Permit w
CITY TIGARD PLUMBING PERMIT
PERMIT #: PLM2006 -10035
DEVELOPMENT SERVICES DATE ISSUED: 3/21/2006
13125 SW Hall Blvd., Tigard, OR 97223 503- 639 -4171 PARCEL: 1S12600 -00300
SITE ADDRESS: 09710 SW WASHINGTON SQUARE RD F - 1 ZONING: C - G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
Project Description: Reconfigure ADA restroom.
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: 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 4/5/2006 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcha 4/5/2006 $5.80
Phone : Total $78.30
Contractor:
TWO BROTHERS PLUMBING INC
PO BOX 384
BORING, OR 97009 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503 -491 -1246
FAX 503- 668 -8667
Reg #: LIC 131298
PLM 26 -657pb
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: -� A
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.
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City of Tigard Received _ \ , .� ///� ,
13125 SW Hall Blvd., Tigard, OR 97223 M�� 1
j y Date/BY � Permit I`1" �rC�/V ����U �
Phone. 503.639.4171 Fax: 503.598.196d"'AR 2' 2006 , Plan Review
;s, Date/By Other Permit No.:
24- Hour Inspection Line: 503.639.4175 _1_114- ° ' I I
Internet www.tigard- or.gov � 9 ' u 9 °" "" " ""' Date Ready/By. Jun', - 1 // ® Soe Pen l for
`�� Y $
1 �q V � � Liu iii 1:D Notified /Method T (� Supplemental Information
E. if ,�'r� ^l rTsTON FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
Addition/altrration/replacement 0 Other: New 1- 2- family dwellings (includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 24920
❑ I- 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 0 Other:
9 1 / Fire spnnkler ( sq. ft.) Page 2
JOB SITE GL INFORMATION AND LOCATION Site utilities
Job site address: C/ T IN 5 - S I.V �,1�t1� � ' `' Catch basin or area drain 16.60
City / State/ZIP: .:-'''/ I � n I 9 � � (J Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: i .-2;,g 4l) ,,r z / Footing drain (no. linear R: ) Page 2 -
Cross street/directions to job site: / ( Manufactured home utilities 110.00
�,,w c � ���'� l v xl 1 ..6 Manholes 16.60
`v f L. t7 4 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
Tax map /parcel no.: Fixture or item
Absorption valve 16.60
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DESCRIPTION OF WORK
Back flow preventer Page 2
Q
'e cC' f 464- �(F.e.-,' Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Name:
Ejectors/sump 16.60
Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /State/ZIP: Floor drain/floor sink/hub ' 16.60
Phone: ( ) I Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Business name.
Ice maker 16.60
Interceptor /grease trap 16.60
Contact name. Medical gas (value: $ ) Page 2
Address: Primer 16.60
City / State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) I Fax: . ( ) Sink/basin/lavatory ( 16.60
E-mail. pan 16.60
Urinal 16.60
CONTRACTOR I Water closet 16.60
Business name: � U , e 4 A 4�l L h i y 7 Water heater 16.60
Address. p 2 ., X 3 �. __ r � /J Other:
City /State/ZIP: igiy-(1 b )Z 19 !1 9 7 9 Subtotal
Minimum permit fee: $72.50
Phone. (C>23 4/ 51 _ 1 2:41 I (F x 403) (fig.. Qf / 7 Residential backflow minimum permit fee- $36.25
CCB Lic : /3! Z 9 umbing Lic. no.: 2 kp -6„,7 / Plan review (25% of permit fee)
Authorized signature: State surcharge (8% of permit fee)
/ TOTAL PERMIT FEE - - (/
Print name: �/ ([ �r'dt Date: / (o 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'.Buddung\ Permits \PLM- PemotAppdoc 17/30/05 4404616T(I0/02/COM/WEB)
Plumbing Permit Application - City of Tigard • V
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
Sewer - 1st 100' 55.00 3,601 to 7,200 $220.00
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
specially requested inspections - per hour 72.50 and including $50,000.00.
$50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: 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 (Future) Work Performed ❑ Any new commercial building.
Future 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.
Dishwasher - Commercial ❑ Any new residential building containing three (3) or more
- Domestic dwelling units.
Drinking Fountain
Eye Wash ❑ Any NFPA I 3-D multipurpose fire sprinkler system.
Floor Drain /sink - 2"
- 3" Submit 2 sets of plans with any of the above.
-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 ermit results in an
Water Extractor p
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 \Bwlding\Permits\PLM- PermitApp doc 07/06/05
CITY OF TIGARD
BUILDING DIVISION A - PERMIT #: PLiV12006 -1UO36
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 31,M2006
Phone: (503) 639 -4171 14111
' Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 5/:1/2006 TIME: 7:10AM PAGE:
SITE ADDRESS: 09710 SW WASHINGTON SQUARE RI) F - 1 CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: FOR LOVE 21
DESCRIPTION: Reconfigure ADA restroom.
OWNER: WASHINGTON SQUARE LLC, PHONE #:
CONTRACTOR: TWO BROTHERS PLUMBING INC PHONE #: 503. 491 - 1246
Inspection Request Scheduled For: Date: 5/4x12006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 029$8E 04 360-601-8167 N
Corrections /Comments /Instructions:
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SASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: /7/7 , Date: Phone #: (503) 718-
\
' CITY OF TIGARD • _
BUILDING DIVISION .
l
PERMIT #: OM ADD(:' /0D3S i
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639-4171 p�
Inspection Requests (24 Hrs.): (503) 639 -4175 e - —
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SISUBDIVISION: D X710 �� I- S� Pd CLASS
LOT #: CL WORK:
TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:6:1) � qq f
CONTRACTOR: / I - l 1 I PHONE #: ` I��
Inspection Request Scheduled For: Date: 3-- - DG Pour Time:
Code # Inspection Description firm # Contact # Message
L et,d pl��►�;ti5 o 4J wovie- c...... 1 2 / K ...-1, .. . p,i. OuLA
Corrections /Comments /Instructions: ' ,
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•
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: N h 1 ` Date c / ( Phone #: (503) 718-