Permit •
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CITY OF TIGARD PLUMBING PERMIT •
C COMMUNITY DEVELOPMENT Permit #: PLM2012 -00340
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/20/2012
Parcel: 1 S 135AB00900
Jurisdiction: Tigard
Site address: 10200 SW GREENBURG RD 110
Project: Fidelity National Title Subdivision: METZGER, TOWN OF Lot: 9
Project Description: Cap (1) sink and relocate 10' to new location, replace with new fixture and add (1) water heater
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Contractor: MCKINSTRY COMPANY LLC Owner: LINCOLN CENTER LLC
16790 NE MASON ST., STE. 100 BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97230 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 - 331 -0234 PHONE:
FAX: 503 - 331 -6907
FEES -
Quantity Description Date Amount
1 ea Fixture /Sewer Cap 11/20/2012 $25.02
Specifics: 1 ea Sink 11/20/2012 $25.02
1 ea Water Heater 11/20/2012 $37.52
Type of Use: COM 1 12% State Surcharge - 11/20/2012 $10.51
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
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Total $98.07
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 Notification 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 direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
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Issued By: ,,,( / Permittee Signature: ,
!ll ��� ���[[[ Call 503.639.4175 by 7:00 a.m. for the next available inspection 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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Plumbing Permit Application 7070
Building Fixtures RECEIVE FOR OFFICE USE ()NIX
City of Tigard NOV 2 012 Received /�
0 13125 SW Hall Blvd., Tigard, OR 97223
2 O Date /By: # o �� ermit NoPL,y„� /a _403 yo
C Plan Review
IN
Phone: 503.639.4171 Fax: 503.598.196Q, OPTIGARD Other Permit No.:
l Date /By:
Inspection Line: 503.639.4175 ISIO Nate Read /B +164 ® See Pa e 2 for
''`' "''D g g BUILDINGDN y y: g
Internet: www.tl and -0r. ov otified/Method: 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 I- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
❑ I- and 2- family dwelling ® Commercial /industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi- family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 10200 SW Greenburg Road Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City/State /ZIP: Tigard, Oregon 97224
Footing drain (no. linear ft.: _ ) Page 2
Suite/bldg. /apt. no.: 110 I Project name: Fidelity Title 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.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Demo and remove (1) existing sink. Alter plumbing lines to the new sink location Dishwasher 25.02
(approx 10 feet from original location) and install new sink. Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ® TENANT Expansion tank 12.51
Name: Fidelity Title Fixture/sewer cap / 25.02
. Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State /ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
® APPLICANT ® CONTACT PERSON Interceptor /grease trap 25.02
Business name: McKinstry Co Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: Janet Lipe
Roof drain (commercial) 12.51
Address: 16790 NE Mason Street Suite 100 Sink/basin/lavatory 1 25.02
City/State /ZIP: Portland, Oregon 97230 Solar units (potable water) 62.54
Phone: (503) 278 -3954 Fax: : (503) 331 -6907 Tub /shower /shower pan 12.51
E -mail: janell @mckinstry.com Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater I 37.52
Business name: Same as above Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal
Phone: ( ) Fax: ( ) .27-g2/1 Minimum permit fee: $72.50
CCB Lic.: 172811 / / /4/g Plumbing Lic. no.: 3 .2PB"" Plan review (25% of permit fee)
State surcharge (12% of permit fee)
Authorized signatur • TOTAL PERMIT FEE Cfi 0 7
Print name: Janel Lipe Date: 11.19.12 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.
1:\ Building \Pcnn its \PLMU -Perm itApp.doc 10/01/09 440.461 6T(I01021COAUWEB)
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 ec
Ins tions or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to
Inspections and including $10,000.00.
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 Plan Review for Plumbing Installations
accurately report fixtures could result in increased sewer fees *. Plan review is required for any of the following.
Quantity by (Fixture) Work Performed Please check all that apply.
Fixture Type: Replace Pp y
Previous Capped Added Existing ❑ Any new commercial building with water service 2" and
Baptistry/Font greater, except systems designed and stamped by licensed
Bath - Tub /Shower engineer.
- Jacuzzi/Whirlpool ❑ New exterior plumbing site utilities for any complex structure
Car Wash - Each Stall as defined in OAR918- 780 -0040.
- Drive Thru ❑ Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator ❑ Any multipurpose fire sprinkler system.
Dishwasher - Commercial ❑ Any complex structure as defined in OAR918 780 - 0040.
- Domestic
Drinking Fountain Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink - 2" - Isometric or Riser Diagram
3 ❑ Isometric or riser buildings
diagram is required for new buildin
- g q g
Car Wash Drain that meet the qualifications above.
Garbage - Domestic
Disposal - Commercial
- Industrial
Ice Mach. /Refrig. Drains Comments regarding fixture work:
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar /Lavatory
- Bradley
- Commercial
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter
Washer - Clothes increase of sewer EDUs, a sewer permit will be issued and
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet - Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
\\ mckinstry\portland \Construction\Projects \705 OR SPG Hard Cards \ - SIT SERVICE -HARD CARD PROJECTS \70969 Fidelity Suite
110\Permit \70969 - PLMB Permit Application.doc