Permit n _ CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2006 -00550
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/13/2006
PARCEL: 1S135AB-00900
SITE ADDRESS: 10200 SW GREENBURG RD 200 ZONING: C - P
SUBDIVISION: LINCOLN CENTER /FIVE LINCOLN LOT: JURISDICTION: TIG
Project Description: Demo: 1 sink,1 hub drain, 1 primer, ldishwaser, 1 water heater. Add 1 sink, 1 hub drain, 1
primer, 1 coffee supply(other fix) and 1 water heater.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS; 2 TRAPS:
STORIES: WATER HEATERS: 2 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 2 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 2 WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Owner: FEES
EQUITY OFFICE PROPERTIES TRUST
ONE SW COLUMBIA ST #300 Description Date Amount
PORTLAND, OR 97258 [PLUMB] Permit Fee 11/13/200E $166.00
[TAX] 8% State Surcha 11/13/200E $13.28
Phone : Total $179.28
Contractor:
MP (MILWAUKIE) PLUMBING CO
P.O. BOX 393
CLACKAMAS, OR 97015 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 655 -9161
FAX 503- 650 -7050
Reg #: LIC 5002
PLM 3 -17PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these 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.
From: 11/09/2006 09:15 #116 P.002/003
RECEWED
t5I 3 B - o'
NOV 9 2006 ,is
Plumbing Permit Application FOR (WI ICE USE ONLY' -
'ATV OF'fl
City of Tigard BUILDING .DIV. .ta : Received
13125 SW Hall Blvd., Tigard, OR 97223 Date/By;' 1.3 0&, Permit No }���/ . J�rJO
Plan Review I
Phone: 503.639.4171 Fax: 503.598.1960 i,,,z� it ;I Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 ..„_.._,W. ■ .. J Date Ready/By: tons: El See Page 2 for
Internet: w ww.ci.t'Igard.or.us Notified/Method:: Supplemental Information
t £ �jf{ {;C 't {llg� p l t I g t ( f t i l.. ' i � 971 t tSU ; t } }t "Jt � } ���`t, ty N l �tj{fjy�,�'fI((7 rill i li ' +> k, fi d 3 m n;� R, it ��Y i• �' i'1�7' i .' f r i s t rtj'f
EP JIdttlilF` 1 t IntA ?' 4:r�k'oIllW ➢°UUCfil,I lAU 'J�PlY f4h77}3 ' 1 7i�ttiff7f:5Li tai' 1 1 ' ..:. i � �t . 'C 1 t1 �....,li;i7 L .��1 U ,R a iu7^ 7I tr, "'l�k ,, 11t
❑ New construction ❑ Demol For special information use checklist
Description I Qty. I Ea. I Total
11 Addition/alteration /replacement ❑ Other New 1- 2- family dwellings (includes 100 ft. for each utility connection)
r, 'z ""lI' f R U { bl,��`� 1 # It l lt t�tl 1° ��,� t �T Rp ktl LA { ^ [ R t `� �s 3 �} tl' .
t $ffr ti(' ' 1i uNl ^� ' �{i r °fr!5 t.adnl"ril > l;,. t 6�u .I SfM 11 SFR (1) bath 24920
❑ 1- and 2- family dwelling P/ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other
11 4 rr b t , tc a � a , a a I 1 ,... � ,. Fire sprinkler l _ sq. ft.) Page 2
L Y e ' , ! t a�'1 s ,,adpiiri 1(t t g gfAtb d niK �l ' iJl . . Site utilities
Job site address: e , „ /� /f ., J � , f Catch basin or area drain 16.60
City /State /ZIP: , , , `/ / 7 /7] . Drywell, leach line, or trench drain 16.60
4, Project name: ji^ !� -, Footing drain (no. linear ft,: ) Page 2
Sui '.ldg. /apt. no.:
_.,,:. .vas/ oo
Manufactured home utilities 110.00
Cross street/directions to job site: .e - 4
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
/ arcel no.: Fixture or Item
Tax map/parcel pt�it f r tit t� a i 1 � }' 1 (il l Absorption valve 16.60
-• r H '�, dd,l fi'r1 i � a a . - r#�4 }t f I, i b�
f) a�mr?gi .. 11141 fF�r.> ttgi , if lt' tidal 11 I , l �l Backflow preventer Page 2
,�f Backwater valve 16.60
• Clothes washer 16.60
Dishwasher 16.60
� m � yni I Ir.' `7; l l � t�r 'l ∎} � - . , .11 . 141riga tcn 5 y . i i 1 -. _Drinking fountain 16.60
l?�U 5 4 1 l l t.?�t 1 1 u � kil tt' ::'Idi f11L !i Au,s , . Q ui a � .. :1t li = Ejectors /sump 16.60
Expansion tank e 16.60 r' -
Address: Fixture /sewer cap 16,60 0:1' ,
City /State/ZIP: Floor drain/floorsink/hub I6.60 //
Phone: ( ) Fax: ( ) Garbage disposal 16.60
r i' ¢ P 1 �' ! ,; a a 1 , Hose bib 16.60
t ll i m f .es. t ; pt i Cii.:AA,1 zr u .t ? �Y v SA I maker 16.60
Business name: NIP PLUMBING CO. Interceptor /grease trap 16.60
Contact name: TAMI Medical gas (value: $ ) Page 2
Address: PO BOX 393 Primer / 16.60 )04--
City/State /ZIP: CLACKAMAS OR 97015 drain (commercial) 16.60 ' /�
Phone: (503) 655 -9161 Fax: : (503) 650 -7050 Si asin / lavatory 16.60 , b f tW/
u /shower /shower pan 16.60
E-mail: Urinal 16.60
l l { l l , ( � t i It i i I I Ck 4 i $ac 'n i t i . ti ' h xf ` f t f � 1, , i l r f Wa ter closet 16.60 IM 4 Business name: NH' PLUMBING CO. Water heater ' 16.60 i
Other: J,,
Address: PO BOX 393 b� 11 ,/�rr'� 1 /1. 7 , /
�y {{ Subtotal
City/State /ZIP: CLACKANIAS OR 97015 Minimum permit fee: $72.50
Phone: (503) 655 -9161 Fax: (503) 650 -7050 Residential backflow minimum permit fee: $36.25
CCB Lic.: 5002 Plumbing Lic. no.: 3 -17PB Plan review (25% of permit fee)
Authorized signature: /
State surcharge (8% of permit fee) /), 2
/�%�f' /� TOTAL PERMIT FEE
Print name: TAMI GEORGE ��°° !` Date: // 9 -a 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.
it Building \PermitsN.PLM- PermitApp.doc 06!05 4404616T(10/027COM/WEB)
Accumulative Sewer Tally Parcel # 1S135AB -00900
Tenant Name: Farrrs Insurance This SWR# NA CREDITS DUE
Site Address: 10200 SW Greenburg Rd. #200 This PLM# PLM2006 -00550
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 2 4 0 -2 -4
Drinking Fountain 1 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 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash Dr 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 HP) 16 0 0 0 0 0
- 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 0 0 0 0
- 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 2 4 0 0 -2 -4
Current Fixture Value -4 divided by 16 = -0.3 Current EDU 1 EDU = $ 2.700
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -4 divided by 16 = -0.3 over (under) $ (810.00)
Enter EDU Change Here -0.3
Notes: CREDITS
Authorized Name /Signature: Barbara Butler Date: 11/13/2006
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 \SewerTallySheet.xls 7/1/06
CITY OF �°mu m n=�o TIGARD
BUILDING DIVISION PERMIT #: PUN200&OO660
13125SVVHQBlvd.. Tigard, OR07223 DATE ISSUED: 11113y3008
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 6394175
INSPECTION WORKSHEET FOR DATE: 12/26/2006 TIME: 7 PAGE: 19
SITE ADDRESS: 10200 EWGREENBUR{) 201 CLASS OF WORK:
SUBDIVISION: LINCOLN CENTER/FIVE LI .()LN LOT #: TYPE OF USE:
PROJECT NAME: FARMERS INSURANCE
DESCRIPTION: Demo: 1 oink,1 hub drain, 1 primer, 'idiehvvaumr, 1 water heater. Add 1 sink, 1 hub drain, 1 primer, 1
coffee supply(other fix) and 1 water heater.
OWNER: EQUITY OFFICE PROPERTIES TRUST, PHONE #:
CONTRACTOR: MP (MILWAUKIE) PLUMBING CO PHONE #: 509.656'3151
Inspection Request Scheduled For: Date: 12/26/2008 Pour Time:
Code # Inspection Description Confirm # Contact # M -•
399 Plumbing final 041498-01 503-655^9101
Corrections/Comments/Instructions:
c\
}
J
PASS El PARTIAL APPROVAL n CANCEL I NO ACCESS
17 FAIL I I CALL FOR INSPECTION Li ADDITIONAL FEES ASSESSED
\ �� �i
Inspector: / �~ ~^ ~~ ���^ Date: �' ~~~ U^0 Phone #: (503) 718-
.
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM200&- 00650
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/13/2006
Phone: (503) 639 -4171
At
Inspection Requests (24 Hrs.): (503) 639 -4175 ` ..
INSPECTION WORKSHEET FOR DATE: 11/21/2006 TIME: 7 :00AM PAGE: 27
SITE ADDRESS: 10200 SW GREENBURO RD 200 CLASS OF WORK:
SUBDIVISION: LINCOLN CENTER /FIVE LINCOLN LOT #: TYPE OF USE:
PROJECT NAME: FARMERS INSURANCE
DESCRIPTION: Demo: 1 sink,1 hub drain, 1 primer, ldishwaser, 1 water heater. Add 1 sink, 1 hub drain, 1 primer, 1
coffee supply(other fix) and 1 water heater.
OWNER: EQUITY OFFICE PROPERTIES TRUST, PHONE #:
CONTRACTOR: MP (MILWAUKIE) PLUMBING CO PHONE #: 503-655-9161
Inspection Request Scheduled For: Date: 11/21/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 0400913-01 503. 6559161 Y
Corrections /Comments /Instructions:
•
!,
14 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION f] ADDITIONAL FEES ASSESSED
��
Inspector: Date: /I � Phone #: (503) 718-