Permit C ITY OF TIGARD PLUMBING PERMIT
DEVELOP.MENT SERVICES PERMIT
#: PLM2004 -00253
II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/7/2004
SITE ADDRESS: 09800 SW WASHINGTON SQUARE RD PARCEL: 1S12600 -00300
SUBDIVISION: ViThilifRONGTON 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: FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: 4 GREASE TRAPS:
LAVATORIES: 12 OTHER FIXTURES: 3
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 12 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Replacing and relocating plumbing fixtures. No new or capped fixtures for this TI.
FEES
Owner:
Description Date Amount
PPR WASHINGTON SQUARE LLC [PLUMB] Permit Fee 6/7/2004 $514.60
BY THE MACERICH COMPANY
9585 SW WASHINGTON SQ. RD. [TAX] 8% State Surcharl 6/7/2004 $41.16
PORTLAND, OR 97223 Total $555.76
Phone:
Contractor:
WESTERN PLUMBING
9460 SW TIGARD STREET •
TIGARD, OR 97223 REQUIRED INSPECTIONS
Phone : 503- 639 -5296 Rough -in Insp
Drinking Fountain
Reg #: LIC 2439 Final Inspection
PLM 34 -29PB
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. 7 ��
Issued By: ; r , ' %i f dgEh Permutes Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Plumbing PeriiiEGFOligpm Received / .._. .._ ..
FOR OFFICE USE ONLY
lumbing A
Date/By: (p , Permit Norte Zoo5
(' of Tigard JUN 7 2004 • Planning A pr / al
y
Date/By: Sewer
Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 CITY OF TIGARD A Date/By: Permit No • •
Phone: 503-639-4171 FIVKAING- NOM • Post Land Use
te fi-4 i c i " Date/By• Case No.:
Internet: www.ci.tigard.or.us
.F.414- 1 I,.. Contact Juris.: El See Page 2 for
24 Inspection Request: 503 - Name/Method. Supplemental Information.
- • '' ; • - ....:, : .. ■ :. TYPE'OFWORK ,,.; ', ..i.-. ';;IN:;:• '.:: i .. 4:1:1'.": 1St) ..
New construction H Demolition Description . j Qty. j Fee(ea.) I Total
..-.1
Addition/alteration/replacement Other: ,Ie. , •. . ,„ V . I_ . i.ii. ;4 . ,, .,,,, ,
..-i ' 'd J'aViiirt r ii ' till J r" s - ' • ' ''
,, , , .p.,, , -,- 1,t;:. ne es . leac . . connee on t
l'7....,DA.TE'GORY-itiF',CONSTRUCTION:,:: '
1 & 2-Family dwelling 1 E Commercial/Industrial
'• Master Builder Other: Each additional bath/kitchen
j 1 E Multi-Family
I SFR (I) bath
SFR (2) bath
SFR (3) bath
249.20
350.00
Accessory Building
399.00
45 00
. • •',.r. : !•J'013:8iTZINFORMATION *slid tOCATION'. •I'• ' • Fire sprinkler - sq. ft.: Page 2
Job site address:TcO(1
Suite #: ,Stlirebily/4/1).4.rdt446454 Ykini-ililkilW:Tiftl:.:vii-VaU.tiliirerag:t.; 4 :1124;v:'.!i:Y, 4 2.1'i ':
Bldg./Apt.#: Catch basin/area drain 16 60
Drywell/leach line/trench drain 16.60
Project Name: .5641.$ /A/A. SOVIY1 Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes 16.60
W4SavtlzA/ Se,v1)4Z Rain drain connector 16 60
Sanitary sewer (no. linear ft.) Page 2
Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2
Water service (no. linear ft.) Page 2
Tax map/parcel #: iri7 . •
•"'":'• 1:1•. WORK•: :.;: -:: :-
Absorption valve 16.60
igte i Ili4 glOrideg P441 Backflow preventer Page 2
10/ 9- ga014# 4i )ff7W-(72e(Slitg.) Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 3 16.60 4
0 TRolikamo,WNER g --, - ID TT : - - .:1.:;`. : ,- I Ejectors/sump 16.60
Name: Expansion tank 16.60
Address: Fixture/sewer cap 16.60
City/State/Zip: Floor drain/floor sink/hub 16.60
Garbage disposal . 16.60
Phone: Fax: Hose bib 16.60
, t2 APPLICANT. :1: '-. ' • - 0 CONTAtT.PERSON' ' . ' : Ice maker 16.60
Name: Interceptor/grease trap 16 60
Address: Medical gas - value: $ Page 2
Primer 16.60
City/State/Zip: Roof drain (commercial) 16 60
Phone: Fax: Sink/basin/lavatory 0 16.60
E-mail: Tub/shower/shower pan 16 60
• ,.-- r:' ..' CONTRACTOR. . , -t. r , ....:: Urinal 4 1 16.60
Business Narne14/457V4/ itt/ftekt Water closet ),,2 16 60 iff,4
Water heater 16.60 ,'
Address: gy‘ si,,i 7-7z,44.0 igtbe A/69 Other.
City/State/Zip: 7744(.40 / 9,1_ 97 Other
Phone: 6 Fax:ey-961/5- .1;:.yi .,,. ie.,* , ;1. ; Otrii Peernitlies*. i- -,,
CCB Lie. #: e n_59 Plumb. Lic.#:3Meg Minimum Permit Fee $72.50 $
Authorized 4 , Residential Backflow Minimum Fee $36.25
Signature: 49 )1 ' ...***---- Date: 97frt esi Plan Review (25% of Permit Fee) $ ---
MU/19A 4?L‘e.5 State Surcharge (8% of Permit Fee) $ '/, 4k-
(Please pnnt name) TOTAL PERMIT FEE 5 55s, 2fi
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\Perrnit Forms\PlmPermitApp.doc 01/03
CITY OF TIGARD 24 -Hour 1
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested ° - 7 AM PM BUP
Location �t9� L . J&- • sC�. Suite MEC
Contact Person Ph ( ) 6,3q- , 5e 2 W PLM aOo -pU a5 3
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation 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
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
F
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 O L ��/ i
ADA Date '1 Inspector Ext
Approach/Sidewalk l
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL