Permit CITY OF TIGARD PLUMBING PERMIT
' COMMUNITY DEVELOPMENT Permit#: PLM2022-00268
Date Issued: 8/30/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S135A601003
Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD 200
Project: Resource Financial Planning Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Interior plumbing for TI: Replacing (1)dishwasher, (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 Dishwasher 07/18/2022 $25.02
Specifics: 1 ea Sink 07/18/2022 $25.02
1 ea Water Heater 07/18/2022 $37.52
Type of Use: COM 1 12%State Surcharge- 07/18/2022 $10.51
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total S98 07
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
Issued By: �vL � Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
<--$uilding Fixtures FOR OFFICE USE ONLY
City of Tigard Datee/B Received 7/j$7/2-; l - Permit No.: A r at� ,v,k/
IN ■ 13125 SW Hall Blvd.,Tigard,OR 9.j� Y (/"
'/�+10EIVCD Plan Review
Phone: 503.718.2439Blvd. Fax: 503.5 L C Date/B Other Permit No.:Q�� y-00/5-7
Y� es^ (//yV
Inspection Line: 503.639.4175 Date Ready/By: Juris: See Page 2 for
] ftiAK U Internet: www.tigard-or.gov JUL 8 202 NotifiedMethod: j,/; Supplemental Information
TYPE OF WORI-Y OF TIGARD FEE" SCHEDULE
❑New construction LONGOIVISION For special information use checklist. Total
Description Qty. I Ea. I
Dir Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility cormection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ 1-and 2-family dwelling p 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
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: R, Catch basin or area drain 18.76
�o lOt7 S0) ��Ztc>J ilk' &d Drywell,leach line,or trench drain 18.76
City/State/ZIP: t1/v/- '� ZZ3
rt l G'�(LC) f�..Q(j R Footing drain(no.linear it: ) Page 2
Suite/bldg./apt.no.: Zc° I Project name:Zop,xfw.c;/tome.6 I Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
I Lja,rain SJI+G too 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:
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
�n/� Clothes washer 25.02
Ie9l4t 0( LA Sl'1�/ rfx �CA T }�!l (�11�VR �fII Dishwasher 0 25.02 ,2S �:L
-For 'LT • Jp5,f+..iaS Drinking fountain 25.02
Ejectors/sump 25.02
X PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name: <.14.O() /JST e id f Fixture sewer cap 25.02
�q Floor drain/floor sink/hub 25.02
W
Address: S Aip„/1-0-p/n70.y S'" Garbage disposal 25.02
City/State/ZIP: 5 t4/J f(I.A4.i. W t CA Ct e 4 1 a cl Hose bib 25.02
Phone:(q ) '1 7 2 • 7 00 0 Fax:( ) Ice maker 12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
t�,�-, r� Medical gas(value:$_) Page 2
Business name:
g-�T-1 135 el...)M�tN� Primer 12.51
Contact name: .4 4,M j -({#i_J CtFo/'1 Roof drain(commercial) 12.51
Address: (1 4 Q 0 ft l C,i Qo L c Sink/basin/lavatory 0 25.02 0?
City/State/ZIP: "(JAt.-A7tN 01 froN 1I04,2 Solar units(potable water) 62.54
Phone:(SOS) b 9 2-C(I 19 Fax::(S'o)) foci 1- 1.3z4
Tub/shower/shower pan 12.51
E-mail: 14 Af5 e- 1A...f 00(1/t/S 7. ( 0✓` Urinal 25.02
Water closet 25.02
CONTRACTOR Water heater 37.52
37.s}
Business name: tgs..4,1ap45 IQ(,,a•.•l t,ifr Water piping/DWV 56.29
Address: (Lr qqa 5-6,1 (']pot. (ID Other: 25.02
City/State/ZIP: v AAA 7,A/ o/t( A,) 4 706 2 Subtotal 77.
Phone:�3 ) 6H 2. L( (3 4 Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.: 8'7 gs-z Plumbing Lic.no.:34-At 4 Pl3
State surcharge(12%of permit fee) i /0.S/
Authorized signature: TOTAL PERMIT FEB74 g' 0 7
Date: (S7U(.'1 L q,- This permit application expires if a permit is not obtained within 180 days
Print name: ' 4 ,t 5 d`Vt. u,a y�/ after it has been accepted as complete.
R J" *Fee methodology set by Tri-County Building Industry Service Board.
I:1Building0Permits\PLMU-PermitApp.doc 10/01/09 440-4616TO0/O2/COM/WEB)
Plumbing Permit Application - City of Tigard
--'page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
lrtt S• ��, ,�� �.� .�� �����. 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
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 90.00/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/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:
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
❑ Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
-Jacuzzi/Whirlpool
Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
ElMedical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator
Dishwasher: Commercial ❑ Any multipurpose fire sprinlder system.
Domestic /i1 ❑ Any complex structure as defined in OAR918-780-0040.
Drinking Fountain lJ
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
3" Isometric or Riser Diagram
-4„ ❑ 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
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station) v N(LiQ C " ij .ks F 4 X`I 4dt S
Rec.Vehicle Dump Station Q VipuJ(e e r
Shower: -Gang
-Stall
Sink: -LavBar non-food related U
-Bradley
-ConilServ/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 f`
Other Fixtures: f
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