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Permit CITY OF TIGARD PLUMBING PERMIT s COMMUNITY DEVELOPMENT Permit #: PLM2012 -00367 Date Issued: 12/19/2012 T E G AR D 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel: 1 S135AB01002 Jurisdiction: Tigard Site address: 10220 SW GREENBURG RD 417 Project: Cypress Subdivision: METZGER, TOWN OF Lot: 9 Project Description: Cap (2) sinks, (2) hub drains, (2) water heaters and (1) disposal and add (1) sink, (1) hub drain and (1) water heater for TI Contractor: POWER PLUMBING CO Owner: LINCOLN CENTER LLC PO BOX 19418 BY SHORENSTEIN PROPERTIES LLC PORTLAND, OR 97280 555 CALIFORNIA ST 49TH FL SAN FRANCISCO, CA 94104 PHONE 503 - 244 -1900 PHONE FAX: 503 - 244 -8825 FEES Quantity Description Date Amount 7 ea Fixture /Sewer Cap 12/19/2012 $175.14 Specifics: 1 ea Floor Drain /Floor Sink/Hub 12/19/2012 $25.02 1 ea Sink 12/19/2012 $25.02 Type of Use: COM 1 ea Water Heater 12/19/2012 $37.52 Class of Work: ALT 1 12% State Surcharge - 12/19/2012 $31.52 Type of Const: Plumbing Occupancy Grp: Stories: Total $294.22 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 OU NC by calling 503 232.1987 or 1 800.332.2344 �I Issued By: / Permittee Signature: a pPLI �' f4 7i0 yySSJJ -�� / D ILL. 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. DEC /17/2012/MON 01:00 PM POWER PLIIBING FAX No, 503 244 8825 P. 001 di RECIV�D Plumbing ermit Ap Ilcataoeh� � Q 17 2012 Building Fixtures DEC FOR OFFICE USE ONI.S City of Tigard „„� (1 OF TI ARD Dat ei y ( / Permit No.: • 131 SW H Blvd., Tigard, OR 9 ` rw may' a-1 4 / a- s� /��st .20/.1 - QC 34. 7 Phone: 503.718.2439 Fax: 503 .59> D�4G DIVI Plan � Review Other Permit No,36910 0100- - tom TIC A . r. D Inspection Line: 503.639.4175 Date Ready/By Judo; ® See Page 2 for Internet www.tigard or.gov Notibx/Matbod: Supplemental Information _. � i � � � i /i - `L .. y sy� s; 1 . ;'! ",`� T '+� F 1 t � :±:c!'`'''.'' __-�� ;." _ -. -i.' ..., .. +F u ' i:. - Su 1 .1 �0 :: : 11 AS X s rr ht�. :� v.l'v✓ rfi : ... ..�..._.c :_ �..i.. _.., _ . . ., For , eaal - ormation use checklist iv,. ew con �i ❑ Demolition Description NMI Ea. Total ri Additio.• . - on/ ,lacement ❑ Other New 1 - 2- family dwellings (includes 100 ft for each utility connection) J - ' , te `; SFR (1) bath 312.70 ❑ 1- and 2-family dwelling tu Comercial/mdu atrial SFR (2) bath 437.78 SFR (3) bath 50032 ❑ Accessory building ❑ Multi- family _ Each additional bath/kitchen 25.02 ❑ Mester builder 0 Other Fire sprinkler ( sq. ft.) Page 2 -, :5 f_i 1 �.,'. n t7wlOJa .∎.i C Y et :O t �L'{Ls` Site ub1ities: .ate �v* ......: f xz :; Job site address: Yt / f Catch basin or area drain 18.76 City/State/ZIP: L Drywell. leach line, or trench drain 18.76 Mil '� , .... Footing drain (no. linear fL: ) Page 2 rf ldg./apt. no.. ,, �` , Project name: ar/z • Manufactured home utilities 50.03 Cross street/direct:6 ,S4. 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: • Lot no.: Fixture or item: _ Tax reap /parcel no.: IS ! > A ©I 0 0 D- • Baddlow preventer 31.27 {�� �- t ;..,• . .. :x• .._ , • • Y ;� Backwater valve 12.51 t.f -Z > , - 1 . t1 1,t �`t< F T^ „� G n jy - " ,+ 1 - .i - � •--- Clothes her 25.02 f f ► ' r V' -- /a. Dishwasher r 1 � _ a pi. :=1111 Drinking fountain 25.02 116 111 'r 1 1 Ejectors/sump 25.02 -i�- t i) -) ; _ `� t a u t; t ,. Expansion tank 12.51 Fixture/sewer cap Sid P!;- 'f 25.02 Name: Floor drain/floor s- 01, r 25.02 yall Address: Garbage disposal ri m pg . 25.02 w-.- City /StatclZIP: Hose bib 25.02 - Phone: ( • ) Fax: ( ) Ice maker 12.51 ' 1 - r r el• : r _ ��`` iii,4 .'`rn Interceptor /grease trap 25.02 . Medical gas (valve: S ) . Page 2 ' Business mane: 1 I). P - ._-A lAe Primer 12.51 Contact name: ■ -A r PM ... ... f ... Jr irarslLcommerciag - - - Address: P 10 / /♦ P Sink/basin/lavatory �,w� 25-02 �� ' yam, - - -601ar- units{potable-water)- Phone: ( ) • ),,t,I _ 1 CO . - Fax: ( ) i -.V. 2.5 Tub /shower /shower pan 12.51. • Urinal 25.02 IA r "t'L• T i xd '^"rs'' ."aI" y �' dt' t3 ' Yft Water closet 25.02 �.��. Win...._ � r '�n+`vTh!� .. �� c i :ro_i, J �hti,i y • _ w 4 ..d•,kM1. : cif ��c Water In . �� ®■ -VS' Bus nest name: I / _Aid Water piping/DWV Address: P D M • Z Other; 25.02 City/Statc/ZIP: ° a i O\ A`7, 1 Subtotal Phone: ( ) D..4.4-1,106 Fax: ( ) -144- w2.5 ti Minimum permit fee: 572.50 CCB Lie.: Plumbing Lic. no.: " + Plan review (25 °k of permit fhe) 5 3 ' 18 ' : S - State surcharge (12°3 of permit fee) Authorized signature: / TOTAL. PERMIT FEE, Print name; '- ' --e" _ Date. �� ' 7 f 2- Tbia permit application expires ire permit is not obtained within 180.drys emcee r it t Irma been accepted as complete.. "Fee methodology set by Tri-County Building Industry Service Board •finuelde IPermuu\PLMU -1' .doo 70/0039 • 410.4elirtle/a7/COl 5 ) DEC /17/2012/M0N 01:00 PM POWER PLUMBING FAX No, 503 244 8825 P. 002 Plumbing_ Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Su ' . ression stems: + ;)4r'3 1 11 1n tl6`fntJi ',. y ' I/7 7,e st1T f it m la',' EV < . i � [% c r I L•- , _ -_.__ .... : ...,.._ .— ...J `�1. i'L.1 x.., .',.-.-. . i:_.. At: mar.;,. L , _ ' „ l... _. _ 'i ff4 14 . .:d Footing drain - 1°' 100' 50 -03 0 to 2 000 $121.90 • Footing drain - each additional 100' 111E.111111 2 001 to 3 600 $169.69 3,607 to 7,200 • $233,20 Sewer - 1st 100' 62.54 7,201 and : • ater $327.54 Sewer - each additional 100' 37.52 IIIMI Water Service - 1st 100' 62.54 MI Medical Gas S stems: Water Service - each additional 100' MO 37.52 > �� r ;„ #i tt vl�;t��r���J ulio l -c ,: -1, id..l .�i;��a rtst,7�.l!.J:� i,TiJt +,;- •.des . r• rr :fir rK,:.; Stomt & 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 � �} p ` -,. '� +r ' i rn'r "� a� 1 I�,�" y 5. �,�' i ,n each additional $100.00 or fraction thereof, to ��i J� li E7�1�, �J7� ] �J. � E1f �i'. 1 �Oi. ��. y : a . �1.' 9 €'A �rv'7:t~: �y and including 510,000.00. 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 III 90.00/hr each additional $100 -00 or fraction thereof to (minimum char :c -1/2 boor) 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 : _ -2 hours each additional $10000 or fraction thereof to Reiospection Fees 90.00/hr and including $50,000.00. Additional plan review for revisions 1111 90,00/hr - $50,001-00 and up $742,00 for the first $50,000.00 and $1.20 for minimum char: -1/2 hour each additional $101100 or fraction thereof Subtotal: Commercial Fixture Work: • Are you capping, adding or replacing fixtures? If "yes ", , please indicate work performed by fixture. Failure to accurate' re iort fixtures could result in increased sewer fees * . ,,: " i ru ti „ r .[" . �� � �•;'pYr �^ Y"�?x•t � ra A nrr r ^ �;; r : .$ p ''', � T PI ,- . r. iF M .,k'^C ,T d..?.1 E,'.�+•1 tan, i x �r k_i S1 � a,.ic �i {ILu1141Cf' 1 �l C��T3 ,l0 cl '-i l„ lq t 11 ` - } rSJr s.,4: „, .r 'tr �' 4 ;,- T .�, �r b l; > .__ .. S.._ . .....,. . ... ;,;, J u ra, ri ; , gip ' T `* � 4 Plan review is required for any of the following. Baptistry/Font `{"' " s Please check all that apply. Bach Tub /shower 171 Any new commercial building with water service 2" and -Jacuzzi/Whirlpool greater, except systems designed and stamped by licensed Car Wash Each Stall engineer, Drive T1uu ❑ New exterior plumbing site utilities for any complex structure Cuspidor/Water Aspirator as defined in OAR918- 780 -0040. Dishwasher Commercial ❑ Medical gas and vacuum systems for health care facilities. - Domestic ❑ Any multipurpose fire sprinkler system. Drinlang Fountain ❑ Any complex structure as defined in OAR918- 780 -0040. .. E e Wash Floor Drain/sink -2" Submit 2 sets of plans with any of the above. -3" - 4 t'+, + yr- t� y ^.�^ji' lam K '$ -':', •�..f l3 '„y+!•w },!] "�} ,� a• a ; r. ,,, t .. J'i...�,� ...,, ,G.01r� 0 lit , Ol , „4:\J l '1,1.;;;,...:.„1.,../111?"..?,,:,.., ..: "15 p c . y . i. ah -Car Wash - Drain - .. N, F =J . . _ Garbage Dornestio- non -food ❑ Isometric or riser diagram is required for new buildzrags . Disposal : , Domestic -food related = - that meet the�ualifications above. - Commercial -food related • hidustrial -nod related J Ice Mach- /Refrig. Drains / U Oil Se. arator (Gas Station omments. regardi P . xxtnre work: Rec. Vehicle Dump Station _ g 1.. ]I ...— Shower -Gang _� a -Stall 1 / .. w��� ' . u i 5init/Lav Non food related 2 I __ '�r ' .11 _ i -Bradley ■ 1 I-. 8 . D • - Commercial -food related _I -Service � Swimming Pool Filter *Note: the fixture work under this permit results in an Washer - Cloth Wate Extractor IIIII increase of sewer E Us, a sewer permit will be issued and Water Closet - Toilet fees assessed for the sewer increase must be paid before the - Urinal . - plumbing permit can be issued. Other Fixtures: 1 1 _.__.._ //www.tt �. or. oWez - kialUd artments /c 7docs/PEVIF :PtimttA c -'- - -- — -- -- - __. . .. _. ... . _. - -- .._ _ _.. _ _ _ -- -,- - -- - -.- h tip: � B tY eP P3�oy - Accumulative Sewer Tally I II 0 n Tenant Name: Cypress SWR # TIGARD Site Address. 10220 SW Grecnburg Rd., Ste. 417 PI.M # 2012 -00367 Parcel #: 1S135AB -01002 Fixture Value Previous Previous Credits Capped Fixture Fixture New New # value count capped #s value count added # added value total #s total values Baptistry/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 2 4 1 2 -1 -2 - 3 inch 5 0 0 0 0 0 - 4 inch 6 0 0 0 0 0 - Car Wash 6 0 0 0 0 0 Garbage Disposal: - Domestic (to 3/4 HP) 16 0 1 16 0 -1 -16 - Commercial (to 5 I IP) 32 0 0 0 0 0 - Industrial (over 5 I IP) 42 0 0 0 0 0 Ice Machine /Refrigerator Drain 1 0 0 0 0 0 Od 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: - I,av /Bar - Non -Food Related 2 0 2 4 1 2 -1 -2 - Bradley 5 0 0 0 0 0 - Com /Serv/Uul - Food Related 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 5 24 2 4 -3 -20 Current Fixture Value -20 divided by 16 = -1 250 Current EDU 1 EDU = $4,665.00 Previous Fixture Value 0 divided by 16 = 0.000 Previous I?DU Change -20 divided by 16 = -1 250 over (under) S (5,831.25) Enter EDU Change Here -1 250 Notes. ** *CREDIT* ** Authorized Name /Signature: Shirley Treat Date: 12/19/2012 Building 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 \ Building \ Sewer Tally \Scwcrl'allyShect -4665 xls 07/01/12