Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2021-00046
Tr GA RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 2/8/2021
Parcel: 1 S135AB01004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 400
Project: VSP Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Interior plumbing:Capping(1)dishwasher and(1)sink; Adding(1)dishwasher and(1)sink at other end of suite;
Installing(1)hub drain,(1)primer,and(1)water heater.
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
1 ea Dishwasher 02/04/2021 $25.02
Specifics: 1 ea Fixture/Sewer Cap 02/04/2021 $25.02
1 ea Floor Drain/Floor Sink/Hub 02/04/2021 $25.02
Type of Use: COM ea Primer 02/04/2021 $12.51
Class of Work: ALT 1 ea Sink 02/04/2021 $25.02
Type of Const: 1 ea Water Heater 02/04/2021 $37.52
Occupancy Grp: 1 12%State Surcharge- 02/04/2021 $18.01
Stories: Plumbing
Total $168.12
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: Permittee Signature:
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.
Plumbing Permit Application 13-1 2S 2
Sitrutflities 4 "lsiW.f (7.tfi""rri RECEIV I OR OFFICE E t'SI.: ()NIA
City of Tigard �/ " /n BY 1 �J�- Permit No.:
. • 13125 SW Hall Blvd.,Tigard,OR 97223 JAN Plan Reviewf y a - " ��� -
Phone: 503.639.4171 Fax: 503.598.1960 5 20z1 fin Other Permit No.: •
-
Date/By:
Inspection line: 503.639.4175 7�/„ T Aate Rea /B / / 1 ® See Page2 for
-IA l;A IL 1) �'I' i vF I��jAr+((plotified/Method: pZ/it gJ '
Internet: line: gatd-or.gov f Supplemental Information 3UILDINU DIVISION '+-�i s FEE' SCHEDULE
TYPE OF WORK
0 New construction 0 Demolition For special information use checklist. -
Description I Qty. I Ea. I Total
-g Addition/alteration/replacement 0 Other. New 1-2-family dwellings(includes 100 ft.for each utility connection)_
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 _
1 a I-and 2-family dwelling 1 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑ Accessory building 0 Multi-family
Each additional bath/kitchen 25.02 _
❑ Master builder ❑Other: Fire sprinkler(_sq.ft.) Page 2
-.0 _4 .c,•,as .J.,,91c.t§g '.riFQRMATiON AND LOCATION ...:... Site utilities:
��v Catch basin or area drain 18.76
Job site address: a Uj ICOT.,l SJ i-jc_ eQ7/Oq Sv-)(l ag:eg3(]Q(r Re, Drywell,leach line,or trench drain 18.76
City/State/ZIP: TI1(rAall oa 9+223
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Liao I Project name: VS?/L(00 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
DESCRIPTION OF WORK Backwater valve 12.5 I
t�� � /� Clothes washer 25.02
11rAv0 I)eta as4A 'Y 4 figh,.. .t-.r lb) (.4)C4)i 4el/ Dishwasher ,) 25.02 "a,
lAf3i-1l Aet*) mad. tltb- 4 At(Li/lyrit,es (i )LOc.*r-, w) Drinking fountain 25.02
- F.ixt>~rY I / / cat Ati-e„o( A.G it, Ejectors/sump 25.02
0 PROPERTY OWNER I (�� 0 TENANT Expansion tank 12.51
Fixture/sewer cap 25.02 K iJ),
Name:
Floordrain/floorsin dl
25.02 7s-',„{)1._
Address: Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
111 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: �4. oitiv.8 PL vl M Q►nl(/ Medical gas(value:$ ) Page 2
,r_ Primer V 12.51 i�..S'i
Contact name: /4'I go, �J
KS WtiRto,n/ Roofdmin(commrrcial) 12.51
Address: Ili i0 X..,' CJOet.t. 12c. Sink/basimlavatory 25.02 �U�
City/State/ZIP: •ru44.�? tit/ 0R S 70(0 2. Solar units(potable water) 62.54
Phone:(503 ) eq2.- Yt3R Fax::(03 )6;1/' li3z," Tub/shower/shower pan 12.51
E-mail: f.lortA ifa aq.y OoiJ,,I, , ron, Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater I 37.52 '�-2.r�)_
Business name:RAYBORN'S PLUMBING INC Water piping/DWV 56.29
Address: P.O. Box 69 Other. 25.02 1
City/State/ZIP:Tualatin,OR 97062 Subtotal /�.ii
Phone:(503)692-4139 Fax:(503)691-2328 Minimum permit fee: $72.50 '-
Plan review (25%of permit fee)
CCB Lic.:87852 Plumbing Lic.no.:34-166P8 State surcharge(12%of permit fee) it,(,I
Authorized signature: TOTAL PERMIT FEE /61:,i}
Print name: This permit application expires if a permit is not obtained within l days
[,. ,d Date: //LS(2 d I after it has been accepted as complete.
FANS �1�u•'lod4.✓ ( L *Fee methodoloi,,ry set by Tri-County Building Industry Service Board.
P,lumbing Permit Application - City of Tigard
'Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(es) Total ` Square Footage: Permit Fee: -
Footing drain-1 i 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:
Storm&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
hand 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 ❑ 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 tall El Any multipurpose fire sprinkler system.
ElCuspidor/Water Aspirator Any complex structure as defined in OAR918-780-0040.
Dishwasher -Commercial 0
-Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash Isometric or Riser Diagram
Floor Drain/sink -2" ❑ Isometric or riser diagram is required for new buildings
3., that meet the qualifications above.
-4"
Car Wash Drain J 4 n `S n� '
Garbage -Domestic { V 1 I/
Disposal -Commercial
-Industrial S CA/comments regarding fixture work:
r
Ice Mach./Refrig.Drains 5L 2L -e- rOil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower -Gang
-Stall ,e-�
Sink -Bar/Lavatory I l ]
-Bradley V
-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
U
Other O D
lher Fixtures: 3
O 3
http://w ww.tigard-orgov/city_hal l/departments/cdidocs/PLMF-PermitApedoc
Branden Taggart
From: Branden Taggart
Sent: Thursday, February 4, 2021 3:03 PM
To: hans@rayborns.com
Subject: RE: Plumbing Permit for VSP: 10220 SW Greenburg Rd Suite 400
Attachments: Invoice.pdf
Hi Hans,
The Plumbing permit for VSP is ready to issue now. The balance due is$168.12,and I have attached an invoice above
for you to reference. The fees can be paid online now at https://aca-prod.accela.com/TIGARD/Welcome.aspx by
searching for the permit record number PLM2021-00046 under the Building tab. There is a 3% service fee for credit
cards, but e-checks do not have a service fee.
Once the fees are paid, please email the Permit Technicians at TigardBuildingPermits@tigard-or.gov so that we may
issue the permit. After the permit is issued, we will email the permit paperwork to you.
Thank you,
, _ Branden Taggart
"piit City of Tigard
:„, Senior Permit Technician
Community Development
13125 SW Hall Blvd
Tigard, OR 97223
(563)718-2449
brandent@tigard-o r,gov
From: Branden Taggart
Sent:Thursday, February 4, 2021 1:17 PM
To: 'hans@rayborns.com' <hans@rayborns.com>
Subject: Plumbing Permit for VSP: 10220 SW Greenburg Rd Suite 400
Hi Hans,
I received your voicemail regarding the status of the Plumbing Permit for VSP, located at 10220 SW Greenburg Rd Suite
400. I will be working on the permit this afternoon for you,and I will let you know when it is ready to issue.
Thanks,
i