Permit C ITY OF TIOARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00010
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/14/2008
PARCEL: 1S12600-00300
SITE ADDRESS: 09302 SW WASHINGTON SQUARE RD V05 ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
PROJECT: LUCY
Project Description: rough -in and setting two roof drains
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: M FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 2
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
WASHINGTON SQ. LLC Description Date Amount
9585 SW WASHINGTON SQ. RD.
TIGARD, OR 97223 [PLUMB] Permit Fee 1/14/2008 $72.50
[TAX] 12% State Surch 1/14/2008 $8.70
Phone : Total $81.20
Contractor:
MODERN PLUMBING
11120 SW INDUSTRIAL WAY
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503 -691 -6166
FAX 503 -691 -6771
Reg #: LIC 87906
PLM 34 -250PB
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: 9� ,,/?R2c2. .4../
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.
Jan. 11. 2008 4:25PM Modern Plumb ing No. 6541 P. 2
- J „
Plumbing Permit ApplicatirECEN E • 1:01; 01. -- 1; E oNL. \
l 3125 Hall Blvd., TigardOR 9722A) AN
Fax City of Tigard 1 4 L 1 ou8 R.,-c / lif at, ..6)77 )4. rnacta_ctoto
__,,..„-- 1 SW , 1 .., ' PI= Itturn-
' . Vr: . Phone: 503.639.4171 50159/C1960- m a i , Dme By Other Perrne No
Inspection Line: 501639.4175 GUY Or' r IS iBr hew El See Pegg 3 for
. blieThet: WWW.ligafd.Or.gOV BUUDINGIV 14 Date. RtadY _ supplemental Information
' oFNiit•iik " '" . ' ' ' 'PEE' kriktOimi • , . : ' ' , -.,---„
O New construction El Demolition For special len-motion we check fixt
••••-•-•-•- rkillYiptitul 1 QM I En . r . Total
i gAddition/alleration/replaccmtmt 0 Othcs: New 1- 2-family dwellings (includes 100 9_ for each utility connection)
eATtOORt.Ot.tiiii4Rtklii* : ' '.. : :.`: :'' , " ' SFR (1) bath 24910
-
O 1- and 2-family dwelling f reCoinmercial/industrial SFR (2) bath 350.00
0 Accessory building ij Mulli-family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
El Master builder 0.
F o spriolder (_ sq. ft.) Page 2
CIPX I "NiithOlATION'
- '• ,•:4';'; ei3ca 1 . - .. • . - • . ‘• • . site animus -
Job site address;....9-krirf .).\),.) kija 6.- oCillyi. 5 q kel Catch basin or area drain 16.60
City/State/ZIP: -- y- 9 a i ci 1 ni ei 7 3 _. Pooting drain (no, linear ft. ) Page 2 Drywell, leach line. or bench drain 16.60
: ,
sukcjtildg,/apt. nary I \ 1 Project name: 1 tk e
Manufactured home utilities r I 10.00
Canes 0,e...wired:fly,. in job sit l e; . -
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear It: ) Page 2
Storm sower (no. linear ft: ) Page 2
Water service (no. linear fL:_) 1 Page 2
Subdivision: 1 Lot no.: Wt
Fixture or ttem
Tax map/parcel no.: ..
Absorption vatve 16 60
‘T '::, L. " 'I': Backflow preventer Page 2
-
R (1,Alk y, stA- a f_,.YP (4 ra orNS Backwater vUlve 16.60
Clothes washer . 16.60
Dishwasher 16.60
, , . ,, .: ,,. ..• : .,7 Drinkin,g &amain 16.60
toigAiii iiiiiiiii:;!"..',"';''T'.",';''''''.-:.1-.Torost,,,,,..,,,.:,-.,••••,.
16.60
Name:
Etpansion tank 16.60
Address: Fixture/seivercap 16.60
: City/State/ZIP: Floor drain/floor sink/hub - 16.60
Garbage dieposal
Phone;( ) Faxz ( ) 16.60
' . • ', • .; , Hose bib
''' ' '... .■ ':. !;(0: ' r1,00 710 '." .:, 16.60
I ce maker
16.60
. Busincse nainc:
Interceptor/grease trap 16.60
_ .
Contact name:
Medical gas (value: $ ) Page 2
Address: Primer 16.60
City/State/ZIP: Roof drain (commercial)
Sink/basin/lavatory 16.60
Phonc ( ) I Fax: : ( )
Tub/shower/shower pan 16.60
E-mail:
Urinal 16.60
•::'''; :(..:.:, '. . .. - :::::..., ' ', ' . wau closer 16.60
Business name: Modern Plumbing Co. Water heater 16.60
Address: 11120 SW Industrial Way OT ; I ar idit Other:
l
City/State/ZIP: Tualatin, OR 97062 Subtota
- Minimum permit fee: $72.50
Phone: (503) 691 6166 Fax: (503 ) 691 6771 Residential backllow minimum permit fee: $36.25 7 ;., 5 0
COB Lie.: 07906 P.0 ■ .. ■ g Lie. no.: 34 250PB Plan review (25% of permit fee)
•
Aft.
State surcharge (12% of permit fee) 5310
Authorized signature: /
/ TOTAL PERIvICT FEE .R 1 IC)
[Print name: D ,-..
( A -e,Li--ret - Date 1 -1 I -08 This perndt application expires if a permit is not obtained within
180 days alter Kline been accepted as complete.
*Pee methodology set by Tri-County Building Industry Service Board.
1 :\8uilding■Per1ts1PLM-PeuratAppiloc 06 440-46L6T(10/02/COM/WEEI)
CITY OF TIGARD , , .
BUILDING DIVISION PERMIT #: Pt_M2Ot) 00010
13125 SW Hall Blvd., Tigard, OR 97223 . DATE ISSUED: 1/14/2008
Phone: (503) 639 -4171 Aitotoot
Inspection Requests (24 Hrs.): (503) 639 -4175 014 '11.
INSPECTION WORKSHEET FOR DATE: 1/29/2008 TIME: 7:02AM PAGE: 23
SITE ADDRESS: 09307 SW WASHINGTON SQUARE RD V05 CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: LUCY
DESCRIPTION: rough -in and setting two roof drains
OWNER: WASHINGTON SQ. LLC, PHONE #:
CONTRACTOR: MODERN PLUMBING PHONE #: 503.591 -6
Inspection Request Scheduled For: Date: 1/29/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 00121 -01 503 -691 -5155 N
Corrections /Comments /Instructions:
Ca re- ! II fr
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: (;r6\(vr-A-_r V k•... -. Date: 1/1 29407 {O ?F Phone #: (503) 718-