Permit 14 CITY OF TIGARD PLUMBING PERMIT
2 : COMMUNITY DEVELOPMENT Permit#: PLM2020-00381
T IGAR C7 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 9/28/2020
Parcel: 15135AB03400
Jurisdiction: Tigard
Site address: 10260 SW GREENBURG RD 900
Project: Guild Mortgage Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Cap existing fixtures and relocate same number of fixtures to new locations: (2)dishwashers,(2)lays,(2)primers
and(2)water heaters.
Contractor: RAYBORN'S PLUMBING INC Owner: LINCOLN CENTER LLC
PO BOX 69 BY SHORENSTEIN PROPERTIES LLC
19990 SW CIPOLE RD 235 MONTGOMERY ST, 16TH FLOOR
TUALATIN, OR 97062 SAN FRANCISCO, CA 94104
PHONE: 503-692-4139 PHONE:
FAX: 503-691-2328
FEES
Quantity Description Date Amount
4 ea Fixture/Sewer Cap 09/25/2020 $100.08
Specifics: 2 ea Floor Drain/Floor Sink/Hub 09/25/2020 $50.04
2 ea Primer 09/25/2020 $25.02
Type of Use: COM 2 ea Lavatories 09/25/2020 $50.04
Class of Work: ALT 2 ea Water Heater 09/25/2020 $75.04
Type of Const: 1 12%State Surcharge- 09/25/2020 $36.03
Occupancy Grp: Plumbing
Stories:
Total $336.25
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 4t1n/1, O n Permittee Signature: 0,1 a^o `c .t.,
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
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P3umbin2 Permit Applic --,C:1\�/ .n
'Site-�jttMies tf r 4.Q,'nfo F;A S �`..' 123) -
City of Tigard 5 E P 2 3 2020 Received �J
Ill ■ 13125 SW Hall Blvd.,Tigard,OR 97223A. Date/By: of 74 J'l a ..d d Permit Nopim ZQze-DO ge I
I Phone: 503.639.4171 Fax: 503.598.1960 .I L t �;i!. Plan Revievvl/
Inspection Line: 503.639.417$ `''
Date/By: Other Permit No.:
TIUAJtI) P - ' Date Ready/By:
Internet: Line:gard-or.gov ` ' �' y orris: S See Pagel for
Notified/Method:i/4"iif 40 47 I Supplemeetal Information _
TYPE OF WORK 14/i- A/471/s FEE* SCHEDULE
❑ New construction ❑Demolition For special information use checklist.
Addition/alteration/replacement 0 Other: Description I QIY• I Ea. I Total
New 1-2-family dwellings(includes 100 ft.for each utility connection)_
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
I-and 2-family dwelling Commercial/industrial SFR(2)bath 437.78
./°�
❑Accessory building 0 Multi-family SFR(3)bath 500.32
❑ Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler(_sq.ft.) Page 2
,,w ,:,d.xa,„„•sg y,,, 1,t911 '11k 4NFOl ATION AND LOCATION Site utilities:
Job site address: ili24# Sx,! crittre w Gjiufl -
it I Catch basin or area drain 18.76
City/State/ZIP: or 1 trA4� AR Drywell,leach line,or trench drain 18.76
t Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt. no.: 100Project name: ( e i d / 44 W1 irdi Manufactured home utilities
50.03
Cross street/directions to job site: Manholes
18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: I Lot no.:
Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
Clothes washer 25.02
€Ma LAr e CZ) Vast,'i CII `I Isal41'v I Dishwasher 25.02
en"[.0 LJ S drain, - /41.1.,.i i ( .) ec a et. d-a Drinking fountain 25.02
MA--rCi._ fLs4tEft friut.t ftl . .,_ t4(:`+i41.5 Ejectors/sump 25.02
❑ PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Address: Floor drain/floor sin Y 25.02
Garbage disposal 25.02 City/State/ZIP:
Hose bib 25.02
Phone:( ) Fax:( ) Ice maker
12.51
twi APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: ZA.vaitt Ivr pi.u„,,8,,v,. Medical gas(value:$ ) Page 2
PContact name: ({aa s N4 846AbaJ Roof d Z. 12.51
Address: rain(corm ial) 12.51
�iI to ciedL. ad Sinkbasi la story 25.02
City/State/ZIP: TU ATnJ I
1?642. Solar unitslpota le water) 62.54
Phone:(51,3)61 L-Yi3q Fax:: W(A! ) yil- O Z3Zf� Tub/shower/shower pan 12.51
E-mail: >',T..s Urinal 25 02
e ofY +Sa [erN
CONTRACTOR Water closet 25.02
Business name: RAYBORN'S PLUMBING INC Water heater y 37.52
Water piping/DWV 56.29
Address: P.O.Box 69
Other. 251)2
City/State/ZIP:Tualatin,OR 97062
Subtotal
Phone:(503)692-4139 Fax:(503)691-2328 Minimum permit fee: $72.50
CCB Lic.:87852 Plumbing Lic. no.:34-I66PB Plan review (25%of permit fee)
Authorized signature: State surcharge(12%of permit fee)
TOTAL PERMIT FEE R2(A 2,S
Print name: ] t 2...J Date:it 5e,to This permit application expires if a permit is not obtained within IRO days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ca) Total Square Footage: Permit Fee: •
Footing drain-1" 100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer- 1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service- 1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
Valuation: Permit Fee:
Stone&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes", Plan Review for Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees*. Please check all that apply.
Quantity by(Fixture)Work Performed ❑ Any new commercial building with water service 2"and
Fixture Type: Replace greater,except systems designed and stamped by licensed
Previous Capped Added Existing engineer.
Baptistry/Font i'C/71.❑ New exterior plumbing site utilities for any complex structure
Bath -Tub/Shower as defined in OAR918-780-0040.
-Jacuzzi/Whirlpool
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive Thru 0 Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator 0 Any complex structure as defined in OAR918-780-0040.
Dishwasher -Commercial
-Domestic Z. Z Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash Isometric or Riser Diagram
Floor Drain/sink -2" 0 Isometric or riser diagram is required for new buildings
that meet the qualifications above.
-4"
Car Wash Drain
Garbage -Domestic
Disposal -Commercial
-Industrial Comments regarding fixture work:
Ice Mach./Refrig.Drains CAP ac p (2) IANi$ In 01(A+A$if (r W1
Oil Separator(Gas Station) (-1-e..4-►15 4- Prl,n...J I btj5. e(rA ..t I
Rec.Vehicle Dump Station
Shower -Gang
-Stall (1tI0as-e.. el.) L,. raed LaLt4?air3
Sink -Bar/Lavatory Z. 2. .. AlA+c6„n` a ,. t (.a . 114arv. Laws
-Bradley J
-Commercial *Note: If the fixture work under this permit results in an
-Service increase of sewer EDUs,a sewer permit will be issued and
Swimming Pool Filter fees assessed for the sewer increase must be paid before the
Washer-Clothes
Water Extractor plumbing permit can be issued.
Water Closet-Toilet
Urinal
Other Fixtures: 1 'jam
http://www.tigard-or.gov/ci ty_hal l/departments/cd/docs/P LM F-PermitApTdoe