Permit q CITY OF TIGARD PLUMBING PERMIT
- COMMUNITY DEVELOPMENT Permit#: PLM2015-00150
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/13/2015
Parcel: 1 S 135BA00102
Jurisdiction: Tigard
Site address: 10206 SW WASHINGTON SQUARE RD
Project: Ulta Beauty Subdivision: OAKBURG Lot: 9
Project Description: Backflow preventer installation.
Contractor: II S MECHANICAL INC Owner: PPR SQUARE TOO LLC
520 WILLAMETTE AVE PO BOX 847
STAYTON, OR 97383 CARLSBAD, CA 92018
PHONE: 503-769-3738 PHONE:
FAX: 503-769-4374
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 05/13/2015 $31.27
Specifics: 1 12%State Surcharge- 05/13/2015 $8.70
Plumbing
Type of Use COM 41 ea Minimum Fee Adjustment- 05/13/2015 $41.23
Plumbing
Class of Work: OTR
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. 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 the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
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.
May. 13. 2015 4: 06PM C}EIvL��1 N0. 4229 P. 2
riumuing Permit Applica 1. , J1 ,
Building I<)tz mini_ 1 ,1 cl•, ,
City of Tigard MAY 18 2015 Re iwd i.'L Pent tNo.: 1(Mar,fS- j
11....___ 61 4 dip
13125 SW Hall Blvd,Tigardel`r
■ Phone' 503 718.2439 • i 391V1410 10 a 1(rf li t.t Date By: other Permit No.:�(4 )(9
n Date/By: a/-
T IL;:')li i) Inspection Line: 503.63': L D jj\I D y t, Date Ready/By; 1W+c See Page 2 far
Internet www.tigard-or.gov �t 1 11,41 IN. Notified/Method: p�.1 Su,'kmentallnformadon
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®New construction 0 se checklist
I Qty. I Ea I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
441I 1 t art + >• 1 t3+ �y ,.:..1 G"r}� i u i>,u [.. r^ f
�1tikl:.W.irlya:a II 1•'�i'•- cis}u111,11 �ra:4f•rir iS�;+.r�i:iLLtli�:11E(''ud kill �;,. I:1.*:;U�if,..:ar+.iat ilf lligi:la1{ ,mlluli•'0 SFR(I)bath 312.70
❑ 1-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500 32
El Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
C7 Master builder ❑Other: Fire sprinkler(_,_ sq.ft.) Page 2
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Site utilities:
i-, L eiWa',..iiJ , :1v ; 1Si 11iit f 4, e:l'Ooz ;1.:1 sl.0 l ilA Gtmil,L'∎Lt l:lS.
Job site address: 10206 Sw Washington Square Rd Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,Or 97223 Footing drain(no.linear ft.:T) Page 2
Suite/bldg./apt.no.: Project name:Ultra Beauty Manufactured home utilities ■ 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no,linear ft.:_) Page 2
- Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision:Oakburg J Lot no. 9 Fixture or item:
{tI Tax map/parcel no.'ISI35BA00102 p Backflowpreventer 1 31.27 31.27
[,.j.;,..;,,- -rr it +i y lIt f, tl( ;,..-1 u�; �• ' iI 'lily r w:Ylgd '!f _,.7;T t)1 n f`({ '1 s l Backwater valve 12.51
i.i+ i 1 J,.lJ' .. �a -i„!��,i,u5 t+ :.ft:u l,q'a+,...timaytlor:' fi,.i;5ti-,1,11.Ji Clothes washer 25.02
.- ^^"•- &Double Check
Dishwasher
gfo ■ 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
r.. rytm+ i
l 1rr , ' 'trr `2;i N y i ft'r� it�l nil(1 NW1%'k 171R Tt ^;ti i I , I! -'-31 . Expansion tank 12.51
i 1 t! i L.w......v.0 m iu.,t',t twVtit,;u cl.::, . ,d.l,;iu...f7 uJa'1hs ff i,, t
to
Name:PPR Square Too LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:PO Box 847 Garbage disposal 25.02
City/State/ZIP:Carlsbad,Ca 92018 Hose bib 25.02
Phone:( ) Fax.( ) Ice maker 12.51
r;r;ttrrt+-pm,.2„--�r1 .rl .,t,.cia".;y"i:iiL'i^.t;77"+r.^nsn,7,7,7,Pi f,l,!"ia`'F.�F. �7:-'16I11: ar:xt:V:i!tn is }'A 25.02
.{ `� )`a`h � f 1 � �" 1, ��s+ + +� v Interco tor/ ease ifs
P-i:i -. i,::.t t.,lima. 'U�Fia,Jautl atla±I1.., ni+i.,1�.Lru;{ 1 :; ,1,i+tnr,!,4'i„1„y.,,-,d.;{-,d.;{ P P
Business name:171-S Mechanical Medical gas(value:S�) Page 2
Primer 12.51
Contact name:Ken Fotopoulos Roof drain(commercial) 12.51
Address:520 Willamette Ave Sink/basin/lavatory 25.02
City/State/ZIP.Stayton,Or 97383 Solar units(potable water) 62,54
Phone:(503)769-3738 Fax::(503)769-4374 Tub/shower/shower pan 12.51
.. :. . Urinal 25.02
E-mail ken @2smechanical.com
Ir 11 ,17 ' .1n1 kF . P i+ 1 1 l r.t,4i ly i 1 ti3 Ytrt' It Water closet 25.02
11 +. ,ir i ,'11..1i.u,:..ill:illi ik2,1!12i4 � ag'i,, ` lliil' Ptl,3lift"Wiliii1i l atil,,11
Water heater -.
Business name:11-S Mechanical Water piping/DWV 56.29
Address:520 Willamette Ave or 1 25.02 25.02
City/State/ZIP:Stayton,Or 97383 Subtotal 56.29
Phone:(503)769-3738 Fax:(503)769-4374 Minimum permit fee: $72.50 72.50
CCB Lic.:54464-P Plumbing tic no..24-185-P Plan review (25%of permit fee)
State surcharge(12%of permit fee) 8 70
Authori2ed signature' TOTAL PERMIT FEE 81.20
Aira,��'J9Ar Date.5111/I S This permit application expires it a permit is uor obtained within ISO days
Print name: :� r''/�" after it has been accepted as compkte.
*fee meniodology set by Tri-County wilding lndsstry Service Board.
11111widin g4PernislPLAtU-PerrnitApp.do, 1661'05 440-46161410/021COM/WE111
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10206 SW WASHINGTON SQUARE RD,
TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2015-00150
Inspection Type: Inspector:
399 Plumbing final George Heimos
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10206 SW WASHINGTON SQUARE RD,
TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
FAIL
PLM2015-00150
George Heimos
1. Back flow device: provide lawn irrigation device backflow test results. Recall
inspection when completed. 310.3/407.2
All else ok
bob@gbcconstruct.com
Violation Summary:
Inspector Contractor