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Permit CITY TIGARD. PLUMBING PERMIT l+� DEVELOPMENT SERVICES PERMIT #: PLM2004 -00123 ` 13 SW Hall Blvd., Tigard, O R 97 (503) 639 -4171 DATE ISSUED: 3/25/04 SITE ADDRESS: 09644 SW WASHINGTON SQUARE RD G -13 PARCEL: 1S12600 -00300 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; 1 TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: 2 OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: 1 WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Plumbing TI, add (1) lay, cap (1) 2" floor sink, relocate (1) lay & (1) toilet. No increase in sewer EDU's. FEES Owner: Description Date Amount PPR WASHINGTON SQUARE LLC BY THE MACERICH COMPANY [PLUMB] Permit Fee 3/25/04 $72.50 9585 SW WASHINGTON SQ. RD. [TAX] 8% State Surcharl 3/25/04 $5.80 PORTLAND, OR 97223 Total $78.30 Phone : Contractor: ANCTIL PLUMBING INC 16900 SW MERLO RD BEAVERTON, OR 97008 REQUIRED INSPECTIONS Rough -in Insp Phone : 503 Insp existing /capped fixtures 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 I ued B : / P ermittee Signature: A. Call (503) 6 ° -4175 by 7:00 P.M. for an inspection neede • the next business day Building i' ixtul•es Plumbing Permit Application - FOR OFFICE :USE ONLY R eceived j Plumbing 7L�y . n Date/By. i D y Permit No.: ' i, 0 0 /A3 C of Ti Planning Approval Sewer City Tigard Date/By: i'crmit No.: 13125 SW Hall Blvd. . Plan Review Other Tigard, Oregon 97223 Date../By. Permit No.: Phone: 503 -639 -4171 Fax: 503 - 598 -1960 Post- Review Land Use / / s; 4 pct' � it \ Date /By: Case N • Internet: www.ci.tigard.or.us J J„l, � rya I I Contact s. 131 See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 Name /Met /lam Supplemental information. :: h, ^ ' '' >1+..• ' •i: ,'` : ' - : '['YPE'•OF WORK •. 1 ..` ';'s .•l •'w FEE* SCIIEDULI✓ (for special iiiforriialton;'tl .' li • , , ).: 1 111 New construction • Demolition Description Qty. (��(�•) Total F:PAddition/alteration/replacement ■Other: , , ; New, l- & 2- fondly thyelllh�tl t};'; ' TE It1 OF;CONS'1R1UCT1, a.'. : i '' (I) , , R' ': (Includt`sn1 0 0 ft. for.cacti utility.tultnC "J .". ; t. •' '� • si•3' t•• r��� Ulq. ' ' SFR (I) bath 249.20 • 1 & 2- Family dwelling t ommercial/Industrial SFR (2) bath 350.00 ■Accessory Building • Multi- Family SFR (3) bath 399.00 • Master Builder • Other: Each additional bath /kitchen 45.00 " E 1 0 > t , .' O a nd L0Q, A_ :0:31511MIE Fire sprinkler - sq. fl.: Pa • e 2 _ Job site address: �Itl:�'�l���i� 9 +w�=.► :i . ' .1 :.c` '.. Site Utilities' : "I'f. ;•a ,;.• : „'!, Suite #: Bid. . /A. t.,; : Catch basin/area drain 16.60 � E � CTIM �� ' j�cll /leach Itne/trench drai 16 Pro'eCt Name: ,sir . �� _ F oo t ing drain (no. linear ft.) Pa 2 Cross street/Directions to j site: Manufactured home utilities 110.00 ,(� _ n �' 1 An connector 16.60 Sanitary sewer (no. linear ft.) Page 2 Subdivision: I Lot #: Storm sewer (no. linear ft) Page 2 Tax ma. / #: Water service (no. linear R.) Page 2 . y ;b ' • r `1 , ' ,' . :4 Fixture or iteit v . , :et' `` . • `` �D)r SCRIPTLO OF W ORK ., LL Absorption valve 16.60 -- 1 /� -J)'4* (/VI Back low preventer Page 2 Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 •1 :1?.; .: e WNE1t i ' • , moo EIV' • Ejectors/sump 16.60 Name: + I ) 14 • l.4.t) Expansion tank 16.60 Address: Fixture/sewer cap 16.60 Cit /State,Zi Floor drain/floor sink/hub 16.60 Garbage disposal 16.60 Phone: Fax: Hose bib 16.60 y tt.s.0s ( . © ;. ?' 0 . ;R ■ 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: I Fax: Sink/basin/lavatory 4, 16.60 E -mail: Tub /shower /shower pan 16.60 yO)til:': >•. •, *', -''- .. a Urinal 16.60 Business Name: C 'tic_ p(dn-? 6 4- Water closet 16.60 Water heater f 16.60 Address: / OD 5a) i Ce (.0 Po other: City /State /Zip: '(j 11/ 6i2 9-.644.... Other: Phone: („c42„, "4 3Z3 Fax: Z -q- ?' S . . ;' .0Plumbing Permit Feeg : `:4 ;'•,••: l � 21 1 , . Subtotal $ CCB L1C. #: �� Plu b. .. 1C. #: t M inimum Panel Fee $72.50 $ 5-0 Authorized ," 3 �S. 6[ Residential Backflow Minimum Fee $36.25 _ 7A Signature: i i Date: v I Plan Review (25% of Permit Fce) $ !//, i! ti Aln A , i <� State Surcharge (8% of Permit Fee) $ '� (Please print name) TO 1'ERM IT FEE $ 7r. 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 resins. . *Fee mellwdulugy set I,y'I i i-County Building Industry Service Board. i• \Dsts \Permit Forms \PlniPennmApp doe 01/03 . Plumbing Permit Application - City of Tigard Pag 2 - Supple Information , ,, Fee Schedule: Residential Fire Suppression Systems: — IN•; r', -'`'':Sitt Utilities ' ` Qty. Fee (e Total Square Footage: _ _ Permit Fee: Footing drain - I " 100' 55.(x) 0 to =500 _ - - _ $1 15 00 4640 2,001 to 3,600 - $16000 Footing drain - each additional 100' 3,601 to 7,200 $720 00 Sewer - 1 s t 100' 55 (x) 7,201 and greater S O ' ) ( ' ' ) Seaer - each additional IOW 46.40 - WaterScivicc - Ist 100' 5500 Medical Gas Systems: Water Service - each additional 1()O' 46 40 Valuation: Permit lee: Storm & Rain Drain - 1st 100' 55 00 $1 011 to $5,000 00 f■lu Icr$72 5 46.40 $6,001 011 to $10.1100 0(1 $72 c0 In, the first $5,000 00 and $1 52 for cash Storm & Rain Uram - each additional 100' additional $100 00 or fraction thereof, to and i ..• • Fixture or Item Qty. Fee (ca) Total _ ,,,c Iud ou 510,000 00 Commercial Back Flow Prevention Device 46 40 $10,001 00 to $25,000110 `14R_0 or the first $10,000 and SI 54 for each 2,ldunrnaI $100 00 or fraction thereof, to Residential Back(low Prevention Device and rnr lulling 825,050 00 (minimum permit fee $36 25) 27 55 - - - - -- -- -- - - — Rain Drain. single family dwelling 65 25 $25.001 01) to $511,0011 00 $17 `I) fur the first $25,00000 and $1 45 for each additional $105 00 or fraction thereof, to Inspection of existing plumbing or and 1n..ludrny, $55,050 00 specially requested inspections per hour 72 50 -� ,ir the first $50,000 00 and $1 20 for P Y 9 P P $511.11!11 - and up ' $ 7.12 rr0 I Subtotal: rack additional $100 00 or fraction thereof. —__ 1 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 *. Lu t+len ,` regardip fi «ort.; r Quantlt by (Fixture) Work Performed � s , ../ , ' - - -s n c j A i -/' . ; - • • 1Ftiiltire Type: ,:- ; t '" ' ' , . epa c,. 1 ` " r ' Rlk — 4-'i °•V},a• • .. ', - .••5. r' New ,: - Moved ' 'Ealstlak..• Capped Baptistry/Font Bath = fuh /Shower - Jacuzzi/W Inr (pool Car Wash -Each Stall —' • -Drive Tlau Cuspidor/Water Aspirator Dishwasher - Commercial - Domestic Drinking Fountain yc Wash -. Floor Drain /sink - 2" 1 - 4" Car Wash Drain *Note: If the fixture wort; under this permit results in an Garbage - Domestic increase of sewer I;l)lls, a seer permit will be issued and Disposal -Commercial -Industrial fees assessed for the seer increase must be paid before the Ice Mach /Refrig. Drains plumbing permit can Inc issued. Oil Separator (Gas Station) 1 Rec Vehicle Dump Station '� , `� ( =t' j 1 1 ', ' ' Shower -Gang • -Stall U 6 , - 'r.•i ,s • Sink -Rai /Lavatory I l 1 ' • ' ' e • r , - Bradley , ' s .: 1' . } ; ;; j v n - Commercial ,. 4 1 �' 1 • -Service ' Swimming fool Filter . • • ' A • Washer - Clothes ; ° ". i Water Extractor Water Closet - Toilet I , / "."1.15, ' ■ \ t, +• , , Urinal Other Fixtures. is \Dsts \Permit Forms \PlmPei nutAppl'g2 doe 01/0) CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST / BUP XL Received c 7- �� ' / Date Requested 4 � AM PM BUP Location f 6 `x 9 01A- - /11a0 Suite 1 3 MEC Contact Person Ph ( ) PLM0 S/ - 0d / Z3 Contractor Ph 5-6 2 ' - " 73 SWR BUILDING Tenant/Owner /� 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 Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Oth 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 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE 111 Please call for reinspection RE: 111 Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date 71/ 99/() Inspector ✓ / Ext Other: Final DO NOT REMOVE this inspection record from the job site. • PASS PART FAIL