Permit CITY OF TIGARD PLUMBING PERMIT
• COMMUNITY DEVELOPMENT Permit #: PLM2010 00333
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/19/2010
Parcel: 2S101 DA00102
Jurisdiction: Tigard
Site address: 13221 SW 68TH PKWY 100
Subdivision: TRIANGLE CORPORATE PARK Lot: 2
Project: Lincoln Heritage
Project Description: Interior plumbing: Capping (3) 3" floor sinks and (2) sinks. Adding (1) dishwasher, (1) ice
machine and (2) sinks.
Owner: FEES
GK TRIANGLE CORPORATE PARK III L Quantity Description Date Amount
BB# 73- 1771- GK1130, CBRE, PO BOX 2096
WARREN, MI 48090 1 ea Dishwasher 10/19/2010 $25.02
PHONE: 5 ea Fixture /Sewer Cap 10/19/2010 $125.10
1 ea Ice Maker 10/19/2010 $12.51
2 ea Sink 10/19/2010 $50.04
Contractor: 1 12% State Surcharge - 10/19/2010 $25.52
RAYBORN'S PLUMBING INC Plumbing
19990 SW CIPOLE RD
TUALATIN, OR 97062
PHONE: 503 -692 -4139
FAX: 503 - 691 -2328
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $238.19
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: 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.
...503 691 2328 Rayborns Plumbing 01:33:37 p.m. 10- 14-2010 1 /2
Plumbing Permit Application _ , `
Building Fixtures ri rlil< urrlc t: t:r1 ( i\l 1
City of Tigard a P e rm it No
• 13 125 SW Hall Blvd., Tigard, OR 97223 0 ` � ,,, j/ Azigaviiia
B C n Rev i ew o.: ,
- 1111 t
Phone: 503.639.4171 Fax: 503.598.1960 ` �� Date/B Other Pennil No.: , ._ ,
1 l li I Inspection Line: 503.639.4175 c)\ mil � O� ` Date Ready/By: iris: 6d See Page 2 for
Internet: ww ���Q�` \ w\G NotifiedMethod: T P Supplemental Information
-
TYPE OF WORK - FEE* SCHEDULE
❑ New construction ❑ Demolition Forspeclallnformadon use checklist
Description f Qty. 1 Ea. 1 Total
EvJ Addition/alteration/replacement ❑ Other. ; New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTR,CTION SFR (1) bath 312.70
❑ I- and 2- family dwelling C ommercial /industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi- family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other. Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 13 1 SW IG / kwo. Ste_ 100 Catch basin or area drain 18.76
/StatelZlP: /I Q^ Drywell, leach line, or trench drain 18.76
Ci
h �l Aff� 0 R l + �.5 Footing drain (no. linear ft.: _) Page 2
./apt. no.:
Suite/bldg./apt. t �+
8 I Project name: NLaN 1 1 q L Manufactured home utilities 50.03
Cross street /directions to job site: 1 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 R.: _) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Teiv,r»+ le. pr t er.e.„ Dishwasher I 25.02 Sto_
Drinking t'ountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap ____5_ 25.02 42 425; j !
Floor draiNRoor sink'hub 25.02
Address: Garbage disposal 25.02
City /StateiZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker + 12.51 1),,S1
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: Roof drain (commercial) 12.51
Address: Sink/basia'Iavatory a 25.02 9.0
City /State/ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax:: ( ) Tub;shower'shuwerpan 12.51
E -mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
I r Water heater 37.52
�`o /nS
Business name: J P( .t. ) .11 C r DWV 56.29
! + Wat er PP in 8/
Address: (v � Q,p Other. 25.02
City!StateiZlP: Tajo,. fq
;.v,1/4. C Q 9106a Subtotal 0. !- ?..1_ 6, 7
Phone: (9 ) 69 a ' .,- 4139 Fax: ( �3) 6 / l' � Minimum permit fee: $72.50
CCB Lic.: 815c> Plumbing Lic. no.: - - Plan review (25% of permit fee)
State surcharge (12% of permit fee) to S( 0 5
Authorized signature: e TOTAL PERMIT FEE ' ?At 1/ �� a 11
v This permit application expires if 1 permit is not obtained within t I 9 days
Print name: y,� N /5/ Date: plight) p e after it has been accepted as complete.
fl *Fee methodology set by Tri- County Building Industry Service Board.
1: Bailding Prrrits PamitAlMvdac 100109 440.4616T(I0.02,COM'WPB)
X503 691 2328 Rayborns Plumbing c y \ 09:57:45 a.m. 10 -15 -2010 3
19‘ r� �
Plumbing Permit Application - City of Tig p
Page 2 - Supplemental Information �`(\G' C %\
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee:
Footing drain - I 100' 50.03 0 to 2,000 $121.90
Footing drain - each additional 100' 37.52 2,001 to 3,600 SI69.69
3,60110 7,200 $233.20
Sewer- 1st 100' 62.54 7,201 and greater 5327.54
Sewer - each additional 100' 37.52
Water Service - 1st 100' 62.54 Medical Gas Systems:
Water Service - each additional 100' 37.52
Stonn &Rain Drain - I st 100' 62.54 Valuation: Permit Fee:
$1.00 to $5,000.00 Minimum fee 572.50
Storm & Rain Drain - each additional 100' 37.52 55,001.00 to 510,000.00 572.50 for the first $5,000.00 and 51.52 for
Other Inspections or Fees Fee (ea) Total each additional 5100.00 or fraction thereof. to
1 and including $10,000.00.
Inspection of existing plumbing or for $10,001.00 to 525,000.00 $148.50 for the first $10,000.00 and 51.54 for
which no fee is specifically indicated 90.00/hr each additional S100.00 or fraction thereof, to
(minimum charge - 1/2 hour) and including 525,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to $50,000.00 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
Reinspection Fees 90.00/hr and including 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
(minimum charge- 1/2 hour) each additional $100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes ", Plan Review for Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees *. Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixture Type: Replace greater, except systems designed and stamped by licensed
Previous Capped Added Exbdpg engineer.
Baptistry /Font ❑ New exterior plumbing site utilities for any complex structure
Bath - Tub/Shower as defined in 0AR91 8- 780 -0040.
- Jacuzzi /Whirlpool ❑ Medical gas and vacuum systems for health care facilities.
Car Wash -Each Stall
-Drive Thru ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water
Driv for ❑ Any complex structure as defined in OAR9 I 8-780-0040.
Dishwasher - Commercial
- Domestic , r Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash Isometric or Riser Diagram
Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings
3 that meet the qualifications above.
-4 ..
Car Wash Drain
Garbage - Domestic
Disposal - Commercial
Industrial Comments regarding fixture work:
Ice MachRefrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Duinp Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley
- Coimnercial *Note: if the fixture work under this permit results in an
- Scvvice increase of sewer EDUs, a sewer permit will be issued and
Swimming Pool Filter fees assessed for the sewer increase must be paid before the
Washer - Clothes
Water Extractor plumbing permit can be issued.
Water Closet - Toile
Urinal
Other Fixtures:
1 http: / /www.tigard- or.gov/ city_ hall / departments /cd/docs/PLMF- PennitApedoc
-503 691 2328 Rayborns Plumbing 09:57:16 a.m. 10 -15 -2010 1 /3
117 /15/'Lt1117 ub: i`1 bui5ytil'dbt7 UlIY Ul- IlUPRU I bl /bl
City of Tigard
13125 SW Hall Blvd o
Tigard, OR 97223 OCZ � 5 201
Phone: 303439 -4171
•
C ���, piU1510 "TIG
gUl A R L)
FAX TRANSMITTAL
Date October 15, 2010
Number of pages including cover sheet
To: Jim Waterbury From: Br andcn Taggart
Co: );aybom's Plumbing _ Co: City of Tigard
Fax #: 503 - 691-2328 Fax #: 5a.598
Ph #: X03 - 718-2449
SUBJECT: Lincoln Heritage plumbing permit application
MESSAGE:
Hello Jim,
In order for us to issue your plumbing permit for Line.. Heritage, we will need you to ' omplete the
"comrn.ercial fxture work" section on the second • • of the plumbing permit applicatio. We need
to know if you are capping, adding or replacing ':ring fixtures. In case you are adding u : SDC
fees will need to be paid prior to issuing the permit " you have any questions, please let me 1m....
Thank you,
Branden Taggart (U•�` + .,v,
Permit Technician V\ 'a
City of Tigard �� 5
503 -718 -2449 Q �S c�C
? ‘
'Ow
\ Building\ Jam.\ I'uc'1'nrftminst-T.doc 1/18/U7
Accumulative Sewer Tally Panel # 1S1260000300
Tenant Name: LINCOLN HERITAGE This SWR#
Site Address: 13221 SW 68TI -I PKWY SUITE 100 This PL,M# PLM2010 - 00333
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 - 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 1 2 1 2
Drinking Fountain 1 0 0 0 0 0
f..yc Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 0 0 0
- 3 inch 5 0 3 15 0 -3 -15
- 4 inch 6 0 0 0 0 0
- Car Wash Din 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 1-IP) 16 0 0 0 0 0
- Commercial (to 5 1 -IP) 32 0 0 0 0 0
- Industrial (over 5 1 -IP) 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 /I..avatory 2 0 0 0 0 0
- Bradley 5 0 0 0 0 0
- Commercial 3 0 2 6 2 6 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
Tamils _ 0 0 5 21 4 9 -1 _ -12
Current Fixture Value -12 divided by 16 = -0.8 Current EDU 1 EDU = 5 4,100
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -12 divided by 16 = -0.8 over (under) $ (3,280.00)
Enter EDU Change Here -0.8
Notes: ** *CREDIT * **
Authorized Name /Signature: BRANDEN TAGGARI' Date: 10/19/2010
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 T ally \ScwerTallyShcct- 3600.xls 06 /25/08
Accumulative Sewer Tally Parcel # 1S1260000300 It j 1 os . -
Tenant Name: LINCOLN Illatl l'. \(■I: "RI: \'ISI {1)"12 /13 /1G01111 This S , /' mirld
S
O
ite Address: 13221 ' \ \ 681'11 1 I'I: \\'1' til'I•I•I? 100 to P1 .M2013-00431 his P1M# 'LM2010 - 00333 '
11\ tore \ aluc Previous Previous Credits Capped Fixture Fixture N cw New
# value capped off value added added total total
count off #s count # value #s values
Baptisery/Font 4 0 M 0 111Mr 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 0, 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 I 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 3 15 0 -3 -15
-4inch 6 0 0 0 0 0
- Car Wash Dm 6 0 0 0 0 0
' Garbage Disposal
- Domestic (to 3/4 HP) I6 0 0 0 0 0
- Commercial (to 5 HP) 12 0 0 0 0 0
- Industrial (over 5 HP) 42 0 0 0 0 0
Ice Machine /Refrigerator Drain I 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 0 0 0 0 0
- Bradley 5 0 0 0 0 0
- Commercial 3 0 2 6 2 6 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 5 21 4 9 -1 -12
Current Fixture Value -12 divided by 16 = -0.8 Current EDU 1 EDU = S 4,100
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -12 divided by 16 = - 0.8 over (under) S (3,280.00)
Enter EDU Change Here
Notes: ** *CREDIT * ** 12/16/13, credits applied to PLM2013- 00431. Dadamski
Authorized Name /Signature: Date: 10/19/2010
Building Division
ote: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher which must be
ubmitted to the City of Tigard Building Division to redeem credits towards future system development charges.
r
I: \Building \Sewer Tally \SewerTallySheet- 3600.xls 06/25/08