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1CITY OF TIGARD PLUMBING PERMIT
�`1 B. COMMUNITY DEVELOPMENT Permit#: PLM2021-00434
Date Issued: 10/21/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S135AB01003
Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD 180
Project: VSP Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Interior plumbing:Replacing(1)hub drain,(1)primer, (1)sink,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 Floor Drain/Floor Sink/Hub 10/21/2021 $25.02
Specifics: 1 ea Primer 10/21/2021 $12.51
1 ea Sink 10/21/2021 $25.02
Type of Use: COM 1 ea Water Heater 10/21/2021 $37.52
Class of Work: ALT 1 12%State Surcharge- 10/21/2021 $12.01
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $112.08
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 sett-. QAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
1
Issued By: zio‘-/l/f Permittee Signature: Sr12,/74717' ,S11.
�
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.
RECEIVED
Plumbing Permit Application OCT 1 3 2021
Site Utilities CITY OF fIGARD rf►I/ f)I rl( r t SI. 0v1 1
City of Tigard BUILDING DIVISION !ir Permit No.
4 13125 SW Hall Blvd.,'Tigard,OR 97223 De'cterByA /�/aL/` "� � �� � ��
. Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 [}ate.By Other Permit No.;`{�" A_"lit a
�f/
lit It 1 Inspection Line: 503.639.4175 Date Ready-By: ile ® See Page 2 r ``
Internet: www.tigard-or.gov Notified;Method: y Supplemental Information
TYPE OF WORK FEE* SCHEDULE
0 New construction 0 Demolition For special information use checklist.
- Description 1 Qty. ( Ea. j Total
RI 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
0 1-and 2-family dwelling 0Commercialiindustrial SFR(2)bath 437.78
❑Accessory buildingMulti-family SFR(3)bath 500.32
❑ _
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: /0300 $IIAJ Green bvrq 2.Q Catch basin or area drain I8.76
City,'Slatei7.IP: / Q ..] Drywell,leach line,or trench drain 18.76 _
t Qom/ D ` 7.223 Footing drain(no,linear ft.:_) Page 2
Suite/bldg.lapt.no.: u-Eed Project name: , /�' _ Manufactured home utilities 50.03
Cross street/directions to job site: �/` Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no linear ft.:_) Page 2
Storm sewer(no.linear R.: ) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31 27
DESCRIPTION OF WORK Backwater valve 12.51
t ` I ` Clothes washer 25.02
1 5lh i, I 1{1/IJQTe k.hedrj-f I hVL LL/arl1 aric/ Dishwasher 25.02
/ ift4/2 Or/mer Drinking fountain 25.02
r Ejectors/sump 25.02
❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Fixture'sewer cap 25.02
Name:
Floor drain'floor sinkihub I 25.02 2S DI"
Address:
Garbage disposal 25 02
City,State/ZIP: _ Huse bib 25 02
iPhone:( ) Fax:( ) Ice maker 12.51
❑ APPLICANT Si CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$_) Page 2
+ ybornS Plvrnbtr� _ Primer 1 12.51 1t ail
Contact name: �/ ,/_/Gh5 / �J � Roof drain tcmnmercial) 12.51
1lyo sw c fro 1 rz-....6 1
Address: f* Sinkbasinlavatory 1 2502 2_5 Z
City,State'ZIP: 7(/Sa,7I i t. f706z- - - Solar units(potable water) 62.54
Phone:(503) 4 3 q I Fax: :( ) ! Tub/shower shower pan 12.51
Urinal 25.02
fay r
E-mail: ens 4. f t1.5•C01N•.
CONTRACTOR Water closet 25.02
Water heater 1 37.52 37 6/-
Business name: RAY BORN'S PLUMBING INC
Water piping,DWV 56.29
Address: P.O.Box 69 Other 25 02
City.`State ZIP Tualatin,OR 97062 Subtotal
MO"
Phone:(503)692-4139 I Fax:(503)691-2328
Minimum permit fee. 572.50
Plan review (25%of permit tee)
CCB Lic.:87852 Plumbing L is no.:34-166P6
I State surcharge(12%of pennit fee)
Authorized signature: TOTAL PERMIT FEE /Iz a8 ,
Print name: by..„..) e I Date: 10 ._1 This permit application expires if a permit is not obtained within IN days
after It has been accepted as complete.
'Fee rocthodology sot 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 S uare Footage: Permit Fee:
Footing drain-f°I00' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $233.69
3,601 to 7.200 S233.20
Sewer- 1st 100' 62.54 7,201 and_grwter S327.54
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 51.00 to 55,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional I00- 37 52 55.001.00 to$10,000.00 $72.50 for the first 55,000.00 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 S25,000.00 S 148.50 for the first S10,000.00 and S1.54 for
which no fee is specifically indicated 90,001r each additional$100.00 or fraction thereof,to
(minimum charge-112 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001 00 to$50,000.00 537950 for the first$25,000.00 and$1.45 for
hours(minimum charge--2 hours) each additional 5100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00,
Additional plan review for revisions 90.00/hr S50,001.00 and up 5742.00 for the first$50,000.00 and$1.20 for
(minimum charge- I i2 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.
Baptistrv%Font ❑ New exterior plumbing site utilities for any complex structure
Bath -Tub/Shower as defined in OAR918-780-0040.
Jacuui'Whirlpool ❑ Medical gas and vacuum systems for health care facilities.
Car Wash -Each Stall
-Drive Thru ❑ Any multipurpose fire sprinkler system.
ElAny complex structure as defined in OAR9I8-780-0040.
Cuspidor/Water Aspirator
Dishwasher -Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash Isometric or Riser Digram
Floor Drain/sink -2" in Isometric or riser diagram is required for new buildings
-3- that meet the qualifications above.
Car Wash Drain
Garbage -Domestic
Disposal -Commercial
-Industrial Comments regarding fixture work:
Ice Mach.'Refrig.Drains
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower -Gang
-Stall _
Sink -Bar/Lavatory. I
-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
Urinal
Other Fixtures: Pr' ve _ 3
WA*tlla{iGf
Nub dniin
http://www.tigard-or.gov/city_hal l/departments/cd/docs/P LMF-Permit Apldoc