Permit •
CITY TIGARD PLUMBING PERMIT
i DEVELOPMENT SERVICES PERMIT #: PLM2002 -00054
.,� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/7/02
SITE ADDRESS: 09591 SW WASHINGTON SQUARE RD B -10 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: FLOOR DRAINS: 5 TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 3 URINALS: GREASE TRAPS:
LAVATORIES: 4 OTHER FIXTURES: 2
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 6 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Commerical TI: Capped fixtures = (1) drinking fountain, (2) 2" floor drains, (1) sink, (2) lays, (1) mop sink, and
(2) water closets. New fixtures = (1) drinking fountain, (3) 2" floor drains, (2) lays, (1) mop sink and (4) water
closets.
FEES
Owner:
Type By Date Amount Receipt
PPR WASHINGTON SQUARE LLC PRMT CTR 3/7/02 $348.60 27200200000
P.O.BOX 21545 PLCK CTR 3/7/02 $87.15 27200200000
SEATTLE, WA 98111 5PCT CTR 3/7/02 $27.88 27200200000
Phone 1: Total $463.63
Contractor:
ANCTIL PLUMBING INC
16900 SW MERLO RD
BEAVERTON, OR 97008 REQUIRED INSPECTIONS
Phone 1: 503 - 642 -7323 Rough -in Insp
Underfloor /Underslab
Reg #: LIC 24184
PLM 26 -162P6 Top -out Insp
Insp existing /capped fixtures
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 calling (i3) 246 -1987.
Issued By: �j�y, Permittee Signature: 41/P
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed th- next bus -' - day
iL f&i+ # lop � 2ai°�- 0663.6 40
Fy
Plumbing Permit Application b
Datereceived: y/ O 2 Permit no.: y ono pi
City of Tigard se wer Building 11. �I _I ! permit g permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City ofTigard Phone: (503) 639 -4171 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 Date issued: Bib') I Receipt no.:
Land use approval: Case file no.: Payment type: 4, 0
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory „iiKCommercial/iindustrial ❑ Multi - family ❑ Tenant improvement
0 New constructionddition /alteration/replacement 0 Food service 0 Other.
JOB SITE INFORMATION FEE SCIIEDULE (for special infori ation use checklist)
Job address: lA5A5 /4 , c AIL - 959/ Description Qty. Fox(ea.) Total
Bldg. no.: Suite no.: New 1- and 2- family dwellings only:
(includes 100 0. for eachutility connection) '•
Tax map/tax lot/account no.: SFR (1) bath
Lot: I Block: I Subdivision: SFR (2) bath
Project name: U ;CAT) R. i A SeCie E1 SFR (3) bath
Citykounty: I ZIP: Each additional bath/kitchen
Des and location of wo re
on mises: Site utilities:
- � 4 pea eel/ Catch basin/area drain
Est. date of completion/inspection: Drywellsfleach line/trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft )
Manufactured home utilities
Business name: IOW I gd- ...,.jr� Manholes
Address: )l 4a> S 4J At A Rain drain connector
City: State:aj. ZIP: 1760C Sanitary sewer (no. lin. ft.)
Phone: 4`7/2 I Fax: 771 E-mail: Storm sewer (no. lin. ft.)
CCB no.: 2j.i ( Act I Plumb. bus. reg. no: Water service (no. lin. ft.)
City /metro lic. no.: MS7 Fixture or item:
Contractor's representative signature: T3.....-_/ A bsorption valve
Back flow preventer
Print name: /-1.K i- vr•1.4ct- . Date: Z Backwater valve
CONTACT PERSON 'Basins/lavatory ✓ Y 7 /6 •Go 66,ya
Na > v; , Z o ^nti Clothes washer
Dishwasher _/
Address: u - :AN , ifip \ t i j Drinking fountain(s) • ` a- ! /6 • 46 33, Zo
City: l State: I ZI P Ejectors/sump
Phone: Fax: E -mail: Expansion tank
OWNER Fixture/sewer cap
Name (print: 1 Floor,drains/floor sinks/hub /G • 4., 0 I3, o'o
Mailingtaddiess: c - • 1' % •-/�� �i 1 • , -.1 - i f -j--- Garbage dis .
Hose bibb
41rr : tl' :N: t` i �. r :.+ f Ice maker
Phone: IFax I E- Interceptor/grease trap
OwndlinAtillididiValtidentidimaintenanWonlysal actual installation Primer(s)
wiljbe rpadt ale or the"lnaintenance kind repair made lily 'my regular Roof drain (commercial)
emplbyeeotithe piopeityTiown atilpb'r iDtS Ct(aptef4 7.../1 — • Sink(s), basin(s), lays(s) tv • j , /b . 6 0 /(• GO
Owner's 4s' nature: pater, Sum
Tubs/shower /shower an
. Urinal
Name: Water closet ✓
/o il /G.tar) .ton
Address:
Water heater ✓ / / a .60 /4.40
City: State: ZIP: Other. "JP S/n/,. - oL / /ti , too 3 3, 20
Phone: I Fax: I E -mail: Total 3yJ', •G
Not all jurisdictions accept credit cards. please call jurisdiction for e farmatia Notice: This permit application
CI Visa o Minimum fee $ Y� • a
sa 0 MasterCard expires if a permit is not obtained Plan review (at a5 %) $ ' �7 . /5
Credit card number: within 180 days after it has been State surcharge (8%) $ ' FP
Expires
accepted as complete. TOTAL $ 3 . G 31
Name of cardholder as shown oo credit card
$
Cardholder signature Amount 440-4616 (6i00rCOM)
Ai el' ,f SQ. iy9- M6
/LOG-E2 a71 6 39 - PS O .
6t) - 1 c.1,: CI ;_) 1 Cf' . 4 , •
. 01 -.
;. . 1 ftt \ (• , F. • „---
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' , - • ' . .
r:PLUMBINGREMIFFEESi -..--• ..),A‘tr e .. . •
• .:. :', ,s. ::'.-.2..."-: •.--:•.--•..; ...:- = ' . • - '; ,. - ' •- - ' ' . ' -1- ;;.:,, ''' ,: ' ,
:,;.., . awA , .......„.. - ,w mcni ,-, •„*ft• *I efijwityggio .J.1 I. J es -.. 1 . 1 v•;;;; -'- :. --....L''''.4., .;i'":,1:
4RXTORESAindiVIdtial)3,',..rge V 0, irQTY ,i1; & OUNTP „Ifcluda:MiiIi:iiiiblilgiu ';i L.1
,tflp ;. .;,,' , 4-., '2 -, - 0.44-i, • 5' 3 OT • :1
Sink 16.60 ith,TAIIIrtg pridjatcs ZI4,--v4 * .',- ea '• -‘'.'t 'Fi.,,,.OUNT
,i4oredattitiliijitotthecteari "" 1. 9_,;■ 4 A . :,.... ' ink4:4 '' A
Lavatory 2.- 16.60 3 ,30 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 Li 16.60 zz,hip SUBTOTAL , -' `• - , .
Urinal 16.60 8% STATE SURCHARGE • .A;:' ,-,': r , ,.'-;;- .•'.
Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL
TOTAL
Garbage Disposal 16.60 V '
Laundry Tray 16.60
0 ,k..,-
Washing Machine 16.60 C!‘irrit -
e
Floor Drain/Floor Sink 2" 16.60 y9; p) . , .; ■ ‘r
3^ 16.60 PLEASE COMPLETE: I 1' .
- 4" 16.60
Water Heater 0 conversion 0 like kind 16.60 , . Quantity . Mork Performed .
Gas piping requires a separate mechanical Fixtute '
,Type; --.. / - tieati 7 ,; ,-;Mo :yed j .'Replaced . Rambvedl
permit. ' -... .. ,:_... j . ' ,1 . - , ; : .ed ; ,
MFG Home New Water Service 46.40 Sink 1=11=1 Vity TS Fit ,
MFG Home New San/Storm Sewer 46.40 Lavato / Maritt'alAWIMAP" AIM b
. ir Tub/Shower : - • - .. - •
Hose Bibs 16.60 Combination
Roof Drains 16.60 Shower On! MI ,
Drinking Fountain 1 16.60 t L , Go Water Closet
Urinal 1 /1111111SIIIIMW;S 4 3201 a
Other Fixtures (Specify) 16.60
1111
Dishwasher
..,Seegor S ‘' 't• I it.( lo , top Garbage Disposal
Liundry Room Tray
Washin • Machine
Floor Drain/Sink: 2" ,% .4161111Fri.11 ,/ IIPIK111
Sewer - 1st 100' 55.00
Sewer - each additional 100' 46.40 4" . ; tg,
Water Service - 1st 100' 55.00 Water Heater
Other Fixtures
Water Service - each additional 200' 46.40 (Specify)
Storm & Rain Drain - 1st 100' 55.00
Storm & Rain Drain - each additional 100' 46.40 LI 0 1!1Zr..4 IIKAIIIIIIM=Effinfla, 3
Commercial Back Flow Prevention Device 46.40 imerim=ommil
vmearmramiNNIMMENIINCII/WAINI)
Residential Backflow PreVention Device* 27.55 .11%%---■___--INIMMIMS'.%
Catch Basin 16.60 111V 11=1111■11■11PMff. f.;;:f
Inspection of Existing Plumbing or Specially 72.50 - '! ,4 - iar f
Requested Inspections -...., per/hr COMMENTS REGARDING .: BO r: . - 6. . ..,
Rain Drain, single family dwelling 65.25 -:•,i ..., i
i . I .
Grease Traps 16.60 - "Cr! *
,-,
isometric or os tlit i N r r i l .o T o O '., ''' -3n-_,.' 're''.;,1: -/: ''..":'. '
C.----- VA-, '. "
1 - - v- ,
1, ,f 1 .,,,. , , ,....,..„.., ..aaj,
.....------ o-z-LLAg 'e: - ''' "
'; r ....e4'; iba ilz. ir. D..!_a1111 lett Li A
Quantity Total is > 9
-i , V = I 7 T A r
-TOTAL oWa EWA irT. f el i I k e
-
8% STATE SURCHARGE r 04. ..',-.--,-;,,,' -. _Tv:. •_.=7/7:7N2rO=
'PLAN REVIEW 25% OF SUBTOTAL MO. Klpf Ipc 1?-61/b c- m-feo , 1..ievt) /Li 64 -,..n.
Required only If fixture qty. total Is >9 "Fg. '.=.4,, iiii1, k - k / ■., /
. . TOTAL Pidi":.: AI $ 1/2,5 40 , 4 4* - -
. .
■
* Minimum permit fee Is 572.50 + 8% state surcharge, except Residential B I
Prevention Device, which Is $3625 + 8% state surcharge. . . ' ' . , ) \
** All New Commercial Buildings require plans with Isometric or riser diagram and
q .
plan review. " .
... ... , . .
. . ..'.. : .i! , 1 -. I). t.'; . _. : . -•
, , • i ' - . r. .' eta- -
. O • I viA--, . • , 1
INCIatiifomis‘plm-fees.doc 10/10/00
, - til t
OF TIGARD 24-Hour \
UILDING Inspection Line: (503) 639 -4175 •
INSPECTION DIVISION • ' Business Line: (503) 639 -4174' MST
BUP
Received Date Requested 3 --- g AM PM BUP
c�
Location / 5 / ithq. ` C- g - Suite MEC
Contact Person Ph ( ) PLM aO0 DOd 3---4
Contractor Ph ( ) 6 gal. - 732,1 SWR
BUILDING Tenant/Owner �-.4__nJ __ _ _ • _% - - ELC
Footing
Foundation ELC
Access.
Ftg Drain 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:
Final
PASS PART FAIL .
PLUMBING
Post & Beam
n er $JSFi7
ough -F
Water Service
Sanitary Sewer • aff
Rain Drains
Catch Basin / Manhole AIM,
Storm Drain MEI
Shower Pan
Other: (.4.133-1,4
Final {� AM‘
SAS)PART FAIL
MECHANICAL
Post & Beam
Rough -In .
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
\ Fire Alarm
Final D Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
_ SITE 0 Please call for reinspection RE: 0 Unable to inspect - no access
Fire Supply Line
■ 'ADA _ �f' '
J Approach/Sidewalk
D� ? tr' c' Inspef to /" / 6 ' € • ' Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY. OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVIS II1 Business Line: (503) 639 -4171
MST
Z BUP
Received Date . uested _ AM PM =r! BUP ' �%
Location 9-‘11 £)A- 4 PP. Suite MEC
Contact Person Ph ( ) PLM 'Z490 1 —CO oay
Contractor - Ph ( ) SWR
BUILDING Tenant/Owner l/ r c �," �-c c W ELC
Footing
Foundation ELC
Access:
Ftg Drain 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 �J / ��pp
Roof ia � L[— l l/<
Other:
Final
'i `T FAIL
111 ii
Post & Beam
Und b
gh -I
ervice
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Ot i
PART FAIL
ANICAL
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: 111 Unable to inspect – no access
Fire Supply Line 2 2 /
ADA te — C1 ✓� e .
Approach/Sidewalk Da Z Ze Inspector f Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503)639 -4175
INSPECTION DiJiN Business Line: (503) 639 - 4171 MST
BUP
Received Date Requested 1�� AM PM BUP -.1 p
Location q c 1 �cl� , . . RD. Suite MEC }
Contact Person 1 Ph ( ) PLM 000 ;020 SY
Contractor - SWR
, l Ph ( ) 6, 7 � 73-413
BUILDING Tenant/Owner V - -� :.� J ELC
Footing ELC
Foundation Access:
Ftg Drain 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 ,\
Roof
Susp'd Ceiling / / e � (/y.sV / J
�
Other:
Final
PA •
PLUMBING 4
Post & Beam
Under Slab
Rough -In •
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Ir
Shower Pan
_ Other:
PART FAIL
ECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
•
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final 0 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
Oit ADA 5
Approach/Sidewalk Date .- 7...-- Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL