Permit • II CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00053
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/14/2008
PARCEL: 1512600 -00300
SITE ADDRESS: 09619 SW WASHINGTON SQUARE RD L04 ZONING: C - G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
PROJECT: POTTERY BARN
Project Description: Fixtures: Add, cap and replace. Other fixture (2) drinking fountains.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: M FLOOR DRAINS; 3 TRAPS:
STORIES: WATER HEATERS: 2 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 2 URINALS: GREASE TRAPS:
LAVATORIES: 4 OTHER FIXTURES: 2
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 4 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 2/14/2008 $282.20
TIGARD, OR 97223 [TAX] 12% State Surch 2/14/2008 $33.86
Phone : Total $316.06
Contractor:
BRUNER PLUMBING
PO BOX 23985
TIGARD, OR 97281 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503 -624 -4880
FAX 503- 624 -2173
Reg #: LIC 81837
PLM 26 -445PB
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: ' therou �/ Permittee Signatur
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.
+a t o_4- -3 _ .'4 - (b, E Plumbing Permit Applicant o - ,o_ r
`J
• r v , d FOR OFFICE USE ONLY
14 City of Tigard DateBy l ' 6 Permit Nu Uh 2,0a -0005;
V 13125 SW Hall Bl vd., Ti gard, OR 9 722 i� 1 �'= 2008 Plan Review /
2 Phone. 503.639.4171 Fax 19,60_ Date/By: Other Permit No
Inspection Line: 503.639 4175�I 1 1 U-• 1 s -kyy t 1 I 'late Ready/By m Page 2 for
TIGARD y B y y; ® See Pa g
Internet. www tigard -or.g T T7° .tilied/Method. - ++ Supplemental Information
TYPE OF WORK t FEE* , SCHEDULE
El New construction ❑ 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 CONSTRUCTION SFR (I) bath 249.20
❑ 1- and 2- family dwelling Commercial /industrial SFR (2) bath 350 00
❑ Accessory building ❑ Multi - family SFR (3) bath 399 00
Each additional bath/kitchen 45.00
❑ Master builder _. ❑ Other:
Fire sprinkler ( sq ft) Page 2
i I, ) 9 JOB SITE_ I NFORMATION AND LOCATION Site utilities
Job site address: 9(0 / 9_ J k ,� / w f o v6 c t Catch basin or area drain 16.60
City /State /ZIP: ( 9 / I z Drywell, leach line, or trench drain 16.60
Suite/bldg./apt. no.: Project name: PO N ,� / may
Footing drain (no linear ft.. ) Page 2
( / J � ,/ 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 OF WORK Backflow preventer Page 2
Backwater valve 16 60
Clothes washer 16.60
Dishwasher 16 60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16 60 _ .A_ _>■ic
Ejectors/sump 16 60
Name: Expansion tank 16 60
Address: Fixture /sewer cap • 16.60
City/State /ZIP: Floor drain/floor slnk/hub 3 X 16 60
( )
Phone: ( ) Fax: Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16 60
' Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value $ ) Page 2
Address: Primer 16 60
City /State /ZIP: s � (r Roof drain (co? cial) 16 60
'Smbasin/laAt6ryi g 16 60
Phone: ( ) J Fax: : ( )
Tub /shower /shower pan 16 60
E -mail: Urinal 16.60
CONTRACTOR Water closet 4. - 16.60
Business name: 6 Y' V vtene L/ .- 5 y,-c, Water heater Z 16.60
Address: (9, 01 , 6 Z3 Cl e s Other —
City/State /ZIP: 77- ^ � 1 /7 Z F j - 3 a-A`i Subtotal
f � � .
Minimum permit fee $72 50
Phone: Sd3) 6,2„4 veg O Fax: (j a3 ) G Z c( �t 7 3 Residential backflow minimum permit fee $36 25 oN. pc .0S0
CCB Lic.: Se ( tr 3 "7 Plumbing Lic. no.: �� - 4/YS-Ye) . Plan review (25% of permit fee)
State surcharge (12% of permit fee) 5 3. 5e.lo
Authorized signature:
____- TOTAL PERMIT FEE giko .
Print name: 6✓l q t," p-- Date: / y l o p This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board
1 \Buddmg\Permits\PLM- PermtApp doc 12/27/06 440- 4616T(10 /02/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
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
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 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
and including $50,000 00
specially requested inspections - per hour 72 50
Subtotal: $50 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, adding or replacing fixtures? If "yes ", Plan Review for Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees * . Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixture Type: Replace greater, except systems designed and stamped by licensed
Previous Capped Added Existing engineer.
Baptistry/Font
Tub /Sr ❑ New exterior plumbing site utilities for any complex structure
Bath -Tub/Shower Tub /S owerlpool as defined in OAR918- 780 -0040.
Car Wash -Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive Stall ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain ! /'
Eye Wash Isometr or -Riser Diagram
Floor Drain/sink - 2" Z - % - ❑ Isometric or riser diagram is required for new buildings
3 that meet the qualifications above.
-4"
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach /Refrig Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar avator? Z *Note: If the fixture work under this permit results in an
- Bra
Commercial increase of sewer EDUs, a sewer permit will be issued and
- ervice / / fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes
Water Extractor
Water Closet - Toilet 2- / /
Urinal
Other Fixtures.
I \Building\Permits\PLM- PermiApp doc 12/27/06
Accumulative Sewer Tally Parcel # 1S12600 -00300
Tenant Name: Pottery Barn .. This SWR# CREDITS TO BE APPLIED( $1680.00)
Site Address 9619 SW Washington Sq Rd. This Pi.i\1# 2008 -00053
Itixture 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 - l :ach 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 1 1 1 1 0 0
I ,ve Wash 1 0 0 0 0 0
Hour Drain /Sink - 2 inch 2 0 2 4 1 2 -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 1 -1P) 16 0 0 0 0 0
- Commercial (to 5 i -1P) 32 0 0 0 0 0
- Industrial (over 5 i -IP) 42 0 0 0 0 0
ice \lachine /Refrigerator Drain 1 0 0 0 0 0
— 011 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 2 4 1 2 -1 -2
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 0 0 0
- Service 3 0 1 3 1 3 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 0 0 0 0 0
Water I?xtractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 2 12 1 6 -1 -6
Urinal 6 0 0 0 0 0
Previous I?DU Count 0 0
Capped [DU Credit 0
TOTALS 0 _ 0 8 24 5 14 -3 -10
Current Fixture Value -10 divided by 16 = -0.6 Current EDU 1 EDU = S 2,800
Previous Fixture Value 0 divided by 16 = 0 0 Previous EDU
Change -10 divided by 16 = -0 6 over (under) $ (1,680 00)
Enter EDU Change Here -0 6
Notes.
Authorized Name /Signature: Barbara But tier Credits to apply to later permits Date: 02/14/12008
Building Division
Note The property owner shall retain the ORIGiNAI, sewer tally record If credits exist, this document will serve as a voucher which must be
submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
I \ Budding \ Forms \Scwer'I'allyShcct xis 1)2/02/117
CITY OF TIGARD ,
BUILDING DIVISION ERMIT #: PLM2008-00053
13125 SW Hall Blvd., Tigard, OR 97223 TE ISSUED: 2/1412000
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 5113/2008 TIME: 7:02AM PAGE: 21
SITE ADDRESS: 09619 SW WASHINGTON SQUARE RD LU4 CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: POTTERY BARN
DESCRIPTION: Fixtures: Add, cap and replace. Other fixture (2) drinking fountains.
OWNER: WASHINGTON SQUARE LLC, PHONE #:
CONTRACTOR: f3RUNER PLUMBING PHONE #: 503 - 4880
Inspection Request Scheduled For: Date: 5/13/2008 Pour Time: IA A!
Code # Inspection Description Confirm # Contact # Mes ag
399 Plumbing final 069797 -01 503.624 -4880 Y
Corrections /Comments /Instructions:
1 . \it t i \ )( (v .d . )0
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED . 3 4 Inspector: _ Date: W #: 718 - v 2f,
p Date. Phone (503) /
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PL.M t008-0O053
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2I14/200f
Phone: (503) 639 -4171 ,weq� 1
Inspection Requests (24 Hrs.): (503) 639 -4175 ': °'I I..
INSPECTION WORKSHEET FOR DATE: 4/1/2008 TIME: 7 :01AM PAGE: 31
SITE ADDRESS: ()9619 SW WASHINGTON SQUARE RD 1.04 CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: POTTERY BARN
DESCRIPTION: Fixtures: Add, cap and replace. Other fixture (2) drinking fountains.
OWNER: WASHINGTON SQUARE LLC, PHONE #:
CONTRACTOR: BRUNER PLUMBING PHONE #: 5036244000
Inspection Request Scheduled For: Date: 4/1/2000 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 067634.01 503- 624 -41380 Y
Corrections /Comments /Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: al \ 1. A -J M\ 45• Date: LI ( 1 \/O Phone #: (503) 718-
CITY OF TIGARD 'd - ••
BUILDING DIVISION PERMIT #: PLM2008.00053
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2J14/2009
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175 __..
INSPECTION WORKSHEET FOR DATE: 3/31/2008 TIME: 7:01AM PAGE: 5
SITE ADDRESS: 09619 SW WASHINGTON SQUARE RD L04 CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: POTTERY BARN
DESCRIPTION: Fixtures: Add, cap and replace. Other fixture (2) drinking fountains.
OWNER: WASHINGTON SQUARE LLC,
PHONE #:
CONTRACTOR: BRUNER PLUMBING PHONE #: 6 03 - 624 - 4880
Inspection Request Scheduled For: Date: 3/31/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 067592 -01 503.624 -4880 Y =
Corrections /Comments /Instructions: 61
U,5 ■■<, 2 " LaA>
°wk.
. m/A-7-A �,,� �; i,� l�v►.��e. �- se. �Cb ��
M o p S LC 4— fie r�
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: �" Vim. - Date: -3 1 1 CA Phone #: (503) 718
. R
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2008 -000 3
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2//4/2008
Phone: (503) 639 - 4171^'
Inspection Requests (24 Hrs.): (503) 639 -4175 F 'I � ..
INSPECTION WORKSHEET FOR DATE: 2/29 /2008 TIME: 7:03AM PAGE: 19
SITE ADDRESS: 09619 SW WASHINGTON SQUARE RC) L04 CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: POTTERY BARN
DESCRIPTION: Fixtures: Add, cap and replace. Other fixture (2) drinking fountains.
OWNER: WASHINGTON SQUARE LLC, PHONE #:
CONTRACTOR: BRUNER PLUMBING PHONE #: 503 -6241 -4880
Inspection Request Scheduled For: Date: 202912008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
30 Plumbing underslab 065907-01 503-- 624 -4880 Y
Corrections /Comments /Instructions:
iii PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: rit\i/m-AV V"'........-- Date: 21QP11 Phone #: (503) 718-