Permit
_ k
r n CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2010-00024
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 01/22/2010
Parcel: 1 S135AB03400
Jurisdiction: Tigard
Site address: 10260 SW Greenburg RD 1250
Subdivision: LINCOLN TOWER Lot: 0
Project: Reinisch & McKenzie
Project Description: Replace (2) breakroom sinks. Provide connections to owner provided refrigerator and water
cooler.
Owner: FEES
LINCOLN CENTER LLC Quantity Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555
CALIFORNIA ST 49TH FL 2 ea Sink 01/22/2010 $50.04
50 da Misc Other Fee 01/22/2010 $50.04
PHONE: 1 12% State Surcharge - 01/22/2010 $12.01
Plumbing
Contractor:
MCKINSTRY COMPANY
12021 NE AIRPORT WAY SUITE G
PORTLAND, OR 97220
PHONE: 503-331-2461
FAX: 503-331-6906
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $112.09
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Ore n
Utility Notifi nter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0100. Y ay obtain a of the ules
or direc uestions to UNC b calling 503.246.6699 or 1.800.332.2344.
l
1
Issue By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
• Plumbing Permit Application . .
Building Fixtures FOR OFFICE USE ONLY •
City of Tigard DaeiB YDate /B /- ID Permit No.: )) / /, �
Ii Y 13125 SW Hall Blvd., Tigard, OR RECEIVED "'/
� Plan Review
Phone: 503.639.4171 Fax: 503.598.1 Other Permit No.:
.i$�1: 2010 Date /By:
TIGARD Inspection Line: 503.639.4175 Date Ready /By: Juris: • ® See Page 2 for -
Internet: www.tigard or.gov • Notified /Method: Supplemental Information
TYPE OF WOR'IkTY OF TIGARD FEE* SCHEDULE
,7„ ' ' • F or special information use checklist.
❑ New construction r r emo i ion P j
Description I Qty. I Ea. I Total
® Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20 •
❑ I - and 2- family dwelling ® Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
• Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 10260 SW Greenburg Road Catch basin or area drain 16.60
City/State/ZIP: Tigard, OR 97224 . Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Reinisch & McKenzie Footing drain (no. linear ft.: _) Page 2
• Manufactured home utilities - 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _) Page 2
• Storm sewer (no. linear ft: _) Page 2
Subdivision: • I Lot no.: 03400 Water service (no. linear ft.: _ ) Page 2
. Fixture or item
Tax map /parcel no.: 1S135AB • .
Absorption valve 16.60
_
, DE CRIPTION OF WORK Backflow preventer Page 2
•
Provide and install (2) new s n ks w7faucets. Connectiot6to owner provided • Backwater valve 16.60 •
refrigerator& water cooler. Clothes washer 16.60
McKinstry Job # c134'd Dishwasher • 16.60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: Expansion tank 16.60
Address: Fixture/sewer cap 16.60
City/State /ZIP: Floor drain/floor sink/hub 16.60 •
Phone: ( ) • Fax: ( ) Garbage disposal 16.60 •
0 APPLICANT ® CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: McKinstry Company, LLC
Interceptor /grease trap 16.60
Contact name: . • • Medical gas (value: $ ) Page 2
Address: 16790 NE Mason Street, Suite 100 Primer . . 16.60
•
City/State/ZIP: Portland, OR 97230 Roof drain (commercial) 16.60
•
Phone: (503) 331.0234 I Fax: : (503) 331.6907 Sink/basirl/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR • Water closet 16.60
Business name: McKinstry Company, LLC Water heater 16.60
Address: Same as applicant Other: a A5,09-
City /State /ZIP: - Subtotal
Minimum permit fee: $72.50
• Phone: ( ) ' ax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: 17281 Plumbing Lic. no.: 37 -22PB Plan review (25% of permit fee)
/ State surcharge (12% of permit fee)
Authorized si / �� n
, ,._,i„ .. ._� TOTAL PERMIT FEE I !� ,1.
Print name: ; _ \ - 4 a vVe Date: / / h • This permit application expires if a permit is not obtained within
180 da ys after it has been accepted as complete.
•
. *Fee methodology set by Tri-County Building Industry Service Board.
1: \ Building \Permits \PLMF- PamitApp.doc 12/27/06 440- 4616T(10/02 /COM/WEB)
1(,
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' 55.00 0 to 2,000 S115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $ 160.00
3,601 to 7,200 S220.00
Sewer - 1st 100' 55.00 7,201 and greater S309.00
• Sewer - each additional 100' 46.40 -
WaterService - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40
Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' • 55.00 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof, to and
including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to
(minimum permit fee $36.25) 27.55 and including $25,000.00.
• Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
• and including $50,000.00.
specially requested inspections per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: each additional $100.00 or fraction thereof.
Commercial Fixture Work: Plan Review for Plumbing Installations
Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees*. ❑ Any new commercial building with water service 2" and
Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: Replace engineer.
Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 - 0040.. .' -
Bath - Tub /Shower - ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic
Drinking Fountain Isometric or Riser Diagram
Eye Wash .. ❑ Isometric or riser diagram is required for new buildings
Floor Drain/sink - 2" that meet the qualifications above.
3"
-4 „
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial •
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station) •
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink -Bar/Lavatory
- Bradley *Note: If the fixture work under this permit results in an
• - Commercial • increase of sewer EDUs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures: ` •
i:\ Building \Permits \PLM- PamitApp.doc 11/27/06 •