Permit CITY OF TIGARD
2 • COMMUNITY DEVELOPMENT PLUMBING PERMIT
Permit
INrt #: PLM2022-00501
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/15/2022
Parcel: 1S135AB01004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 610
Project: Keyence Subdivision: METZGER,TOWN OF
Lot: 9
Project Description: Interior plumbing for TI:Capped(1)sink and(1)hub drain;Replaced(1)dishwasher,(1)sink,and(1)hub drain;
Installed(1)primer and(1)water heater.
Contractor: RAYBORNS 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
I ea Dishwasher 12/09/2022 $25.02
Specifics: 2 ea Fixture/Sewer Cap 12/09/2022 $50.04
1 ea Floor Drain/Floor Sink/Hub 12/09/2022 $25.02
Type of Use: COM 1 ea Primer 12/09/2022 $12.51
Class of Work: ALT 1 ea Lavatories 12/09/2022 $25.02
Type of Const: 1 ea Water Heater 12/09/2022 $37.52
Occupancy Grp: 1 12%State Surcharge- 12/09/2022 $21.02
Stories: Plumbing
Total $196.15
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 CCeenter. 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: /!,{/ _ �,/' 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.
Plenbing Permit Application
BuildingFixtures a
' 0 1'0I( c)hf l( 1. 1>SI. ON I \
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n Received
teY. r1)r /I,-,- Pemvi No.: 01-" •1cca- - S`.--o
City of Tigard Zpg2y 'v,/ i• '�7�Vi7
n 13125 SW Hail Blvd.,Tigard,OR 97223 Plan Revie Other Permit No.: �fI' i �� �j
Ili ■ ' Phone: 503.718.2439 Fax: 503.598.1960 C� 0nateRc: Ov
Inspection Line: 503.639.4175 ate Read B : 4 kris: El See Page 2 for
?"_4 i1' ? °"•y 4n.°1. Y Y I i 'j Supplemental Information
l I��A LLI Internet: www.ligard-or.gov �° S - - - - otified/Method: (�
t
TYPE OF WORK ..,1/0-' FEE* SCHEDULE
For special information use checklist
❑New construction ❑Demolition Description 1 Qty. 1 Ea 1 Total
cg Addition/alteration/replacement ❑Other: New 1-2-faintly dwellings(includes 100 ft.for each utility connection)
SFR(1)bath 312.70
CATEGORY OF CONSTRUCTION 437 78
SFR(2)bath
❑ 1-and 2-family dwelling ®Commercial/industrial 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.) Pagc 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Catch basin or area drain 18.76
Job site address: to'L't,0 SW (rfl.te JP)J(t(r 0-0 Drywell,leach line,or trench drain 18.76
City/State/ZIP: ''rl(f'AIto ,o q it Footing drain(no.linear ft.:___) Page2
Suite/bldg./apt.no.:Ci0 I Project name: k.c1,4,1(..e., Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.7618 76
I Rain drain connector
Lt,.e"lam 3`1\l to 43 2 0.,LZ ee r o l n) Sanitary sewer(no.linear ft.:_) Page 2
SJ i F t CO l t'1 Storm sewer(no.linear ft.:_____) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: ts'3 5-4--8 01 CJ(i 1 I Lot no.: Fixture or item:
Backflow preventer 31.27
Tax map/parcel no.: Backwater valve 12.51
DESCRIPTION OF WORK Clothes washer 25.02
•
/ (A• A- ,t0('\;r,,,.t, J eG (2)(o {+.g..5 Dishwasher (1) 25.02 a'c >-
r•,o/P<�J s'+n 25.02
f Dunking fountain
Ejectors/sump 25.02
1..1 S}e.1 1 6 CA..l Si a L` a- Ni(r l i Ai c e,1 t o c a.--'o r1
T Expansion tank 12.51
($ PROPERTY OWNER TENANT
Fixture/sewer cap -(Z." 25.02 CD,cil
Name: CtKll`G�S'tt,^ Qf,pslirfle-5 Floor drain/floor sink/hub _ t") 25.02 0.z-,4.4„
Address: 7 g S Mn¢
oer,s,"a Qy 57 Garbage disposal 25.02
City/State/ZIP: 54.../ Ip}/JCi)[O C 01 4'4/otit Hose bib 25.02
iax:( ) Ice maker 12.51
Phone:(x{(S ) ,'j7'L -7'oou 25.02
Re-APPLICANT VCONTACT PERSON Interceptor/grease trap
Medical gas(value:$__) Page 2
Business name: aA,4 06aA-J e Ls)key,gIn/w Primer _C1) 12.51 iisi,5-f
Contact name: .t41,4 43 .E.40k%-4 a el-. ' Roof drain(commercial) 12.51
Address: `co el 0 Ste) 64 P 61 C, a_tl Sink/basin/lavatory (1) 25.02 g j 41-
n p Solar units(potable water) 62.54
City/State/ZIP: �J)4 t,ATIe/ O '{` Q�la 2 Tub/shower/shower pan 12.51
Phone:(ye p j) b i 2 - 413 q Fax::(Spy) b g( - Z 3 Z 8 Urinal - 25.02
E-mail: ,/ i.ti4) (t7:tet4,-4 0 ts0-ntri _ ( O M Water closet 25.02
1 CONTRACTOR Water heater Ca 37.52 37,t1
Business name: gfri(oit,I f (J M 1T I,41& Water piping/DW V 56.29
Address: t � Other: 25.02
gCt(to 3`,..../3`,..../ L i gn�,,t'^v �' Subtotal j�'� /3
City/State/ZIP: Lse►T t d Q ?O 2
'i-J/4- /it f Minimum permit fee: $72.50
Fax:( q I' 232�
Phone:( ,,3) 6�L. H 13Q (RI) ) G ��/ T Plan review (25%of permit fee)
CCB Lie.: ' .1 s'y Plumbing Lic.no.: .7t'r- i1 w,, pe State surcharge(12%of permit fee j, 02,
Authorized signature: ""V.1 -0"1/1.„,...--*--- TOTAL PERMIT FE} 14�,/S`
if'- This permit application expires Ka permit is not obtained within ISO days
Print name: C/ Date: 12.-9 7077, after it Las been accepted as complete.
0.44 f L V Gnd *Fee methodology set by 7ri-County Building Industry Service Board.
1:\Budding.PermiisdPLYN-rermiiApp.doe I(WI/(N
440-46161(I0/02/COM/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
37.52 2,001 to 3,600 5169.69
Fooling drain-each additional 100' 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 55,000.00 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 51.54 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 525,001.00 to$50,000.00 $379.50 far the first 525,000.00 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/]tr $50,001.00 and up $742,00 for the first$50,000.00 and 51.20 for
each_additional 5100.00 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 for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate 0 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 ❑ New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru ❑ Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator ^ ❑ Any multipurpose fire sprinkler system.
Dishwasher: Co r mercial f� 1 0 Any complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2"
Isometric or Riser Diagram
0 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 Comments regarding fixture work:
Ice MacloRefrig.Drains
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
-Sink -Lav/Bar non-food related (.1/) (,i 7
-Bradley
-ComiServ/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: AU LO(Uot,rs/ (9 U)
1:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
I = Tenant Name: KEYENCE Accumulative Sewer Tally
I SWR# N/A
Site Address: 10220 SW GREENBURG RD PLM# 2022-00501
rlGnen Parcel#: 1S135AB01004
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 2 8 1 4 -1 -4
-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
-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 IIP) 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/Scrv/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 4 12 2 6 -2 -6
Current Fixture Value -6 divided by 16= -0.375 Current EDU 1 EDU= $6,625.00
Previous Fixture Value 0 divided by 16- 0.000 Previous EDU
Change -6 divided by 16= -0.375 over (under) $ (2,517.50)
Enter EDU Change Here -0.380 *
*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: 12/8/2022
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\Sewc rTally Shee t_6625_070122.xl s x