Permit , Y ( PLUMBING PERMIT
CITY OF TOGARD
` 3 COMMUNITY DEVELOPMENT Permit #: PLM2010 -00133
T f GAarj 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/30/2010
, , Parcel: 1S135AB01004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 380
Subdivision: LINCOLN CENTER/TWO LINCOLN Lot: 0
Project: Waldron Company
Project Description: TI - adding (1) 2" hub drain, (1) dishwasher, (1) primer & (1) 4 gal. water heater. Replacing (1)
sink.
Owner: FEES
LINCOLN CENTER LLC Quantity Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555
CALIFORNIA ST 49TH FL 1 ea Dishwasher 04/30/2010 $25.02
PHONE: 503-619-3200 1 ea Floor Drain /Floor Sink/Hub 04/30/2010 $25.02
1 ea Primer 04/30/2010 $12.51
1 ea Sink 04/30/2010 $25.02
Contractor: 1 ea Water Heater 04/30/2010 $37.52
POWER PLUMBING CO 1 12% State Surcharge - 04/30/2010 $15.01
PO BOX 19418 Plumbing
PORTLAND, OR 97280
PHONE: 503 - 244 -1900
FAX: 503- 244 -8825
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp: B
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. Alt 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 -0100. You may obtain a copy of the rules
or direct t to 0 NC by calling 503.246.6699 or 1.800.332.2344.
Issued By: J CeierA/14-A1-PLI A Permittee Signature: �, . , / , //,4,
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.
Accumulative Sewer Tally Parcel # 2S135AB01004 '
Tenant Name: Waldron Co This SWR# 2010 -00063 .
Site Address: 10220 SW Grcenburg Rd #380 • This PLM# 2010 - 00133 .
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off #s count # value #s values
Baptistry/Font 4 0 0 0 0 0
Bath -'I'ub /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 0 0 0 0
- Domestic 2 0 0 1 • 2 1 2
Drinking Fountain 1 0 0 0 0 0
?ye Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 • 0 0 1 2 1 2
- 3 inch 5 0 0 0 0 0
- 4 inch 6 • 0 0 0 0 0
- Car Wash Drn 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 I -1P) 16 0 _ 0 • ' 0 0 0
- Commercial (to 5 1 -IP) 32 0 0 0 0 0
- Industrial (over 5 HP) 42 • • 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 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 - Bar /I..avatory 2 0 0 0 0 0
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 0 0 0
- Service 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 0 0 2 4 2 4
Current Fixture Value 4 divided by 16 = 0.3 Current EDU 1 EDU = S 3,600
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 4 divided by 16 = 0.3 over (under) S 1,080.00
Enter EDU Change Here ' 0.3
Notes:
Authorized Name /Signature: 'Debbie Adamski Date:. ' 4/30/2010
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 \ticwer l'allyShcet- 3600.xls 06 /25/08
APR /27/2010/TUE 10:27 AM POWER PLUMBING FAX N. 503 244 8825 P.001 11
Plum bin;? Permit Applieation
Building Fixtures ` TO1 1G�: U IT'ON g '', y. .' r ,'`
.. ,_ aw:k Pzts F, 1 0vl 'IPr r r kaa
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Rece ived Per No.:
; i City or Tigard y a p io ,� ��M .
� A 2 � ?. �10 Datd6y: o�o- v)/3,3
r " u 13125 SW Hall Blvd,. Tigard, OR 97223 Plan [review
. Phone: 503.639.4171 Fax: 503.598.1960 pate/sy. Permit � Oder 1Jo.:�Q p( - d a96 J ?
u _I :_ P ins ection Line; 503.639.4175 CITY OF TIGARD
p b ate Ready/By: ®See Page 2 for
.T1GAP.D 1� enta info mason
..,,,, Internet www.tigard-or.gov , • k , i , N otified /Method: Supplem
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v "141 Y �rf 5e 11 ? 31: iii o f i?L°t�tl" :�1 �r: eh 4 f 7 v t7y :14, 'c nr}k i l ��� t 4 : Sn',!"!Mr,' f.r s P. ' .ok t ?'.ii. ?liat3i '
❑ New construction ❑ Demolition
For speelul information use checklist.
Desert, non •• Ea. Total
Addition/alteration/replacement • 0 Other: New I- 2- family dwellings (includes 100 ft. for each utility connection)
U h ,, ,,,� an �' t ;r r .., m.d.� w . 'o-;';.1n'' SPR(I) bath 312.70
i,+ t9P 0,�1 l_ ,C d' .. y' "^`-tiP �d ' ,i41 '�`s .:c w!
O 1- and 2-family dwelling g Commercial /industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building 0 Multi - family
Each additional bath/kitchen 25.02
,��''`1❑ Master builder i�r ;ee,,,.� ❑ Other: Fire sprinkler �_ sq. ft) Page 2
• • �f n w RE � .L ^ - l„yktr ( f ) . " ' i i NO n...�'e � `i � r "1t t " s 0 R . 4 . Sire utilities:
Irk '.a7:d�.tt,?,.ti.� t
� Catch basin or area drain 18.76
D2-24: ,
Job site address: 1 D2 . t r 4 i, A
Drywel leach line, or trench drain 18.76
City /State /ZIP: tf / i A Footing dram (no. linear ft: _) Page 2
Suite/bldg- /apt. no.: I Project name: 1 4, / .lhl► ■ , Manufactured home utilities 50.03
I Cross streeUdirections to job sae: Manholes 18.76
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.: 1 5 135 A 6 0 too Back preventer 31 -27 •
<�, 3 „ + rd, i t + 13 ac kw ate r va I v e 1151
„ "T. : � ",.V : -' �,:.``�..1,� ,ix ' / . ". ''..-7;'."t" . "' � Clothes washer 25.02
t ` / i �ir�V i _ Dishwasher t 25,02 .bZ
Drinking fountain 25.02
Ejectors /sump 25.02
gggg
. r
5 - - - lit °i ,R . tn i l w s° rn °k y I kF"w � RE ,'n°..., E tank 12 -51
'r" t ` 6.,,,,,F5 Fixture/sewer cap 25.02
Name: Floor drain /floor sink /hub I 25.02 2.5. 07-
Address: Garbage disposal 25.02
City/Slate/Z1P: Hose bib 25.02
Phone: ( ) Fax: ( ) ice maker - 12.51
x m r r r���+ v ,� r r� '^ a rhY O • r y$rx gp + i b yvf' ; 11.1 r § , r "ge i ke ,R' ,its � h w tt ttd{ Interceptor /grease trap
i Business name. 25.02
�r. •! .•.a .al, . , ^ : w . e rcn.... � �
e'
, 10 _ j ' L I Medical gas (value: $ _) - Page 2
` ) Primer , 12.51 )2_5) Contact name: d'V Roof drain (commercial) 12.51 •
Address: P el l / 1 v t Sin >esin/lavatory 1 25.02 2.6 c
City/State/ZIP: 1 p ' 12 o ar units (potable water) 62.54
Phone: (SO) ,3).}y--I Lj • Fax: : (50 . -01crzo Tub /shower /shower pan 12.51
_- Urinal 25.02
E-mail:
L i a tI611,S b p v in y t Sri h'+1, '� em IWf 4y5 � e,,A t �' iM'' 74 t Ca u Water closet 25.02
r'.22 ° V" ' '' . ' 5 ' ' N4 ;c= rd Fd'"W , w� ' -"".''' rte . s v' ." "f ''�9''' ' '' % -* ''''''' I'f�l : d''v"•'f''''"' Water )seater 37:52 6 C.ro '' , .
Business name: Water piping/DWV 56.29
Address: Other: - 25.02
City /State/ZIP: Subtotal 12_5
( ) I t I `) Minimum permit fee: $72.50
P tone: ( )
ff ` Plan review (25% of permit fee)
•
j - CCB Lie.: S2_ 7 1 1 t2 I \ \ ,' Plumbing Lic, no.: i5bP (_J
permit ' State surcharge (12% of fee) 1 o
Authorized signature:
■
TOTAL PERMIT FEE 1LI 10 •
pp Date: t Thls permit application expires if a permit is not obtained .5' tbie ISO days • Print name: / ‘_11-41S ‘_11-41S '� / �-'7 �d after it has been accepted as complete - Ali "Fee methodology set by Tri•Couoty Building Industry Service Board.
44a-4616T(1Q/0'J /wEa)
/U 7 a ( / / L.' /e /,‘./ G
APR /27 /2010 /TUE 10:28 AM POER PLUMBING FAX No, 503 244 8825 P. 002
Plumb inlz Permit Application - City of Tigard •
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su • ression S stems: - �L)
i .. r . `•�� 4; , '" " v vK 4 P c1� t+t !3 i i !otii (v '` r 1 ,i, 0 i;t ) . 11 . . rk 1 1 S�Sf
o , j� , 4, t ., ti i. , :, 4 , :. - .� ;I e" ! ota i F,,..�: k �`� . ,�"��' :?` _. P
� � M , � ., � i� 6 ?' �. V , / ^i^, !;,� S'et: �l :-..,30:,, -
Footing drain - 1" 100' 50.03 - 0 to 2,000 , $121.90
2.001 to 3.600 5169.69
Footing drain - tech additional 100' 3752 3.601 to 7,200 $233.20
-
Sewer - 1st 100' 62.54 7,201 and Freater - 5327.54
- Sewer - each additional 100' • 37.52
Water Service - 1st 100' 62.54 Medical Gas S stems:
Water Service - each additional 100' 37.52 . ' Fa "1' +a 1 a,, `'7 b 3 "s�• ''t'
j � 1 1)(071! ` ' pc � s r lit r } � }�a±�y � 4y `�b��i
Storm & Rain Drain - 1st 100' 62.54 51.00 to 55,000.00 Minimum fee 572.50
-
Storm & Rain Drain - each additional 100' 37.52 55,001.00 to 510,000.00 572,50 for the first 55,000.00 and 51.52 for
1_f ,rt
'..rnRa� xiw f3 ' In each additional 5100.00 or fraction thereof, to
«xv 'cl.ti 4 `t''�r± and including $10,000.00.
Inspection of existing plumbing or for 510,001.00 to 525,000.00 5148.50 for the first 510,000.00 and $1.54 for
which no fee is specifically indicated 90.00/hr each additional 5100.00 or fraction thereof: to
(minimum char;e- 1/2 hour) and including $25,000.00.
Inspections outside of normal business 90.00 /hr . 525,001,00 to 550,000.00 5379.50 for the first 525,000.00 and $1.45 for
hours (minimum charge -2 hours) each additional 5100.00 or fraction thereof, to
Weinspection Fees 90.00/hr and includin: 550,000.00. •
' Additional plan review for revisions 90.00/hr 550,001.00 and up $742.00 for the first 550,000.00 and 51.20 for
each additional $100.00 or fraction thereof
chrge
minimum a (lour) -
Subtotal: • .
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If es" Fi~;gxiw '.. 'u . 'it ;- ;
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtur co uld result in increased sewer fees * . Please check all that apply.
* t�,w�;, n � a • �• /w� en f2usntfttilig .titiiiii)MiiilePiiiiii; ed;:2 ❑ Any new commercial building with water service 2" and
a�yn ,r e'dm''ewa;t a a te, M; , • - +^* �1.1zepl6�p c
i greater, except systems designed and stamped by licensed
i , _ rt ec,.,�i}o`�rSSr1�74414? i k ,i V. , : 5 :?e , GA"" nl � IP w,w
a7 tF1 s,; , "',,,rk,,,{v M - iPiviOUS „,',S . Tiro L !;; tureii n r.61suri engineer.
Baptistry/Fon ❑ New exterior plumbing site utilities for any complex structure
Bath - Tub /Shower - as defined in OAIt918- 780 -0040.
- Jacuzzi/Whirlpool - -- ❑ Medical gas and vacuum systems for health care facilities.
Car Wash -Each Stall . _ ❑ Any multipurpose fire sprinkler system.
- Drive Thru ❑ Any complex structure as defined in OAR9] 8 780 0040.
, .. 7• -A .. - ' r .
- Dishwas er - Commercial Submit 2 sets of plans with any of the above.
- Domestic _____I
Dr kin FFnunyttaiinn� i - y t' i gi wx f a ,: � t/� 1 { . y f�� .. ry 1'I4e r t R � 'k tE ,n+ f gittCYn54ll ..
- �i _ I Z..'�v��y ZaWth./OJ V4 4c.t9,' ∎gg,, 1� L'.1 OZ /G Z
Floor Drain /sink - 2" i ❑ Isometric or riser diagram is required for new buildings
,a - 3" that meet the qualifications above.
litAh`vtA _ 4°
Car Wash Drain
Garbage - Domestic
Disposal - Commercial Comments regarding fixture work:
- Industrial -
Ice Mach-/Refrig. Drains -.
- oil Separator Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
_ Stall -
Sink -Bar/Lavatory '-' -
- Bradley
- Commercial 4 `Note: If the fixture work under this permit results in an
Sery ice _ increase of sewer EDIJs, a sewer permit will be issued and
Swi P Filter - fees assessed for the sewer increase must be paid before the
Washer = Clothes _ - plumbing permit can be issued.
water Extractor
-
Water Closet - Toilet
Urinal
Other Fixtures: 1 tt, 0'1'■
hell/ rlrnartmP .n ts /cd /docs/PLMF- PermltApt9doc