Permit
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2009-00342
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/01/2009
Parcel: 1 S 135AB04500
Jurisdiction: Tigard
Site address: 10250 SW GREENBURG RD 300
Subdivision: Lot: 0
Project: Forest City
Project Description: Replace (2) existing sink and (2) w/c with ADA. Replumb for replacement d/w and coffemaker.
Owner: FEES
LINCOLN CENTER LLC Quantity Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555
CALIFORNIA ST 49TH FL 1 ea Dishwasher 12/01/2009 $25.02
2 ea Lavatories 12/01/2009 $50.04
PHONE: 2 ea Water Closet 12/01/2009 $50.04
1 12% State Surcharge - 12/01/2009 $15.01
Contractor: Plumbing
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 $140.11
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 sta ithin 180 days-of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow th les ad pled by 15e Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0100. Y may obt in a cop of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature: Gi
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 RECEIVE
Building Fixtures FOR OFFICE USE ONLN'
City of Tigard DEC 0120 9 Received ]t Date Permit No.: V1
n 13125 SW Hall Blvd., Tigard, OR 97223 ~G 7
~ Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit No.:
Inspection Line: 503.639.4175 Date Ready/By: J ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description Ea. Total
® Addition/alteration/replacement ❑ Other: New I- 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
E] Each additional bath/kitchen 45.00
Master builder El Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 10250 SW Greenburg Road, Suite 300 Catch basin or area drain 16.60
City/State/ZIP: Portland, Oregon 97233 Drywell, leach line, or trench drain 16.60
Suite/bldg./apt. no.: Project name: Forest City T.I. 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: Lot no.: 04500 Water service (no. linear ft.: Page 2
Fixture or item
Tax map/parcel no.: IS135AB
Absorption valve 16.60
DESCRIPTION OF WORK Backflow, preventer Page 2
Install (2) new ADA sinks, (2) ADA toilets o r Backwater valve 16.60
and water connections to owner supplied dishwasher and coffee maker... Clothes washer 16.60
McKinstry Job #9335 1 Dishwasher 16.60
❑ PROPERTY OWNER ® TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: Forest City 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
® APPLICANT ® CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: McKinstry Company, LLC interceptor/grease trap 16.60
Contact name: Diane Parke, Project Coordinator 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) 331.2465 Fax:: (503) 331.6907 Sink/basin/lavatory 2 16.60 33.20
Tub/shower/shower pan 16.60
E-mail: dianep@mckinstry.com
Urinal 2 16.60 33.20
CONTRACTOR Water closet 16.60
Business name: McKinstry Company, LLC Water heater 16.60
Address: Same as applicant Other:
City/State/ZIP: Subtotal
Minimum permit fee: $72.50 66.40
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: 172811 Plumbing Lic. no.: 37-22PB Plan review (25% of permit fee)
State surcharge (12% of permit fee) 7.97
Authorized signature:
TOTAL PERMIT FEE 7
Print name: Diane Parke Date: 11/30/09 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
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