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Permit
RECEIVED.7 AN042021 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT It . CITY OF TIGARD 3 Request for Permit Action BUILDING DIVISION TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard, OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov FROM: ❑ Owner Q Applicant ❑ Contractor ❑ City Staff Check(✓)one REFUND OR Name: INVOICE TO: (Business or Individual) VLMK Engineering + Design Mailing Address: 3933 S Kelly Ave City/State/Zip: Portland, OR 97239 Phone No.: 503-222-4453 ,YLEAST TAKE..ACTION FOR THE ITEM(S) CHECKED (✓): ) ,._..._CEL/'VOID PERMIT APPLICATION. ❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). ❑ INVOICE FOR FEES DUE �(aattach case fee schedule and provide explanation below).I Permit#: L4"1 ZQ 2.0 OO 9 71 Site Address or Parcel #: 11117 SW Greenburg Rd Project Name: AZ Wire&Cable TI Subdivision Name: Lot#: EXPLANATION: Decided to not go forward with the building TI. Signature: �XJ�I Date: 1/4/21 Print Name: Amy Tallent Refund Policy 1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of: • Any fee which was erroneously paid or collected. • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 80%of the application or permit fee for issued permits prior to any inspection requests. 2. All refunds will be returned to the original payer in the form of a check via US postal service. 3. Please allow 3-4 weeks for processing refund requests. FOR OFFICE USE ONLY Route to Sys Admits: Date By A Route to Records: Date f J/�/ B „OP Refund Processed: Date A/ /9-- By 41(� Invoice Processed: Date / By Permit Canceled: Date I ZS/2( By 40 Parcel Tag Added: Date By I:\Building\Forms\RegPermitActio n_1 51 8.doc Plumbing Permit Application VO / b 1j A. _ Building FixturesRECEIVED FOR OFFICE USE ONLY City of Tigard Received _ y,/ /� O V 2 4 2020 Date'Rv: // OS IJ 4 'yV,/ Permit No.: LV n//, ,,./t 1 I"' ` � III " 13125 SW Hall Blvd.,Tigard,OR 972- Plan Review ( L _ Phone: 503.718.2439 Fax: 50 5�i 1�6(ri T!�`AR® Dale Other Permit No.: 0 '2 ' __err yt"ti Inspection Line: 50 639.417 TIGARD 1 111 «!NiG DIVISION Date Read_y.B y burs: ® See Page 2 for Internet ww��.tigard-or.gov i v, �^ Notified,Method: 5. Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑New construction ❑X Demolition For special information use checklist. Description Qty. Ea. Total ❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 ❑ 1-and 2-family dwelling ©Commercial industrial SFR(2)bath 437.78 ❑Accessory building ❑Multi-family SFR(3)bath 500.32 Each additional bath/kitchen 25.02 ❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: 11117 SW Greenburg Rd Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State%ZIP: Tigard, OR 97223 Footing drain(no.linear ft.:_) Page 2 Suite/bldg.apt.no.: I Project name: AZ Wire& Cable TI Manufactured home utilities 50.03 Cross streetidirections to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.:_) Page 2 Stone sewer(no.linear ft.:_) Page 2 Water service(no.linear ft.:_) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map/parcel no.: /5/3 j iico Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 Demo to plumbing fixtures to be capped Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ® PROPERTY OWNER I 0 TENANT Expansion tank 12.51 Name: Greenburg Space Center LLC Robinson Fixture/sewer cap 25.02 Floor drain:floor sink:chub 25.02 Address: P.O. Box 91305 Garbage disposal 25.02 City/State/ZIP: Portland, OR 97291 Hose bib 25.02 Phone:( 503) 209-8545 Fax:( ) Ice maker 12.51 El APPLICANT F! CONTACT PERSON Interceptor'grease trap 25.02 Business name: VLMK Engineering + Design Medical gas(value:$ ) Page 2 Contact name: Primer 12.51Amy Tallent Roof drain(commercial) 12.51 Address: 3933 S Kelly Ave Sink/basin/lavatory 25.02 City/State/ZIP: Portland, OR 97239 Solar units(potable water) 62.54 Phone:(503) 222-4453 Fax: :( ) Tub/shower%shower, pan 12.51 E-mail: amyt@vimk.com Urinal 25.02 CONTRACTOR Water closet 25.02 Water heater 37.52 Business name: Robinson Construction Water pipingDWV 56.29 Address: 8060 NE Walker Rd Other: 25.O2 City/State/ZIP: Hillsboro, OR 97124 Subtotal Phone:(503 )645-8531 Fax:( ) Minimum permit fee: S72.5O Plan review (25%of permit fee) CCB Lie.: 63147 Plumbing Lic.no.:3ii,ittodP 77t State surcharge(12 of permit fee) Authorized signature: TOTAL..PERMIT FEE Print name: Amy Tallent Date: 11-24-20 This permit application expires if a permit is not obtained within ISO days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:'.Building;Perowts;PLMU-Pet mitApp.doc 11HO1,09 440-4616TI 10/02!COM:"WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee: Footing drain- I"100' 50.03 0 to 2.000 S121.90 Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 S233.20 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: Storm&Rain Drain-1st 100' 62.54 S 1.00 to$5.000.00 Minimum tee$72.50 Storm&Rain Drain-each additional 100' 37.52 S5.001.00 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 S I0.000.00. Inspection of existing plumbing or for S 10,001.00 to S25,000.00 $148.50 for the first S 10,000.00 and SI.54 for which no fee is specifically indicated 90.00/hr each additional S 100.00 or fraction thereof.to (minimum charge-1/2 hour) and including S25,000.00. Inspections outside of normal business 90.00/hr $25,001.00 to$50.000.00 $379.50 for the first S25.000.00 and S 1.45 for hours(minimum charge-2 hours) each additional S100.00 or fraction thereof,to Rcinspection Fees 90.00 hr and including S50,000.00. Additional plan review for revisions 90.00 hr S50.001.00 and up $742.00 for the first S50.000.00 and SI.20 for (minimum charge- 1.'2 hour) each additional$]00.00 or fraction thereof: Subtotal: Commercial Fixture Work: Are you capping,adding or replacing fixtures? If"yes", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees*. Plan Review for Plumbing Installations Quantity by Fixture Type Plan review is required for any of the following. Fixture Type for Replace/ Please check all that apply. work Performed: Capped Added Relocate ❑ Any new commercial building with water service 2"and Baptistry Font greater,except systems designed and stamped by licensed Bath: -Tub Shower engineer. -Jacuzzi/Whirlpool Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure Drive as defined in OAR918-780-0040. Cuspidor,'Water Aspirator ❑ Medical gas and vacuum systems for health care facilities. Dm s pidor r: Commercial ❑ Any multipurpose fire sprinkler system. Domestic ❑ Any complex structure as defined in OAR918-780-0040. Drinking Fountain Eye WashSubmit 2 sets of plans with any of the above. Floor Drain/sink: -2" 2 Isometric or Riser Diagram ❑ isometric or riser diagram is required for new buildings -Car Wash Drain Garbage Domestic non-food that meet the qualifications above. Disposal: -Domestic food related -Commercial food related 1 -Industrial food related Ice Mach./Refrig.Drains 1 Comments regarding fixture work: Oil Separator(Gas Station) Demolition of existing fixtures only. Rec.Vehicle Dump Station Shower: -Gang -Stall Sink: -Lay/Bar non-food related -Bradley -Com'Serv'Util food related -Service *Note: If the fixture work under this permit results in an Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and Washer-Clothes fees assessed for the sewer increase must be paid before the Water Extractor Water Closet-Toilet plumbing permit can be issued. Urinal Other Fixtures: I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2