Permit 11111 CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2021-00456
Date Issued: 11/3/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 1 S 135AB04500
Jurisdiction: Tigard
Site address: 10250 SW GREENBURG RD 200
Project: Spec Space Subdivision: 1991-055 PARTITION PLAT Lot: 1
Project Description: Interior plumbing for TI:Capping(1)water closet and(1)urinal;Adding(2)2"floor drain/sinks;
Replacing/relocating(1)dishwasher,(1)2"floor drain/sink,(3)sinks,and(2)water closets; Installing(2)primers
and(1)water heater.
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
2 ea Fixture/Sewer Cap 11/01/2021 $50.04
Specifics: 3 ea Floor Drain/Floor Sink/Hub 11/01/2021 $75.06
2 ea Primer 11/01/2021 $25.02
Type of Use: COM 3 ea Sink 11/01/2021 $75.06
Class of Work: ALT 2 ea Water Closet 11/01/2021 $50.04
Type of Const: 1 ea Water Heater 11/01/2021 $37.52
Occupancy Grp: 1 ea Dishwasher 11/01/2021 $25.02
Stories: 1 12%State Surcharge- 11/01/2021 $40.53
Plumbing
Total $378.29
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
Issued By: Permittee Signature:
Hc-LLy Vaw De,Wege Ow App-Lix-culio-vt
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 ApplicatioRECEIVED glii
Building Fixtures OCT 18 2021
Cityof Tigard Received
g r T /�Rj DatelBy I / / 07J'' Permit No.: _
III 41 13125 SW Hall Blvd.,Tigard,OR 97223OI k Y OF 1 GARLk plan Revie 1
B Phone: 503.718.2439 Fax: 503.598 f Other Permit No.:
8u1LDING DIVISION Date/By: _-- �G 1- e1
1,`r v 1_h inspection Line: 503.639 4175 Date ReadyiBy: /��- ® Se age 2 for
Internet. aww.ligatd-Ur.gov Notified/Method: i�. "`".r{/ Supplemental Information
TYPE OF WORK 41kr"-.,al.tof FEE" SCHEDULE
❑New construction 0 Demolition For special information use checklist.
Description I Qty. I Ea. I Total
®Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
1-and 2-family SFR(2)bath 437.78
❑ wcllin> ®Commercial/industrial
500.32
❑Accessory building 0 Multi-family SFR 3 O bath
Each additional bath/kitchen 25.02
❑Master builder 0 Other: _ Fire sprinkler( sq.ft) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 10250 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.:200 Project.name:Spec. 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: /5'f 3 5-Ago 4,�--.,(JL t I Lot no.: Fixture or item:
Tax map/parcel no.: 4 V Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
TENANT IMPROVEMENT, VACANT SPACE PREP Dishwasher 1 25.02 ,9- „01-
SUITE 200, 4 LINCOLN Drinking fountain 25.02
Ejectors/sump 25.02
• 0 PROPERTY OWNER 1 ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 2 25.02 5-c,,GN
Floor drain/floor sink/hub 3 25.02 'ZJ,U In
Address:
Garbage disposal 25.02
City/State/TIP: Hose bib
25.02
Phone:( ) Fax:( ) Ice maker 12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:POWER PLUMBING CO. Medical gas(value:$_) Page 2
Primer 2 12.51 ?5-.43,.
Contact name: MIKE WARREN Roof drain(commercial) 12.51
Address: P.O. BOX 19418 Sink/basin/lavatory 3 25.02 77,d6P
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 25.02
Water closet 2 25.02 TD s c)tl
CONTRACTOR
Water heater 1 37.52 37-S]
). Business name:POWER PLUMBING CO. Water i m DWV 56.29
F P P�
Address:6611 SW MULTNOMAH BLVD Other 25.02
City/State/ZIP:PORTLAND, OR 97223 Subtotal 337,76i
' Phone:( 503-244-1900 Fax:( 503)244-8825 Minimum permit fee: $72.50
Plan review (25%of permit fee)
I
CCB Lie.:52378 Plumbing Lic.no.: 34-150PB T 3
State surcharge(12%of permit fee) jO.f
Authorized signature: ty TOTAL PERMIT FEES75,
Print name:KRISTIE RAMWELL Date:10-18-2021 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
'Tee methodology set by Tri-County Building Industry Service Board
1 Building,PermiisPt-AIU-PermitApp doe 10/01/09 440-4616T(10/02/COM.WEB)
1
,
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 $121.90
Footing drain-each additional 100' 37.92 2,001 to 3.600 $169.69
Sewer-I st 100' 62-54 3,601 to 7,200 $233.20
7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-I st 100' 62.54
Medical Gas Systems:
Water Service-each additional 100' 37.52
Storm&Rain Drain-1st IOW 62 54 Valuation: Permit Fee:
$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
Inspection of existing plumbing or for and including$10.000.00.
which no fee is specifically indicated $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
P ) 90.00Por 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:
gCommercial 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.
I Fixture Type for Replace/ Please check all that apply.
I Work Performed: Capped Added Relocate
Baptistry/front ❑ Any new commercial building w ith water service 2"and
Bath: -Tub/Shower greater,except systems designed and stamped by licensed
-Jacuzzi/Whirlpool engineer.
Car wash: Each Stall 0 New exterior plumbing site utilities for any complex structure
Drive tall �-7 as defined in OAR918-780-0040.
• uapidth/Warii Aapuatoi ❑' Medical g..3uttd"eau Jmi ayatcii r7 health' dlt:.`�}tlil S.
Dishwasher Commercial 0 Any multipurpose fire sprinkler system.
Domestic El Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2" 2 1
3,. Isometric or Riser Diagram
4 ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain K q
Garbage Domestic non-rood that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig.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: -Ear/Bar non-food related 3
-Bradley
dbm/Sen•/tltil food related
-Service *Note: lithe fixture work under this permit results in an
Swimming Pool Filter
washer-Clothes increase of sewer EDUs,a sewer permit will be issued and
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet-Toilet t 2 plumbing permit can be issued.
Urinal 1
Other Fixtures:
I:\Building\Pcrmits\Pl,MF_PermitApp.doe 08/04/201I 2
Accumulative Sewer Tally
•
i Tenant Name: SPEC SPACE SWR# N/A
Site Address: 10250 S\V CRI II NBURG RD SUITE 200 PLM# 2021-00456
TIGARD
Parcel#: 1 S 135AB04500
Fixture Value Previous I 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
I -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 0 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 0 2 4 2 4
-3 inch 5 0 0 0 0 0
-4inch 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 1 6 0 -1 -6
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 2 12 2 4 0 -8
Current Fixture Value -8 divided by 16= -0.500 Current EDU 1 EDU= $6,085.00
t Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -8 divided by 16= -0.500 over (under) $ (3,042.50)
Enter EDU Change Here -0.500 *
*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: 11/1/2021
i 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
ti submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
1 I:\Building\Sewer Tally\SewerTailySheet_6085_070121.xlsx
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