Permit CITY TIGARD PLUMBING PERMIT
PERMIT #: PLM2005 -00689
l� DEVELOPMENT SERVICES DATE ISSUED: 4/11/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S12600-00300
SITE ADDRESS: 09777 SW WASHINGTON SQUARE RD D9,10 ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
Project Description: T.I. Other fixtures: (1) drinking fountain, (1) water heater expansion tank. ALL FIXTURES ARE
REPLACEMENT.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 0
OCCUPANCY GRP: FLOOR DRAINS; 0 TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: 2 OTHER FIXTURES: 2
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 2 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
WASHINGTON SQUARE LLC Description THE MACERICH COMPANY escription Date Amount
9585 SW WASHINGTON SQUARE RD [TAX] 8% State Surcha 4/11/2006 $10.62
TIGARD, OR 97223 [PLUMB] Permit Fee 4/11/2006 $132.80
Phone : Total $143.42
Contractor:
MODERN PLUMBING
11120 SW INDUSTRIAL WAY
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 691 -6166
FAX 503 - 691 -6771
Reg #: LIC 87906
PLM 34 -250PB
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: /lit) Permittee Signature:
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.
Apr 07' 06 02:14p DON GEORGE 503 691 6771 p.2
I
RECEIVED
Plumbing Permit Applicatio FOR OFFICE USE ONLY
City of Tigard A' t` " '� 2 0�' , Rece
13125 SW Hall Blvd, Tigard OR 97223 Date/B /a /06 $ Permit No.��� hlOac'29a6 A ?
CITY OF TIG i
Phone: 503.639.417/ Fax 503 598.1960 i «: ` I ., D Plan Revie
Other Permit No : 5
24- Hour Inspection Line: 503.639.4175 BUILDING DI 1 . '.,� I : o
Internet www ci.tigard.or.tu - Date Ready/By: 1 v 1 s 65 See Page 2 for
Notified/Method, d SEM for each additional
TYPE OF WORK FEE'' SCHEDULE
❑ New construction ❑ Demolition
For speciel injormution 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 (1) bath . 24920
❑ I - and 2- family dwelling I Comaterciall/mdustriat ; SFR (2) bath 350.00
❑ Accessory building 0 Multi-family SFR (3) bath I 399.00
•
• ❑ Master builder ❑ Other: Each additional bath/kitchen ! 45.00
/y ^ Fire sprinkler (_ sq. ft.) Page 2
K / JOB SITE INFORMATION AND LOCATION
Site utilities
Job site address: 1 , 5 � li)etc r. 5 9 , R Catch basin or area drain 16.60 '
City /State/ZIP: ( a a
1 R 7 ���13 Drywell, leach linc, or trench drain I 1660
Suite/bldgJapt. no.: f _ 9 Project name: 14.0 ` k', s i- r 4.t- L I Footing drain (no. linear II.: ) P e 2
t
Cross street/directions to job site: Manufactured home utilities 110.00
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 8.: ) 1 Page 2
Tax map/parcel no.: Fixture or item
- Absorption valve 16.60
DESCRIPTION OF WORK
Backflow prevcnter Page 2
- 1 m NJ e_ mr e rL� Backwater valve 16.60
elt&F..I//l. I i • / I r Clothes washer 1660
J/' / Dishwasher 1660
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain b C
Name: EjeetorslEjectors/sump ✓ I • 16.60 I l 16.60 •
Expansion tank 16.60
•
Address: Fixture/sewer cap 16.60 / L,40
City/State/ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60 .
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Business maker 1660
usiness name:
_ 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: ( ) , Fax: : ( ) Sink/basin/lavatory �/� 7� [6.60 L � • S� n
E -mail:
Tub/shower/shower 16.60
. Urinal 16.60
CONTRACTOR Water dose[ / , 16.60 3 ]�
Business name: -\c C\ e c--‘,--N \ `� W, . J t Water hearer 1 16.60 ((
Address: \ \ 1 'Z U 5 v.) 1 Y1 Ck kks 1 - } 1 � \ t a \ uk.jo t Other:
City /State/Z1P.
Subtotal_ /
T��a1 -, C 1Z ` � ' �c��Z A
Pho ( t Minimum permit fee: S72.50
503 Co cl k Co I to Fax: (503) �,C) I ( 77 ) Residential backilow minimum permit fee: $36.25
CCB j (n Plumbing Lic. no.: b 34 a5c.1 C Plan review (25% of permit fee) _ _ I
Authorized sigruilmum . Q J + State surcharge (8 %ofpermit fee) /0/&*
� /� 1 -� TOTAL PERMIT FEE �- 2
Print name: Op Incy t� C .. (^ Pc.. � n Date; e .. `
Q �. � � y .- 7. • () � I This permi app licat ion expires if a permit is not obtalmrea �..�..!
(f 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
. leuadir Parnas.PLM- Pcrmitlpp dec oasis 44C- 4616Tt10,02/conva>:el
CITY F
C O TIGARD
BUILDING DIVISION PERMIT #: PLM2005.00639
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/11/2005
Phone: (503) 639 -4171 "0:0
Inspection Requests (24 Hrs.): (503) 639 -4175 .�'��- I
INSPECTION WORKSHEET FOR DATE: 5/30/2006 TIME: 7:15AM PAGE: 48
SITE ADDRESS: 09777 SW WASHINGTON SQUARE RD D9,10 CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: HOLLISTER CO.
DESCRIPTION: T.I. Other fixtures: (1) drinking fountain, (1) water heater expansion tank. ALL FIXTURES ARE
REPLACEMENT.
OWNER: WASHINGTON SQUARE LLC, PHONE #:
CONTRACTOR: MODERN PLUMBING PHONE #: 503- 691 -.i166
Inspection Request Scheduled For: Date: 5/30/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
339 Plumbing final 030740 -01 503-691 -6166 N
Corrections /Comments /Instructions:
Y r — PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector jk Date✓ (/ Phone #: (503) 718 -