Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2010 -00291
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/02/2010
Parcel: 1S135AB00900
Jurisdiction: Tigard
Site address: 10200 SW GREENBURG RD 600
Subdivision: LINCOLN CENTER/FIVE LINCOLN Lot: 0
Project: Axium
Project Description: Interior plumbing: (1) ice maker, (1) sink, (1) water heater, and capping (2) sinks.
Owner: FEES
LINCOLN CENTER LLC Quantity Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555
CALIFORNIA ST 49TH FL 2 ea Fixture /Sewer Cap 09/02/2010 $50.04
1 ea Ice Maker 09/02/2010 $12.51
PHONE: 1 ea Sink 09/02/2010 $25.02
1 ea Water Heater 09/02/2010 $37.52
Contractor: 1 12% State Surcharge - 09/02/2010 $15.01
WEST COAST CENTRAL PLUMBING LLC Plumbing
12714 SE MAJESTIC LN
HAPPY VALLEY, OR 97086
PHONE: 503 - 298 -0435
FAX: 503- 855 -3264
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
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. 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: • J 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.
?^U •: 4`..71r+[!W'}..a'
• New con..tmetion
- .`
C i t e s st> Frottiaa to job site 1,„ 41,„ 3 Ll i.c0 lit_ bl
7:Z'1, Iq A.F.,1W .Vw...•..
0 Demolition
3 Addition/alteration/replacement
❑ Other.
Tax map/parcel nc.:
❑ 1- and 2-family dwelling
-
NI Commercial/industrial
r
❑ Accessc+ry building
Name:
0 Moltt•family
City/Stele/ZIP:
❑ Muter builder
Fax: ( )
• Other
Iv
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n
F r,a o ;;;t4: - ',1
. .i.' , .1;.4=f
i sidde no.: J l Project name: Nei Valk . T. 1
- .`
C i t e s st> Frottiaa to job site 1,„ 41,„ 3 Ll i.c0 lit_ bl
Subdivision: I Lot no.:
Tax map/parcel nc.:
P . ��ti •.'�' : • �i'gi.i �':• nr. - s • .. ��` '••'�'�''•'.;' �:��`�•.; a .. ,.- ...�rl`a [
r
Name:
Address:
City/Stele/ZIP:
Phone: ( )
Fax: ( )
5Y1.717:4$7 'y, i• �rl 74-1:!-':7,1:: . :
Basin's name, • = ' t:: � y]t e ►t
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COMM. name: 16
Addresz 12711 M 0 tS i rL. 1 k -
II
City/State/72P: NA\\ b' 41b1lo
1
Phone: (*Y5)4411:1 ?A ! Fax : (503) 1
Ewnail: yfC,Cp1lx.11tip1 s 1 ('_Dl(1rlC'A$t. Viet
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Business name; •
Address: 1 :l4 9,F"
, (•P,4 fr -
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City/State/ZIP: 1"tA 0 g bey,
32 )
Phnnc ( b$)z. - L'1�
q
Fax: (53 ) %. ). )',1 65
CCB Lic.: 192.c.
Plumbing Lie, no.: pi? 59,9
08/31/2010 11:03 5035981960
Plumbing Permit Application
CITY OF
oco'
Cr 0 1 X11
City of Tigard
13125 SW flan Blvd., Tigard, OR 97223
Phone' 503 639 4171 Fax: 5 93 598 1960 ®��l
Inspection
LMC: 503,639.4 75 C G
m
rateet: www.tigard- or.gov
ate Rea+dyl9):
Natifl.dRNelbpel:
Joh site odd,ess:1)2.bb C �Yi Nye h tAT . ) Igt f
City/Stift:ZIP:
Authorized :signature: C
ignature: 1, / r1, ll`
Print earn. N , - 11ij l"
1:1Buildseeno4100Wh ppd
eailAoo 1041/19
Z'd 179N
I Dam cApyloi
esors ien t eltd.0 Ol el W a ni
T IGARD
I (Ili fSFI'I(' • Vii; (1'.1.1
I 3
SFR (1) bath
SFR (2) bath
SFR (3) bath
F,ac) additional bath/kitchen
F Fin; sprialder ( eq. R)
Site utllitieq
Catch basin or area drain
1 Drywctl. leach line, or trench drain
Footing drain (no. linear R.. _ )
Menufactmed home utilities
&I adtn
Rain drain cone or
Siairary sewer (no.linear R:
Storm sewer (no. linear R.:
Water scvtee (no. linear it! __ J
Fxtare or item:
Backtlow prevents,
Backwater valve
Qothes washy
Dishwasher
Drinking fountain
Ejectors/sump
Expansion tank
Fixi selsewer cap
Floor drain /Boos sink/bub
Garbage disposal
Hose bib
lee maker
1 erceptor /grease trap
Medical ps (value: 5
Primer
Roof drain (commadat)
Sink/beein/lavatory
Solar units (potable water)
Tub /shovier /shower pan
Unnal
Water closet
Water heater
Water piping/DW V
Other:
PAGE 01/03
PP*de 1do.: t ell In - W2-4 /
Other :trice ho 4 e,3610 - ei I
® 9ee Page 2t'r
Supptemeatel laformad
For wedat Worn:Mon dire e*celdirt
Daacron l Qty. ( Fa ) Total
New 1 -1- family dwellings (includes 100 R. for each cannecbon)
312,70
437.78
500.32
25.02
Page
2
1,8.76
18.76
Page 2
50.03
16,76
18.76
Page 2
Page 2
Page 2
31.27
17St
25.02
25.02
25.02
25.02
12.51
25.02
25.02
25.02
25.02
12.51
25.02
Page 2
12.51
12.51
25.02
62.54
12.51
25.02
25.02
37.52
5629
25.02
Plan review (25% of permit fee)
State surcharge 112% of permit five)
50
9nb,otal • C�
Hainan', permit t 372.50
of-
31. 521
tK.vl
TOTAL PERMIT FEE
Ma Permit epsllaWam milli ten ti permit Is ant ob gained within M0lap
deer It bas been accepted tie complete.
'Fee ersteo lology Nee by Tn.Coontyr Building Ieabaery Wei= Bend.
Bulgwnld oom e9Z:90 01 •0 deS
t.�
.7
:-.•.;\:•;
.Q a tl b� 1 19 tnkture.wa'kt?erfcirtiee.
Pi osa • .
D"ae6 .
•
pp i t .'
.
2optist,y/Fent
3379.50 for the first 523.000.00 and 3145 for
each additional 3100.00 or fraction thereof, to
and ineiuding.S50,000.00.
350.001.0D and up
5742.00 for Om fast 330.000.00 and 3120 for
each additiana13100.00 or fraction thereof.
Water Service - 1st 100'
Bath - Tub/Shower
-Jacuzzi/Whirlpool
62.54
Water Servioc - each additional ICO'
37
Storm 8t Rain Drain - In 100'
T
Car Wash -Each Stall
-Daive Thin
Storm a Rain Drain - each additional 100'
3732
-+.. ; 777.7 7• - ;..- -•n-ti^rl- n
.:.;z, . *:. '- c_;� , 7. . t:; ` <�
Inspection efexistin3 plumbing or for
which no fee is specifically indicated
minimum do ?• - 1R h
µ 3"7 •: ,' -L . __ .
lei
■
—lir-
:r% •, ., .
Trtspections outside or norms' business
hours minimum eh : _ -2 hours`
-
90.00/hr
Cuspidor/Water Aspirator
Rcinspectioa Fees
90.00/1ar
Dishwasher -Commercial
- Domestic
-
90.00/hr
_
Subtotal:
Drinking Fountain
Eye Witch
Floor DrainMnk • 2"
- 3"
- 4"
Car Wash Drain
Oatbage - Domestic
Disposal - Ccntmereial
- industrial
tyc MachJRcti g. Drains
Oil Separator (Cat Station)
Rex. Vehicle Dump Station
Shower
-Stn 1[
Sink - 13WLavatory
- Bradley
-Commercial
- Service
r
J
`
(l
7 ,
�
Swimming Foul Filter
•l
Washer - Cloth*
Water Esosetor
Water Closet • Toile
Urinal
1
Other Fixtures:
-
1, • i to 33.000.00
Minimum tee 372.50
ri5.001.00toS10.000.00
S72. 50 fix the first 33,000.00 sad S1.52for
each additional 3100.00 or fraction thereof, to
and including 110.000.00.
310.001.00 to 325,000.00
3148.50 for the first 110.000.00 and 31.54 for
cash additional 3100.00 or fraction tbereaf to
and including 315,000.00.
025.001.00 to 350.000.00
3379.50 for the first 523.000.00 and 3145 for
each additional 3100.00 or fraction thereof, to
and ineiuding.S50,000.00.
350.001.0D and up
5742.00 for Om fast 330.000.00 and 3120 for
each additiana13100.00 or fraction thereof.
.�A!.. .n:..4 f -i •^ .:A -4`!3 r. :Jr.:yl iii. if
Footing drain • I` 100'
i' .'~`':� -:
b� Y Yi..:•.
50.03
Footing drain • each edditinnel 100'
_KZ.
MUM
37.52
Sewer • 1st 100'
Sewer • each additional I00'
Water Service - 1st 100'
62.54
Water Servioc - each additional ICO'
37
Storm 8t Rain Drain - In 100'
62.54
Storm a Rain Drain - each additional 100'
3732
-+.. ; 777.7 7• - ;..- -•n-ti^rl- n
.:.;z, . *:. '- c_;� , 7. . t:; ` <�
Inspection efexistin3 plumbing or for
which no fee is specifically indicated
minimum do ?• - 1R h
µ 3"7 •: ,' -L . __ .
lei
■
>e:
90.00/hr
:r% •, ., .
Trtspections outside or norms' business
hours minimum eh : _ -2 hours`
-
90.00/hr
Rcinspectioa Fees
90.00/1ar
Additional pit a review fctr revisions
minimum eh . - iR hour
-
90.00/hr
_
Subtotal:
08/31/2010 11 ;03 5035981960
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule:
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes",
please indicate wort performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees'.
£•d
!Ulundi ng \Peril itS\PLMF- PemtitApp.doc
179Z£
2
CITY OF TIGARD
Residential Fire Su
ression stems:
PAGE 02/03
0 to 2.000
2,001 to 3,600
3,601 to 7,200
7.201 and Fearer
Medical Gas Systems:
3121.90
3169.69
323320
3327.54
Plan review is required for any ofihe following.
Please check all that apply.
❑ Any new commercial building with water service 2" and
greater, except systems designed and stamped by licensed
engineer.
O New ectcrior plumbing site utilities for any complex structure
as defined in OAR91 8-780 -0040.
❑ Medical gas and vacuum systems for health care facilities.
❑ Any multipurpose fire sprinkler system-
❑ Any complex gruCtU a as defined in OAR918- 780 -0040.
Submit ; sets of plans with any of the above.
�°.1ti i;•`+ •
❑ Isomeric or riser diagram is required for new buildings
that meet the • ualitications above.
Comments regarding fixture work:
"Note: if the fixture work under this permit results in an
increase of sewer EDUI, a sewer permit will be issued and
fees assessed for the sewer increase must be paid before the
plumbing permit can be issued.
6ulgwnid oom e9Z :80 0l• l0 deS
Accumulative Sewer Tally Parcel # 1S135AB00900
Tenant Name: AXIUM This SWR# NONE
Site Address: 10200 SW GREENBURG RD SUITE 600 This PLM# PLM2010 - 00291
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
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 0 0 0 0
- 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 Drn 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 1 -I1') 16 0 0 0 0 0
- Commercial (to 5 HP) 32 0 0 0 0 0
- Industrial (over 5 I -1P) 42 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 0 0 1 1 1 1
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 /Lavatory 2 2 4 2. 4 1 2 1 2
- 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 _ 2 4 _ 2 4 2 3 2 3
Current Fixture Value 3 divided by 16 = 0.2 Current EDU 1 EDU = $ 4,100
Previous Fixture Value 4 divided by 16 = 0.3 Previous EDU
Change -1 divided by 16 = -0.1 over (under) $ (410.00)
Enter EDU Change Here -0.1
Notes: ** *CREDIT * **
Authorized Name /Signature: BRANDEN TAGGAR'I' Date: 9/2/2010
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.
1: \ Building \ Sewer Tally \Sewer 1'allySheet- 3600.xls 06/25/08