Permit CITY OF TIGARD
PLUMBING PERMIT
I� DEVELOPMENT SERVICES PERMIT #: PLM2004 -00160
� I I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 63 -4171 DATE ISSUED: 4/16/2004
SITE ADDRESS: 09718 SW WASHINGTON SQUARE RD F -5 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: 1 BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS; 1 TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: 5 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Plumbing TI, install new fixtures: (1) 2" floor drain, (4) lays & (1) water closets, replace,(1) lay & (1) water
heater.
FEES
Owner:
Description Date Amount
PPR WASHINGTON SQUARE LLC
BY THE MACERICH COMPANY [PLUMB] Permit Fee 4/14/2004 $149.40
9585 SW WASHINGTON SQ. RD. [TAX] 8% State Surchari 4/14/2004 $11.95
PORTLAND, OR 97223 Total $161.35
Phone:
Contractor:
ANCTIL PLUMBING INC
16900 SW MERLO RD
BEAVERTON, OR 97008 REQUIRED INSPECTIONS
Phone : 503 - 642 - 7323 Rough -in Insp
Top -out Insp
Reg #: LIC 24184 Final Inspection
PLM 26 -162PB
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.
Issued Byr10_ -�,► _ - Permittee Signature: OA/ 4 - PPc / C , 9 - 770AJ
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
iiuiiui g li ixtures
FOR OFFICE USE ON ¥
Plumbll Permit Application Received ® Plumbing /�„
! ,�( }�
Date/B : D _ Permit No. • j , /y (e(i
(? �\ % Date / Planning Appr Sewer qq ee--__ Doi /
City of Tigard � Date/B pP Permit No.o/��AGp ' �/,
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 r . i s ���� Date/B : ____ Permit No.:
Phone: 503 -639 -4171 Fax: 503- 598 - 1 9 0. , t.O Post - Review Land Use
,1 • i t. i' qt r,� Date/B : Cas • • ..:
Internet: www.ci.tigard.or.us O'r � ,\ \I\S....14 - ` I�1 � Contact ris. See Page 2 for
24 -hour Inspection Request: 50- - - ; ' ' Namc /Method , / Su .. lemental Information.
S
ic‘4i. .#. ,4 •., " t:' ` - ' TYPE 'OFWOR1C :.'' ;; `- ::'ti:; _ „ FEEtSCIIEDULE (for special infOin allbnl. ° g iJ . `'1st)
• New construction • Demolition Description - I Qty. I Fee(ea.) Total
ddition/alteration/re � lacement
' ', •,,. • New;"1- & 2- family,dvyell ns?' •I' ' , '' ;; ; ' 'Rd' � Other:' ' '
�yr� �� �t�( ? � i' "Y� �' ft. for'each utill d'n, - wf Y c t? @:'
����'� SFR (I) bath
■ 1 & 2- Family dwelling I!? ommercial/Industrial SFR (2) bath 350.00
■Accessory Building • Multi- Family SFR (3) bath 399.00
• Master Builder ■Other: Each additional bath/kitchen 249.20
45.00
rtis0VM:iilial , b' ar k : PTO01i;1TN re sprinkler - sq. R.: Pa :e 2
I X 4 . • . ,,r. : , i ',..,'t site Utilities.- ,; ;;14 *' ` ifx -.';;: ,.
Job site address � ��t�.�����' ,� t ' _ ���� ' -
Suite #: - 5-- Bldg. /Apt. #: , Catch basin/area drain - 16.60
Drywell /leach line/trench drain 16.60
Project Name: A/ u VO Footing drain (no. linear IL) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
1 1 V J i N' e�Mte mA Manholes 16.60
�/ Rain drain connector 16.60
• Sanitary sewer (no. linear ft) Page 2
Subdivision: I Lot #: Storm sewer (no. linear ft.) Page 2
Tax ma. /. arcel #: /5 0/40"0 00 300 Water service (no. linear ft.) Page 2
,, y a,..: s M , FizturelOr'Itetri; .;`+'"
f T . ? VOC� :. : �. ,. , .!..' tn•.. , t ,.4:73
F"�i'� {'-�'.� DESCi TtOOP RI ��'� � ° '?' • ��;�", " Absorption valve 16.60
IMIN Iii J ' 'V / a Back flow preventer Page 2
Backwater valve 16.60 '
Clothes washer
/ 16.60 /(tl •fin
Dishwasher 16.60
inking Dr ng fountain 16.60
F.' . OP ;; ' y'' •SOU ' ■ ■IDEMOV
11MV
Dr 16.60
IIRMIC�y1y1 ' L YAM. Expansion tank 16.60
Address: Q$ 4 0, • 5eZ Fixture/sewer cap 16.60 I
City /State /Zip: .-774 -4 On-. 9 729 3 Floor drain/floor sink/hub oar / 16.60 /(/ . Gi)
Garbage disposal 16.60
Phone: Fax: Hose bib 16.60
cup , IG`AiN7`.: • ,, ti• . ree CONTAC , it) ' 0 .a .1 Ice maker 16.60
N ame: Interceptor /grease trap 16.60
Address: Medical gas - value: $ Page 2
Primer 16.60
City /State/Zip: Roof drain (commercial) 16.60
Phone: I Fax: Sink/basin/lavatory 5 O 16.60 $ .5.0 0
E -mail: Tub /shower /shower pan 16.60
! ;; -;: ,∎,' ; " - 'CO NTRACTOR• '' :•'," t . '. Urinal 16.60
Business Name: � ,,t Water closet / 16.60 / .40
/ , "' ��� ` vm� I /D Water heater 16.60 /6•40
Address: / c Q 06 5th.) Yi Other: .
City /State /Zip: i b 6 V, t. 9 it Other: .
2 Fax: �ikZ- s ' • .. 1 , 'I'lu ml►ing Permit F t s ��: y '
CCB Lic. #:
Phone: ( Z_ X32 � , m. Lic. #: 2 • / 6 2 'f
/ g Minimum i cnnit Fee $72.50 S
Authorized 4111/-64/ Residential Back(low Minimum Fee $36.25
Signature: - /�� - -'L-+ •� Date: Plan Review (25% of Permit Fee) $
Ali!//fin //)C jL- State Surcharge (8% of Permit Fee) $ g . 16"
(Please print name) TOTAL PERMIT FEE $ / * b
Notice: This permit application expires If a permit Is not obtained within All new commercial buildings require 2 sets of plans with isometric or
180 days after it has been accepted as complete. riser diagram for plan review.
• Fee methodology set by Tri- County Building Industry Service Board.
i:\Dsts\Permit Forms\PlmPermitApp doc 01/03
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
r<
Fee Schedule: Residential Fire Suppression Systems:
' v "'. Site Utilities : Qty. Fee (ea) Total . Square Footage: Fee:
Footing drain - I" 100' 55 00 0 to 7,0(X) Si 15)1(1
Footing drain - each additional 100' 46 40 2,001 lu 3,600 $160 rnl
3,601 to 7,200 5220 (In
Sewer - 1st 100' 5500
7,2111 and Lu Calci — Gin') UII
Sewer - each additional 100' 46 40
Water Service - 1st 100' 55.00
Medical Las Systems:
Water Service - each additional 100' 46 40 Valuation: Perini( Fee:
Storm & Rain Dram - Ist 100' 55 00 $1 0)) to $5,000 00 Minimum Ice $72 50
Storm & Rain Drain - each additional 100' 46 40 ¶5. 0(1 to $10.000 on $12 50 Ior the first $5,000.00 and $1.52 for each
additional 5I0)1 00 or 0- action thereof, to and
• Fixture or Item Qty. Fee (ea) Total includrn f : S IU,000 00.
Commercial Back Flow Prevention Device 46.40
$10,0(11 (I0 lu $25,0(10 00 514!i s0 !rn the first $10,0(0 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 525,000 00
Rain Drain, single family dwelling 65 25 $25,1101 nO to 550,000 1)0 5179 51) I the first $25,000.00 and $I 45 for
Inspection of existing plumbing or each additional $100 00 or fraction thereof, to
and nncludin $50,000 00
specially requested inspections - per hour 72.50 550,001 00 and up 5742 on Ior the first $50,000 00 and Si 20 for
Subtotal: each additional $100 00 or fraction thereof.
Fixture Work:
Are you capping, moving or replacing existing fixtures? If
"yes ", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees *.
Quantity by (Fixture) Work'Perfonued Comments regarding fixture work!
• Fixture Type :, Reptaei -
NC* „ • Moved E:laanig. Capped - -- —
Baptistry/Font _ _—
BatIj -Tub/Shower
- Jacuzn /Whirlpool -- — — —
Car Wash -Each Stall
-Dr ve Thru
Cuspidor /1Vater Aspirator —.- - --
Dishwasher -Commercial
.
- Domestic —
Drinking_ Fountain --
Eye Wash
Floor Dram/sink - 2"
-4"
Car Wash Drain
Garbage Domestic *Note: If the fixture work tinder this permit results in an
Disposal -Commercial increase of sewer .1 Is. a sewer hermit will be issued and
- Industrial fees assessed for he scsNer increase must be paid before the
Ice Mach /Refrig. Drains plumbing permit can he istired.
Oil Separator (Gas Station)
Rec Vehicle Dump Station
"Shower -Gang
-Stall
Sink - Bar /Lavatory I '
- Bradley
-Commercial •
-Sei vice
Swiin nmgi'ool Filter
Washer - Clothes j
Water Extractor
Water Closet - Toilet I
Urin51 '
Other Fixtures.
1' \Dsls\Penllil Font's \l'lrnPerniltAppl'g2 doe 01/03
CITY OF TIGARD 24 -Hour
BUILDING' Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
/ BUP
Received Date Requested �/ mi l (� AM , � BUP
Location < ` es Suite MEC
f�
Contact Person Ph ( ) PLM 4
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 -t
Drywall ll Nailing
Dryll N � •
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
T FAIL
Post & Beam ,��/�
Under Slab G •
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
• PART FAIL
HANICAL
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: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Da � Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL