Permit CI TY OF TIGARD PLUMBING PERMIT
I DEVELOPMENT SERVICES PERMIT
#: PLM2003 -00162
� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/29/03
SITE ADDRESS: 09491 SW WASHINGTON SQUARE RD A -4 PARCEL: 1S126C0 -01107
SUBDIVISION: WASHINGTON SQUARE ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
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: 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
Remarks: Relocate (1) lay, (1) water closet & (1) 2" floor drain for ADA upgrade.
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:
MODERN PLUMBING
11120 SW INDUSTRIAL WAY
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone : 691 6166 Top -out Insp
Final Inspection
Reg #: MET 00002486
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
Issu d By: ?!'� / � Permittee Signature: C.
Call (503. , • -4175 by 7:00 P.M. for an inspection needed the next business day
, Ys.
• Plumbing Permit Application
Date received: 4/ D3 Permit no.: v// l-el9g0 2
'; City of Tigard
,A 1! City g Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 Date issued: By: I Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory J1- Commercial/industrial ❑ Multi- family ErTenant improvement
❑ New construction G-Addi tion /alteration /replacement• ❑ Food service ❑ Other:
JOB SITE INFORMATION FEE SCHEDULE (for special iuforn ation use checklist)
1 l� Description Qty. Fee(ea.) Total
Job address 1 99 $�� h► t1��{ S Q . • New 1- and 2- family dwellings only:
Bldg. no.: Suite 'nb.: A -- (includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot: IBlock: [Subdivision: SFR (2) bath
Project name: Z u y...-- e Z SFR (3) bath
City /county: I ZIP: 9 7 2...3 9 Each additional bath/kitchen
Description and location of work on premises: A DA ',Mak- Site utilities:
1 e n a r.+ 1 rr p t�4� t en. Catch basin/area drain
• Est. date of completion inspection: - O - f7
Drywells/leach line/trench drain
Footing drain (no. lin. ft.)
PLUMBING CONTRACTOR Manufactured home utilities —
Business name: O * et VI 1 \U If Ct £, Manholes
Address: % 1 tO 5 W k tnetV f i_, co �( Rain drain connector
City: u.aIc State: il l , / ZIP: y'1 706 Sanitary sewer (no. lin. ft.)
Phone: (ogl ( Fa x: 41. (6711 E -mail: Storm sewer (no. lin. ft.)
$-7 9 D reg. � c �� Water service (no. lin. ft.)
CCB no.: Plumb. bus. re . no: —
City/metro lic. no.: 3 4 g (p Fixture or item:
Contractor's representative signature: I. Absorption valve
Back flow preventer
Print name: e b0- f , k Geo t • C. Date: `- 28-03 Backwater valve
CONTACT PERSON Basins/lavatory • I !(O. &0 H.40
-
Name: Clothes washer
Address: Dishwasher
Drinking fountain(s)
City: I State: I ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank
Fixture/sewer cap
Floor drains/floor sinks/hub 1 i ( ('� ‘I, (0
• Name (print): Garbage disposal
Mailing address: Hose bibb '
City: I State: I ZIP: Ice maker
Phone: I Fax: I 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 I own as per ORS Chapter 447. Sink(s), basin(s), lays(s)
Owner's signature: Date: Sump
ENGINEER Tubs/shower /shower pan
Urinal
Name: • Water closet I o O lio !to k D
Address: Water heater
City: I State: I ZIP: Other.
Phone: I Fax: I E -mail: Total
Not all jurisdictions accept credit cards, please call jurisdiction for mote information. Notice: This permit application
Minimum fee $
on (at review _ %
Cl Visa MasterCard expires if a permit is not obtained Plan rev ( %) $
Credit card number: / / e
ekaba rah CI Or E? Expires
accepted days after it has been State surcharge (8%) .... $
TOTAL $
Naope o c c cr�l $ accepted as complete.
ItiJ X.Uf A 1 card
Cardhol ! shown on me Amount 440-4616 (6100 /COM)
PLUMBING PERMIT FEES:
PRICE TOTAL New 1 and 2- family dwellings only:
FIXTURES (Individual) QTY (ea) AMOUNT (includes all plumbing fixtures in PRICE TOTAL
Sink 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT
Lavatory 16.60 for each utility connection)
One (1) bath $249.20
Tub or Tub /Shower Comb. 16.60 Two (2) bath $350.00
Shower Only 16.60 Three (3) bath $399.00
Water Closet 16.60 SUBTOTAL
Urinal 16.60 8% STATE SURCHARGE
Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL
Garbage Disposal 16.60 TOTAL
Laundry Tray 16.60
Washing Machine 16.60
Floor Drain /Floor Sink 2" 16.60 .
3" 16 PLEASE COMPLETE:
4" 16.60
Water Heater 0 conversion 0 like kind 16.60 Quantity by Work Performed
Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/
permit. Capped
MFG Home New Water Service 46.40 Sink
MFG Home New San/Storm Sewer 46.40 Lavatory
•
Tub or Tub /Shower
Hose Bibs 16.60 Combination
Roof Drains 16.60 Shower Only
Drinking Fountain 16.60 Water Closet I
Urinal
Other Fixtures (Specify) 16.60 Dishwasher
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain /Sink: 2"
Sewer - 1st 100' 55.00 3"
Sewer - each additional 100' 46.40 4"
Water Service - 1st 100' 55.00 Water Heater
Water Service - each additional 200' 46.40 Other Fixtures
(Specify)
Storm & Rain Drain - 1st 100' 55.00
Storm & Rain Drain - each additional 100' 46.40
Commercial Back Flow Prevention Device 46.40 .
Residential Backflow Prevention Device" 27.55
Catch Basin 16.60
Inspection of Existing Plumbing or Specially 72.50
Requested Inspections per/hr COMMENTS REGARDING ABOVE:
Rain Drain, single family dwelling 65.25
Grease Traps 16.60
QUANTITY TOTAL
Isometric or riser diagram is required if
Quantity Total is > 9
`SUBTOTAL
8% STATE SURCHARGE
**PLAN REVIEW 25% OF SUBTOTAL
Required only if fixture qty. total is > 9
TOTAL $
* Minimum permit fee is $72 50 + 8% state surcharge, except Residential Backflow
Prevention Device, which Is $36 25 + 8% state surcharge.
** All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
i:ldstsforms\plm- fees.doc 10/10/00
CITY OF TIGARD 24 -Hour
•
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received �[ Date Requested 7 - - 7 AM PM BUP
Location ( '( w / ' S Q • Suite MEC
Contact Person Ph ( ) q, —C / (o PLM 3 J OCR i
Contractor • Ph ( ) SWR
BUILDING Tenant/Owner 2 ELC
Footing
Foundatiori ELC
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam •
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
ed
Final
PASS PART FAIL
PLUMBING
Post & Beam
. Under Slab
•
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole .
Storm Drain
Shower Pan
Other:
4r PART FAIL
HANICAL
•
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm •
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: ' Unable
•
to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date / Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL