Permit CITY OF TIGARD PLUMBING PERMIT
1111
COMMUNITY DEVELOPMENT
Permit#: PLM2021-00134
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 4/6/2021
TIGARD Parcel: 1 S135AB00900
Jurisdiction: Tigard
Site address: 10200 SW GREENBURG RD
Project: Lincoln Center Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Second floor restroom remodel.
Contractor: POWER PLUMBING CO Owner: LINCOLN CENTER LLC
PO BOX 19418 BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97280 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503-244-1900 PHONE:
FAX: 503-244-8825
FEES
Quantity Description Date Amount
1 ea Fixture/Sewer Cap 04/06/2021 $25.02
Specifics: 4 ea Sink 04/06/2021 $100.08
2 ea Urinal 04/06/2021 $50.04
Type of Use: COM 5 ea Water Closet 04/06/2021 $125.10
Class of Work: ALT 1 12%State Surcharge- 04/06/2021 $36.03
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $336.27
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: Permlttee 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 ApplicaRECEI V E® •
Building Fixtures
City of Tigard MAR 2 2 2021 Received p
;� i 13125 SW Hall Blvd.,Tigard,OR 9 Date/By: it�- aZ( / _ Permit No.:/�� /9).,_txj i
Phone: 503.718.2439 Fax: 503.5 „ OF TIGARD Plan Review PCb'
Inspection Line: 503.639.4175 BUILDING DIVISION DateReady/By: Other PermitNSeePage2for
TIGARtt Internet: www.tigard-or.gov Notified/Alethod: hair
-",„.. Supplemental Information :
_._ TYPE OF WORK FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist
Description 1 Qty. I Ea. . Total
®Addition/alteration/replacement 0 Other: New I-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
0 I-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
0 Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 10200 SW GREENBURG RD Catch basin or area drain 18.76
City/State/ZIP:TIGARD, OR 97223 Drywell,leach line,or trench drain I8.76
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: , Project name:2 j,376 LI ju inf (Pnc' Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear fl.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: J Lot no.: Fixture or item:
Tax map/parcel no.: /5i 3 5,160 Grgw Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
5 LINCOLN 2ND FLOOR RESTROOM REMODEL Clothes washer 25.02
Dishwasher 25.02
ALL FIXTURES EXISTING REPLACE WITH NEW Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name: Fixture/sewer cap 1 25.02 „
Address: — Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP:
Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12 51
0 APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name:POWER PLUMBING CO. Medical gas(value:S_) Page 2
Contact name: MIKE WARREN Primer 1251
Roof drain(commercial) I L
Sink/basin/lavatory 4 25.02 I(�C). O
City/State/ZIP: PORTLAND, OR 97280-9418 Solar units(potable water) 62.54
Phone:( 503-244-1900 Fax::( 503-244-8825 Tub/shower/shower pan 12.51
E-mail:SERVICE@POWERPLUMBINGCO.COM Urinal 2 2502 5 O 01-1
CONTRACTOR Water closet 5 25.02 j). i0
•
Business name:
POWER PLUMBING CO. Water heater 37s2
Water piping/DWV 56.29
Address:6611 SW MULTNOMAH BLVD Other: 25.02
City/State/ZIP:PORTLAND, OR 97223 Subtotal 3dC, ,
Phone:( 503-244-1900 Fax:( 503-244-8825 Minimum permit fee: S72.50
CCB Lie.:52378 Plumbing Lic.no.: 34-150PB Plan review (25%ofpermit fee) �/✓ 7
U Authorized signature: ��[�C /p f l� n
TOTAge(12%L PERMofpermitITFEEfee) 3
Print name:KRISTI BRAMWELL I Date:3-19-2021 I State surcharge
This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
•Fee methodology set by Tti-County Building Industry Service Board.
\BuildingTermits\PLMII-PermitApp dor 10/01109 440-0oltlt 10/02/COM WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qtr. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-I a 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 I00' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52 Valuation: Permit Fee:
Storm&Rain Drain-tat 100' 62.54 $1.00 to$5,000.00 Minimum fee$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$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 S25,001.00 to S50,000.00 $379.50 for the first$25,000.00 and S1.45 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 S50,000.00 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",
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 Replica/ Please check all that apply.
Work Performed: Capped Added Relocate
Baptistry/Font ❑ Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuui/Whirlpool engineer.
IDCar 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.
Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system.
Domestic ❑ Any complex structure as defined in OAR918-780-0040.
Drinking Fountain i
Eye Wash Suhmit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
3" Isometric or Riser Diagram
❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain that meat the 'talific"tienaov abe.
0 a1 Loge -Duniesut.nun-tbod Q
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
IceMachlRefrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station PLEASE CALL MIKE WARREN WITH QUESTIONS 503-936-5929
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related 4
-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
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet-Toilet 5 plumbing permit can be issued.
Urinal 2
Other Fixtures:
1:\Building\Permits'PLMF_PermitApp.doc 08/04/2011 2
II . si Accumulative Sewer Tally
Tenant Name: LINCOLN CENTER SWR#N/A
T I GARD Site Address: 10200 SW GREENBURG RD(SECOND FLOOR) PLM# 2021-00134
Parcel#: 1S1135AB00900
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s value count added# added value total#s total values
Baptistry/Font 4 0 0 0 0 0
Bath: -Tub/Shower 4 0 0 0 0 0
-Jacuzzi/Whirlpool 4 0 0 0 0 0
Car Wash: -Each Stall 6 0 0 0 0 0
-Drive through 16 0 0 0 0 0
Cuspidor/Water Aspirator 1 0 0 0 0 0
Dishwasher: -Commercial 4 0 0 0 0 0
-Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 1 1 0 -1 -1
Eye Wash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 0 0 0 0
-3 inch 5 0 0 0 0 0
-4 inch 6 0 0 0 0 0
-Car Wash 6 0 0 0 0 0
Garbage Disposal:
-Domestic(to 3/4 HP) 16 0 0 0 0 0
-Commercial(to 5 HP) 32 0 0 0 0 0
-Industrial(over 5 HP) 42 0 0 0 0 0
Ice Machine/Refrigerator Dram 1 0 0 0 0 0
Living Unit 16 0 0 0 0 0
Oil Sep(Gas Station) 6 0 0 0 0 0
Rec.Vehicle Dump station 16 0 0 0 0 0
Shower: -Gang(per head) 1 0 0 0 0 0
-Stall 2 0 0 0 0 0
Sink:
-Lav/Bar-Non-Food Related 2 0 0 0 0 0
-Bradley 5 0 0 0 0 0
-Com/Scrv/Util-Food Related 3 0 0 0 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer-Clothes 6 0 0 0 0 0
Water Extractor 6 0 0 0 0 0
Water Closet-Toilet 6 0 0 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 1 1 0 0 -1 -1
Current Fixture Value -1 divided by 16= -0.063 Current EDU 1 EDU= $5,800.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -1 divided by 16= -0.063 over (under) $ (348.00)
Enter EDU Change Here -0.060 *
*Round EDUs to the nearest 1/100th: a count ending in.005 shall be rounded up to.01,and a count ending in.014 or less shall be rounded down to.01.
Notes: ***CREDIT***
Authorized Name/Signature: BRANDEN TAGGART X2449 Date: 4/5/2021
Building Division
Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist,this document will serve as a voucher which must be
submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
I:\Building\Sewer Tally\Sewer I'allySheet_5800_07(1119.xlsx