Permit C ITY OF TIGARD PLUMBING PERMIT
� � DEVELOPMENT SERVICES PERMIT #: PLM2003 -00160
Ail DATE ISSUED: 4/29/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 09426 SW WASHINGTON SQUARE RD K -4 PARCEL: 1S126C0 -01107
SUBDIVISION: WASHINGTON SQUARE ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 3 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Install (3) sinks and (1) water heater.
FEES
Owner:
Description Date Amount
PPR WASHINGTON SQUARE LLC
BY THE MACERICH COMPANY [PLUMB] Permit Fee 4/29/03 $72.50
9585 SW WASHINGTON SQ. RD. [TAX] 8% State Tax 4/29/03 $5.80
PORTLAND, OR 97223 Total $78.30
Phone :
Contractor:
ANCTIL PLUMBING INC
16900 SW MERLO RD
BEAVERTON, OR 97008 REQUIRED INSPECTIONS
Phone : 503 642 - 7323 Rough -in Insp
Top- outlnsp
Reg #: LIC 24184 Final Inspection
PLM 26 -162PB
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 By: eUfki Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection neede4the next business day
Building Fixtures
Plumbing Permit Application FOR OFFICE USE ONLY
R eceived Plumbing .
Date/By: 1 a 1 - C!../ Permit No.'1r1,14 3 - Map
Planning Approval Sewer
City of Tigard Datc /By: Permit No.Sf u?..-)07 -CIO 1!
13125 SW Hall Blvd. A � Plan Review Other /
Tigard, Oregon 97223 Date/By: Permit No U? 7O 3 -O()/ 7
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
aa Date/By: No.:
Internet: www.ci.tigard.or.us j Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 '*""" Name /Method: Supplemental Information.
TYPE OF WORK FEE* SCHEDULE (for special information use checklist)
❑ New construction ❑ Demolition Description I Qty. I Fec(ea.) I Total
Addition/alteration/replacement ❑ Other: New 1 - & 2 - family dwellings
CATEGORY OF CONSTRUCTION (includes 100 ft. for each utility connection)
SFR (1) bath 249.20
❑ 1 & 2- Family dwelling ,Commercial /Industrial SFR (2) bath 350.00
❑Accessory Building ❑ Multi - Family SFR (3) bath 399.00
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00
JOB SITE INFORMATION and LOCATION Fire sprinkler - sq. ft.: Page 2
Job site address: 'C(7 � J (4.494, 5 Xt. 1 Site Utilities
Suite #: Bldg. /Apt. #: Catch basin/area drain 16.60
n Drywell/leach line /trench drain 16.60
Project Name: u1/0 Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
"fi,,,�,� �j ` / ( Manholes 16.60
✓✓ ✓ 7 Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2
Water service (no. linear ft.) Page 2
Tax map /parcel #: Fixture or Item
DESCRIPTION OF WORK Absorption valve 16.60
Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
❑ PROPERTY OWNER I ❑ TENANT 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
y p Garbage disposal 16.60
Phone: Fax: Hose bib 16.60
❑ APPLICANT ❑ CONTACT PERSON Ice maker 16.60
Name: Interceptor /grease trap 16.60
Address: Medical gas - value: $ Page 2
Primer 16.60
City /State /Zip: Roof drain (commercial) 16.60
Phone: Fax: Sink/basin/lavatory 3 16.60
E-mail: Tub /shower /shower, pan 16.60
CONTRACTOR Urinal 16.60
Business Name: i� ->
� m 04^ / c Water closet 16.60
y Water heater / 16.60
Address: 1G4ez7 7k) A -1,w \
(o ij Other:
City /State /Zip: �it„...,....4(si.„ b .t ,461:4 Other:
Phone: li'/71 -- Fax: 442,-- 773-5- Plumbing Permit Fees*
$
CCB Lic. #: 7�(l Plumb. Lic. #: -> U'i Minimum Permit Fee $72.50 $
Authorized � Residential Backflow Minimum Fee $36.25 �p�
Signature: , 4,6,,,,,, D ate: l `4 Plan Review (25% of Permit Fee) $
/4Cx- . -,t.__ '4, State Surcharge (8% of Permit Fee) $ S_
(Please print name) TOTAL PERMIT FEE $ /7 r. 30
Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or
180 days after it has been accepted as complete. riser diagram for plan review.
*Fee methodology set by Tri -County Building Industry Service Board.
i:\Dsts\Permit Forms\PlmPermitApp.doc 01/03
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee:
Footing drain - I' 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
additional $100.00 or fraction thereof, to and
Fixture or Item Qty. Fee (ea) Total 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
each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or and including $50,000.00.
specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: 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 Comments regarding fixture work:
Fixture Type: Replace
New Moved Existing Capped
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 *Note: If the fixture work under this permit results in an
Garbage - Domestic
Disposal Commercial increase of sewer EDUs, a sewer permit will be issued and
- Industrial fees assessed for the sewer increase must be paid before the
Ice Mach. /Refrig. Drains plumbing permit can be issued.
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar /Lavatory
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
i:\Dsts\Permit Forms\PlmPermitAppPg2.doc 01/03