Permit CITY OF TIGARD PLUMBING PERMIT
. COMMUNITY DEVELOPMENT Permit#: PLM2022-00454
Date Issued: 11/8/2022
T t G AR1.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1 S135AB00900
Jurisdiction: Tigard
Site address: 10200 SW GREENBURG RD 110
Project: Spec Space Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Interior plumbing prior to TI:Replacing(1)hub drain,(1)primer,(1)sink,and(1)water heater.
Contractor: RAYBORNS PLUMBING INC Owner LINCOLN CENTER LLC
PO BOX 69 BY SHORENSTEIN PROPERTIES LLC
19990 SW CIPOLE RD 555 CALIFORNIA ST 49TH FL
TUALATIN, OR 97062 SAN FRANCISCO, CA 94104
PHONE: 503-692-4139 PHONE:
FAX: 503-691-2328
FEES
Quantity Description Date Amount
1 ea Dishwasher 11/08/2022 $25.02
Specifics: 1 ea Floor Drain/Floor Sink/Hub 11/08/2022 $25.02
1 ea Primer 11/08/2022 $12.51
Type of Use: COM 1 ea Lavatories 11/08/2022 $25.02
Class of Work: ALT 1 ea Water Heater 11/08/2022 $37.52
Type of Const: 1 12%State Surcharge- 11/08/2022 $15.01
Occupancy Grp: Plumbing
Stories:
Total $140.10
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
Permittee Signature: /! t
Issued By� �c
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 ApplicatioECElVED
Building Fixtures Ran
a� City of Tigard 17 2022 Received •
/ -7 a /��
•sue 2 g OCTar 1 DateJBy: �// / p� �/r/_'T Permit No.: q�'1 }' C0�.�1
A13125 SW Hall Blvd,Tigard,OR 97223 Plan Review 1 J
I Phone: 503.718.2439 Fax: 503.598.1 60 Date/By A/� Other Permit Na.:6//2�9/_ �t ?
Inspection Line: 503.639.4175 �ITY OF TIGARDdr P / Seth: laSupplemental
See Page 2 for /- (�(�" `�1\TIGARU Internet wwwti and-or. ov BUILDING DIVISION Date Rea B / "..
- g g Notified/Method: ( / Su lemenmllnformalion
TYPE OF WORK ltigisir /L FEE* SCHEDULE
D New construction ❑Demolition For special information use checklist
rroott - -- Description 1 Qty. 1 Ea. 1 Total
E Addition/alteration replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ I-and 2-family dwelling (C Commercial/industrial SFR(2)bath 437.78
- SFR(3)bath 500.32
0 Accessory building
0 Multi-family -
Each additional bath/kitchen 25.02
D Master builder ❑Other: Fire sprinkler( sq.ft.) Paget
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 'Q Z O 0 S t.J a RFpNQ o al. A-0 Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: et((rAvas o Z q}Z 1.
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.:5- ►to Project name:SI-fJi4mrtip YS? Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
�'J( ,� I, 0 i n Gu`I 4;h+ S Rain drain connector 18.76
J 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
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
IYIa,w 8/4-e-el Are,,, f: yc,+,r.rx S ♦ ce/11RaeL f Dishwasher i 25.02 25,D2
7 Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: Fixture sewer cap 25.02
Floor drain/floor sink/hub 1 25.02 2>,01-
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
Al APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: j.,�b� rt pi u kO t Medical gas(value:5_) Page 2
Primer I 12.51 11.5 1
Contact name: 140.e.i.a t"4G.k.V JCS a is. Roof drain(commercial) 12.51
Address: 1 `\01`30 Sly c. f0\G ;,2J- Sink/basin/lavatory I 25.02 2c.01
City/State/ZIP:1 a\ c3,...n , OIL cf a4t)(o Z Solar units(potable water) 62.54
Phone: 5ci )Gela . Li 3G Fax::( ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail: I
SNeNt.•s ti?h r Ra4 .our K S • G.ow-- Water closet 25.02
CONTRACTOR
Water heater I 37.52 37.c i
Business name:" yam tt,w .1 Pld v,...t 1'vsr- Water piping/DWV 56.29
Address: ( 10‘0 SW C i e to\L (e, Other: 25.02
City/State/ZIP: -D.,a,l 04_y h a 2 91 d (p L Subtotal I Zj,WI
Phone:( m7)1�9 y _k..4 I 9 Fax:( ) Minimum permit fee: $72.50
�`- - PlumbingPlan review (25%ofpermit feet
CCB Lic.: 8-4. W 4 Lic.no.: 3.f`/0,�F -
// State surcharge(12%of permit fee) 1Sr o
Authorized signature: �/! Th
.,....„1. ry�I�_� TOTAL PERMIT FEE 140,10
Print name: S\ A -3l�Zr 6 Date: 1 b/ .-7 This permit application expires If a permit is not obtained within ISO days
V‘II.� per i 1 / a... ? L after it has been accepted as complete.
•Fee methodology set by Tri-County Building Industry Service Board.
f:d3uitding.orn,sTLMU-PcrmitAppdoc 10/OI/09 440.4616Ti 10'02/COM'WFB)
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
2,001 to 3,600 $I69.69
Footing drain-each additional 100' 37.52 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 S100.00 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 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$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
each.additional$100.00 or fraction thereof.
(minimum charge-1/2 hour)
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 fur ReplaCs.' Please check all that apply.
Work Performed: Capped Added Relocale
❑ Any new commercial building with water service and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
-Jacuzzi/Whirlpool 0 New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru 0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator 0 Any multipurpose fire sprinkler system.
Dishwasher: -Commercial-Domestic 0 ❑ Any complex structure as defined in OAR91 B-780-0040.
Drinking Fountain Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2"
3•• Isometric or Riser Diagram
❑ Isometric or riser diagram is required for new buildings
-Car Wash Dram that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related Comments regarding fixture work:
Ice Mach./Refrig.Drains
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -LavBar non-food related I
-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 plumbing permit can be issued.
Water Closet-Toilet
Urinal
Other Fixtures:trt'fk *Qr-:M el .
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