Permit CITYOF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2003 -00217
t 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/18/03
SITE ADDRESS: 10260 SW GREENBURG RD ' PARCEL: 1S135AB-03400
SUBDIVISION: LINCOLN TOWER -TOWN OF METZGER ZONING: C -P
BLOCK: LOT: 014 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS: 4
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: 200 ft
Remarks: Site utility work (sanitary, storm & catch basin) for construction of on -grade pedestrian link.
FEES
Owner:
Description Date Amount
EOP LINCOLN, LLC
10260 SW GREENBURG RD [PLUMB] Permit Fee 7/18/03 $167.80
SUITE # 100 [PLMPLN] Plan Review 7/18/03 $41.95
PORTLAND, OR 97223 [TAX] 8% State Tax 7/18/03 $13.42
Phone : 892 - 2500 Total $223.17
Contractor:
C SCHIEWE & ASSOCIATES
1024 NE DAVIS STREET
PORTLAND, 0 97232 REQUIRED INSPECTIONS
Phone : 503 Storm Drain Insp
Storm Drain Insp
Reg #: LIC 54105 Final Inspection
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
Issued By: j9i 0)7G'l LA) Permittee Signature/
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the nex • usiness day
ran, . - Rovet) 7- -03.
Plumbing Permit Application , 'OFFICE USE ONLY
Date received:. /2 -Vag' Permit no,�L /X.0o3 do,, 1
A City of Tigard
Address: 13125 SW Hall Blvd, Tigard, OR
��� '�97223 � /
Sewer permit no.: Building permit no.:
City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 MAY 2 3 2003 Date issued: By Byx00 Receipt no.:
Land use approval: CITY OF TIGARD 1 - Case file no.: Payment type:
A DING DIVISOR
. • TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory 0 Commercial /industrial ❑ Multi- family 0 Tenant improvement
0 New construction 0 Addition /alteration/replacement 0 Food service Xl Other: *ii ' imrseowAtchir
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: 10 3 (oo S(,j ivice' feopkp i Po Description Qty. Fee(ea.) Total
New 1- and 2- family dwellings only:
Bldg. no.: I Suite no.: (includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot: (Block: I Subdivision: SFR (2) bath
Project name: (,(N 691.4) CEWDee SFR (3) bath
City/county: re ItTucrND ZIP: 41 3 Each additional bath /kitchen
Description and location of work on premises: MODinar ILpAb Site utilities: .
WO it. Ic AM> LoeNp SLA 1,1a(9 Catch basin/area drain
Est. date of completion /inspection: Drywells /leach line /trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft.)
Manufactured home utilities
Business name:
GM 1 N. A - ,. Manholes
Address: O jJt, so. (,D Rain drain connector
City: .s_ State: ore_ ZIP: 1 7.23 2- Sanitary sewer (no. lin. ft.)
Phone: 3 -4,6 Fax: E -mail: Storm sewer (no. lin. ft.) App/ ./
CCB no.: `�y /ej j Plumb. bus. reg. no: Water service (no. lin. ft.)
City /metro lie. no.: Fixtur or item
Contractor's representative signature: Absorption valve IJ�
Back flow preventer
Print name: Date: Backwater valve
C ONTACT PERSON Ba sins /lavatory
Name: P: 1SA P✓26o L, l NS W v G1C > Clothes washer
Address: 'Pi/ (o8' ,Alv6r N Sv(T 4 0o Dishwashe
I Drinking fountain(s)
City: $z(A,cs I State: vtA I ZIP: q8.004 Ejectors /sump
Phone' 88 3332. Fax: b 7$. °Il I b E -mail: Expansion tank
OWNER Fixture /sewer cap
Name (print): re &V I Tli O rr F (co 4 lep;Pb'IGTI e5 Floor drains /floor sinks /hu
Mailing address: I o >(.o S' GIa 6i 130 beD Gar
disposal
Hose e bi bb
City: 'o 124 I State: OiCI ZIP: ")1 7 3 Ice maker
Phone
4,'l5 . g'f Ov I Fax: (075 • S si I E -mail: Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain (commercial)
employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s)
Owner's signature: Date: Sump
ENGINEER i Tubs /shower /shower pan
Name: Urinal
Address: Water closet
Water heater
City: State: ZIP: Other:
Phone: I Fax: E -mail: Total
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $
Notice: This permit application
1:1 Visa review (at Visa ❑MasterCard expires if a permit is not obtained ( %) $
Credit card number: / / State surcharge (8 %) .... $
Expires within 180 days after it has been TOTAL $
Name of cardholder as shown on credit card accepted as complete.
Cardholder signature Amount 440 -4616 (6 /00 /COM)
■
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PLUMBING PERMIT FEES:
;: ,, ' r.,;, - :, „: ", •:,,,:,, 4 , ':, I PRICE TOTAL: , ,ls,Iew 1 ;and,2-family dwellingszonIV,:=
;-FIXTURES (individual) , ; , , ''' .: -., :: ',' QTY - ',; , :AMOUNT r (iOCIOdei all iplumbing fixtures in' ',. .PRICE; -,.:, ATOTAL, ,-
Sink 16.60 0, 6.6 ft ' ' - ' - 9TY .:(00) :' ' 'AMOU
Lavato 16.60 for ea6fi'UtilifY6Oniiection)
ry
One (1) bath $249.20
Tub or Tub/Shower Comb. 16.60 Two (2) bath $350.00
Shower Only 16.60 Three (3) bath $399.00
Water Closet 16.60
SUBTOTAL :'‘ ' i' - ",„°• , ::- , ' - r' , ”;,.
Urinal 16.60 8% STATE SURCHARGE
Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL ,','
Garbage Disposal 16.60 TOTAL
Laundry Tray 16.60
Washing Machine 16.60
Floor Drain/Floor Sink 2" 16.60
3" 16.60 PLEASE COMPLETE:
4" 16.60
Water Heater 0 conversion 0 like kind 16.60 i ++ ' ',: '+:.., , ;f+e +++ 1:+t; - lQuantity by.W,ork1Peifeified'4
Gas piping requires a separate mechanical =, Type:N . - ,Neer , ,, Moved - _Replaced,, RemOvedi,
p ermit. ' ' '` 1) , ° -..ii ' ,J .. L+ ' - „ - „r ++.+i +++++ - :, ,CaPPe ,
MFG Home New Water Service 46.40 4" ,'i," .-- .,..--i0 a,:
Sink
.
MFG Home New San/Storm Sewer 46.40 Lavatory kVA
Tub or Tub/Shower
Hose Bibs 16.60 Combination
Roof Drains 16.60 Shower Only
Drinking Fountain 16.60 Water Closet
Urinal
Other Fixtures (Specify) . 16.60
Dishwasher
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain/Sink: 2"
Sewer - 1st 100' 55.00
3•
Sewer - each additional 100 46.40 4"
Water Service - 1st 100' 55.00 Water Heater
Other Fixtures
Water Service - each additional 200' ...tai 46.40
Storm & Rain Drain - 1st 100' 010. / 55.00 (Specify)
Storm & Rain Drain - each additional 100' 46.40
Commercial Back Flow Prevention Device 46.40
Residential Backflow Prevention Device* 27.55
Catch Basin ik 16.60
Inspection of Existing Plumbing or Specially 62.50
Requested Inspections per/hr COMMENTS REGARDING ABOVE:
Rain Drain, single family dwelling 65.25
Grease Traps 16.60
QUANTITY TOTAL: % :.,,: ,.:',,= ,,
Isometric or riser diagram is required if
Quantity Total is > 9 1. l i ' '41" 4 ,. ^.
*SUBTOTAL: *rtl,,pt , i4, 4,!; A l J:
EfiA
8% STATE SURCHARGE: ,'.':" 7:
:' i
**PLAN REVIEW 25% OF r,14
SUBTOTAL:
Required only if fixture qty. total is > 9 ,: i t,i :++
TOTAL PERMIT FEE: F"`C`:,°,-!:" ' "A $
','
* Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow
Prevention Device, which is $36.25 + 8% state surcharge.
** All New Commercial Buildings require 2 sets of plans with isometric or riser
diagram for plan review.
i:\dsts\forms\plm-fees.doc 02/05/02
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CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST ( I
BUP
Received Date Requested �%Z — � AM PM BUP
Location /d 2.c Suite MEC -
Contact Person °�� Ph ( ) 30 — 3a - 4.10 3 — OOP
Contractor Ph ( ) SWR
BUILDING Tenant/Owner £ 7P L,rvt co %1 Ce 1 - ' ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm /./
Susp'd Ceiling
Roof
Other:
Final
T FAIL
PLUMBING
am
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
C- • = - 'n / Manhole
torm Dr.'s
ower Pan
Other:
F
PART FAIL
CHANICA L
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: Ei Unable to inspect — no access
Fire Supply Line
ADA (c- d
Approach /Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection cord from the Job site.
PASS PART FAIL