Permit CITY OF TIGARD PLUMBING PERMIT
;. COMMUNITY DEVELOPMENT Permit 4: PLM2012 -00123
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/22/2012
T L G A R. i? 9 Parcel: 1 S 135AB01003
Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD 370
Project: Epic Land Solutions Subdivision: METZGER, TOWN OF Lot: 9
Project Description: Install breakroom sink, emax water heater, hub drain for water heater blow off.
Contractor: RAYBORN'S PLUMBING INC Owner: LINCOLN CENTER LLC
19990 SW CIPOLE RD BY SHORENSTEIN PROPERTIES LLC
TUALATIN, OR 97062 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 - 692 -4139 PHONE:
FAX: 503 - 691 -2328
FEES
Quantity Description Date Amount
1 ea Floor Drain/Floor Sink/Hub 05/16/2012 $25.02
Specifics: 1 ea Sink 05/16/2012 $25.02
1 ea Water Heater 05/16/2012 $37.52
. Type Use: COM 1 12% State Surcharge - 05/16/2012 $10.51
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $98.07
Required Items and Reports (Conditions)
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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, • suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility 'otification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or . • ect questions to OUNC • W •ng 503.232.1987 or 1.800.332.2344.
Issued By: 4 i of / Permittee nature:
Call 503.639.4175 by 7:00 a.m. for the next available ins .ection 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.
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503 691 2328 Rayborns Plumbing 02:00:10 p.m. 05 -15 -2012 1 /2�m
Plumbing Permit Applica ECEI ED .. P, ,1 - tvt
Building Fixtures rolz orrlc.l: rsr (,\I.,
MAY 15 2012 Q�Kl .�[l
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City of Tigard Received
IPII Date/By: 5/ (o! /. sr PermitNo.: atolol -, 0°/a3
13125 SW Hall Blvd., Tigard, OR ?N //�� i� Y �± h Plan Review
Phone: 503.639.4171 Fax: 503.19811160J I Date/By: Other PermitNo.:� g Q�p (a � 0 8►
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r I c : A „ inspection Line: 503.639.4175 BUILDING DIVISION Date Ready /By: rmis: FB See Page 2 for
Internet: www.tigard NotifiedtMethod: 11 Co Supplemental Information
TYPE OF WORK FEE* SCHEDULE • •
❑ New construction ❑ Demolition For special kformadon use checklist.
Description I Qty. I Ea. I Total
ddition/alteration/replacement ❑ Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION • SFR (I) bath 312.70
❑ 1- and 2- family dwelling ommercial /industrial SFR (2) bath 437.78
❑ Accessory building ❑ Multi- family SFR (3) bath 500.32
❑ Master builder Each additional bath/kitchen 25.02
❑ Other: Fire sprinkler( , sq. ft) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 30e) .SG/ G.(e „ t,� 3� -� L) r Catch basin or area drain 18.76
q
City/State /ZIP: a� z),- z),- U a Drywell, leach line, or trench drain 18.76
//' ' L Footing drain (no. linear ft.: _ ) Page 2
Suite/bldg. /apt. no.: 70 Project name:£nf Z4iJD Anti "415
C. 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: I Lot no.: Fleture or item:
Tax map /parcel no.: 45455'116e/403 Backflow preventer 31.27
/ , /, // I DESCRIPTION OF WORK Backwater valve 12.51
(tiS#&(.� K J & IL
Clothes hwaher 25.02
washer 25.02
, y Dishwasher
(.4+14X lAlr m ile - Drinking fountain 25.02
,4 Qra.; cot' leek hiter} &Oh O r / C Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02 •
Address:
Floor drain/floor sink/hub / 25.02 , 0 9'
City/State/ZIP: Garbage disposal 25.02
Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
'
Business name: �l Li' s4. S /tot A y /AC
Medical gas (value: S _) Page t
Primer 12.51
Contact name: 31 t A
Pak1-.9 I' G6 vim.
Roof drain (commercial) 12.51
Address: IT ! 0 _ /, i d Sink/basinAavatory 25.02 9-5s0 >-.
City/State/ZIP: . J ,, ' 0 ( Y041 Solar units (potable water) 62.54
Phone: ((03) (f/,., - w 3r Fax: : (4 3 ) 6 -� 3� • Tub/shower /shower pan J 12.51
E -mail: J ► %.,,,_ n ft ylrost vs. S . (_.0 u•-•--- Water Urinal 25.02
V � r W closet 25.02
Rea CONTRACTOR / , 57.5'7 I Water heater 37.52
Business name: ` VO v K P 1 u IMVs LA4- Water piping/DWV 56.29
Address: " 9' / p/ C' D n Other 25.02
City /State/ZIP:�/Vet. O r 4 Subtotal F
Ph e: ( So ) 0 2 _ y 2 paq, Fax: ,3) 6 co , D 3 .. Er Minimum permit fee: 572.50 g - p-
Plan
Lic.: ?Vs- 1 V Plu .i : Lic. n. review (25 %ofpermit fee)
�ti - c66 P L
State surcharge (12% of permit fee) L .61
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Authorized signature: ��� /i ` _
i� %� TOTAL PERMIT FEE .
Print name: �/a/� J . Date: !� _ A.1. This permit application expires if a permit Is not obtained within SO da 6 7
�4 kid �� l after it has been accepted as complete.
•Fee methodology set by Tri .County Building Industry Service I.
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Plumbing 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' 50.03 0 to 2,000 $121.90
Footing drain - each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 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: Permit Fee:
Storm & Rain Drain - 1st 100' 62.54 $1.00 to $5,000.00 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
Other Inspections or Fees Qty. Fee (ea) Total and including $0 additional r fraction thereof, to
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 $1.45 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:
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 * . Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
- Fixture Type for Replace/ Please check all that apply.
Work Performed:' Capped Added Relocate ❑ Any new commercial building with water service 2" and
Baptistry/Font greater, except systems designed and stamped by licensed
Bath: - Tub /Shower
- Jacuzzi/Whirlpool engineer.
Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive Stall as defined in OAR918- 780 -0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system.
Domestic ❑ Any complex structure as defined in OAR918 -780 -0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: - 2" 1
- 3" Isometric or Riser Diagram
4 " ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage - Domestic non -food that meet the qualifications above.
Disposal: - Domestic food related
- Commercial food related
- Industrial food related
Ice Mach./Refrig. Drains Comments regarding fixture work:
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower: -Gang
-Stall
Sink: - Lay/Bar non -food related 1
- Bradley
- Com/Serv/Util food related •
- Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs, a sewer permit will be issued and
Washer - Clothes fees assessed for the sewer increase must be paid before the
Water Extractor
e plumbing permit can be issued.
Water Closet - Toilet P g P
Urinal
Other Fixtures:
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