Permit 'CITY OF TIGARD PLUMBING PERMIT
PERMIT #: PLM2002 -00236
jll DEVELOPMENT H BMENg Tigard, SERVICES 639 -4171 DATE ISSUED: 7/17/02
SITE ADDRESS: 09573 SW WASHINGTON SQUARE RD B -6 PARCEL: 1S126C0 -01107
S
SUBDIVISION: WASHINGTON UARE ZONING: C -G Q
BLOCK: LOT: • JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: M FLOOR DRAINS; 2 TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES: 1 —
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Plumbing tenant improvement, capping (1) sink, (2) lays, (2) water closets, (1) 2" floor drain. Installing (1) mop
sink, (1) lay, (1) water closet, (2) floor drains & (1) backflow preventer
FEES
Owner:
Type By Date Amount Receipt
PPR WASHINGTON SQUARE LLC PRMT CTR 6/20/02 $182.60 27200200000
P.O.BOX 21545 PLCK CTR 6/20/02 $45.65 27200200000
SEATTLE, WA 98111 5PCT CTR 6/20/02
$14.61 27200200000
PRMT CTR 7/17/02 \$79.80 27200200000
Phone 1: . PLCK CTR 7/17/02 $19.95 27200200000
Contractor: 5PCT CTR 7/17/02 $6.39 27200200000
MSI MECHANICAL SYSTEMS INC Total $349.00
21195 NW EVERGREEN PKWY STE 20
HILLSBORO, OR 97124 REQUIRED INSPECTIONS
Phone 1: 503 - 642 -1234 Top -out Insp
Reg RP /Backflow Preventer
eg #: LIC 00070032
PLM 34 -183 Final Inspection
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 -0080.
You may obtain copies of these rules or direct questions to OUNC by calli• • )03) 246 -1987.
Issued B • if, l Permittee Signature: /
Call (503) 639 -4175 by 7:00 P.M. for an inspection need the next business day
It ' 1 sU2
Plumbing Permit Application - ; 1111 G1: t ,i. -
City of Tigard Date received: / A/ 4p- Permit no.: � i /,, tv . ,3t
, t - ^ I : i ' Sewer permit no.: ding permit no.: •
Address: 13125 SW v : t 5 9 r •
City of Tigard Phone: (503) 639 - 4171 '� • V i — I � j (k Prnject/appl. no.: , Expire • .
Fax (503) 598 - 1960 ` Date issued: MMI = 'pt no.:
Land use approval: jUN 2 n 2002 Case file no.: Payment type:
- 1) P I - 01 l' I R i l I I
CI 1 & 2 family dwelling or accessory 't __ A i •111a,� r .T �� '❑ Multi - family ❑ Tenant improvement
❑ New construction _ ' • ddition/alteration/replacement ❑ Food service ❑ Other
JOB Sll I INFO101:111ON FI:E S(H1i1)1'I.t O inturnuttion use checklist)
Job address: 5 7 3 ( a • S ■Z o w 66467 Description Qty. Fee (ea.) Total dwellings Bldg. no.: S to no.: f New 1 and 2 dwellings only
Tax map /tax lot/account no.: (i 100 ft. for each utility connection)
(1) bath
Lot: Block: n Subdivision: SFR (2) bath
Project name: /te L MA (iC SFR (3) bath
City/county: 1d\ I ZIP: Each additional bath/kitchen
Description and lotation of work on premises: Site sties=
Catch basin/area drain
Est. date of completion/inspection: ^- .. Drywells/leach line/trench drain
spec
P 1.1 i 11 B NG CON I R. - <: f 012 Footing drain (no. lin. ft.) -
Manufactured home utilities
Business name: ' QM,e (' ( C 4.t • Manholes
Address: g N (1/t V �(C.0 A . 1" 'O ( Rain drain connector
City: \ g /0 I State: I Z : an I Sanitary sewer (no. lin. ft.)
Phone: 4(0(p' .,..7 I Fax :(y(i- a•�.4 I E -mail: Storm sewer (no. lin. ft.)
CCB no.: I Do 5'?- Plumb. bus. reg. no: 3t.� -1 is3 els
Water service (no. lin. ft.)
City/metro lie. no.: (a_ > q Fixture or item: yo
Contractor's representative signa I , ' i Absorption valve Y G 5�G ��
i � Back flow preventer ✓ I a, . I'A.. r
Print name: =LA IAC I / c . 61^ Date: i In 02.7 Backwater valve
(O N I : A (I PERSON Basins/lavatory - p . I I (9. 0 , , I
Name: Q ltl.Q,(( e. ,Vls on - - Clothes washer
Address: 01 U «l ANA Ve,v0 OC. t.n -1 -0 I Dishwasher
/¢L Drinking fountain(s)
City: 1i --11, Sb-� d State: al___, I IP: 1(a-1I Ejectois/sump
Phone: Fax: E -mail: Expansion tank
()'\ I_ R Fixture/sewer cap '-. Viet) ?5). X00
Floor drains/floor sinks/hub I ' - (PO 1 )5. -n
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) r. /41 • 4) 33.k)
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
E \ G I N I. E R • Tubs /shower /shower pan
Name: Urinal
Address: Water closet i I (1.100 1(9• loo
Water heater
City: I state: I ZIP: Other: W. (c, ./ ) t (o (p o I to - lei
Phone: I Fax: 1E ' Total - /e 2 teb
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This Minimum fee $ - I � ` " ',��
permit application Plan review (at �5 %) -L(�T. t75
❑ visa ❑ Mastercard ( ) $ t!0 no
expires if a pemtit is not obtained o
Credit card number. / / State surcharge (8%) .... $ r' I a a l
. Expires within 180 days after it has been TOTAL $ ,g 4 `�' .5 ----
Name of cardholder as shown on credit card accepted as complete. '
$
Cardholder signature Amount
440-4616 (6/00/COM)
/ Accumulative Sewer Tally
Tenant Name: / / ' X - / /1 / T� o • This SWR#
Address: 952 2L . • This PLM #:
Fixture Value Previous Previous Credits Capped Fixtures Fixtures New total New
# Value Capped off value added # added #s total ,
Count off #s count value values
Baptistry/Font 4
Bath - Tub /Shower 4
- Jacuzzi/Whirlpool 4
Car Wash - Each Stall 6
- ,Drive Through 16
Cuspidor/Water Aspirator 1
N. %
Dishwasher - Commercial 4
,, , k - Domestic 2 ,
'Drinking Fountain 1
Eye Wash 1
Floor Drain /sink - 2 inch : 2 # I ✓ 4 2
�" _ h
- 3 inch 5 • d -D
r 4 inch - 6
- Car Wash Drn 6 `
Garbage Disposal 16
- Do,rn (to 3/4 HP)
- Commercial (to 5 HP) 32
Industrial (over 5 HP) 42
Ice Machine /Refrigerator Drains 1
Oil Sep (Gas Station) 6
Rec. Vehicle Dump Station 16
Shower - Gang (Per Head) 1
- Stall 2 v
Sink - Bar /Lavatory 2 ..,62_ 7 /- ' 2
- Bradley 5 ~
- Commercial . 3 /
- Service 3 1/.t 3 / - y 3
Swimming Pool Filter 1
Washer - Clothes 6
Water Extractor 6
Water Closet - Toilet 6 `."2, t Z / '/
Urinal 6
TOTALS 6 z I c 1_ 1
Total fixture values: divided by 16 = EDU .
HISTORY
PLM# EDU# SWR# 'PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
•
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
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