Permit CITY OF TIGARD PLUMBING PERMIT
2 ' COMMUNITY DEVELOPMENT Permit #: PLM2013 -00103
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/27/2013
Parcel: 1 S 135AB01003
Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD 465
Project: Dora/ Healthcare Finance Subdivision: METZGER, TOWN OF Lot: 9
Project Description: Capping (1) sink and relocating (1) sink. Replace water heater and alter exisitng plumbing connections to
accomodate new casework.
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 - 619 -3200
HONE: 503 - 331 -0234
FAX: 503 - 331 -6907
FEES
Quantity Description Date Amount
1 ea Fixture /Sewer Cap 03/27/2013 $25.02
Specifics: 1 ea Sink 03/27/2013 $25.02
1 ea Water Piping /DWV 03/27/2013 $56.29
Type of Use: COM 1 ea Water Heater 03/27/2013 $37.52
Class of Work: ALT 1 12% State Surcharge - 03/27/2013 $17.26
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $161.11
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 Notificatio 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 q ions to O • b - : ling 503.232.1987 or 1.800.332.2344.
Issued By: I / Permittee Signature:
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.
Plumbing Permit Application 7/03a
Building Fixtures RECEIVED FOR OFFICE USE ONLY
Re ceived z
III City of Tigard Date /By: Al /3 / Permit No.. 1 4 1 '00 /3'06 /
IIII 13125 SW Hall Blvd., Tigard, OR 97 � Plan Review
. Phone: 503.639.4171 Fax: 503.5 7 20 3 Date /By: Other Permit No.: atiA0M.00,4 3?
TIGARD Inspection Line: 503.639.4175 /'w T, Date Ready /By: kris: 1Z1 See Page 2 for
Internet: www.tigard- or.gov p� i ` O TIGARD Notified/Method: Supplemental Information
TYPE OF SING DIVISION FEE* SCHEDULE
El New construction 0 Demolition For special information use checklist.
Description I Qty. I Ea. I Total
® Addition/alteration/replacement ❑ Other: New 1- 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
building SFR (3) bath 500.32
❑ Accessory g ❑ 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: 10300 SW Greenburg Road Suite 465 Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City /State /ZIP: Tigard, Oregon
Footing drain (no. linear ft.: _ ) Page 2
Suite/bldg. /apt. no.: 465 I Project name: Dora! Healthcare 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:
ll
Tax map /parcel no.: (./ 35 Q /005 Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Demo (1) existing break room sink and alter existing plumbing connections
Dishwasher 25.02
to accommodate new casework. New 4 gallon water heater to replace the old. Drinking fountain 25.02
Ejectors /sump 25.02
❑ PROPERTY OWNER ® TENANT Expansion tank 12.51
Name: Dotal Healthcare Fixture /sewer cap f 25.02 A5
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: S ) Page 2
Primer 12.51
Contact name: Janet Lipe
Roof drain (commercial) 12.51
Address: 16790 NE Mason Street Suite 100 C 2
Sink/basin/lavatory i 25.02 O�S•
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
a
CONTRACTOR Water closet
119 25.02
Water heater 1 37.52 37.E
Business name: Same as above
Water piping/DWV 1 56.29 56 .2
Address: Other: 25.02
City/State /ZIP: Subtotal /4/5. gS
Phone: ( ) Fax: ( ) Minimum permit fee: S72.50
Plan review (25% of permit fee)
CCB Lie.: 172811 Plumbing Lic. no.: 37 - 22PB
` State surcharge (12% of permit fee) (7,
Authorized signature: TOTAL PERMIT FEE /61,11
Print name: Janet Lipe Date: 3 a 1 ( 3 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.
l:A Building v PermitsVPLNIU- PermitApp.doc 10.01,09 440-46 16T(10'02/CONI, WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qt'. Fee (ea) Total Square Footage: Permit Fee:
Footing drain - 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 each additional $100.00 or fraction thereof, to
P 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 ❑ Any new commercial building with water service 2" and
Previous Capped Added Existing
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 OAR91 8- 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"
4 „ ❑ Isometric or riser diagram is required for new buildings
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\2013271030 Doral Healthcare Suite 465\Permit \71030 - PLMB Permit
Application.doc
111 11111 Accumulative Sewer Tally
C : ' Tenant Name: Doral I lcalthcare SWR # N/A
TI GARD Site Address: 10300 S \ \' Greenburg Rd #465 PI,M # 2013 -00103
Parcel #: 1S135AB01003
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped #s value count added # added value total #s total values
Baptisery/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 0 0 0 0
- 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 3/4 111 16 0 0 0 0 0
- 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
Oil 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:
- l..av /Bar - Non -Food Related 2 0 1 2 0 - -
- Bradley 5 0 0 0 0 0
- Com /Serv/Util - 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 1 2 0 0 -1 -2
Current Fixture Value -2 divided by 16 = -0.125 Current EDU 1 EDU = $4,665.00
Previous Fixture Value 0 divided by 16 = 0.000 Previous EDU
Change -2 divided by 16 = -0.125 over (under) S (606.45)
Enter EDU Change Here -0.130
Notes: * *CREDITS * **
Authorized Name /Signature: Debbie . \damski Date: 3/27/2013
Building Division
. ote: The property owner shall retain the ORIGINAL. sewer tally record. I f 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.
1: \ Building \Sewer 'rally \Sewer I'allyShect- 4665.xls 07/01/12
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10300 SW GREENBURG RD 465, TIGARD, OR,
97223
Commercial - Plumbing
399 Plumbing final
04/15/2013 00:00
PLM2013-00103
PASS - No C of O
Violation Summary:
Inspector Contractor