Permit O sr
CITY TIGARD PLUMBING PERMIT
, ,I 4 ' DEVELOPMENT SERVICES PERMIT #: PLM2005 -00690
� �I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 1/26/2006
PARCEL: 1S12600-00300
SITE ADDRESS: 09681 SW WASHINGTON SQUARE RD C6 ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
Project Description: Plumbing fixtures. Relocating only, no sewer tally required.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: 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 Description Date Amount
BY THE MACERICH COMPANY
9585 SW WASHINGTON SQUARE RD [PLUMB] Permit Fee 1/26/2006 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcharl 1/26/2006 $5.80
Phone : Total $78.30
Contractor:
JACK CORMAN PLUMBING INC
7483 SE JOHNSON CREEK BLVD REQUIRED ITEMS AND REPORTS
PORTLAND, OR 97206
Contact # : PRI 788 - 6947
FAX 503- 788 -6949
Reg #: LIC 88311 pPR
V E
PLM 3 -198PB ? if uu u
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 -6 99 or 1- 800 - 332 -2344. ��
Issued By: Permittee Signature: /�[
4 . .a02 /;2
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.
12/13/2005 09:38 8585928829 { PAGE 03
s
SC': ,�r+EXPRESS PERMITS is Fester ; fi 3103280338; Dec -12 -05 5:24PM; Pege 5/9
r
City of � � � ^- 1 A 1° , , 1 tfo
1 nom 50&, i .t9s:19w 10. PR i � � .. t :I. swabs
24 floor Impaction Liam tas. �tgS % G 0\" '' O . ! r rA , r.- r • , r.�, n "D �
ww 7 ''. d:oras ' , n t.5 ,.� ■ t p - , = , , . , . 1. I ;l , ", i ∎t . ,1: ■
L
i ' A , •
0 Novi
. , ❑ O Now t -2.11ally &Map (ottlatko 100 21j 1
_ - • r :- - c T ,4L 7 rl.,a: rY e. 1J 1V, /OS.;, V ''i Sli M116b ;Je.{1V
11C3D 45.00 iJml�MwS 17 ! - Fat add6lapdb
❑ Y �-� ) In Yege2 MUM i''
{ ,,, ,; ;- I ?,r .. , r. - . I , / . . ...m R.n }r .i�t+� sS T� kL. ;'i 1
cl ,,. ' s� _ $ d wi 1 , - /W/ulrr� • 41 o�baiaa'a ea t+ ern MI ,660 r
y o 'admire �,�•�• /e- - ( 2-2 3 13ryne 1, iaaeb k ca lamb
Sdkdbtdg./ap1 - >t6 40 4 P 10 0 14166111 C ,i4.•010 ' ' Al: • IIIIIII 110"
3•60
CMS, aaneaNdlrorlioea to job a IIIII t 16.60
*lie ova
Balmy atom pm lyrrsl.: ____) 111111E
•
�
pant (60. mar n.:____) . . Iri=1=1:3=731M11121EP71305
Sabdiaiaiom Paslarsas boo 111111=11M1.11 V
T r Pa°2
_ . . \ I . N M F ;S� :1 - '°r V � h �a'� °��c,:j "'I'Y'1�.�6� rA('��. .��.e,A�,
�, rr I' ,.� I �c tlt .1 V r., }1f•r:rytl•Yi�57c`o �t�Y+i�}? rl1. ..r .i- O�aw>A�R � 16.60 mom
��'� • • '' 16.60 IN
Dietravolas 11111 16.60
� l �� (�pa wisher
11 1.1��� Q e � a 1 16'60
.:.., x6.60
� `� w 01LL, i. A ,...., r 16,60
/ }� Fac ( ) 16.60
�� ∎r 1 pp , -,.• , ' _. , 10 16,60 - MINI
:".1: vt • '.k I s . u •` y," ,q;•:AV?96v Y L;• � �•!kJ �al.l _
;> " ha� \. .:c ed: _ 9 16.40
$uem�a imam r1 ) l r t
• Ceapa1 A ► ,I S 1 r ld
Addtas: 0, ► 5 /A v if ( 1660
., '11'1171171'lwl‘T.,10304/4111111111r 16110
: Mum ( (. ) Fax :.(51U ) ''(J 3 ='�� f(�
a6.6o
Waal r 1650
Emma: 0. L . r • ' t n , 14. �y 1xl(ia r .E P i � i l �c - �* - '*`*=.1 I
. � n r ! r, ;: ;nl ,.: :: ;1'.',C .L'.'.\ . 1.1,. ∎ ':4 1 t:... / . � c
��I � . L ,• J .,:. Y�� ... . .: 1 ♦ 16.60
Business tllbmp: �C.1'� l =C) �• �-V Mar
� •L �a 1 50 - So btobi
CI r 6id�S V ►v' , 3 � i 4 fee Sd6.0
> ► ■ ) `1 8 6 ` M' • (4O ? 78 $- 1 Vi I 1�,eda� Peremit 3�.�
• , OM Liw • i allg ► Pl fi 14o. fie.: _;m. j r „ ,
» ate ` 1[L
?ant °M MUM TillIATAIntilli Mk paragt apidesdiss aglow Ka rat* la oat - wilida
Awes �by r a�1rits' 1a Semite Boort
1110 slap Ether tibia WO oroapsos as aaractioto.
Dees .ci�caero m
:•••.:, takaltharoatawlmaaavocied
_ .....
Building Division
,iMr '."I!Li Request for Permit Action or Refund
City of Tigard
TO: CITY OF TIGARD
RECEIVED
Permit System Administrator MAR 174 2006
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard - or.gov CITY OF TIGARD
BUILDING DIVISION
FROM: ❑ Owner ❑ Applicant % Contractor ❑ City Staff
(check one)
o V 0 1 Name: \ , cS ,
(Business or Individual) J U V
Mailing Address: ..5D - .A,rc V1 7 ^ - �
� ��� City /State /Zip: �� .VLF'- SI I I I `Cw fo of
9//e/04, Phone No.: DI 5 1' 6 - 301 o/ / -�- I
✓ e0/1„,s7,
0 s7 , c , N okucati
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
,Er CANCEL PERMIT APPLICATION.
❑ REFUND PERMIT FEES.
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: \... M ?.C:0" D C> 6 ( A()
Site Address or Parcel #: ' L)fvS1-1.1v,a Dl'J % ,, 0
Project Name: [ c\C �` M -
Subdivision Name: Lot #:
EXPLANATION: �D -- C \ jr \ � Lt X - 1'C (= 73-1 :--
Signature: ' ,�_"...■ _.! . Date: DL
.11•0 \ -
Print Name: �A ) IA l 1,S
Refund Policy
I. The Building Official may authorize the refund of:
a) any fee which was erroneously paid or collected
b) not more than 80 percent of the permit fee for issued permits prior to any inspection requests.
c) not more than 80 percent of plan review fee when an application is canceled before any plan review effort has been expended.
2. Refunds will be returned to the original Payer in the same method in which payment was received.
_ FOR Oil US l
Rte to S s Admin: Date ..7 -- - -- B p• ,L_ Rte to Bid! Admin: Date y 4" O6. B E';2
Refund Processed: Date /Fr• 06 B , Invoice Processed: Date B
Permit Canceled: Date ie- as B _ _ l,-„,.,,, Parcel Ta: Added: Date By
Recei it #86 - 3er Date / MEM Method c �k.._ • Amount 8
I:\ Buildmg\Forms\RegPermitAction -B dg.doc 01/20/06