Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2000 -00389
Ai �'�I II 131 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 D ATE ISSUED: 10/17/00
SITE ADDRESS: 09640 SW WASHINGTON SQUARE RD G -11 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; TRAPS:
STORIES: WATER HEATERS: 1 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 work for commercial TI.
FEES
Owner:
Type By Date Amount Receipt
PPR WASHINGTON SQUARE LLC PRMT CTR 10/17/00 $72.50 27200000000
P.O. BOX 21545
SEATTLE, WA 98111 5PCT CTR 10/17/00 $5.80 27200000000
Total $78.30
Phone 1:
Contractor:
ANCTIL PLUMBING INC
16900 SW MERLO RD
BEAVERTON, OR 97008 REQUIRED INSPECTIONS
Phone 1: 503 - 642 -7323 Rough -in Insp
Reg Underfloor /Underslab
eg #: LIC 00000241
Top -out Insp
PLM 26 -162PB
Drinking Fountain
•
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 (503) 246 -1987.
Issued By: Permittee Signature:) z "--`
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
A .
Plumbing Permit Application
Date received: / Permit no.: "ziy Z p - ev — 003 9
d ► { i y, City of Ti
- b 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 /� uAzez a --eo 3 S / Date issued: By: I Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement
0 New construction 0 Addition/alteration /replacement 0 Food service ❑ Other:
JOB SITE INFORMATION FEE SCHEDULE (for special inforn ation use checklist)
Job address: 57/4./ I,cJ'` 4.,, 51., ,,,e,� Rd. Description Qty. Fee(ea.) Total
Bldg. no.: Suite no.: �1 New 1- and 2- family dwellings only:
Tax map /tax lot/account no.:
(includes
(1) 1 .for each utility rnmection)
Lot: I Block: I Subdivision: SFR (2) bath
Project name: C -i'L �r -eu-L SFR (3) bath
City /county: / I ZIP: Each additional bath/kitchen
Description and location of work on premises: Site utilities:
Catch basin/area drain
Est. date of completion/inspection: Drywells/leach line/trench drain
Footing drain (no. lin. ft.)
PLUMBING CONTRACTOR Manufactured home utilities
_ — _Business name:. _ =( -- ic. , .. — :Manholes_
Address: J&1 a0 . Rain drain connector
City: State: CriI ZIP: ?° 4 Sanitary sewer (no. lin. ft.)
Phone: G 73Zf I Fax: �??f5 E -mail: Storm sewer (no. lin. ft.)
CCB no.: 2. (gC ( I Plumb. bus. reg. no: 16,2n3 _Water service (no. lin. ft.)
City/metro lic. no.: Fixture or item:
Contractor's representative signature: Absorption valve
Back flow preventer
Print name: - , „.A,.) Date: Backwater valve
CONTACT PERSON Basins/lavatory
Name: Clothes washer
Dishwasher
Address: Drinking fountain(s) •
City: I State: I ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank -
OWNER Fixture/sewer cap
_ Floor drains/floor sinks/hub
Name (print): < �.� 5 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
Name: Urinal
ame:
Water closet
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 more information. Minimum fee $ 702 . SO
Notice: This permit application Plan review (at %) a _
CI Visa CI MasterCard ( ) $
expires if a permit is not obtained
Credit card number: / / within 180 days State surcharge (8 %) .... $ .5 . P()
Expires ays after it has been TOTAL $ 7 9 . 3 v
Name of cardholder as shown on credit cars accepted as complete.
$
Cardholder signature Amount 440 -4616 (6/00/COM)
•
PLUMBING PERMIT FEES: ` '
• PRICE ":... TOTAL ' New I and 2- family :dwellings only: :-
•
FIXTURES (individual) QTY. (ea) :AMOUNT (includes all. plumbing fixtures In PRICE; TOTAL
Sink 16.60 the dwelling and ; ft. QTY .: (ea) < ; AMOUNT
Lavatory 16.60 fore u tility'connectron)
ry �� 0 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 /4, G A 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" 16.660 0 PLEASE COMPLETE:
3" 16.60
4" 16.60
Water Heater 0 conversion 0 like kind 16 60 . Quantity b Work Performed
Gas piping requires a separate mechanical / // '61, O Fixture Type: New Moved 'Replaced Removed/
permit.
MFG Home New Water Service 46.40 Sink !
MFG Home New San/Storm Sewer 46.40 Lavatorycf) i
Tub or Tu /Shower
Hose Bibs 16.60 Combination
Roof Drains 16.60 Shower Only
Drinking Fountain / 16.60 /4 , coo Water Closet . /
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 / L'
Other Fixtures
Water Service - each additional 200' 46.40 (Specify)
Storm & Rain Drain - 1st 100' 55 ." U,.. Fa-6A,
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 7a S d
8% STATE SURCHARGE . .
5.(P10
"PLAN REVIEW 25% OF SUBTOTAL • .
Required only if fixture qty. total is > 9 ' -
TOTAL $ 7P, 3 0
* 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.
is \dsts \forms\plm- fees.doc 10/10/00
Accumulative Sewer Tally
T 'enant Name. This SWR#
Address: `i`.5 -se() /9 - GTon/ S&. /Z/J . This PLM #: e P.0 DO — DO 3 ?9
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
Dishwasher - Commercial 4
- Domestic 2
Drinking Fountain 1 /
Eye Wash 1
Floor Drain /sink - 2 inch 2
•
- 3 inch 5
- 4 inch 6
- Car Wash Dm 6
Garbage Disposal 16
- Domestic (to 3/4 HP)
- Commercial (to 5 HP) 32
' - Industrial (over 5 HP) 48
: .... Ice Machine /Refrigerator Drains 1
Oil Sep (Gas Station) 6
Rec. Vehicle Dump Station 16
' Shower - Gang (Per Head) 1
- Stall 2
Sink - Bar /Lavatory 2 /
- Bradley 5
•
- Commercial 3
- Service 3
Swimming Pool Filter 1
Washer - Clothes 6
Water Extractor 6
Water Closet - Toilet 6 / 1p / 6
Urinal 6
q TOTALS p{0 (0 f'Q /
P ao c
Total fixture values: ,, 5 divided by 16 = /e V. O EDU ^ /a 9 'v° Chih`ivG€ 7a Ed u. Co-u.v
HISTORY .'77LL / / 6e6 /urraz use
PLM# acoc- <c�l` EDU# 19,9 SWR# (9.600 -00; H PLM #/999-60/3 EDU# /30 SWR# /999
PLM #a0 .. 0 - EDU# SWR# -'o'3.z PLM # / yam DO //7 EDU# / 3o SWR #• / yam , p
PLM# jpgq -z 35EDU #/30 SWR # / PLM# /► _et /o7 EDU# /3 SWR # / ,
PLM # /!q9 -410/9/ EDU# /3 o SWR # /1 -49 PLM # /?,79-6905.5" EDU# i 3 d SWR#
i: ldsts■swrtaly.doc
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested / 6 — AM • PM BLD
Location D fi C/0 5 w t?JG 511 5 dI Suite 6-1 1 MEC
Contact PersorO J4") Ph 5» -b f2 7)z-3 PLM &eo — 3 ;1
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
•
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
( Thr
Roof
Misc: .
Final
PASS PART FAIL
PLUMBING
ost & Beam
Under Slab
Top Out
Water Service -
Sanitary Sewer
Rain Drains
a PART FAIL
CHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Other oach /Sidewalk Date 1 Inspector�l /4 Ext !� ,
•
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.