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Permit
CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit #: PLM2010 00369 T t G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/12/2010 Parcel: 1 S 135AB01003 Jurisdiction: Tigard Site address: 10330 SW GREENBURG RD Project: Red Lobster Subdivision: LINCOLN ONE Lot: 0 Project Description: Replace 40' sanitary sewer line and interceptor /grease trap per CWS guidelines. Contractor: RIVER CITY ENVIRONMENTAL Owner: LINCOLN CENTER LLC PO BOX 30087 BY SHORENSTEIN PROPERTIES LLC PORTLAND, OR 97220 555 CALIFORNIA ST 49TH FL SAN FRANCISCO, CA 94104 PHONE: 503 - 252 -6144 PHONE: FAX: 503 - 288 -3658 FEES Quantity Description Date Amount 40 If Sewer Service 11/12/2010 $62.54 Specifics: 1 ea Interceptor /Grease Trap 11/12/2010 $25.02 1 12% State Surcharge - 11/12/2010 $10.51 Type of Use: COM Plumbing Class of Work: ALT Type of Const: Occupancy Grp: Stories: Total $98.07 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 :0 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules ado! - • .y the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may ob -' a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: r► /�' Permittee Signature: , �lX • 1 Call 503.639.4175 by 7:00 a.m. for the next available insp ction date. This permit card shall be kept in a conspicuous place on the job site un I completion of the project. Approved plans are required on the job site at the time of each inspection. Plumbing Permit Application. 01S1111a JNIQlIf19 Site Utilities QaV9IIJO1110 FOR of i ici: USE ONLY City of Tigard 7 T A p� Received P ennit No ! q ` o Z ` / \OIV Date /By: � ,/�.2�0 4 L . /(f0 /d _ 0 / a 13125 SW Hall Blvd., Tigard, OR 97223 O Plan Review C Phone: 503.639.4171 Fax: 503.59 AI Date /By: Other Permit No.: Inspection Line: 503.639.4175 TIGARp Y Y Juris: ® See g Date Read /B Page 2 for Internet: www.tigard- or.gov Notified /Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE El New construction 0 Demolition For special information use checklist. Description 1 Qty. 1 Ea. 1 Total CR Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 312.70 ❑ 1- and 2- family dwelling [Commercial /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: Catch basin or area drain 18.76 Job site address: /Q Q 61 ) P p�"� go � J .�I/ / � Drywell, leach line, or trench drain 18.76 T City /State /ZIP: Footing drain (no. linear ft.: _) Page 2 Suite/bldg. /apt. no.: Project name: go 14 4f7A/ Manufactured home utilities 50.03 Cross street/directions to job site: 6 a o9 A 1 4, /ow ea Manholes 18.76 Rain drain connector 18.76 Sanitary sewer (no. linear ft.: 40 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.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 4.4 efow'` 14,,i.. 2960o4,91._ 1-116 4PP uio Dishwasher 25.02 r 04446 j 2/ 97P/ REP -19e&WEA/ % Drinking fountain 25.02 ^/0 C'6zgJ6 ---6.61.-- Ejectors/sump 25.02 0 PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: jo�/� �' 1 1p. 0 M Q/ �D��`,/�. Floo r drain /floor sink /hub 25.02 Address: Fixture/sewer 25.02 -' } h / �/ V Floor Q a� �� j� a �O Garbage disposal 25.02 City/State /ZIP: © 'G4.►� A 4 / L. 321'69 Hose bib 25.02 Phone: (47 ) Z ` �6 .. 4/000 Fax: ( ) J Ice maker 12.51 0 APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 1 25.02 Business name: , i'iiirt.rT 44 yr �44 41 -�4. Medical gas (value: $ ) Page 2 Contact name: gT1 ` L ,� vim Primer 12.51 Roof drain (commercial) 12.51 Address: / a 00 (7 Sink/basin/lavatory 25.02 City/State /ZIP: /►/, 1/0 ©h 7Z4 9 Solar units (potable water) 62.54 Phone: r )742._,ii v 6' I Fax: : ( ) 9 Tub /shower /shower pan 12.51 E -mail: ox 0 1441 44. �, v itJ . 4.01,1 i Urinal 25.02 CONTRACTOR Water closet 25.02 Water heater 37.52 Business name: K.LJ.f eki 50Mu71l9e Waterpiping/DWV 56.29 Address: Other: 25.02 City /State /ZIP: Subtotal Phone: ( ) Fax:( ) Minimum permit fee: $72.50 Plan review (25% of permit fee) 1 4 1. - Plumbin ! L 4. State surcharge (12% of permit fee) /0 , 5 Authorized signature: // �� TOTAL PERMIT FEE 9, 0 7 Print name: 4 ,... 4 , 6N�ty� Date: 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. I:\ Building \Permits \PLMU - PermitApp.doc 10 440- 4616T(10/02/COM %WEB) • Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information 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 dram - each additional 100' 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer - 1st 100' 62.54 7,201 and greater $327.54 Sewer - each additional 100' &la 37.52 Water Service - 1st 100' 62.54 Medical Gas Systems: Water Service - each additional 100' 37.52 Valuation: Permit Fee: Storm &Rain Drain - 1st 100' 62.54 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 37.52 $5,001.00 to $ 10,000.00 $72.50 for the first $5,000.00 and $1.52 for Other Inspections or Fees Fee (ea) Total each additional $100.00 or fraction thereof, to p and including $10,000.00. Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for which no fee is specifically indicated 90.00/hr each additional $100.00 or fraction thereof, to (minimum charge - 1/2 hour) and including $25.000.00. Inspections outside of normal business 90.00/hr $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for hours (minimum charge - 2 hours) each additional $100.00 or fraction thereof, to Reinspection Fees 90.00/hr and including $50,000.00. Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 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 Existing engineer. Baptistry /Font Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure as defined in OAR918- 780 -0040. - Jacuzzi/Whirlpool Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities. Drive tall ID Any multipurpose fire sprinkler system. Cuspidor /Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040. Dishwasher - Commercial Domestic 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 Mach. /Refrig. Drains Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar /Lavatory - Bradley - Commercial *Note: If the fixture work under this permit results in an - Service 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 - Toilet Urinal Other Fixtures: http : / /www.tigard - or.gov /city_hal l /departments /cd/docs /PLM U- PermitAp.doc