 0.6 HISTORY Notes: PLM# EDU# SWR# PLM# EDU# SWR# PLM# EDU# SWR# . Name:.. , .` -- _i . _ _ / Dater -no"t - wZ Signature of person that calculated this tally sheet and date perfromed is required GI° TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 IIQSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Requested ' Ua AM PM BUP Location 9 6 / q irdfr, . «-P Suite MEC Contact Person Ph ( ) oU c 7 c9- s8 `t PLM 0004.0 Contractor Ph ( ) SWR BUILDING Tenant/Owner /. �Lr Gi ELC Footing 09. ELC Foundation Access: Ftg Drain 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 • PASS PART FAIL Pos Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole • Storm Drain Shower Pan O In PART FAIL MECHANICAL Post & Beam Rough -In Gas Line • Smoke Dampers ' Final PASS PART FAIL ELECTRICAL Service Rough -In UG/Slab Low Voltage Fire Alarm Final 0 Reinspeclion fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA Date . �� - Ins ector2 // L 4� Ext Approach/Sidewalk P Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL