Permit 711 CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2022-00025
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 1/27/2022
Parcel: 1 S135AB01004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD
Project: Lincoln Center Subdivision: METZGER,TOWN OF
Lot: 9
Project Description: Interior plumbing for second floor restrooms:Capping(1)drinking fountain and (1)water closet;Replacing(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 01/24/2022 $50.04
Specifics: 4 ea Sink 01/24/2022 $100.08
2 ea Urinal 01/24/2022 $50.04
Type of Use: COM 4 ea Water Closet 01/24/2022 $100.08
Class of Work: ALT 1 12%State Surcharge- 01/24/2022 $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.�e 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: ' ,, n , 4 '� Permittee Signature: p�}\ a �11Cat 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.
Wibin2 Permit Application , 4-
Site Utilities FOR OFFICE USE ONLY
RECEIVt ived . P a - �a,�
S City Tigard a By: N/21 Permit No.:
• 13125 SW Hall Blvd.,Tigard,OR 97223
= Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 JAN A 2022 Dale/BIn �/ Other Permit No.: /4/-®2,,11_�1]ry�
Inspection Line: 503.639.4175 `t L L4, �T ��M f/(Jrlr GCAr�d'
T I G A R D Date Ready/By: y-y ms 0 See Page 2 for
Internet: www.tigard-or.gov ^+ Notified,T4ethod: / a( //t ,w'..t. Supplemental Information
CITY OF rir�nr� _ /��TYPE OF WORK BUILDING DIVISION )F'M‘ t 1 FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist.
Description I Qty, I Ea. Total
lgr Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
-
❑ 1-and 2-family dwelling ElCommercial/industrial SFR(2)bath 437.78
❑Accessory building ❑Multi-family SFR(3)bath •
500.32
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: lozzo 5W G'reenb0 Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: �4A,/ Q� ,17ZZ _ -
U Footing drain(no.linear ft.:_1 Page 2
Suite/bldg./apt.no.: Z"�fl - Project name: 2_1., C. , Q,,nr Manufactured home utilities 50.03
Cross street/directions to job site: Lr 1„-ic..6)l„, (.0 r-. 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: I Lot no.: Fixture or Item:
t,Tax map/parcel no.: /3�drr i ,; Backflow preventer 31.27
w5 DESCRIPTION OF WORK Backwater valve 12.51
Ii // Clothes washer 25.02
Y 7o1Ie!It 2 IJiiYt sIISS awl
/ ; 45 Dishwasher 25.02
gf t i Id 1Yl q rr1'S IT i 7_0z1-czZ 2-Z Drinking fountain 25.02
U Ejectors/sump 25.02
0 PROPERTY OWNER a Expansion tank 12.51
Name: Fixture/sewer cap a 25.02 S 2) t''61
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
r'9 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: K rAy6 Y.5 L p tuyykb Medical gas(value:$ ) Page 2
'r t�J Primer 12.51
Contact name:14a Ks ry
/� Roof drain(commercial) 12.51
Address: l n t Sln/ C,t�o le 12d Sink/basin/lavatory 25.02 /W,aCity/State/ZIP: -rut, h O 170/ 2. Solar units(potable water) 62.54
Phone:(5-03 ) 6,1a LA31 Fax::( ) Tub/shower/shower pan 12.51
E-mail: at 1 RA horn .Co rh Urinal Z. 25.02 �.D (
Water closet 1 25.02 rw•a'Water heater 37.52 6
Business name: GIY ,rn c Om bi Kq Water piping/DWV 56.29
Address: i77/0 SW ( i Ie Kc[ J Other: 25.02
City/State/ZIP: TUa IA f l Irk I OR.. 5706 Z Subtotal
Phone:(5D3 )` 2_ ei139 Fax:( ) Minimum permit fee: $72.50
CCB Lie.: SZ 55 Z Plumbing Lic.no.: 13-I(4,pB Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: �•- �;-/./ TOTAL PERMIT FEE
Print name: 1) G (� l`l - Date: I-'-ZZ This permit application expires if a permit is not obtained within 1 0 day
1 after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:1Building\Permits\PLMU-PermitApp.doe 10/01/09 440-4616T(10102/CAM/WEB)
bins 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 $1.00 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
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 $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/br 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:
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*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ Plan review is required for anyof the following.
Work Performed: Capped Added Relocate q g
Baptistry/Font Please check all that apply.
Bath Tub/Shower ❑ Any new commercial building with water service 2"and
-Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain Q ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3"
4" Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food $ q g
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
I:\Building\Permits\PLMU_PermitApp.doc 2
Accumulative Sewer Tally
= Tenant Name: LINCOLN CENTER SWR#N/A
Site Address: 10220 SW GREENBURG RD PLM# 2022-00025
I G A HD
Parcel#: 1 S 135AB01004
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 = $6,085.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -7 divided by 16= -0.438 over (under) $ (2,677.40)
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 be rounded down to.01.
Notes: ***CREDIT***
Authorized Name/Signature: BRANDEN TAGGART X2449 Date: 1/21/2022
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\SewerTallySheet_6085_070121.xlsx
Branden Taggart
From: #Building Permit Technicians
Sent: Wednesday,January 19, 2022 3:35 PM
To: 'Hans Halverson'
Subject: 3 Lincoln Plumbing Permit Submittal - 10220 SW Greenburg Rd.
Hi Hans,
We received the second Plumbing permit submittal for 10220 SW Greenburg Rd. In the future, we recommend that you
do not send us multiple submittals to prevent duplicate permits. Our permit processing timeline is 1-3 weeks for
commercial plumbing permits,and we are currently close to (3) weeks at the moment due to our current workload and
the impact of the pandemic. I see that the updated application has (2) capped fixtures. I may be able to process this
permit by the end of the day on Thursday, but if not,then the first part of next week will be the anticipated completion
date.
Thank you,
ppCity ofBran en Taggart
, Cityof Tigard SenJt ior.Perm it Technician
Community Development
13125 SW Halle Blvd
Tigard, OR 97223
(503)718-2449'
brandent@tgard-ar,gov
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