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Permit CITY OF TIGARD PLUMBING PERMIT �. COMMUNITY DEVELOPMENT Permit #: PLM2009 -00068 Date Issued: 03/30/2009 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S135AB01002 Jurisdiction: Tigard Site address: 10220 SW GREENBURG RD 415 Subdivision: Lot: 0 Project: Spec Space Project Description: Cap (1) sink and (1) water heater. Owner: FEES LINCOLN CENTER LLC Quantity Description Date Amount BY SHORENSTEIN PROPERTIES LLC, 555 CALIFORNIA ST 49TH FL 2 ea Fixture /Sewer Cap 03/30/2009 $33.20 CALIF CALIF: 1 12% State Surcharge - 03/30/2009 $8.70 Plumbing 39 ea Minimum Fee Adjustment 03/30/2009 $39.30 Contractor: - Plumbing MP PLUMBING CO PO BOX 393 CLACKAMAS, OR 97015 PHONE: 503 - 655 -9161 FAX: (503)655 -1726 Type of Use: COM Class of Work: ALT Type of Const: 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 rules adopted by the Oregon Utility ca io nter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules Issu \y: Permittee Signal e: 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. f . ?.,;?/ c Plumbine Permit Applicati ` � E ,, ' , / ,; Site Utilities a ,_ I () I2 milk I t ti l (,\I, City of Tigard MAR 2 7 Z009 , wr�/1 IN ,____ R ei,: sey-. 3 /► i o MI P N o.: ti-/j407- G�� 13125 sw Hall Blvd., 'fie,anl, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.59 - OF TIGARD Date/By: (hhcr Permit No.. l l ( i Inspection Line: 503.639.4175 r" tJ I I DING DIVISIO Date Ready /By: is See P,.ge 2 Co.' r.gov U l t_ Notificd/Method: W f ' Sappiementat Information rp(, pM1�p;11p7� f ) , 1) Internet: www.tiRard o r , :: , ;,,',.; , ,ii . ,,„:',' , ., , ,' i . u� 1 r n r 4 1� }F JI ,{ , 1 r it 11 °EEilP11iS',, ,'r.' ;."...,..' (c ..x ,P.V.axVSr.rf4,iE:', I: . ,t.t.,4., U .Mr r' 4.:' ^ � i . ,l. New construction For special i " rnsatian nse chealist. [] ❑ Demolition Description I city. I En. I Total El Addition /alteration/replacemettl ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) i f I 1 r ~ sell r l l I I V h ,{, 1 r y, x 1 r r ' y 'l td ,, +X a.n.} :L;■,i ., ,.. v 0 , :n, „! „,.A,. ..... .,..b', ° ',n t.0 SFR (I) bath 249.20 ❑ 1 - and 2 - family dwelling El Commercial /industrial SFR (2) bath 350.00 building SFR (3) bath 399,00 El Accessory g ❑ Multi - family ❑ Master builder Each additional bath/kitehcn 45.00 ❑ Other Fire sprinkler ( sq. ft.) Page 2 1 2 05 , , ;' : ' 111 n " v l % '' he n ,t n Jv M E M1 h tai P , 1 1' ) n+ ; ;: ) �Ll f �l -1 { •.. r - : r � '"4 r ., p i n ' M ) Site utilities :m,(+6ri�J,�huu M,,.aL �i .r<,. . ,..„, ':,r dd;(nf a I, r S14a ,, v:) p r . .��'�r el (� , ,,,,.4,,k:'2.,,`,,' , :','/.5: Job site address: 492.2(3W GREENBUIRG, SUITE • i-t J 5 Catch basin or area drain 16.60 City /State./ZIP: TIGARD, OR 97223 Drywell, leach line, or trench drain 16.60 Suitelbidg. /apt. no.: . /{'_� Footing drain pia linear ft., _ ) Page 2 t i i5 I Project name:f manufactured home utilities 110.00 Cross street/directions to job site: Manholes 16,60 1111 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 Tax map /parcel no ( 5 j 1 5 5-it 4 (00-.., / Fixture or item ) N + �(i +ii t ) " r ti r , , k ' ''''' o +u s ta'v ) 1 '''''" : t , 1 r Absorption valve 16.60 u "iar' Uri /)I �� a Page 2 CUT AND CAP I SINK AND WH Backwater valve 16.60 Clothes washer 16.60 • Dishwasher 16.60 l / p ar1N� ➢I =" r r . 'a ,. r r r l A , r , ,,. Drinijng fountain 16.60 rr h v ,.. d e, rl.}.r . '.;r, 1 fun :Wn >r:m ) ,, - ,e, e: Mm' t �x' aYbTlr :,':41.74,2tsw, „,S ,v.rur'!.r..,uuu� Ejexanndsump 16.60 Name: RUSSELL CONSTRUCTION Expansion tank 1 6.60 Address: Fixtureiscwcr cap 2 16.60 33.20 City /State/ZIP: Floor drain/floor sink/hub 16,60 Phone: ( ) Fax; ( ) Garbage disposal 16.60 i'Ir � 1L•u�Ay+�,M4 ,y� � V SJNnu Ar`I" , r'+ r , 7 r7 1 rc'fi ' a Hose bib 16.60 III e. r r! I T� ) ;,; 1") n h ,i IUh r f .. 4, 1 r b 1 1 rVi, 1 6�e a„Pa � ^ r Tr„ v , (..h Ice make 16.60 Business name: MP PLUMBING COMPANY Intereeplur /grease: trap 16.60 Contact name: DONNA TUNING Medical gas (value: $ _ ) Page 2 Address: PO BOX 393 Primer 16,60 City/State/ZIP: CLACKAMAS, OR 97015 Roof drain (commercial) 16,60 Sink/hasin/lavatory 16.60 Phone: (503) 655 I Fax: : (503) 655 -1726 Tub/shower /shower pan 16.60 E-mail; DONNAT @MPPI UMBINC COM �n Urinal 16,60 1G lf S l�rr , r g , '' , WI h, { IN , sn ti10 , A','% , 4ti ,',7,1,1 ' � h,!b.;+`v, l .lw..bn.Y . ., M.., , .. ,... i.. a ^,,.r,rr,r rc„ ,n}. -nr l� ..I.A.{ w�e'kn W3Ier Closet 16.60 Business name: SAME Water heater 16.60 Address :er City/State/Z1P: Subtotal 33.20 Minimum permit fee: 572.50 72,50 Phone: ( ) Fax: ( ) Residential hackflow minimum permit fee: 536.25 CCB Lie.: 5002 Plumbing Lic. no.: 3 - 17PB Plan review (25 %ofpermit fee) Authorized signature: State surcharge (12% of pennit fee) 1.70 TOTAI PERMIT FEE 81.20 Print name: DONNA TUNING ate 3/27/09 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 Sclvice Board. I k Holdall!' Poll., k11 MI 1- Pel IIIIIA rip . ,,W I2 /27,(16 4441-461(1f( III 11' /W f.H) 1 L d Z1,800000SL'oN /SL:OL'lS /OZ :OL 800Z OE )1VW(NOW) NONA I. Plumbing Permit Application - City of Tigard IN G / Page 2 - Supplemental Information ) 0 0 S Gift t ' ' .6W' 1 I Fee Schedule: Residential Fire Su 1 1 ressios S stems: , A t ;;y � t ,.l , s'" ` "; 7 a!„,,,,,'';„'.,L t y m A y �1� ���� liii' 1y, ,. ' D k '' ' � n,' M, ... ..,.e1.12,11 i>n`'l n M P.. v ..... r . r.. .`... .....' . ,;1. µ'' ., ,l 1 . �. ::',., ... .... . ..Lt...n H{ ..,,... .L.i.`1;:a �A.�.E;Y t Footing drain - 1' 100' 55.00 0 to 2 000 $115.00 Footing drain - each additional 100' 46.40 2 001 o3 600 $160.00 ':ewer - 1 e 3 601 to 7 200 $220.00 • t 100' -- --/ 55.00 7,201 and -mater $309.00 Sewer - each additional 100' 46.40 — Water Service - 1st 100' 55,00 _ Medical Gas S stems: Water Service - each additional 100' 46.40 Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5 000,00 Mi fee $ 7 2 .50 Storm & Rain Drain • each additional 100' 46,40 $5.001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each additional $100.00 or fraction thereof, to and includin: $10 000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 5 148.50 for the first $10,000.00 and 51.54 for Residential Hackflow Prevention Device each additional $100.00 or fraction thereof, to (minimum permit fee $36.25) 27.55 and includin: $25 000.00. Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for Inspection of existing plumbing each additional $100.00 or fraction (hereof, In g P g or and includin: 550 000.00. s.ccially requested inspections -per hour _ 72.50 Subtotal 550,001.00 and up $742.00 for the first $50,000.00 and $ 1,20 for each additional $100.00 or fraction thereof. Fixture Work: " Are you capping, adding or replacing fixtures? If "yes ", A "complex structure" is defined as an installation of a plumbing please indicate work performed by fixture. Failure to system that meets any of the following criteria c fees*. Please check all that apply. accurate re .ort fixtures could result i n increased sewer fe ❑ My new commercial building. ❑ Any new exterior plumbing site utilities. .. ..;., _ © A commercial building with installation, alteration or addition 9saptist y Iron[ . of nine (9) or more new or relocated plumbing fixtures. .lath - Tub/Shower ❑ Medical gas and vacuum systems for health care facilities - Jacuzzi/Whirlpool providing services to human beings. Cal Wash -Each Stall ❑ Plumbing installations, alterations or additions to food service _ -Drive Thnr -. facilities where new plumbing fixtures, including interceptors, - Cuspitlor/Water Aspirator _.. - arc being installed for the food service area_ Dishwasher -Conunercial - Domestic — ❑ Any new residential building containing three (3) or more Drinking Fountain dwelling units. Eye Wash - ❑ Any NFPA 13 -D multipurpose fire sprinkler system. Floor Drain/sink - 2" 3 •• Submit j sets of plans with any of the above. Car Wash Drain , ' ' garbage - Domestic ❑ Isometric or riser diagram is required for new b uildings Disposal - Commercial Industrial three 3 or more stories in hei :ht. Ice MachiR.efri:. Drains . . . Oil separator (Gas Station)' ' '.. Comments regard fixture work: Rec. Vehicle Dump Station . ''. `' Shower -Gang -Stall Sink - Bar/Lavatory i -Bradley - - Commercial — _- 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 acr Urinal fees assessed for the sewer increase must be paid before the )thcr Fixtures" i., . ria plumbing permit can be issued. \HaildinsTermit,\PLM- Pcm..1 npp.dac 07/06105 l d L0$00000SL 'oN /OZ : tr l ' 1S /OZ : p l 6003 L3 diW (( lid) HOd. ■ Accumulative Sewer Tally Parcel # 1S135AB01002 Tenant Name: Spec Space This SWR# N/A Site Address: 10220 SW Greenburg Rd Suite 415 This PLM# 2009 - 00068 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 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 Drn 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 1 3 0 -1 -3 - 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 1 3 0 0 -1 -3 Current Fixture Value -3 divided by 16 = -0.2 Current EDU 1 EDU = $ 3,100 Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU Change -3 divided by 16 = -0.2 over (under) $ (620.00) Enter EDU Change Here -0.2 Notes: ** *CREDITS * ** S i eZ Authorized Name /Signature: Debbie Adams � Date: 3/30/2009 ..ri g 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: A Building \Sewer Tally \SewerPallySheet- 3100.xls 06/19/08