Permit CITY OF TIGARD PLUMBING PERMIT
= COMMUNITY DEVELOPMENT Permit#: PLM2022-00048
Date Issued: 2/17/2022
T I G A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1 S 135AB03400
Jurisdiction: Tigard
Site address: 10260 SW GREENBURG RD 300
Project: Spec space Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Plumbing interior for spec space:CAPPING(2)sinks;ADDING{1)sink,(1)water heater, and(1)hub drain.
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 02/16/2022 $50.04
Specifics: 1 ea Floor Drain/Floor Sink/Hub 02/16/2022 $25.02
1 ea Lavatories 02/16/2022 $25.02
Type of Use: COM 1 ea Water Heater 02/16/2022 $37.52
Class of Work: ALT 1 12%State Surcharge- 02/16/2022 $16.51
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $154.11
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: I n n y(�t� (���� Permittee Signature: t� awF 7 _ �^
`CJ w (beds?b�✓LJ�K `l l Or\1 ' ' I `
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 ApplicaFC
Building Fixtures JAN 2 i FOR OFFICL USE Oyl.'1
ved
City of Tigard ,, Date/ByRecei . ,2 /ee ,ZL # )022- a^
114 t260 L
+ 13125 SW Hall Blvd.,Tigard,OR 96 Y OFT!. 'DID Plan Review �.l �y�y,,
■ Phone: 503.718.2439 Fax: 503 Date/By: 4i�C '000
Inspection Line: 503.639.4175 ""�G+��� �IYIJI®�
1IGAftIT p Date Read /B •.a.'ry ® See Page 2 for
>»r + g Internet: www.tigard-mgov Not' d'Method: N Supplemental Information
TYPE OF WORKjjFEE* SCHEDULE
New construction ❑Demolition i�T Forspecial information use checklist.
❑ Description I Qty. I Ea. 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
SFR(2)bath 437.78
❑ I-and 2-family dwelling ®Commercial/industrial SFR(3)bath 500.32
❑Accessory building 0 Multi-family Each additional bath/kitchen 25.02
0 Master builder ❑Other Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: /0260 GrEet�U RA
Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: � � 97Z,2. ��� " Footing drain(no.linear ft.:_) Page 2
Suite/bldg./ .no Project name: U,5 P taer, Manufactured home utilities 50.03
Cross stree tree tons to job site: (I _ �/ 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: f Lot no.: Fixture or item:
Backflow preventer 31.27
Tax map/parcel no:
Backwater valve 12.51
DESCRIPTION OF WORK
Clothes washer 25.02
Ca o4 2 Sinks . Xl44ati1 I Sink amt Dishwasher 25.02
I to +er- ke 1Yr aril I kulf, elroilh Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Fixture/sewer cap 04. 25.02
Name:
Floor drain/floor sink/hub I 25.02
Address: Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
❑{{}�APPLICANT CONTACT PERSON Interceptor/grease trap 25.02
1'`C1.�bprv�S PI vm..b,YIC� Medical gas(value:$_) Page 2
Business name: ..J
Primer 12.51
Contact name: /arts N Roof drain(commercial) 12.51
Address: l MIO ski Gi a,`k Sinkibasin/lavatory I 25.02
City/State/ZIP: Tuc.I a-1-t y‘ OR 9 7U 6 L Solar units(potable water) 62.54
Phone:(5( ) 6 1q Z y139 Fax: :( ) Tubishower/shower pan 12.51
Urinal 25.02
E-mail: mar (.J geky r
r16•Covvx i andretoe Water closet 25.02
CONTRACTOR rG.ykk,ens• Colo-t. Water heater 1 37.52
Business name: ‘/bry c P1[J Mb i l Water piping/DWV 56.29
Address: I il V G;po it Other: 25.02
City/State/ZIP: ` -DalA{-tyl lOT 7062... Subtotal
Phone:(5D3) 69L 41 J Fax:( ) Minimum permit fee. $72.5(1
������ Plan review (25%of permit fee)
CCB Lic.: Plumbing Lic.no.: a
'tune: 1 } �1State surcharge(12%of permit fee)
Authorized signature: ) ///a TOTAL PERMIT FEE
D roA) R�k Date:1-Z.7-Z.Z. This permit application expires if a permit is not obtained within 180 days
Print name: after it has been accepted as complete.
`Fee methodology set by Tri-County Building Industry Service Board.
1 nuilding.Perm iSTLMU-PermitAppdoc 10'/11.05 440-4616T(10.02COM'WEB)
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-1"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 On to S5,000.00 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
and including$10,000.00.
inspection of existing plumbing or for $10,001.00 to S25,000.00 S148.50 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 S25,000.00.
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 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 S742.00 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",
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 Replace/ 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
-Jacuai/Wh'vlpool engineer.
Car Wash: -ack Stall 0 New exterior plumbing site utilities for any complex structure
-Drive Thm as defined in OAR918-780-0040.
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial El Any multipurpose fire sprinkler system.
-Domestic 0 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"
3" Isometric or Riser Diagram
❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
IceMach./Refiig.crams Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lay/Bar non-food related Z 1
-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 fees assessed for the sewer increase must be paid before the
Water Extractor Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:1Building\Permits\PLMF_PennitApp.doc 08/04/2011 2
= Accumulative Sewer Tally Tenant Name: Spec Space SWR# N/A
T 1 t] Ft l� Site Address: 10260 SW GREENBURG,SUI1E 500-530 PLM# PLM2022-00048
Parcel#: 1 5135AB03400
Fixture 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 0 0 0 0
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 1
-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 2 4 1 2 -1 -2
-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 0 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
'TOTALS 0 0 2 4 1 2 -1 -2
Current Fixture Value -2 divided by 16= -0.125 Current EDU 1 EDU= $6,085.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -2 divided by 16= -0.125 over (under) $ (791.05)
Enter EDU Change Here -0.130 *
*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: JULIE DRINKWATER X2804 Date: 2/16/2021
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.
1:\Building\Sewer Tally\SewerTallySheet_60S5_070121.xlsx