Permit CITY OF TIGARD PLUMBING PERMIT
3 : • COMMUNITY DEVELOPMENT Permit #: PLM2009-00055
Date Issued: 03/16/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S1260000300
Jurisdiction:
Site address: 9665 SW WASHINGTON SQUARE RD CO2
G _ -
Subdivision: Lot: 0
Project: ARITZIA
Project Description: TI - remove and replace fixtures, no change in EDU's.
Owner: FEES
WASHINGTON SQUARE LLC Quantity Description Date Amount
BY THE MACERICH COMPANY, 9585 SW
WASHINGTON SQUARE RD 1 ea Floor Drain /Floor Sink/Hub 03/16/2009 $16.60
PHONE: 1 ea Lavatories 03/16/2009 $16 60
1 ea Water Closet 03/16/2009 $16 60
1 ea Water Heater 03/16/2009 $16.60
Contractor: 1 12% State Surcharge - 03/16/2009 $8.70
MODERN PLUMBING Plumbing
11120 SW INDUSTRIAL WAY 6 ea Minimum Fee Adjustment - 03/16/2009 $6.10
TUALATIN, OR 97062 Plumbing
PHONE: 503 - 691 -6166
FAX: (503)691 -6771
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. 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 the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility ificatiort enter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or rest questions to O N ing 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signat e:
��� - .I Al m u—t�
p
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mar. 13. 2009 3:14PM Modern Plumb l og No 0532 P. 1 /3
. .
1"W Ilermit A licatio Foi i ►I ric is t SF. O I.)
City of Tigard CEDED Dare Er 2 1 J ! D C� Perm
Dare pdhv • c J AS
Drrr Er V /
13123 SW Hall Blvd, Tigard, OR 97223 ZmU9 Plan ReL niter P<mut No
N.,_ Phone: 503.639.4171 Fax 503.598,19S AR 13 Date E,
-' Jmspec ion line: 503.639.4175 �± p� Date Ready/9y FS See Page 2 for
'' ' is I Interne wwwligard - at.gov y1► • I GARD No r / 1 C0• Supplemental information
.;y r �'a„, a .1y ' w, ; T7t'PE Oo mit •�i' a . GDN ' • ,1 FEE* BC')�1LTI/E .
• Demolition For spedal L+femsofen use checklist
❑ Hew construction _ Desuriptioa _, (fit) ' E? J To'al
Addition/alteration/replacement D Ofhedr. New 1- 2dardly dwellings (includes 100 R for each utility connection)
■
;� 4:'' z'i;:,,.' �;Ci'JtGORX'OF t'l3NNbJRTTCTION SFR (1)batb 249.20
,I ,: .,. , a Commcrcial/industriel SFR (2) bath 350.00
❑ 1 - and 2- Family dwelling �" - '
SFR (3) bath 399.00
❑Accessory building 0 Multi-family Each additional bead/kitchen 45 00
❑ Mesta builder D Other Fire sprinkler (._ a 4. IL) Page 2
." 1 ' ,: ' , ',''; '•!OB `SITE 1NPO IA NNT1 ' 91 : TIbN . Site utilities
Job site address � 1 L _(,J &s h t 713 4 i W S * Li. Catch basin m area drain. 16.60
City /StateIZIP7 1 9 a et-a(, D)2_ '17 d Drywall, leach lino, or much drain 16.60
ttite/bldg /opt no.: f r 1 1 4 .r Footing drain (no. linear ft: _) Page 2
S
I erect naBle Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60 .. O . ` - .$,� -1).1 Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _i Page 2
Sform gewer'(no. linear ft: Page 2
Subdivision:
Lot do.: Water service (nu linear R.: _) Page 2 - ,
Fhltare or bun
Tax map /parcel no.: �� ; y y� � y� Absorption valve 16.60
� ?�! ;�� iiw�',i'� -�; "' '' ' ", ';� t'' ;i; ;•,� ,' , : ' W uf' ' ;bR�► ' a Baek11ow pm Page 2
-al A-4 A AA ^ / ' I . JII ` , _ Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
I?rmk� fbu>t1{ain 16.60
' ":'. Y i; +• ;;, ` 1 P,BiT.i,, 'R '(iY • 12,1rAlf'1' ' Ejectots/6nmp 16.60
Name: Lal . • Expansion tank 16.60
Address:
Fixture/sewer cap 16.60
City /StateJZIP: Floor drain/floor aihk/latb I 16.60 I t)
Phone: ( ) Fair ( ) Garbage disposal _ 16.60
-� Hose bib 16.60
' •, nii , ,Q. ' , .PPUCaN1 • ] CONTACT' PERSON .
;. '- . Ice maker 16.60
Business name: interceptor /grease trap 16.60
Contact name: Medical gas (vnloe: S ) Page 2
Address. Primer 16.60
City/Slnte/ZW: ROOF drain (commercial) 16.60
Sink/baain/lavatory 16.60 1 b . t. f -
( Fax
Phone: ) ( ) 'Fob/shower /shower pan NE 16.60
E-mail: Urinal 16.60
h ° , PC01 RAC°I'OR ' : ' , Water closet 1 16.60 . o k
Business name: Modern Plumbing Co. _Wader hare- 1 h 4s.,rah:tnetl v S 1 16.60 I ( . (
Address: 11120 SW industrial Way Other:
Subtotal to /, YD
City /State/ZEP: Tualatin, OR 97062 _ Minimum permit fee; $72.50
7 ?•SC
Phone: (503) 6916166 Fax: (503 ) 691 6771 Residential bacidlow minimum permit fee: $36.25
CCB Lic.: 87906 Plumbing Lic. no.: 34 2SOPB
plan revi (25% of perntil fee)
-' ; . State surcharge (12°6 of permit fee) 70
Authorized signature: / TOTAL PERMIT FEE I, )0
Print name: I i , Datr.3 This permit application expires if a permit is not obtained within
14 - - 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building industry Service Board.
I1Bu11dirakPmade \PLM- PamitApp.dac 06126/06 440.4616T(IO/02/COM/WEB)
,_ • Mar. 13. 2009 3:15PM Modern Plumbing No. 0532 P. 3
Plumbing rmit A _pplication - City of Tigard 3! 3
Pe
Page 2 - Supplemental Information nwdetty■
Fee Schedule: Residential Fire Suppression Systems: r I vrtib
:SiteTtilities - . Qt 5 (es) Tom, ' Square Footage: Per it' Fee": ' '
Footing drain -1 100' 55.00 0 to 2000 $115.00
Footing drain - each additional 100' 4d - 40 2- OOl 3 -600 $160 00
Sewn - 1st 100' 3.601 to 7.200 $220.00
A 7,201 and greater $309.00
Sa had eac additio l00'
Water Service - lst 100' 55.00 -
Water service - each additional 100' Medical Gas Systems:
storm &. Rain Drain - 1st 100' 55.o0o 1I11atiQR, 46101110 Fee '
& Rain Drain .each additional 100' $1.00 to $5,000.00 Mi�uunn fee S72 50
IT -Storm . , , 46.40 55,001.00 to $10,000.00 $72.50 for the first $5,000.00 and-$1.52 for each
, allies' ilk: ite1D T - Qty. Bee (cl) ,. Total' additional $100.00 or fraction thereof, to and
• Commercial Back flow Prevention Device — 46.40 imtudin $10.000,00,
_ $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Badcllow Prevention Device each additional 5100.00 or fraction thereof to
(minimum permit fee $36.25) 27.55 and inclu 525.000.00.
Rain min, single family dwelling 65.25 $25,001.00 to $50, 000.00 $379.50 for the first 525,000.00 and $1.45 for
Inspection of existing plumbing or each additional $100.00 or fraction thereof to
specially rat t led inspections - per hour 72.50 wd tnehr E50 OOD.00
Subtotal: $50,001.00 and up $74100 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Future Work:
of the following
an
Are you capping, ,", ;Fli%n:'R+I lec940 -. tiM `
Y pp g, addi or replacing fixtt es " Xltgsta�Iatipbs ""
"yes", + Plan review is required following please indicate work o ed by fizfure: )failure to Please cheek all that apply.
accurate] report fixtures could result in increased sewer fees*. ❑ Any new commercial building with water service 2 -- and
, ';,rC 11Z4`; }': f':54'.. "9' ,'i.&:4 ' ;t., , ,, ,, ,c; � ,i; . Y' r, ., •, l iiiii • ;'' 'Bar '.'4..'''' greater, e�pt a stems designed and stamped by licenser]
'I d ttlii i 4 „.,' +;it�: ,, ,;;, '•r, .' L, •'; ' ” ; - - ;`,a. �-y engineer.
1:4,, ,„ c• ^, ,,,Pi'e:iAifsa� $ 5' .: ,' ilded ,.: t,' U Any new exterior plumbing site utilities.
Bath
Baptistry/Font Tub/Sh — ❑ Medical gas a0d v S stems for health care facilities,
Cilities,
,lueomrWlnd 1 .— ❑ Any multipurpose fun sprinkler stead.
Car Wash Each Stall Q Any complex structure as defined in OAR918- 780 -0040.
Drive Thru
cuspidor Water Aspirato Submit 2 sets of plans with any of the above.
Dishwasher • ercia1 �... t n,
Drank* Fountain - � 1 "'
Eye Isometric or riser diagram is required fbr new buildings
floor Drain/sink - Wash that meet th e qualifications above,
I
CatlO11S A s
-3"
• 4" — Comments regardin fixture wor :
_ Car Wash Drain
Oacbagc - Domestic r- �) • �/
Disposal - Commercial
-Industrial J
Ice Mach./Rehig, Drains
Oil SeOar:t tor tOaa St
Rec. 1 Station — "--
Shower - Gang --
-Stall 'Note: If the fixture work under this permit results in an
Sink Dar avatory ` — increase of sewer EDUs, a sewer permit will be issued and
- Bradley fees assessed for the sewer increase must be paid before the
-Commercial plumbing permit can be issued.
- Service
Swimming Pool Filter
_Washer - Clothes
Water Extractor
Rater Clo Toilet t
"(Instal
- Olhcr Thaures:
i,gtaidragtptrmdslP1•M -PBOOM D doe 09422/06