Permit CItY OF TIGARD PLUMBING PERMIT
�i DEVELOPMENT SERVICES PERMIT #: PLM2004 -00092
X11 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/2/04
SITE ADDRESS: 09633 SW WASHINGTON SQUARE RD FC -4 PARCEL: 1S12600 -00300
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: 2 TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 2 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Relocating (2) sinks, (2) floor drains and (1) water heater.
FEES
Owner:
Description Date Amount
PPR WASHINGTON SQUARE LLC
BY THE MACERICH COMPANY [PLUMB] Permit Fee 3/2/04 $83.00
9585 SW WASHINGTON SQ. RD. [TAX] 8% State Surcharl 3/2/04 $6.64
PORTLAND, OR 97223 Total $89.64
Phone :
Contractor:
PMSI LLC
21195 NW EVERGREEN PKWY STE 20
HILLSBORO, OR 97124 REQUIRED INSPECTIONS
Phone : 503 Rough -in Insp
Final Inspection
Reg #: LIC 158286
PLM 34 -434PB
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
..fil,' A
I sued By:1 ; I i � / Permittee Signature: �:��� Ate,
Call (503) —9-4175 by 7:00 P.M. for an inspection needed the next business day
1. a u...,:9-000 -oe)(014/ •
_ j FkuinbingPermitApplication ( „ (I t 1 \i
• Date received: AM' Permit no.: i .. •� , i i
�l CI � of Std
Address: 13125 S Hal Sewer permit no.: , , Aaildin®. •
City of Tigard Phone: (503) 639 - 4171 111 Project/appl. no.: _ date:
Fax: (503) 598 -1960 • 200 Date i ssued: ,' �/' Receipt no.:
Land use approval: MAR Case file no.: .. Payment type:
ARD
❑ 1 & 2 family dwelling or accessory ercial/industrial 0 Multi - family 0 Tenant improvement
❑ New construction ddition/alteration/replacement ❑ Food service O Other.
.101i1 S111 l \10101 \ 11O\ 1 1:1: St 111.1)1 I1•. (lm •Itcci:11 i lwinalii'n a'c clic(klisI)
Ilescripthm Qty. Fee(ea.) Total �
Job address: 9(p3.3 SKI tvASwi ti(�lDti sr� v�r� lam, Net. 1 - and �raotity dwellings only:
Bldg. no.: Suite no.: C- (des 100 ft. for each utility comedian)
Tax map /tax lot/account no.: 76./A 600 -.r.)0360 it p SFR (1) bath
Lot: !Block: [ Subdivision: SFR (2) bath
Project name: f1fE7j4.L PREfl E,L SFR (3) bath
City/county: Ob Qg.0 OR,. I ZIP: q /a4,3 Each additional bath/kitchen
Description and location of work on premises: Siiteutilities:
Catch basin/area drain
Est. date of completion/inspection: Drywells/leach line/trench drain
Fo dra (no. tin. ft.)
Manufactured home utilities
Business name: P msi, ad, Manholes
Address: �Iq5 Nit) eveitb ie PKGUY STE my Rain drain connector
City : j./ t t:SeQ1 I State: oo I ZIP: gW-aq Sanitary sewer (no. lin. ft.)
Phone: Iii- in(p(p -ug4 I Fax: (,G- tat I E -mail: _ Storm sewer (no. lin. ft.)
CCB no.: 12,0, t /,,/ g j Plumb. bus. reg. no: 3 tai _ Water service (no. lin. IL)
City/metro lic. no.: / 2 /�/S Fixture or item:
Contractor's representative signature: *i.JUNI 4 0.0 Absorption valve
°� Back flow venter
Print name: f nd iv /fl4 rl is /D Da e: 3 l 0 Backwater valve
Basins/lavatory
Name: 8144 NE Fillua Clothes washer
Dishwasher
Address: 1,10.5 NW EMIChILUEN PKWY St 2.04 - Drinking fountain(s)
City: 444 uS BMW I State: 0 R I ZIP: gyp./ Ejectors/sump
Phone: (p , Z Fax: y(0(I. U. l ( E -mail: Expansion tank
Fixture /sewer ca .
Name (print): Floor drains/floor sinks/hub / • 3. Ao
Mailing address: Garbage disposal -
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 Primers)
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) Al (z (P0 35. Ste
Owner's signature: Date: S um
Tubs/shower /shower pan
Name: Urinal
Address. Water closet
Water heater ( /101010 /6.
City: I State: I ZIP: Other.
Phone: I Fax: I E - mail: Total _ y�q
N • all jurisdictions accept • - it cede, p 1- cell diction for mom information. Minimum fee $ u 5-
• -. Notice: This permit application Plan review (at _ '/0) $
visa :. , . ' `, i .;.. e xp ires if a permit is not obtained o
- .,r c 4 • ,1. t : , _ : Y rq ,_ : 1D/ l07 State surcharge (8/0) .... $
Expires w i t hin 180 da s after it has been
tsI1rii Le/�:1I111 y TOTAL $ 3'
accepted
.me . eo;l /1� '!!:r, + $ accepted as complete.
r yv
Cardholder signature Amount 440 .4616 (6/00/COM)
Z0'd TTEE99t'20S ISW ET:2T b00Z -TO -?idW
' CITY OF TIGARD 24 -Hour
BUILDING 411 Inspection Line:, (503) 639 -4175
INSPECTION DIVISION Businesg ;one: (503) 639 -4171 MST •
BUP
Received Date Requested AM PM BUP
Location 9 3 3 S Q • Suite MEC
Contact Person —� -v- Ph ( ) 7 �° �O - Z Z Z L- PLM 0 e o ZR
Contractor Ph ( ) SWR
BUILDING Tenant/Owner / / � _ / ELC
Footing •
Foundation ELC
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
P RT FAIL
LU
-
am •
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
( Ot�er:
'-•t • 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 0 Please call for reinspection RE: 0 Unable to inspect - no access
Fire Supply Line
ADA - (f / `./ Approach/Sidewalk Date Inspector - Est
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
•