Permit CITY TIGARD PLUMBING PERMIT
r° I DEVELOPMENT SERVICES PERMIT #: PLM2005 -00685
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 12/12/2005
5126
PARCEL: 1S126
SITE ADDRESS: 09185 SW HALL BLVD ZONING: C -G
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Backflow preventer for irrigation.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 0
OCCUPANCY GRP: B FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
WASHINGTON SQUARE LLC Description Date Amount
BY THE MACERICH COMPANY
9585 SW WASHINGTON SQUARE RD CITY OF TIGARD MEIN 12/12/200E $72.50
TIGARD, OR 97223 [TAX] 8% State Surchari 12/12/200E. $5.80
Phone : Total $78.30
Contractor:
NATURAL EFFECT LANDSCAPE INC,.
28877 S. SALO RD. REQUIRED ITEMS AND REPORTS
MULINO, OR 97042
Contact # : FAX 503 -577 -8089 same as a
PRI 503 -577 -8089
Reg #: PLM 11815
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. „estions to OUNC by
calling 503 -246 -6 9 or 1- 800 - 332 -2344. � / •
Issued By. Permittee Signature: l9 � . fro
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.
Building Fixtures ` . r':Y ` „ .
Plumbing Permit A p plica ti n t- FOR OFFICE USE ONLY
City of Tigard /�j�j
13125 SW Hall Blvd.,.Tigard, OR- 9722 (('` R
9'�v 2005 Date/By: � f/ - ./ �� 4 Y 6
Plan Revie
Phone: 503.639.4171 Fax: 503.598.1960 I/ t ri l yi�� , �li;�� fi Date /by Other Permit No.:
24 -Hour Inspection Line: 503.632„, 1 f5Y� OF TIC f j ',11.' . Date Ready/By: / ® See Page 2 for
Internet: www.ci.tigard.or.usp T DIN-0_ r--T\ I TS, 11 \la } Notified/Method: 1G( Supplemental Information
TYPE- OF'WORK A FEE *. SCHEDULE , , ,
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
Addition /alteration/replacement ❑ Other: New 1 dwellings (includes 100 ft. for each utility connection)
- : CATEGORY OF CONSTRUCTION • , SFR (1) bath 249.20
❑ 1- and 2- family dwelling Commercial /industrial SFR (2) bath 350.00
ID Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
Fire sprinkler ( sq. ft.) Page 2
' ,j,JOB 'SITE' INFORMATION AND LOCATION Site utilities
Job site address: 7 / S �it / /� ; // Catch basin or area drain 16.60 •
City /State /ZIP: 7 - 1 7 4 1 - 6 5 " c k Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: U s Footing drain (no. linear ft.: ) Page 2
• Manufactured home utilities 110.00
Cross street /directions to job site:
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 ft.: ) Page 2
Fixture or item
Tax map /parcel no.: Abtion valve 16.60 .
. ,. D ESCRIPTION OF WORK 4. . C Backflow preventer Page 2
I 0 S -I- 1r Ll to de fr y- o' ...-7/9)-I ✓! l� t'.,,, � c , e krieet/ Backwater valve 16.60
f/1 / Clothes washer 16.60
Dishwasher 16.60
' . ' ❑ "OWNER - ❑ ,TENANT * Drinking fountain 16.60 •
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
Phone: ( ) Fax: ( ) Garbage disposal 16.60 •
Hose bib 16.60
.
D. APPLICANT - ❑ CONTACT 'PERSON, :. „ '
Business name: �(/ �_ r r Ice maker 16.60
/ tl Gt l -Ul,, 1 d� �,,�,r,.1c S e. /.41 C___ Interceptor /grease trap 16.60
Contact name: ,_f_w 0 lam , � `,� /
, � Medical gas (value: $ ) Page 2
Address: --- 7 / , C 1 p ci Primer 16.60
City /State /ZIP: ��GT 7,� G � ? 7' z/' Z Roof drain (commercial) 16.60
Sink /basin /lavatory 16.60
Phone: ( S J 7 7 g- Fax:: ( )
!� Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
' ' ' - ' CONTRACTOR . • "' - Water closet 16.60
Business name: �G� __ Water heater 16.60
Address: Other:
ALL � 3 Subtotal
City /State /ZIP:
- Minimum permit fee: $72.50
Phone: ( )2,/ Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lie.: 7 / ..- 5 7 Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized signature: G - F, State surcharge (8% of permit fee) 34 TOTAL PERMIT FEE
• a� l e GI `l P ' Jr
Print name: J 1 Date: (a - /'� _ '5 This permit application expires if a permit is not obtained within
/ 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
is \ Building \ Permits\ PLMF- PermitApp.doc 06/05 4404616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
•
- Fee Schedule: Residential Fire Suppression Systems:
',Site Utilities-. -. `., ' , .. , , Qty: ° Fee (ea) ,Total: ' • -
' , Sciitiare F ootage: Permit 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 -Feet' ,. -
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
`Picture_ OIr:Item • - - - . .Qty. Fee (ea) .Total additional $100.00.0f fraction thereof, to and
including $10,006.00. •
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 forme first $10,000 and $1.54 for
Residential Backfl w Prevention Device each additional $100.00 or fraction thereof, to
(minimum per it fee $ . 5) 27.55 ard'tncluding $25,000.00. • _
Rain Drain, single family dw •ng 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
specially requested inspections - per h 72.50 / and including $50,000.00.
Subto • $50,001.00 and u./ $742.00 for the first $50,000.00 and $1.20 for
each additional $1'00.00 or fraction thereof.
Fixture Work: - Plan Review for Complex Structures
Are you capping, adding or replacing fixtures? If" • s ", A "complex structure" is defined as an installation of a plumbing
please indicate work performed by fixture. Failure to system that meets any of the following criteria.
accurately report fixtures could result in increased sewe ' •es *. Please check all that apply.
. , Quantity_ by (Fixture) Work Perfor ed' El Any new commercial building .
•
Fixture Type: eplace El Any new exterior plumbing site Utilities.
Previous Capped Added Existing ❑ A commercial building with installation, alteration or addition
Baptistry/Font of nine (9) or more new or relocated plumbing fixtures. •
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities
- Jacuzzi /Whirlpool providing services to human beings. .
•
Car Wash -Each Stall • • Plumbing installations, alterations or additions to food service
-Drive Thru cilities where new plumbing fixtures, including interceptors,
Cuspidor /Water Aspirator ar- being installed for the food service area. .
Dishwasher - Commercial ❑ Any , ew residential building containing three (3) or more
- Domestic dwelli .. units.
Drinking Fountain ❑ Any NF' • 13 -D multipurpose fire sprinkler system.
Eye Wash •
Floor Drain /sink -2" Submi 2 sets of plans with any of the above.
-3'
-4"
Car Wash Drain t, ` ,• ' Isom trio Or Riser Diagram _ . - -
Garbage - Domestic Isometric or rise diagram is required for new buildings
Disposal - Commercial three (3) or more ories in height.
- Industrial
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station) � Comments regarding fixture work: •
Rec. Vehicle Dump Station ..
Shower -Gang
-Stall •
Sink - Bar /Lavatory .
- Bradley '
- Commercial •
- Service
Swimming Pool Filter .
Washer - Clothes *Note: If the fixture work under this p ermit results in an
Water Extractor \
Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and
Urinal l fees assessed for the sewer increase must be paid before the
Other Fixtures: 1 plumbing permit can be issued.
i:\ Building \Pennits\PLM- PennitApp.doc 07/06/05
CITY OF TIGARD A ,- .. .
BUILDING DIVISION PERMIT #: PLM2005-00685
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/12/2005
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): 639-4175
1
INSPECTION WORKSHEET FOR DATE: 12/13/2005 TIME: 7:02AM PAGE:
SITE ADDRESS: u9185 SW HALL BLVD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: US BANK
DESCRIPTION: Backlow preventer for irrigation.
OWNER: WASHINGTON SQUARE LLC, PHONE #:
CONTRACTOR: NATURAL EFFECT LANDSCAPE INC,. PHONE #: 503-577-8089
Inspection Request Scheduled For: Date: 12/13/2005 . ...
Pour Time:
Code # Inspection Description Confirm # Contact # Message "•• ,
399 'Iumbing final 023393-01 503-718-2433 N
Corrections/Comments/Instructions:
• ( g . i",x
__'ASS 7 PARTIAL APPROVAL • 7 CANCEL 7 NO ACCESS
• El FAIL 7 CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
•
Inspector: h •
Date: i° #: (503) 718- L. l'-‘3(--