Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2004 -00319
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/15/2004
SITE ADDRESS: 10260 SW GREENBURG RD�,.38U` 31 5 PARCEL: 1S135AB -03400
SUBDIVISION: LINCOLN TOWER -TOWN OF METZGER ZONING: C -P
BLOCK: LOT: 014 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Remarks: Add 1 dishwasher and relocate 1 sink.
FEES
Owner:
Description Date Amount
EQUITY OFFICE PROPERTIES TRUST
10260 SW GREENBURG RD #100 [PLUMB] Permit Fee 7/8/2004 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcharl 7/8/2004 $5.80
Total $78.30
Phone : 892 - 2500
Contractor:
MCKINSTRY CO
5400 NE COLUMBIA BLVD
PORTLAND, OR 97218 REQUIRED INSPECTIONS
Phone : 331 Rough -in Insp
Top -out Insp
Reg #: LIC 40981 Final Inspection
PLM 37 -22PB
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.
Issued By: frA•�, `.,�. � � ��/ Permittee Signature: X
e_
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
r ` 1s/ 35J�B -hod
PliMnbing Permit Application • - ., FOR OFFI USE O :`LY
City of Tigard
Received =� Permit No.: , / 05 II
13125 SW Hall Blvd., Tigard, OR 97223 Received AV �j� u,�� y -
Plan Revie
Phone: 503.639.4171 Fax: 503.598.1960 i i,, , cj
� " `` D ate /B y: "`iv bo Other Permit N t '� •> ( � 0c)
�!;� oo . 4 ..0020c) DOLJ./�i
24 - Hour Inspection Line: 503.639.4175 1 ' 1 Date Ready/By: lone: 21 See Page 2 for
- Internet: www.ci.tigard.or.us Notified/tvlethod: /6 l Supplemental Information
TYPE OF WORK FEE* -.SCHEDULE
•
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
® Addition /alteration/replacement ❑ Other. New 1- 2 -family dwellings (includes 100 It for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
❑ 1- and 2- family dwelling ® Commercial/industrial SFR (2) bath 350.00
El Accessory building El Multi-family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder El Other:
Fire sprinkler ( sq. ft.) Page 2
JOB .SITE INFORMATION AND (LOCATION - '. Site utilities
Job site address: 10260 SW Greenberg Road Catch basin or area drain 16.60
City/State/ZIP: Portland, OR 97223 Drywell, leach line, or trench drain 16.60
Suite/bldg./apt. no.: Suite 386 I Project name: Master Care Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: Lincoln Tower
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear fl.: _) Page 2
Storm sewer (no. linear ft: _) Page 2
Subdivision: Lincoln Center I Lot no.:
Water service (no. linear R: ) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
Backflow preventer Page 2
Relocate (1) sink Backwater valve 16.60
Add (1) dishwasher Clothes washer 16.60
Dishwasher ' 16.60
;. _ ENANT . r fountain
P II ROPERTY OWNER _',rrx -5:•.', �I- ' ; 4 :, ti:; I T;? , ;.� :i ;,;;__; :,.
Ejectsump 16.60
Name: Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City/State/ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
'•.,-;:.,..'- ;;'' +t r3'.,.,. ,. Hose bib 16.60
',; ' A - PPIICANT'�" r `2` ; T. .IZ 3❑'*CONTACr'PERSON : ii-:
«�;., �'
`�1t s- .. .. , ; „ _ :. :. -xA --.. ,t, a..�„ .. ., -, � _ . . � , Ice maker 16.60
Business name: McKinstry Co Interceptor /grease trap 16.60
Contact name: Clif Hazen Medical gas (value: $ ) Page 2
Address: 5400 NE Columbia Blvd Primer 16.60
City/State/ZIP: Portland, OR 97218 drain (commercial) 16.60
Phone: (503.331.0234) Fax: : (503) 331.6906 S asin/lavatory 16.60
shower /shower pan 16.60
E -mail: Urinal 16.60
•' { ';:.7' � ;- . -t..- _ _ _ �, N+. iF� 4<- ':.,s��r;:'- � °<.i+e•._,_+r�' �te:'rs'�S;�r ..rte: :'� - w'A,�..a `�.:$
." :, ar. <<? ' n .
" si x CONTRACTOR: ? ig' - 1 fi, . is i; Water closet 16.60
Business name: McKinstry Co. Water heater 16.60
Address: 5400 NE Columbia Blvd Other:
City/State/ZIP: Portland, OR 97218 Subtotal
Minimum permit fee: $72.50
Phone: (503) 331.0324 Fax: (503.) 331.0234 Residential backflow minimum permit fee: $36.25 7 57)
CCB Lic.: 40981 Plumbing Lic. no.: 37 - 22PB Plan review (25% of permit fee)
I s-7 -5•') / - o & _ State surcharge (8% of permit fee)
signature: 4 p` TOTAL PERMIT FEE 7 30
Print name: Clifton Hazen Date: 7 -2-04 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.
PMmbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee:
Footing drain - 1 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer - 1st 100' 55.00 7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40
Valuation: .Permit Fee:
Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50
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
Fixture or Item' Qty. Fee (ea) Total : additional $100.00 or fraction thereof, to and
including $10,000.00.
Commercial Back Flow Prevention Device 46 -40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Backflow Prevention Device each additional $100.00 or fraction thereof to
(minimum permit fee $36.25) 27.55 and including $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
each additional $100.00 or fraction thereof to
Inspection of existing plumbing or and including $50,000.00.
specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: each additional $100.00 or fraction thereof.
Fixture Work:
Are you capping, moving or replacing existing fixtures? If
"yes", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees *.
Quan - by (Fixture) Work Performed
.Fixture Type: Replace
New Mooed < c a P � eaN Comments regarding fixture work:
Baptistry/Font MCA; r 1uCl 1Cl 5 t'r N C-, �i �3
Bath - Tub /Shower
- Jacuzzi/Whirlpool NEW bi SI4 M14E- '
Car Wash -Each Stall
-Drive Thru
Cuspidor/Water Aspirator
Dishwasher - Commercial
- Domestic
Drinking Fountain •
Eye Wash
Floor Drain/sink - 2"
-3"
- 4"
Car Wash Drain
Garbage - Domestic
Disposal -Commercial *Note: If the fixture work under this permit results in an
- Industrial
Ice Mach /Refrig Drains increase of sewer EDIIs, a sewer permit will be issued and
Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stall
Sink - Bar /Lavatory l Quantity Total
- Bradley Isometric or riser diagram is required if. fixture quantity
- Commercial
Service total is >9.
Swimming Pool Filter
Washer - Clothes
Water Extractor Plan Review
Water Closet - Toilet Plan review is required if fixture quantity total is >9.
Urinal
Other Fixtures:
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested a -3 AM PM BUP
Location 0 . (Q v : �/l�l�i Suit f75- MEC
Contact Person (Y1, /Ph (t 0'o p 5T — 3Cp 9 3 PLM ° Z � 4 q 6 03/7
Contractor Ph ( ) SWR
BUILDING Tenant/Owner 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
Fi rewal I
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
-
Final
PASS PART FAIL j
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
PART FAIL
CHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Anal
PASS PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect – no access
Fire Supply Line
ADA /
Approach /Sidewalk Date 6 L / I Ext
Other: V
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL