Permit CITY OF TIGARD PLUMBING PERMIT
ffi !r COMMUNITY DEVELOPMENT Permit#: PLM2021-00195
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 5/10/2021
TIGARD 9 Parcel: 1 S 135AB01004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD
Project: Lincoln Center Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Interior plumbing for fifth floor restrooms:Capping (1)drinking fountain and(1)water closet; Replacing and
relocating(4)sinks,(4)water closets,and(2)urinals.
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
2 ea Fixture/Sewer Cap 05/07/2021 $50.04
Specifics: 4 ea Sink 05/07/2021 $100.08
2 ea Urinal 05/07/2021 $50.04
Type of Use: COM 4 ea Water Closet 05/07/2021 $100.08
Class of Work: ALT 1 12%State Surcharge- 05/07/2021 $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: Permittee Signature: ' ,y
eZga
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 AnDlicatiREC E I VE D 2 i
Site Utilities AFEc 21 202' ror� orrlcl: i. i ()NI
City of Tigard Da eB c-J7/yr ',Ay_ Permit No.: /4��].f�,ad 4
IN q 13125 SW Hall Blvd.,Tigard,OR 9713iTY OF TIGARD Plan Review Other Permit No.:
1 1
I • Phone: 503.639.4171 Fax: 503.5�BING DIVISION., Dale/By: n/
T i c;n u n Inspection Line: 503.639.4175 ` Date Ready/By: .� /t ,�rare:� 0 See Page 2 for
Internet: www.tigard-or.gov _Notified/Method: J tfirri 1_It i Supplemental Information
TYPE OF WORK 4 ,t(.yl /lpK,p FEE" SCHEDULE
El New construction ❑Demolition For special information use checklist
Description I Qty. I Fa. I Total
®Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
ElI-and 2-family dwelling yr Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building 0 Multi-family Each additional bath/kitchen 25.02
❑ Master builder 0 Other: Fire sprinkler(_sq.ft.) Page 2
,,,. ,,i ,:,,04,...w. -81TA INFORM TIONV AN¢ LOCATION Site utilities:
Job site address: 'O Z ZO St.J (reeEln(IJR& 1Q Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: 7((rA,.0 I OR q 4-t Z3 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: + ae L,hh..prn.) C .-t z.- Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
/- S.lb rt 1001Z 3 LIAtaOt_N Lane �GStrad�S
( 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.: 1,5 t357,00 i cio:.1 Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Q.L cam.,(1V� feyy-sdr„ �„ AOA flats 1 Dishwasher 25.02
1 Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: Fixture/sewer cap a 25.02 5/-01,1
Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
(I APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
/rMedical gas(value:$_) Page 2
Business name: '(r,AY60,AiS ?UJ i8IN tr Primer 12.51
Contact name: gig Ns liALUt iESonj Roof drain(commercial) 12.51
Address: (1 q qo SW C.i 0ot.E i-J Sink/'basimlavatory 4/ 25.02 !iU,t
City/State/ZIP: A $1tNr 0'(Z- cf 0CIZ Solar units(potable water) 62.54
Phone:(503 )6 q L,t{t 39 Fax::(503 ) b41 -2 3 Z 8 Tub/shower/shower pan 12.51
Urinal a 25.02 .5 .c/`1
E-mail: OAA,I5 C(tAsip gAi 5 , c.M,t Water closet q 25.02 itt),Cy'e
CONTRACTOR
Water heater 37.52
Business name:RAYBORN'S PLUMBING INC WaterpipingiDWV 56.29
Address:P.O.Box 69 Other 25.02
City/State/ZIP:Tualatin,OR 97062 Subtotal 3610. ,
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)
State surcharge(12%of permit fee) 3(0,07
Authorized signature: TOTAL PERMIT FEE 3,3(e.
expires if a permit is not
Print name:MeAll r. to f,resi Date: Z Op/tut I This permit applicationafter ithas been accepted as co pleteed within ISO days
*Fee inethodclogy 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(ea) Total ` Square Footage: `-:: Permit Fee:
Footing drain-l'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
Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
Other Inspections or Fees . 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 90.00Av 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
each additional$100.00 or fraction thereof.
(minimum charge-1/2 hour)
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 ❑ Medical gas and vacuum systems for health care facilities.
Car Wash -Each Stall ❑ Any multipurpose fire sprinkler system.
-Drive Thru ❑ Any complex structure as defined in OAR918-780-0040.
Cuspidor/Water Aspirator
Dishwasher -Commercial Submit 2 sets of plans with any of the above.
-Domestic
Drinking Fountain I
Eye Wash Isometric or Riser Diagram
Floor Draia'sink -2" ❑ Isometric or riser diagram is required for new buildings
3" that meet the qualifications above.
Car Wash Drain
Garbage -Domestic
Disposal -Commercial Comments regarding fixture work:
-Industrial e pp � �
Ice Mach./Refrig.Drains I' ,\o`ie- I '^f/` '^ ^S
Oil Separator(Gas Station) c .tn.aJL p F
Rec.Vehicle Dump Station *lent//tttOralt-ryaa..;.r� FikfWYJ
Shower -Gang
-Stall
Sink -Bar/Lavatory 7
-Bradley
-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 plumbing permit can be issued.
Water Extractor
Water Closet-Toilet I 446' ir-r tv..3 0/, ?T
Urinal V
Other Fixtures:
h ttp://www.tigard-or.gov/city_hal l./departments/ed/docs/PLMF-PermitApp2doc
Application for Permit
RECEIVED
21April2021 AK 21 202i
Rayborns Plumbing, INC. CITY OFTIGARD
BUILDING DIVISION
Scope of work:
Remove existing core restroom fixtures in mens and womens room. Permanently cap 1 water closet in
mens room. Rerough Urinals in mens room. Replace lavatories on existing rough.
Permanently cap drinking fountain.
Reconfigure water closets in womens room for ADA clearances. Replace lavatories on existing rough.
Permit Drawings are provided for reference only. Plan review not required.
IIITei
nant Name: LINCOLN CENTER ccumulative Sewer Tally SWR# N/A
Site Address: 10220 SW GREENBURG RD PLM# 2021-00195
TIGARD
Parcel#: 1 S135AB01004
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s value count added# added value total#s total values
Baptisery/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 Drain 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/Serv/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 1 6 0 -1 -6
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 2 7 0 0 -2 -7
Current Fixture Value -7 divided by 16= -0.438 Current EDU 1 EDU= $5,800.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -7 divided by 16= -0.438 over (under) $ (2,552.00)
Enter EDU Change Here -0.440
*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 he rounded down to.01.
Notes:***CREDIT*** I-1F1'H FLOOR RESTROOMS.
Authorized Name/Signature: BRANDEN TAGGART X2449 Date: 5/7/2021
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 TallySheet_5800_070119.xlsx