Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2011 -00037
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/01/2011
Parcel: 1 S 135AB01003
Jurisdiction: Tigard
Site address: 10300 SW GREEN BURG RD 270
Project: Silverado Funding Subdivision: LINCOLN ONE Lot: 0
Project Description: Interior plumbing: adding (1) 2" hub drain, (1) sink and replacing (1) water heater.
Contractor: POWER PLUMBING CO Owner: LINCOLN CENTER LLC
PO BOX 19418 BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97280 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 - 244 -1900 PHONE:
FAX: 503 - 244 -8825
FEES
Quantity Description Date Amount
1 ea Floor Drain/Floor Sink/Hub 02/01/2011 $25.02
Specifics: 1 ea Sink 02/01/2011 $25.02
1 ea Water Heater 02/01/2011 $37.52
Type of Use: COM 1 12% State Surcharge - 02/01/2011 $10.51
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $98.07
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.19833
Issued By: Permittee Signature:
Call 503.6 ! by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
JAN /28 /2011 /FRI 12:43 PM POWER PLUMBING FAX No, 503 244 8825 P. 002
Plumbinz Permit Application 5 1 Di
Building Fixtures FOR OFFI('I[ LSI ONLY
City of Tigard E aw LL1 � -r� a 13125 SW Hall Blvd. Tigard, OR 97223 �
�� Phone: 503.639.4171 Fax; 503.59$ -1960 ; Date/By: Other Pcnnit No.: au , 11 ,_ 0 i
Inspection Line: 503.639.4175 'r ' °`
T 1 CV A K Date )?eady/By: luris: See Page 2 for
Internet: www.tigard Notiled/Method: Supplemental Information
Fri
l�.- .. _r_ar,l. if._ 1_1- ,.1. -1 ,r,. , a.L, 1 :;..+.. air i r. " 0. ....- -: .. .
. ,.,. . ... U ,.., 1 @l,_:., .r,,... J�,abaiy�s �)ra.;.wa`..,�i-,_,,_..,l4
❑ New construction [l Demolit ion For special information me ehecklis!
Descri .tion • . Ea. Total
V. • ddition/alteration/rcplaccment ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
1 .. ^ ,^^ ;f : S t '] r' l r, j 8hw T,^ R' +'G "'%T"f'IC'£"' r'.
�_ - 17` { � y , r`jcS4ty(iF ? p fr b l) � q0,,,l + , ,r . , . SFR(1) 312.70
❑ 1- and 2- family dwelling ► ommercial/industrial SFR (2) bath 437.78
SFR (3) bath 500.32
0 Accessory building ❑ Multi - fancily
Each additional'bath/kitchen 25.02
N ❑ Master builder ❑ Other
M �d [ ,t ) J l ..„,i',<-,-,17',-,,,11': 1 r - I t l� f i : t i : ; r rf . -t . u i , . f , ( , Fire sprinkler ( sq. ft.) Page 2
`;' Site utilities:
b3UQ J 1 V tir b .t r / Catch basin or arcs drain 1$.76
ob site address: 1
N. City /State/ZIP: .� / / / r1�3 Drywall, leach line, or trench drain 18.76
Footing drain (no, linear ft.; ) Page 2
`" Suit- i ldg. /apt. no.: 2.7 b Project name: Si Vex-:
r Manufactured home utilities NM 50.03
Cross street/directions to job site: 1 i di Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no, linear ft.: P age 2
Storm sewer (no. linear ft: ) Page 2 •
- _ Water service (no. linear ft.: - __) Page 2
.� Subdivision: Lot no.: Fixture or item:
fax map /parcel no.: Backflow preventer 31.27
! a x atj4� , ' ' i -4 1 1 , �a , „ Backwater valve ',
r 1 t r 1 {i ,. : „I d r r N t �: {/e „ ' A � ' i„ ,
� - . � .� ,, ,'a : ;.. : a r -r. �� , w. �.. ��, Lr 3 ' � ' :
r t�Ln.�.r.6,:'s..���.y..: 13 L� '� rw�}r: CIoffiCS washer � 25.02
. 1I . = . .-� Di shwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
T , ir � F 1 t,L, � 'r ]r } n 1 2 1 V F v' + ,P eir } a} ' ;I Expansion tank
Name: Fixture/sewer cap 25.02
C Floor drain /floor si WA / 25.02 2 G
Address: Garbage disposal 25.02 4
1 City /State/ZI3': Hose bib 25.02
.. Phone: ( ) Fax ( ) ice maker 12.51
� ; - r i 1.`t it i r -, }�` tr r. ' s , IE f t - "1, t ^i I a � ri a' eg�r l a _ ... 2 Interceptor /grease trap 25.02
i n “..-....•:•.,..t • ,'.UD.,,,. ,,, e!. ,, ,, a ' ..�.,e,,, .a..._ • . .�.,... ..
Business name: � , a r Med ical gas (va $ ) Page 2
Contact name. ■ Primer 12.51
' "' ` l � Roof drain (commercial) 12.51 IMIll
gt
Address ` E , in/lavatory .� 25.02 MO
• �(� Solar units (potable water) 62.54
I D Phone: P ) .L3y.1 Fax : ( .5: 0 3 ) .>4 4 4 - $ 2._ Tub/shower /shower pan 12.51
E -mail: Urinal 11.111 25.02
r 3r*r � • • i a , +7+ r ,max .. t 1 'gt: -u 1 u7^ t , , i ,r I �,r . , �; Water closet MN 25.02 Effil
rq" t r, }' dF 1- r { i " ,`o a fi r{° � T,l. . , Y le n P i , , 14 ,i
,,:..,�.... e.,: •41; r ,. : ,N. :i. 1nF_ ..,: rs✓:ad ti «.;.,..f ;•.,3 � u t . 1 �• water heater N, 37.52
Business name: I illinr l/ Water P P � L m DWV 56.29
Address: r t1 3, , i &1.V i Other; 25. 02
City /State/ZIP: / • / „ . - Subtotal KUM
Phone: (3) _ .,J - t ip 0 ) � a Fax (S l) .24Y- e' , LS Minimum permit fee: $72.50
IZEIE Plumbing Lic. no.: 4 -.j .> f' / Plan review (25% of permit fee)
71 State surcharge (12% of permit fee) NMI
Authorized signature: 4 S TOTAL PERMIT FEE Win
Print name: ilg,51---Mt r S Date: f A? I 1 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: lBuilding \PermhAPLMU- PennitApp.doc 10/01/09 4404 167(, ND2/COM/W.ft{)
JAN /28 /2011 /FRI 12:43 PM POWER PLUMBING FAX No, 503 244 8825 P. 003
.
Plumbing Permit Application - City of Tigard
Page 2 Supplemental Information
Fee Schedule: Residential Fire Su cession S stems:
Footing drain - 1" 100' 50.03 0 to 2 000 5121.90
Footing drain - each additional 100' I= 37.52 2 001 to 3 600 $169.69
3 601 to 7 200 $233.20
Sewer- 1st 100' 62.54 7,201 and _reater $327.54
Sewer - each additional 100° 37,52
Water Service -1st 100' 62.54 Medical Gas S stems:
Water Service - each additional 100' 37.52 t 7 i i
,F 8 47 " '
Storm & Rain Drain - 1st 100' 62.54 i
$1.00 to $5 000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 37.52 $5,001.00 to 510,000.00 $72.50 for the first $5,000.00 and $1.52 for
I f yt t
7);41,,,7, M14 >,..Wy. d5;� 11 i ,� each additional $100.00 or fraction thereof, to
t lrtJtl k to rt iu l
^� i �� i✓
: � j .�L.,�.w. -.. . -,..• and includinl $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 chart -1 /2 hour) and includin; $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 cha ;e -2 hours each additional $100.00 or fraction thereof; to
Reinspection Fees 90.00/hr and includi ; $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 Char • e- 1/2 hour each additional $100.00 or fraction thereof.
Subtotal:
•
Commercial Fixture Work:
Are you capping adding or replacing fixtures? If "yes" o �° � ' n -
.. is. 4 -,. 6� ,11 C`j'IT . i� n}G4 1 i4 ';'; . 1t�?�
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately re 4 ort fixtures could result in increased sewer fees * - Please check all that apply.
!' ,� r yN.tt t,t..irh i 4l r4 1''• n i �'t'V 4ryd. ID Any new commercial building with water service 2" and
greater, except Systems designed and stamped by licensed
y v ,,, , { {�, ii;l. '''11,�.,w ,�P�Y•� ;fa�SL�.��.R� , ,�K�,r't'"�lY fJ {, �n engineer.
Baptistry /Font ❑ New exterior plumbing site utilities for any complex structure
Bath -Mb/Shower as defined in OAR918 -780 -0040.
- Jacuzzi/Whirlpool El Medical gas and vacuum systems for health care facilities.
Car Wash -Each Stall
-Drive Thru ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator CJ My complex structure as defined in 0AR918- 780 -0040.
Dishwasher - Commercial
- Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash te�� r��izp F y. F Hti r35arrl I •
w.., � a,........ .!i .l ?��4 r � :._ ... a
Floor Drain/sink 0 U Isometric or riser diagram is required for new buildings
that meet the i ualifications above.
-4"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial
Industrial Comments regarding fixture work:
Ice Mach. /Refries Drains
Oil Separator (Gas Station)
Rec. Vehicle Dum�Station
Shower -Gang
- Stall --- •--- --
Sink -B ;veto
- Bradley
- Commercial *Note: If the fixture work under this permit results in an
- Service _ increase of sewer EDYIs, a sewer permit will be issued and
Swimmin: Fool 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.
http : / /www.tigard- or.gov /city_hall/depa. rtments /cd/docs/PLMF- PermitApl doc
Accumulative Sewer Tally Parcel # 1S135AB01003
Tenant Name: SILVERADO FUNDING This SWR# SWR2011 - 00024
Site Address: 10300 SW GREENBURG RD This PLM# PLM2011 - 00037
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
13ye 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 HP) 16 0 0 0 0 0
- Commercial (to 5 I IP) 32 0 0 0 0 0
- Industrial (over 5 IIP) 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 /Lavatory 2 0 0 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 I ] IF 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 = $ 4,100
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 4 divided by 16 = 0.3 over (under) $ 1,230.00
Enter EDU Change Here 0.3
Notes:
Authorized Name /Signature: BRANDEN TAGGART Date: 2/1/2011
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 \Sewer 1'allySheet- 3600.xls 06/25/08