Permit ,� CITY OF TIGARD PLUMBING PERMIT
1 -'= COMMUNITY DEVELOP Permit #: PLM2011 -00207
TIGARL7 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/01/2011
Parcel: 1 S 135AB03400
Jurisdiction: Tigard
Site address: 10260 SW GREENBURG RD 610
Project: New York Life Subdivision: METZGER, TOWN OF Lot: PTS 7 -8
Project Description: Interior plumbing: removing and capping fixtures.
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 Dishwasher 07/01/2011 $25.02
Specifics: 1 ea Floor Drain /Floor Sink/Hub 07/01/2011 $25.02
1 ea Garbage Disposal 07/01/2011 $25.02
Type of Use: COM 1 ea Sink 07/01/2011 $25.02
Class of Work: ALT 1 ea Water Heater 07/01/2011 $37.52
Type of Const: 1 12% State Surcharge - 07/01/2011 $16.51
Occupancy Grp: Plumbing
Stories:
Total $154.11
•
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 503.232.1987 or 1.800.332.2344.
O
Issued By: . Permittee Signature:
- I_ /
'/
Ca 503.639.4175 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.
JUN /30 /2011 /THU 09:16 AM POWER PLUMBING FAX No,503 244 8825 P. 001
Plupbi�ng Permit Applicatio 1 ,4,1 n G ,
.Building Fixtures EIVED FOR OFFICE USE ONLY
City f Tigard Received -
71 = I ' g - 2 011 �' _
q D alaB ; i
13I25 Sw Hall Blvd., Tigard. OR 47223 3 0 y �� Permit No.. ���
Plan Review
Phony 503.639.4171 71 Fax: 503.54 JUN Date/By. Other Permit No.: it, r , _ /
Inspection Line: 503.639 -4175
TIGARD CITY OF TIGARD Data Ready/By: HI Sec Page 2 for
Internet www ngard -or gov Nonfi ed�Method
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0 New construction ❑ Demolition For special information
use el eekl
Descri•tion • . Ea, Total
►� • ddition/altcration/replacement ❑ Other New 1 - family dwellin, s (includes 100 ft. for each utility connection)
N j "�" 1? ° T riT "^- �:, r '� 1i- -�4 t tJ Y' .. t::: r a I7 ' 7
` + , .7 � t Y 'r `�� ri;:i 1 U., " .i +fi l g n qq -, 4 ) .31 `'± I� ' , i2.. -, SF 312.70
R (1) bath
ID 1- and 2-family dwelling Commercial /industrial SFR (Z) bath 437.78
❑ Accessory building CI Multi-family SFR (3) bath 500.32
12 Master builder Each additional'bath/kitchen 25.02
❑ Other
e F r r l r ,�- r t �v ,m +1,7 Fire sprinkler (_ ` sq. ft) Page 2
1F7 r 3 c 2 -itt ,i\l i s ° 4 J1 'i �'ftJ . - yl +lo)tl c' 7' a �+r Site utilities:
lob site address: 1 D � S CO (tiy��� ��� Catch basin or area drain 18.76
� � Drywell, leach line, or trench drain ■ 18,76
City/State/ZIP: - r /
Sui. ,•Idg. /apt. no.: ; 10 name: •, ; , ., , Footing drain (no. linear ft.: �) Pa 2 Mill
1 1
■ . Manufactured home utilities 50.03
Cross street/directions to job sit • . Manholes 18.76
........_. _......�__ _ _ . ...................._._._..,.._ .. w.,. Rain drain connector
Sanitary sewer (no. linear ft: ) Page 2
Storm sewer (no. linear ft.: ___) ) Page 2 •
Water service (no. linear ft.: ) Page 2 Milli
Subdivision: Lot no.; Fixture or item:
Tax map /parcel no Backflow preventer 31.27
f ��i y1 �1 '..r ,x � �",' �37tiF d�� 'l l a @ d�a (� u� ''' C ^ A` ,17 '1,,.uy If �YAS� r.4; -�r ”. ,�;jy 12.51
r ,r`' x f 9 Backwater valve EIMII
, ,,IZIa �4� 4, .w rn, 2 ��1.ad ki;.e. ..,::c: ' w a s.y. s.. 4:1 .., r,� ., ' 1' „tcs � 4',t1; � 12, :. " ,,La„.:a21, 4% ,:i:
Clothes washer
25.02
r + L Dishwasher WM
25 02 OZ.
LtotAt if ' Drinking fountain 25.02
Ejectors /sump ■ 25.02
{ ^ G a ellau 7i, � , 4� :�. 124-:'''2.,9 1 r� ta.. [ ..rii i 7 ,
,'� �x lr,t4 tal,r : 4t i t , 4o 4 4&. - a. ii t, `� r * u , 1 . ',. , Expansion tank
22.5 51.s t h 4 �a a.ctrr,,, ,..,.mob L.l, h,aT. k ,.....,. i l. S ,.,.., „� si .., u.......A _�n.` ,+ N ame; F ix m re/ s ewer caD 5.02
Address - Floor drain /floor s- .02
Garbage disposal _ 25.02 Z5 0-2 .'
City /State/ZIP: Hose bib
25.02
Phone: ( ) Fax ( ) Ice maker IMI 12.51
h',7"-c" r _:ra ;� t F „ � 1rY , T =rE .4 �w �.P1 t � P 25. NMI
. "' 1 ., .-'. ,gr..A ,41..E ?r u,..btu ., " , 4 w.i .∎ .'.
.. 1 , ; 44, ,e , ,a/,,p t �`� r 1,1 1 , % t ' r, 4' �� J ]nterceptodgreasetra
Business name: PO O_QA( I Lain , m # y.fr`` � Medical gas (value: $ ) Page 2
Contact name: /� J /r 1 Primer 12.51
Roof drain (commercial) Rim P a DX. 1 6 1 41 2' ��' •asiNlavatory 25 -02 DZ
City /State/ZIP: r thr - .. •t Solar units (potable water) III Phone; ( ) 44 -- 1 e) CV Fax: : ) 4 -W25 Tub /shower /shower pan 12.51
r 1,._,O Urinal 25.02 MO
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" t �, F"' , ' -l« . r'7'p" kr"' M ats. St : N "' , ., W ater closet •
r f i. Y eFyi. a , K7l tF ' ,. ' '' « yt 25.02
1 � sF �, r �' ,a.1 - , . l e Y, i o ti I' � { i ^ '7 ' �R �
,e0t?i 4142 ?Gc-. "a=k4,., .,nal r d r . .L{r... :evebf�„ I �w ,{ ' �5. 'yf� Water heater 37.52
• ►1� 1 _. Ja! .M Water piping/DWV 5629
Address: r 0 .1 cs 41 c( Other 25.02 Mil
City / State/ZIP: P / • - 7940 Subtotal fr 60
Phone: ( ) D-44--1 / v ) Fax: ( ) F 4 _ l L•`J _Minimum permit fee: $72.50
CCB Lic.: .. -7 Plumbing Lic. no.: 4ii I M 1 Plan review (25% of permit fee)
Authorized Signature: ._----. State surcharge (12% of permit fee) EMI
TOTAL PERMIT FEE b 4, 1 1
Print name; A) ST /O L(. , 1' S_e" Date; , f�1 e 10 j ( This permit application expires if a permit is not obtained within z80 days
J after It has been accepted as complete.
.. `Fee methodology set by Tri.Cour,ty Building Industry Service Board.
1: 18uil0lhB \Pemin1PDAJ- PermiiApp. 10/01/09 44o.46167(70/03/COAJWEn)
JUN /30 /2011 /THU 09:16 AM POWER PLUMBING FAX No, 503 244 8825 P.002
Plumbing Permit Application - City of Tigard
`Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su • ressiora S stems:
r � ,7; i�t, r!.' d �x" ' L) 7•J ?;+..1� ht s U � °l' :v' ' !W' }, . l ,' , , ,,, eN+ ,em 3 .. .. Lava y cpvav a1a ; i es a , 57 -� 7#1 " Odd
! P f . , f `�. I 5vv1 , va � i 4: ld y G if IC 1 i 'I "' rt T.
,: ii..ddii
aa� l'�. � .y �">i" . 7, .,,.wt.{ a�� ;��,,,3��.�:,.,,`'?w� � ' ; h , 1 ' 1 � '" N • J e . ti 4���;�e�l�i ''4i !� y,;s c r�±�.'r� � w .
�i. ..M . L� 1Ld4v � c� F.� - _�. �. `J„[A?. -� Y Lti W` - `jrala , ,YCvL'�`�':
Footing drain - I' 100' 50.03 0 to 2,000 $121.90
Footing drain - 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' 37.52 J
water Service - 1st 100' _ 62,54 Medical Gas Systems:
Water Storm & Rain Drain additional 100' 62. ,'
54 VzI , 1:5
74 e 7.„W,f ��1 � 1 ' ' i� " `,
$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
""rY -', s v aqa t
<1E1 a F' ,j� r A J �,i i `'`�,- t 'u tit* U74, and inadditiona l$100000 fraction thereof, to
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,
]nspcctions 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) 1 each additional $100.00 or fraction thereof_
Subtotal:
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes ", T'" r �,d � . i . - '-:1�. t r? - - `i ii o^� .�-, -; ' .
please indicate work performed by fixture. Failure to Plan review "" vie , ir , d for any an f the l following.
i 6 �i ? " ,
view is required ny of folowing.
accurately report fixtures could result in increased sewer fees'. Please check all that apply.
u lik '41: r 7 - ;�ii'� 6 (Fltiilt'�)' C'etl'Isemmi't li l O 1:1 Any new commercial building with water service 2" and
4iti tF i hN e C' h '+w i . k , - 3" 4 &ii 8 1'cr°lli
i £ >, �' t ��. � °; .r a,� ; ,� e , a >r � greater, except systems designed and stamped by licensed
s
r ,, 1 e s; a gsw 0 1 , - a engineer.
Baptistry /Font 0 New exterior plumbing site utilities for any complex structure
Bath -Tub/Shower as defined in OAR918 - 780 - 0040.
Iacuzzt[Whirlpool ❑ Medical gas and vacuum systems for health care facilities.
Car Wash - Each Stall
-Drive Thru ❑ Any multipurpose fire sprinkler system,
Cuspidor/VJazGr Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial
- Domestic °` Submit Z sets of plans with any of the above,
Drinkin; Fountain
Eye Wash ,�i :s .77.57; ww �l' �:]a�,� 1 no w --7
Floor Drain /sink -2" r , 4,x.711: to 1 `Y� i a s - r v nr v d t
❑ Isometric or riser diagram is required for new buildings
_a, - . that meet the qualifications above.
Car Wash Drain
, - Garbage - Domestic / /'
Disposal - Commercial
Industrial Comments regarding fix ure work:
Ice MachiRefrig. Drains - rein() V. s Ct1 ti) D (! ,) ,.,J( •
Oil Separator (Gas Station) 7 �' �!
Ace, Vehicle Dump Station -
Shower -Gang 1 ILY - 0 S.. ,/
-Stall '. ... Al . 31.• 'r AglirikW - 1-JP,'
Sink -Bar/Lavatory I ,
- Bradley
- Commercial , _ .. *Note: If the fixture work under this permit results in an
- Service increase of sewer EOUs, a sewer permit will be issued and
Swimming Pool Filter fees assessed for the sewer increase must be aid before the
- Washer - Clothes p
Water Extractor - plumbing permit can be issued.
• Water Closet - Toilet
Urinal _
t
Other Fixtures:
http :/ /www.tigard- or.gov/ city_ hall / departments /cd /docs/PLMF- PermitApadoc
Accumulative Sewer Tally Parcel # 1S 1 35AB03400
Tenant Name: NEW YORK LIFE This SWR1t NONE
Site Address: 10260 SW GREENBURG RD This PLM# PLM2011 -00207
Fixture Value Previous Previous Credits Capped Fixture Fixture New N cw
# value capped off value Ad added total total
count off #s count Tt 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 1 2 0 -1 -2
Drinking Fountain 1 0 0 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 1 2 0 -1 -2
- 3 inch 5 0 0 0 0 0
- 4inch 6 0 0 0 0 0
- Car Wash Dm 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 HP) 16 0 1 16 0 -1 -16
- Commercial (to 5 HP) 32 0 0 0 0 0
- Industrial (over 5 HP) 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 1 2 0 -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 0 0 4 22 0 0 -4 -22
Current Fixture Value -22 divided by 16 = -1,4 Current EDU 1 EDU = $ 4,100
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -22 divided by 16 = -1.4 over (under) $ (5,740.00)
Enter EDU Change Here -1.4
Notes: ** *CREDIT* **
Authorized Name /Signature: BRANDEN TAGGART Date: 6/30/2011
Building Division
r ote: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher which must be
bmitted to the City of Tigard Building Division to redeem credits towards future system development charges.
I: \Building \Sewer Tally \ SewerTallySheet-4100.xls 07/01/10