Permit CITY OF TIGARD PLUMBING PERMIT
{ ,:" 7 COMMUNITY DEVELOPMENT Permit #: PLM2011 -00300
Date Issued: 10/04/2011
TIGAR.D 13125 SW Hall Blvd , Tigard OR 97223 503.718 2439 Parcel: 1S135AB01003
Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD 440
Project: Tnstar Subdivision: METZGER, TOWN OF Lot: 9
Project Description: Replace breakroom sink and install new under counter water heater
Contractor: MCKINSTRY COMPANY LLC Owner: LINCOLN CENTER LLC
16790 NE MASON ST., STE. 100 BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97230 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE 503 - 331 -0234 PHONE
FAX' 503 - 331 -6907
FEES
Quantity Description Date Amount
1 ea Sink 10/04/2011 $25 02
Specifics: 1 ea Water Heater 10/04/2011 $37 52
1 12% State Surcharge - 10/04/2011 $8.70
Type of Use: COM Plumbing
Class of Work: ALT 10 ea Minimum Fee Adjustment - 10/04/2011 $9.96
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $81 20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days ATTENTION: Oregon law requires you to follow the rul- . adopted by the Oregon
Utility tification Ce -r Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -s t.• • You may • • ain a copy of the rules
or di ct questions to OU • • Ca ing 13.232.1987 or 1.800.332 2344
Issu d By: \ / , Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application y
RECEIVED F °H" fY 14 -,. .; Y4 y a s i,,,4,, 'r r ` ti k 44.. t , •ft",,
Building Fixtures RECEIVED , '' k 'OR'`tORFICE °USEI nv 3 - <t" � ( ,
ros �$<1 +ax •�;. ..,, -'�c x= '..r3,. s'u: �+y`.a- � :L �;rq i "ue -^7 �.� IJ -,� /� .r. �`- -• ..
'-ti �, l fA y // P /( ��� " l/CJ
City of Tigard n 7 Received . i Permit No
111 ` ■ i 13125 SW Hall Blvd , Tt_aard�tf0 972 al I I Plan Date/By
Review
Review
f, Phone 503 718 2439 Fax 503 598 1960 Date /Bv Other Permit No
' " * = Inspection Ltne 503 63 41P OF TIGARD Date Ready /By tuns El See Page 2 for
3 7IG A 'RD ^
.. Internet, www. noard- 4{g4y- I}ER NG DIVISION
D I *i Notified /Method ' Supplemental Information
rs _ ., , ,_ _, - -• _ ;gym. �. . �_ vi qs - , .. :'kx _a�mi +`3a� ;x�:,Y °:
" ,._ - A
'r�i' -- , . - ,. _ - ..< _ - .,. - _.:. - .- ,. . ..---- 4:
❑ New construction ❑ Demolition - For special information use checklist.
Description Qty I Ea I Total
® Addition/alteration /replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft for each utility connection)
'-= ` ,CliiIEGORT'OF' "CONSTRUCTION£i. SFR (I) bath 312.70
❑ 1 - - and 2- family dwelling ® Commercial /industrial SFR (2) bath 437 78
A ccessory building SFR (3) bath 500.32
❑ ❑M ulti - family
Each additional bath/kitchen 5.02 .
❑ Master builder ❑ Other Fire sprinkler ( sq ft) Page 2
, : : ,,,,JOB - AN D- ;LOCATION x ": , , - r.s Site utilities: -
Job site address 10300 SW Greenburg Road Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18 76
City/State /ZIP: Tigard, Or
Footing drain (no linear ft. ) Page 2
Suite/bldg/apt no. - 430 Project name TRISTAR - Suites 430/440 Manufactured home utilities 50 03
Cross street/directions to job site: 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 ft. ) Page 2
Subdivision: Lot no.: 01003 Fixture or item:
Tax map /parcel no.: 1S135AB Backflow preventer 31.27
T.�,,.,,,,, _ - _> , -::- � TI®N F' *ti'VQRI C r , ; ,.,?: .. %- ``_ - . �;...-- -�. ' Backwater valve 12.51
„�:
�,,.
- _ ,k . .. ... .. . . Clothes washer 25.02
Install break room sink and under counter hot water heater.
Dishwasher 25.02
Drinking fountain 25.02
McKinstry Job #70669 BUILDING PERMIT #BUP2011 -00212 Ejectors /sump 25 02
.. - iz=:�.. ; c <_,r; ._ �,. .. :1 Expansion : ,..42* " „ EROEE . . _' OW1VER F r', -- ' :, T ` = " � 'TE1�AN' ,, ' - ansion tank 12.51
p
Name: TRISTAR Fixture /sewer cap 25.02 - - '
Floor drain/floor sink/hub 25 02
Address.
Garbage disposal 25.02
City /State /ZIP: Hose bib 25 02
Phone: ( ) Fax: ( ) Ice maker 12.51
Al �..APPL1CANVT'` 4,*a ik5 ` ►1 -- CONTACTI PERSON = interceptor /grease trap 25.02
Business name. McKinstry Company, LLC Medical as (value ) Page 2
Primer - 12 51
Contact name: Diane Parke, Project Coordinator
Roof drain (commercial) - 1251
Address: 16790 N.E. Mason Street, Suite 100 Sink/basin/lavatory 1 25.02 25.02
City /State /ZIP. Portland, OR 97230 Solar units (potable water) 62 54
pan 12.51
Phone. (503) 331.2465 Fax. : (503) 331.6907 Tub /shower /shower p '
E - mail: dianep@&mcicinstry.com Urinal 25.02
Water closet 25.02
',`u .CONTRACTOR - " .''"7" F - ' ' '? .
,� �9n ,:' .z'!� L33Y.'.a.k'. , -
y� <..,. - � -- `,.,�a.:';`� > � .. _ _� . F , ., ,,. _- _ � _��`�;�� < '��� Water heater 1 37.52 37 52
Business name: McKinstry Company Water piping/DWV 56 29
Address: Other 25 02
City /State /ZIP Subtotal �f
Phone: ( ) ax ( ) Minimum permit fee $72.50 (� •�
CCB Lie.. 172811 w .lu .ing Lic. no.: 37 - 22PB
J Plan review (25% of permit fee)
-/ ' ` State surcharge (12% of permit fee)
Authorized signat I, L �1i �/, • TOTAL PERMIT FEE g I •
Print name' DianeeEr Date. it 4 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tn- County Building industry Service Board
I \Budd,eg\Permns\PLMU- PermitApp doc 10/01/09 440- 4616T(t0/02 /COM/WEB)
Plurnbin2 Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
• :. t
".Total "- >
�m S .uar.:e =Fo ®ta e:.;= ' -�; - °_
Footing drain - ls' 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'th 7.200 . . $233.20 •
Sewer - 1st 100' 62.54 '.7.201 and greater • $327.54
Sewer - each additional 100 37.52 •
Water Service - 1st 100' 62.54 - Medical Gas SystemS:
• Water Service - each additional 100' 37.52' .;,
;Valuation.£ _,° . ,,.Pernt,ee:
Storm & Rain Drain - 1st 100' 62.54
- $1.00 to $5,000 0,0 - 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
Cjil1el`1r15eC iA1 Oi' FeeS Qta + ` ` `Beem(ea} = aToEal each additional $100.00 or fraction thereof, to
_ and includma $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 $145 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:
{ Other Fixtures I 1
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? if "yes ",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees
.; =x; "` '; - 'Quantity tiv Ttixture Type' .
°Fixt TYPefor` t r . ,h -„ Re l oca t e R 1t� 1 . -.
F= ' ° #- ���`�P]an;Re�iewfor��'lnbrn �I�nstalla� ons ,_ : #
Work:Perfor'med x _ , &"` ' '_` m _- „4Capped5/ - z .'_A'dded :Relocate -r- ` "`" �'
Baptistry /Font Plan review is required for any of the following.
Bath Tub /Shower • Please check aII-that apply.
Jacuzzi /Whul000l' ❑ Any new commercial building with water service 2” and
Car Wash -Each Stall greater, except systems designed and stamped by licensed
-Drive Thru engineer.
Cuspidor/Water Aspirator ❑ New exterior plumbing site utilities for any complex structure
Dishwasher - Commercial as defined in OAR918- 780 -0040. -
- Domestic ❑ Medical gas and vacuum systems for health care facihties.
Drinking Fountain ❑ Any multipurpose fire sprinkler system.
Eye Wash ❑ Any complex structure as defined in OAR918- 780 -0040.
Floor Drain /sink - 2"
3" Submit 2 sets of plans with any of the above.
Car Wash Drain tir
' . 4 som or Ris er =Diag;ra> 11-1,- 44,e e
Garbage - Domestic —non -food
Disposal Domestic - food related ❑ Isometric or riser diagram is required for new buildings
- Commercial - food related - that meet the qualifications- above.
- Industrial -food related
Ice Mach. /Refng Drains
Oil Separator (Gas Station)
Rec Vehicle Dump Station Comments regarding fixture work:
Shower - Gang Sink with under counter water heater.
-Stall
Sink/Lay - Non -food related
- Bradley
- Commercial -food related 1
- Service
Swimming Pool Filter
Washer - Clothes
Water Extractor *Note: If the fixture work under this permit results in an
Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and
Urinal fees assessed for the sewer increase must be paid before the
\ \pofp02 \Data\PDX - Mechanical Construction \SPG -Dept 705\Projects \— $PG SERVICE -HARD CARD PROJECTS \70669 TRISTAR Suites 430
440 \Permits \PLMF- PermitApp- TRISTAR 70669.doc