Permit P
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2010 -00210
jx1 A '` 13125 Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/29/2010
' T `�� g Parcel: 1S135AB01004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 410
Subdivision: LINCOLN CENTER/TWO LINCOLN Lot: 0
Project: EXTERRO
Project Description: Removing and capping fixtures for TI.
Owner: FEES
LINCOLN CENTER LLC Quantity Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555
CALIFORNIA ST 49TH FL 1 ea Floor Drain /Floor Sink/Hub 06/29/2010 $25.02
PHONE: 1 ea Garbage Disposal 06/29/2010 $25.02
1 ea Sink 06/29/2010 $25.02
1 ea Water Heater 06/29/2010 $37.52
Contractor: 1 12% State Surcharge - 06/29/2010 $13.51
POWER PLUMBING CO Plumbing
PO BOX 19418
PORTLAND, OR 97280
PHONE: 503 - 244 -1900
FAX: 503- 244 -8825
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $126.09
Required Items and Reports (Conditions)
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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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature:
iii
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.
JUN /25/2010/FRI 11 :01 AM POWER PLUMBING FAX No, 503 244 8825 P, 001
Phil bin Permit A it,. *.
t � ,,„� i:,t tn, ,, , ,,,,"� ttl7, r'y � w'� , 1ST , i ,,° w ,l,, � ,il d, ��r „I
Building Fixtures JUN 2 5 2010 �� , ; o �tor i , i � olNL ° rt,i °, ,., .. , ., �,,, �.� n , t
,a�:'1d: r 1 I�t>4g..w1, � ; " ; ,t Vv�'p11^Y uws " „,,
r, 174 i?1t City of Tigard Received
as , ' U k inspection n 50 3 n :5 3 97 3 Q� T6GARD Date Read Ley: Other Permit No. i / . r
ii )i Ph 503 639 417 Fax: 503.598. 0 h Date : , , � � a � 3 �
U D BNQ DIVISION Reedy hunt' El See 2 for
,TIG , No d /M b p
. ww.tigard or.goy I _ p S[4 Su plementat information
o r or .. i ! , d i n, 1, W G6 t I. `A'I` V .i 1B11 ,0 0 {fl ' (j I�
�, Internet w ��• - � t lfic el ° 'I
' �I+ r M'. I yI rc' IpI p , ;: ,,,;,, , ,.5.1 . „i,..11 . ,1-21: . ;
(n� .�C 7 y �� . q I. �'� ri�'r - �>�,� ,�It �l ' ;fit,.
I dl uli , „ etA'�6 tFlt.tl 1 .i f ! ;,�YIIC 1
P ❑ Demolition
Fors eels/ information use clreCkL,tsL
New construction Descrittion 1111M. Ea. Total
•'i Addition/alteration/replacement ❑ Other: New I- 2.-family dwellings (includes 100 ft, for each utility connection)
r lb r r, a • ty tt o ° G r 1 i ■ ! . SFR (I) bath 312.70
t ° I l SFR (2) bath 437.78 -
0 1- and 2- fancily dwelling `r, Commercial /industrial
SFR 0) bath 50032
Accessory building • Multi family Each additional bath /kitchen Mill 25,02
❑ Master. builder ❑ Other: Firs sprinkler (.,_ sq. ft.) Page 2
rt , ;tu lYl t A" rt 1. � •
y r an6'lr , U '
rr A ' �„d t ' n n , I c1 I o t �Nf .,1 f IM � i p. o �I 1 �1"��a � , S ttc °utilittes:
U "l� 0 , „ R n , 11 t �'1 'µrw.,ix� w � .' .: Catch basin or area drain 18.76
Job site address: $ 2 7- • S ' , A 6. / 1 w I Drywall, leach line. or trench dram 18.76
City /State /ZIP: : f l 41 r I y Footing drain (no. linear ft.: , ) Page t Ell
uite/b .g-/ap1.. no.: 5 ii, Project name: J_ ✓ `Lt „A, .0 g Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76 NMI
Rain drain Connector 1 8.76 Ell
' Sanitary sewer (no. linear ft.: , ) Page 2
Storm : sewer (no. linear ft.! ) Page2 •
Water service (no. linear ft.: ) - Page 2
Subdivision: _ Lot no.: Fixture oritent: •
-
Sack flow preventLr 31.27
Tax map/parcel no I � �p 12.51
g } W 7
" t4 a' i :;:=7§.' p � r 1 i 1 1 ..t. l3aCkwatcr valve
is Irt: 4 V 1 : 1 17.,k: °l t' p - .1 h “d ,,' " 1"J iPY ` Clothes' washer 25.02
/ �u 0 x d . y 0 _, a J, L. ►_ Dishwasher 25.02 ii ID • Drinking fountain 25.02
Ejectors /sump MIN 25 -02
l ' , I n .. ' . t �"t` , w ;), ii , !t 'S I t 1 1 4Ri l' " Expansion ' -tank �
, � 1 .w . " I, Fixture/sewer ' cap _ 25:02
Nance: Floor drain /floor sin ub ZIIIIIIMI 25.02
Address: • Garbage disposal ."'.'-' i 25.02 -
City/State/ZIP: Hose bib 25.02
Fax ( ) Ice maker
. i 1 u 1 r *P F � .d1 n ;T.1= , 310.09 f
Phone (
,,..,a ",. 4 ;}� 0 ° r F ' ' l 1 r lnte cease trap 25.02 NMI
�e ts ' t
t YN l �� l�° a'iw�rp' 1 , 'I� Yii '. It �l , l . ° o t
r Medical gas (value: $ )
] � r . • - ' . Primer I2.51 IIII
• ,-r r
Contact name: ,,/ ` AI ,I1.Z.A Roof drain (commercial) 12 -51
® L AO / Sink/basinilavatory . 25 -02
Address; - M MI
City /State /Z1P: • per % -11.101 Solar units (potable water) ME 62.54
Fax: i 1 c7N • Tub /shower /shower pan 12.51
Phone: �` _ : a] Urinal 25.02
E-mail: ' f g 41%,',4,175 u '!rtl Water closet 25.02 -
n 41 ( it I ir l0i51 +1s . f rE@ Y��n.7 P 's ' 1 , 241.4 . ;
° dN �t Water heater 37.52
1 (� { �``� , ry� �l' " r d " � " "�'� 9�4 ... '>" Jy, �W 91+ �. n I dl�n
i].�� )Itf � rl �ylt I Y 1 M r, .PI .I.11... .171
�. Water piping/DWV 56.29
Other: 25.02
Address:
Subtotal t',
City /State /ZIP:
Minimum permit fee: $72.50
Fie: ( ) ) Plan review (25% of permit fee)
M Plumbing Lic. no. j ♦ 11. E3 State surcharge (I2 %ofpermit fee) EMI
Authorized signature: J TOTAL PERMIT l E j , Q�1
]'mint name' ,r.
T p � . This permit application expires irp permit is not obtained within 180 days
• � Dater after 11 has been accepted as complete.
C � �P _nn r/ /� ''Fee methodology set by Tri -County Building Industry Service Board.
K 1(.1'�`e( l (/[W j 440-0616T(1oi0vcoMnvea)
mri,dlninaPe m is114 Mt6PtnnitApp.d1W 10/01/09
JUN /25 /2010 /FRI 11:02 AM POWER PLUMBING FAX No, 503 244 8825 P. 002
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Plnmbi>irg Permit .Application - City of Tigard '
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Page ,2 - Supplemental Information
Residential Fire Su I ression. S stems:
't 3 � i � i +r 1 e ni ..:r ix 7 a 7 11 4 � � e °k � !�« �'hrp$til i 1 7k7. �.i
fee Schedule 6 r,� ,�, y !
V r ' S �� i ti�� ^1„ ' r hl� 6 N , 1 /Q( t � Q3 r � r 'i, #.0 �.t ',1' •+• 1 0 r 1006iw y��1h ...I, P' , 1 90
r 5. �lll� il1n1� 4+4 .'�i,nn :
� �� 4 ��ril i I �il`li ;�� d 1_
c;o�fi�' 2,000 $1-
Footing drain 1" --- 2,001, to 3,600 5169 -69
Footing drain - eacb •additional 100' 37.52 3 -60i to 7200 5233.20
Sewer• 1st 100• 62.54 7 -201 and _realer 5327.54 _
Sewer - each;additiOnal 100" 37.52
54
Water Service- 1st 100' 62 - Medical Gas S Stems:
37.52 , 3?''F -, i. ITT - , � F ,. , r1',t v o n,, . , -6'd k
Winter Service each additional 100' I v - ' , 1 . . y c " , 4
� ' , ., Ngl 6
Storm & Rain Drain - 1st 100 6 2.54 $1.00 to 55,000.00 Minimum fee 572.50
Storm & Rain Drain - each additional 100' 3752 $5,001.00 to 510,000.00 572.50 for the first $5,000.00 and 51.52 for
each additional'$100 -00 or fraction thereof, to
'"� , i i ` o s' ° i� � + and including $10 000.00.
� w x01 t. : Y ., . ' flr� ''' .' s�r:i4.
' 1�o" 510,001.00 to 525,000.00 514830 for the first 510,000.00 and 51.54 for
wh Inspection
ch non existing plumbing
at ly indi indicated for 90.00 /hr each additional 5100.00 ar fraction thereof to
which no fee is specifically indicated and including 525.000.00.
(minimum charge -1 hour)
Inspections outside ofnormal business 90.00/hr 525,001.00 to 550,000.00 5379.50 for the first 525.000,00 and 51.45 for
hoursjminimum charge - 2 hours) each additional 5100.00 or fraction thereof, to
90.00/hr and ineludin_ 550000.00.
Ad d iti ectian Fees $50,001.00 and up 5742.00 for theftrst 550,000.00 and 51 -20 for
(minimum plan . - 1/ for isions
90;OOAir each additional 5100.00 or fraction thereof.
(minimum Char Subtotal:
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Commercial Fixture Work: '
Are you capping, adding or replacing fixtures? If "yes", Pram ,. is required , OX; 1n for a ala y
re ; 3 . 7 , - ,i,.:
please indicate work performed by fixture. Failure to y of the following.
apply.
accurately report fixtures could result in increased sewer fees Please y newac that
ommercial building with water service 2" and
a t - -• 'tv' v .` 'i`' 'f�aatiiti.. x; A Blzeirrt:"2*S0t.l�df o r med , 'i
: 9�.`'•', 00, gt . w ,-, 1' gaaZilfil . greater except systems designed and stamped by licensed
4 e� E,J " . 1.. n .ap "' . 1 " " E6 t1,>�,E' X1S i i
P` 4 � n£"i 4 41$^ 4n n.: P ....a a i »i At m. V . GI engineer.
Baptis /Font ❑ New exterior plurnbing •site utilities for any complex structure
B - Tub /Shower IMMI as defined in OAR918- 780 -0040.
- Jacuzzi/Whirl pool IMMI El luledical 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 OAR918- 780 -0040.
Cusliidor As irator
DishwasherCommercial Submit 2 sets of plans with any of the above.
- Domestic
e t 'X P" i a f' < 'L-^,.c r "v1CL "a tf�f "f „x it @o � ll ,� A :' r'. , � i ��e�y � rli,:
Drinking Fountain "d��l� ^tu�yr.S�IT��GIUSt:raD1a :�:, �ixGi s S "r
Eye wash r
Floor Drain /sing: - 2" ❑ Isometric or riser diagram is required for new buildings
- 3•' that meet the:.qualifications above.
4 .,
Car Wash Drain
Garbage D..1 e i c
Disposal .., st rcial Comments re.ardiztg future work:
- I
M� `, .. s ,tlit.d... ,4 G .' L _awl
Ice S a for Drains Gas •Station) ` y®t.0 . 1 °
Oil Sa.artor �� '��
1tec. Vehicle' Dump tation
Shower -Gang _ -
-Stall
Sink -Bar/Lavatory II - .
-Br
CornrnerciaP *Note: If the fixture work under this permit results in an
ervice increase of sewer EDUs, a sewer permit will be issued and
Swimming Pool.Fi�_ fees assessed for the sewer increase must be paid before the
Washed- Clothes -- plumbing permit can be issued.
Water Extractor
Water Closet - .Toiler
A /•
Other Fixtures: a../ IN-
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F.,.,- 11.,,..n.1 tierard- or.eov /city hall /denartments/cd /does /PLMF- PermitA.pp2doc
•
ap'.i rwTaa a s*,� a f
Accumulative :Sewer Tally Parccl # i�1S1,35AB01004 _ il3 :.` .
'Fenant Nam FX1rLRRO't s ,A!„ a ? r ° , ,:s , ti ;t r Y : This SW1Z# `NONE .;. , `. pinto b '" Vw.. "
Sitc•Address, 10220;SW GRL NBURG "RD ', 4� iW r t . This P1 M# M 9 PLM201'0 4 :� 00210 L� r „P. h
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
I E Z:
Baptiscry� /-Font 4 'P.x* 0 0 ( 0 0 0
Bath - Tub /Shower 4 l ;- ,, °
, . 0 .e.. 0 ' ;.
4 .4, ,i ,. ems 0 0 0
- Jacuzzi /Whirlpool
zi /Whirlpool 4 . f_ . ” l 0 l',..%:`;' xi .. ,,f _" 0 r .v t ;` ; 0 0 0
.. Car Wash - Each Stall 6 „ .- . , ,) 0 r' ,� gi „_k,,; 0 � , E 0 0 0
� ` �p�aI
- Drive through 16 ) :, . 0 ,':;,`I 0 V ; i 0 0 0
Cuspidor /Water Aspirator 1 „ _, fi, 0 . „ a t' „- 0 6 �t,n, /„ 0 0 0
Dishwasher - Commercial 4 '* '' I 0 '- x t l 0 0 0
,tea a., � a. ���� - 0 •�
- Doiriestic 2 Z12'.0.0 0 tr ,. s . i [ 0 ;41 F 0 0 0
Drinking Fountain 1 , -tk. 0 .._ , 0 L i:ig 0 0 0
,� � 0 0 0
Eye Wash 1 ��' is 0 i 0 °� r'�� ° °�
Floor Drain /Sink - 2 inch 2
`r , 0 xi 0 _1 -2
=, °l, ,� , a1 �. 2 �„,„„�,�_�. -u,
- 3 inch 5 •�.,0 0 ,... 0 _
- 4 inch. 6 �t 0 t'' „ V' 0 4 ,11;L T 0 0 0
; '.
' - Car Wash Drn 6 " ' "
0 . ._. �r,, . 0 gI ., . 0 0 0
Garbage Disposal
3
- Domestic (to 3/4 HP) 16 _ . 0 , w ; 0 ; �'.
# ;', 0 0 0
- Commercial (to 5 HP) 32 ii. "3 "F 0 i 4 wo 32 ? „=R! 0 -1 -32
- Industrial '(over 5 HP) 42 ;i a' 0 0 ,- " ., ,,,, 0 0 0
Ice Machine /Refrigerator Drain 1 a 4 �1 ,; 0 ';',A, 0 0 0 0
Oil Sep (Gas Station) 6 i l`` 0 0 0 0 0
t t °�:
Rec. Vehicle Dump station 16 " ,:,' 0 ,,� f. 0 , ,^! , 0 0 0
"
Shower - Gang (per head) 1 k., 0 0 '� t ' . „ 0 0 0
- Stall 2 a !iJ' 0 - 0 i' f& , ir. 0 0 0
Sink - Bar /Lavatory 2 4 "s. `. ., ?¢, 0 '.; �.. .. 1. 0 � � 4 :°�,,°;' 0 0 0
- Bradley 5 i *I 4 w a T 0 ',. . 0 +, : .,. , t' 0 0 0
• Commercial 31'$' ` „; :` 0 1, °" 3 a ,', 0 1 3
uP
- Service 3 `� ,i t'.x = 0 g. i 0 • 01.1 . 0 0 0
Swimming Pool Filter 1 gill„ „° 0 , _ ; 0 „”, Y ` 0 0 0
Washer - Clothes. 6 7 1411 2 ,ii 0 i g .. ! 0 0 0 0
Water Extractor 6 0 ! '!'" > 0 if a =' 0 0 0
r,
water Closet - `Poilct 6 a ., � • r_ c : 0 1 `i�_�i 0 ii �,, � :q 0 0 0
sa F • Urinal 6 tires , 1 "' 0 : " `; �.3 ". 0 0 0 0
Previous EDU:Count "' ' 0 0
Capped EDU Credit ;:- l : ` t„ 0
'I'0' l'AL S 0 0 3 _ 37 0 0 -3 -37
CurrentFixture Value -37 divided by 16 = -2.3 Current EDU 1 EDU = $ 3,600
Previous Fiz"ture:Valuc 0 divided by 16 = 0.0 Previous EDU
Change -37 divided by 16 -= -2.3 over (under) $ (8,280.00)
Enter EDU Change Here :::,',..:...;;'.2:•-3
Notes: ** *CREDIT" FOR FUTURE USE***
Authorized Name /Signature BRAND N 1 AGGARZ, ;:::';.- Date: fi , , - ,6/29/2010 „ 1 `: ":. a
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.
l:\ Building \Sewer Tally \SewerTallyShect- 3600.xls 06/25/08