Permit C ITY OF TIGARD PLUMBING PERMIT
PERMIT #: PLM2005 -00352
111 DEVELOPMENT SERVICES DATE ISSUED: 8/31/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1S12600 -00300
SITE ADDRESS: 09512 SW WASHINGTON SQUARE RD H - 2 ZONING: C - G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
Project Description: Replace: (1) lay, (1) fl. drain, (1) water heater. New: (1) water closet. •
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: M FLOOR DRAINS; 1 TRAPS:
STORIES: WATER HEATERS: 1 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 8/5/2005 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcha 8/5/2005 $5.80
Phone : 503- 639 -8865 Total $78.30
Contractor:
BEAVERTON PLUMBING INC
13980 SW TUALATIN VALLEY HWY
BEAVERTON, OR 97005 REQUIRED ITEMS AND REPORTS
Phone : 503- 643 -7619
•
Reg #: LIC 128892
PLM 34 -4PB
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:
•
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.
9,542 LO asp V\gJ - \•■ S% 4 / Z
., Plumbing Plumbing Permit App O 1 11(1•: 1 `ti l 1
J 44 Datc received:, - i55 o 11 Permit no C• 06� Oa/ ' 02....' \ � %,. City of Tiga Sewer pennit no.: Buildin
permit no.:S
` ' Cl ,, .." A dd re s s: 1 31 2 5 S W N � K ® p date:
.�) ;
V o oj Tigard Phone: (503) 6394171 Project/appl. no.: Expire date: O `' 2.
Fax: (503) 598 -1960 AUG 1UU5 Date issued: By: Receipt no.:
Land use approval: Case file no.: Payment type:
...
O I 2 family dwelling or accessory • Commercial/industrial ❑ Multi- family )(Tenant improvement
0 New construction ❑ Addition/alteration/replacement ❑ Food service O Other:
ill,
' .1011 . I I f: I \ I 01 01 VI lO\ 11 f.I: SCI11 I.l (for special information u.c chcclslia) j
Job address: S, uw, �a�ti5thu Descri don Qty. Fee(ea.) Total
. no.: . 3 !�r/.2.. I New I- and 2- family dwellings only:
Bldg. Suite no.: (includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (I) bath
'; Lot: Block: 'Subdivision: SFR (2) bath
l Project name: L i 0 3 SFR (3) bath
City /county: I ZIP: Each additional bath/kitchen
Dcscrip4on and locatio of work on premises: Site utilities:
` ties m OV`•- , �^ h 11,8 Catch basin/area drain
Est. date of completion /inspection: Drywalls /leach line /trench drain III
I'
L l �IRI \1; Cll \I \ClYllt Footing drain
- Manufactured home utilities
Business name: ccµ, W ' v>~ - Jµ y _
Manholes =
Addre • / 3 770 r, w ; ✓ /
Rain drain connector
. City: I, t,,yy f C'�, State:d a ZIP: 9 7cb"" Sanitary sewer (no. lin. ft.) —
Phone: 4.4 -76/9 Fax: - /3- - E -mail: Storm sewer (no. lin. ft.) ■ -.
CCB no.:C} / 7 Q'7 Plumb. bus. reg. nosy- qi 5. Water service no. lin. ft.
City/metro lic. no.: /0 Fixture or item:
Contractor's representative signature: / ' i - Absorption valve
I
Back flow ' reventer
Print name: a j (j(J Date: �� Backwater valve •
:4, CO\ I • ( I 1'1 ItSO\ Basins /lavatory 1111 / , (,Q
Name: • Clothes washer N
/ �" � c t � Dis h washer
Address: I C' . ( ), r y /
City: /S State:C ZIP:`�J .....• Drinking fountain(s) MI
Ejectors/sump MI
Phone: t✓' f II- T "°1 Fax:03 -74 24 E -mail: Expansion tank _
01% \ I It Fixture /sewer cap _
Name not : Floor drains/floor sinks/hub 0
(print)
Mailing address: Garbage disposal
Hose bibb
City: I State: 1 ZIP: Ice maker
Phone: I Fax: E -mail:
Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain (commercial)
employee on the property 1 own as per ORS Chapter 447. Sink(s), basin(s), lays(s)
' Owner's signature: Date: Sump
N t , I \ I I It Tubs /shower /shower pan
Name: Urinal
Address: Water closet /C•40
Water heater /(, ,(,o
City: State: ZIP: Other:
Phone: Fax: E -mail: Total
Not elljuriadictiom accept credit cards, please call jurisdiction for more information. Minimum fee $ ' Q 7e2 f Notice: This permit application
o Visa o Mastercard Plan review (at _ %)
expires if a permit is not obtained
Credit card number: Esptre within 180 days after it has been State surcharge (8 %) j �b
accepted complete.
TOTAL $ d
Name of cardholder as shown on credit card ep as com p
$ l
Cardholder signature Amount
440-4616 (61
■
CITY OF TIGARD ; A BUILDING DIVISION PERMIT #: pLM2005 00352 I
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8!31/2005
Phone: (503) 639 -4171 - • �.,r ,ll 111
Inspection Requests (24 Hrs.): (503) 639 -4175 °__
INSPECTION WORKSHEET FOR DATE: 9/28/2005 TIME 7:08AM PAGE: 81
SITE ADDRESS: ? CLASS OF WORK: 1
SUBDIVISION: 09512 SW WASHINGTON SQUARE RD H LDT #: TYPE OF USE:
PROJECT NAME: WASHINGTON SQUARE
UDS
DESCRIPTION:
Replace: (1) lay, (1) fI. drain, (1) water heater. New: (1) water closet.
OWNER: WASHINGTON SQUARE LLC, PHONE #: 503 - 639-8865
CONTRACTOR: BEAVERTON PLUMBING INC PHONE #: 503 - 643-7619
Inspection Request Scheduled .For: Date: 9/29/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 016788 -01 612 - 360.0152 N
Corrections /Comments /Instructions:
/ —‘ 2-- . 3c4- 0 /S'7
K2.. ,,,
(vzi,
►, SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
il FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
friW2 /
Inspector: Date: I A Phone #: (503) 718-