Permit CITY TIGARD PLUMBING PERMIT
� �;� DEVELOPMENT SERVICES
PERMIT #: PLM2004 -00159
.. � I � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/19/04
SITE ADDRESS: 10246 SW WASHINGTON SQUARE RD C -16 PARCEL: 1S135BA -00102
SUBDIVISION: OAKBURG ZONING: C -G
BLOCK: LOT: 001 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS: 1 TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 2 URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Plumbing TI, converting from retail space to food service. Other fixture is a primer.
FEES
Owner:
Description Date Amount
BY THE MACERICH COMPANY
9585 SW WASHINGTON SQUARE RD [PLUMB] Permit Fee 4/19/04 $83.00
TIGARD, OR 97223 [PLMPLN] Plan Review 4/19/04 $20.75
[TAX] 8% State Surcharl 4/19/04 $6.64
Phone : Total $110.39
Contractor:
•
ROYAL PLUMBING
14035 SW 6TH ST
BEAVERTON, OR 97005 REQUIRED INSPECTIONS
Phone : 646 -8824 Rough -in Insp
Underfloor /Underslab
Reg #: LIC 121274 Top -out Insp '
PLM 34 -311pb Final Inspection
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
Issued B
1,C.Z '6 Permittee Signature: ii AMP 0'
Call (503) 639 -4175 by 7:00 P.M. for an inspection need . the nex d -day
Building Fixtures
Plumbing Permit dly.)
Ap i FOR OFFICE USE ONLY
VV Receiv
City of Tigard Date/By 1' ix/ Permit No. 00491.- 0.0.) /Sy
13125 SW Hall Blvd., Tigard, 1\7223
1 4
Phone: 503.639.4171 Fax: 503.598 LOO /� ' Plan Ry iew
1 ti i Date/B Other Permit No. �k,,Qa_ �/`S(
24 Hour Ins 6 ection Line: 503.639.4 . �++
Internet: www.ci.tigard.or.us Date Ready/By. See Page 2 for
g `� 1GAR� N NotifiedlMetho . ( ( ( o, S Supplemental Information
TO { E'4 ( . = , FEE* SCHEDULE •
8v��'� For special information use checklist.
❑ New construction ❑ Demolition
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 (l) bath 249.20
❑ 1- and 2- family dwelling ›Cscommercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45 00
0 Fire sprinkler ( sq. ft.) Page 2
. JOB SITE INFORMATION AND Site utilities
Job site address: /0 2. V6 5 w v 6/ -i Si. RPd • Catch basin or area drain 16 60
City/State/ZIP: Ttf 9/'O' / oR f72.7-3 Drywell, leach line, or trench drain 16.60
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name:g HQsVe Frye Me
Manufactured home utilities 110 00
Cross street/directions to job site:
Manholes 16 60
Ram 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
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK . Backflow preventer Page 2
- -7� £ a � ry? �� 9,--7-- Backwater valve 16.60
/`, Clothes washer 16 60
I Dishwasher 16 60
1 ®��. PROPERTY_ OWNER . - _ .I • . ❑ _TENANT Drinking fountain 16.60
Y. ' Ejectors/sump 16.60
Name: bTt T�C� �� � � — —
dd Expansion tank 16.60
Address: Q5g,4.� , i' TD h� Fixture/sewer cap 16 60
City/ State/ZIP- � . j > / Q 7 , •3 Floor drain /floor sink/hub 16.60 /a) Phone: ( ) Fax: ( ) Garbage disposal 16.60
- - ` m APPLICANT - ❑ CONTACT PERSON, Hose bib 16.60
'A ` Ice maker 16 60
(� Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value $ ) Page 2
to Address: Primer I / 16 60 I /W ' o
Q City/ State/ZIP: Roof drain (commercial) 16.60
N) * Sink/basin/lavatory 3 16.60 'i q • IsQ
N7' Phone: ( ) Fax: : ( )
00 Tub /shower /shower pan 16.60
1 E -mail:
Unnal 16 60
CONTRACTOR Water closet 16.60
N Business name: R /.G P / ate 6 , Water heater 16 60
Address: G go 35- S 1,, S Other:
^ City/ State/ZIP: 8e p ��_ Q ie 7 7 Q OS Subtotal
to permit fee. $72 50 � OU
Phone: (923 ) 6y6 -�6� y Fax: ( ) Residential backflow minimum permit fee $36.25 e
CCB Lic.: /2„/ 3, 7 l, Plumbing Lic. no.: 3 9'3/ / p, Plan review (25% of permit fee) ./j • 1
Authorized signature/ State surcharge (8% of permit fee) 6./
i TOTAL PERMIT FEE //a • 3 7
Print name: 4 Date: L O This permit application expires if a permit is not obtained within
Ay 4411.ae 9 180 days after it has been accepted as complete.
6,, 3. Q G *Fee methodology set by Tri-County Building Industry Service Board.
i \Building\P \P I - PemtitApp doe 17/03 440 16T(10 /07/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities • Qty. Fee (ea) Total . Square Footage::-' Perini "t 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
3,601 to 7,200 $220 00
Sewer - 1st 100' 55.00 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
and including $50,000 00.
specially requested inspections - per hour 72.50
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1 20 for
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 Performed
Fixture-Type: - Replace
New Moved Existing Capped Comments regarding fixture work:
Baptistry/Font
Bath - Tub /Shower
- Jacuzzi/Whirlpool
Car Wash -Each Stall
-Drive Thru
Cuspidor/Water Aspirator
Dishwasher - Commercial
- Domestic
Drinking Fountain
Eye Wash ^
Floor Drain/sink - 2"
-3"
-4"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
- Industrial increase of sewer EDUs, a sewer permit will be issued and
Ice Mach /Refrig. Drains
Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stall
Sink - Bar/Lavatory
Quantity Total
- Bradley
- Commercial a - Isometric or riser diagram is required if fixture quantity
Service total is >9.
Swimming Pool Filter
Washer - Clothes
Water Extractor Plan Review
Water Closet - Toilet Plan review is required if fixture quantity total is >9.
Urinal
Other Fixtures•
i:iBuddingWemuts\Pi.M- PemutApp doc 3/03
4 .4 , 55 /e F 'e 'CdL S .. .. .. ... a; v T �
Igydv ••....••. ••. •• • .... .. .. .. .. •
109. 51„/ w45411 i70 el SQ k. a - • • • I
Tiy ar, o,Q 872,2-3 • . • • • • • 0✓ • •• . • • • •
CI ? ` ` J p/ .. , 1< S 4, t I Igoe[ I'devJ i`,M. •• • • • •
3 Cum - ` p. �� 4.. k p �.�G 6 1�.. r� °
1� s � R I I P /✓ccfiiC. CJ uf.cc .'tTa D rW li°1 t. S b c+e" -' ... ... • • • •
Per S1 ►.. J
• i• �
Q Pte,.eevicv- 4- Py itoro. 1 V.:vcJ 14-e....t 1 t% 01% I' "OVp✓ °0 ev •
14 , r. nu, ied 1c.- he41.,.
1
�, /%
CITY OF TIGARD
Approved..... l
[x]: J
Conditionally Approved ............ .............[ j•
:
For only the work as described in:
PERMIT NO. PCM 2004.. foal q / I
See Letter to: Follow.....•,... t I
Attach........... �
Job Address: IoZ y 1 1 , w ��,�� k• • It w4-s11
By:__, Ta ta..�.,, i � q �
Data: It; oY P a t
I ,IO • I ��
� I 2 it
I
3" I
1 y ,, 01.46 ,Drain. itis
Fey'
3 co�►P Srv►K qP ��
3 r �e, R 1 AO /
3 e"�o� o ,�T% 1004
,Q9L POD' OFFICE COPY " 0o � � 7
y o"
CITY OF TIGARD 24 -Hour!
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
r BUP
/ /
Received JZ • / Date RequestedJ 2 � � AM PM BUP
Location /0 2- <7(. R)A . Suite _ MEC
Contact Person i Ph ( 3) 9 75 - %6 0 3 PLM o V—
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain T ELR
Crawl Drain
Slab Inspection Notes: �I �,, SIT
Post & Beam �(`�2 70:m �" 7/14
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
Fig
PART FAIL
ANICAL
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 ❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date ,5 a Inspector Mt 1 1►^^J ` t 6 "" ' - Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL