Permit 1 u CITY OF TIGARD PLUMBING PERMIT
11 11 e COMMUNITY DEVELOPMENT Permit #: PLM2013 00193
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/19/2013
Parcel: 1S135BC00202
Jurisdiction: TIGARD
Site address: 10763 SW GREENBURG RD 100
Project: Greenburg Center Subdivision: HILLSBORO Lot: PTS 1 -2
Project Description: Units 100, 110 & 120. Capping fixtures for interior demo, to prep for new tenants. Capping (2) water closets, (2)
lays, (2) floor drains, (2) floor sinks and (2) sinks.
Contractor: CASCADE PLUMBING CO Owner: BELANICH, ROGER M
2416 N HAYDEN ISLAND DR 22020 17TH AVE SE #200
PORTLAND, OR 97217 BOTHELL, WA 98021
PHONE: 503 - 289 -7095 PHONE:
FAX: 503 - 283 -9514
FEES
Quantity Description Date Amount
10 ea Fixture /Sewer Cap 06/19/2013 $250.20
Specifics: 1 12% State Surcharge - 06/19/2013 $30.02
Plumbing
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $280.22
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 OUNC by calling 503.232.1987 or 1.800.332.2344.
ci
Issued By: Ck .__ Ca e a tz,44/L Ak / Permittee Signature: ^w
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 C D
Building Fixtures JUN 1 8 2013 FOR OF'F'ICE (!SF. ONLY
City of Tigard Received
III II Ifle /By: (., / y 3 Peewit No.: 3 l9
13135 SW Hall Blvd„ Tigard, OR 972EITY OFTIGARD plan ReviEw ... - - . .
8 Phone: 503.718.2439 Fax: 503,55,u,,DING DIVISION (_Daterliy: Other Permit No.:
l' t c; n ): rr Inspection Line: 503.639,4175 I lute Ready/Hy: ..- - '�. ^.,,,, .,, ' ^ arc: . 171 Page 2 for
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❑ New canstructi m _.. ems i on _ - ,._, er y eclal r+tformadan use checklist _ _
- _,_
Description_ _._...,I_2 .... Ea." � Total
0 Addition/alteration/replacement 0 Other: New I- 2- faut dwellings (includes 100 tl. for each utilit�connectivn)
AO.Otir Y O1 4`! sfR+ +G'1"1O1V ' (1) bath T ' 3122, fO
0 1- and 2•family dwelling `1Corntnerclat /ind �_ 5F'R (2) bath .. - -� _ ( 43778
— - S _._ -. 500.32
0 0 Multi-family Fa. additions) bath list V
Accessory building ) -.
- _ , - chest 35.02 ! - , _..,,.
❑ Muster builder 0 Other: .. ) w----- __.....
. -�. ..- N., »- r °, - ..,, .,. - - - -- -. _-........-..1.,...............,..-
..;.. ,; " ,,. ;;,.,,. : ,x..1'::;>:,�:. , :�.;�,' - -
M Eire sprinkler
7 1 1JOi3 S`JT' , INFC11 1 'ATXQNND l:( A7,1f.?N , Site ut111tiesc ` ..... . . - Page
e ""^ J Catt h 1 *asatt ar area drbm 1 8,7G
' ,1 7"i, /(a M t testis rain _,..
1 Job site address:
-`� _ K +' Jl 1 �� W . (yrywi , le�cl linen d
-- 'll t h 18.76
City /State/ZTP: -" , C s ; 4. - _ - . •
„„- f _+, ,- ..�.._.„.,.. Footing drain (no linear ti. Page 7.
Suite/bkdg.lapt, no.: /OD //0 / J 7 ` Manufactured home 50.03 ro cxa name; o r t. -C -/ ' /
Cross street /directions to job site: Manholes 18.76
Ram drain conneeuu 18.76
- Sanitary Eewe r .- linear ft.: ) Page 2 . - -- -
.__....... ........... ....-- ._._.-- ..,--- ------ -__.__ ^ -- Storm sewer (no. linear ft.: ) Page 2
,......_.. - -- _ _ „ - . . - - - .............._,__...- _.. - -- - -.._ -.. Water' se (na. liner ft ) 1 Page 2
_
Subdivision: Lot no.: .__.�_._. -- - .. - - - „..
- .. — -...._ ___ .... - ---- -._. -- _ _ ._. M .. _
xt�ire 9r item:
Tax map /parcel no.: fiacktlaw pnevt nits _' 31.1'/ i ___.
washer 75 02
'� 1 .77; jO ,-. 77 - . 1 r '∎ - -
1' Backwater valve 12.51
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(1I ,Ilisi 1 A`-; � r ii lf: M 1 t l � ' 1!
, 1 7 ; f 1 ,. - ... ...........•._,
1 ;, t / r",”
.., ._. 1 ,,.. -.. t,'loClothes ^ • + ` 7<C�
/IC/ c „L. - 4...,� --_ Dishwasher w 25.02
li c - ` - ✓G:. ; I1G':;; !.�C C1'1'. „', 6Z f , - •1 foul
— in Drinking fouin 25.02 I
/ '' /t 1 . � Ejcctors/sutnp M__ _i.02 _._—
1 1 ) i 1 ' ` ,11�1�15 i� 1� 1 1 = , 1� / i
�,/ ' 1 ' 41 AINI „ r,9, 211Fi3.'1 El c . i 1 0 r 11 F..xpans c,tt rank 12.51
Name: Fixture/sewer cap (} _ 25.02 .5e r ,.J
.................. ..._— __.,... ...._.._. ......,. _..... -,..- ”" Floor drrun/floor sink/hub 25.02
--- _.. Ciar1 ajte disposal 25.02
City /State/ZIP: ___
Hose bib ..__. 25 "t12 �,.
Phone: ( ) _. r Fax: ( ) .., - - -- lee maker -- - -- -- ..._ - __........12.51 e .
.r' 1' ;r'('(I;jdll>'�(1�}� 0 `A ,"i,10`i�N7` "'rfr i 11 t(' t ` i 1
' 111 1 /
}I t 1 ' GQl'4 `}�ri rIunenu 'Zi1 ,' Interceptor /g ease trap 2502
.
' 'n!.li : 1 .1 :; ., ,. 1,4 Rip ,, �' !'1 , r _ 1 l� {Li . »....._._, - -- -- - -- -- ..- ......_.- .......
Business name: Same as below Mcclical sits (value: S ) - - Page 2
-- -...__.. - Prima Primer 12,51
Contact ..... .,...,...,,.-- _.._- ..,,... —_ _ -. -- - -- -
--------- ----- ------- Roof drain (commotial) L 12,51
Address: _ Sink/bain/lavatory 25.02
C ^ ity /State/ZIP ___.� 4_ Solar units (potable water) ^ 6234 �
.� -, - --- ,..___.,.,___ futt/showa /shower pan 12.51
Phone: ( ) Fax:: ( ) �., , - _._ ...
_- .-- ...,.,..,._,. ,- _ r
- J _..__. - . .....__.._..__ ...,,_..,... {litutl 25,02
-T -mail: __ •- - -.� _. ------------
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;' P' .'1: 'rfcli ": „�Yi;"It7; "7- 7:1;57 Watts Closet 25.02
lsjl lll,i f (,?..4 ill) its ;(1'llltt l �td)r�r T r= > -T.F 4 5 !;•7jh` ' ��r` i / ) �1 M l �r 6 f12 V t 4 i t � 'f y -. _ ._..
b:. 1`,.k 1 1 1) �..,.1 S:1 .. ,... Water heater 37.52
Business name: Cascade Plumbing Co _.._,- ---- __. ---- -._
_�� Waterpiping/DWV 5629
Address; 2416 N. Hayden Island Drive Other; 2502
City /State/ZIP: Portland, OR 97217 _ Subtotal ,r' iL' _,,?1r
Phone: (503) 2897095 Fax: (503) 283 -9514 w._.. ..-.__ _.,__...., -^ Mirtirrnttn permit fee: $72.50 .____......„__
`"'__- .. Plan review (2S% of permit fee)
fee
CCB Lie.; 120893 Plumbing Lie. no,; 34 -412PB - ee ^- ;
�. —. - - -. W - - W- -• -- --•- -- - �' - -.- State z °' , 4 ,Ilk
Authorizod signature: L l 1.., r' _ _.._._..,. permit fee) ,4 PERMIT FEE �,
$m / / 1. 21 ,.. 'TOTAL l ., ; :
s If a permit is - riot r obtained ;vain ISO days
C Print name: Crystal Jones v .M,... Date: T TLis permit application expire
_ after to has been accepted as complete.
. ;)1 'Fee methodology set by I'd-County Building Industry Service Uoard
1." IS-CA—JAL tA
lil -' F :C k.-' )4 :4:,: ' 1 iL. �...... -/ t -1.- e . i'' inn\Icwia1'LMU•PermitApp.doe 1 01.'09 ( 440- 461611(0/02/cUMw[n)
TO'd t'TS6£2Z£OS 03 bu'q>anTd apeoss3 i asr:£0 £T /ST /90
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su • • ression S stems:
'•1: 1 „ 1., ,. 1 Y t eel., un 5 ilYliF ? r - • q�' I• l"""`
Sfte Utilities .' I:• , ' ,`; a (s ? '•�'9, Squiwe oota a _... _ _ _; '+fit mit Ere. ;:i'.'• ', ~ t,'tc;; i ; �' .
Footing drain . 1" 100' _.._.. 50.03 _0 to 2,000 Y - $121.90
Footing drain - each additional 100' 37.57, 2,001 to 3.6110 S! 69.69
I
3.601 to 7.200 S233.20 --- ..........__....._.......
Sewer - 1st 100' 62.54 7,201 and grwttr $32734
Sewer - each additional 100' 37.52
Water Service 1 s t 100' 62•.54 Medical Gas Systems:
Water Service • each additional 100' 3752 "7 7.77, :" n ., ;;: ~ (^°* ;,?:,• 1 °^,:i'
lua#�on. ; Perinlut:±.ec: ;
Storm & Rain Drain - I st 100' 62.54 $1.00 to $5,000.00 Minimum fee $72.50
Storm I Rain Drain - each additional 100' 37.52 S5,001.00 to S 10,000.00 572.50 for the first 55,000.00 and S 1.52 lbs
for
each additional $ 100.00 or fraction thereof, to
and including 510,
Inspection of existing plumbing or for 510,001.00 to $25,000.00 $1411.50 for the first S 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) andincludiriS15,0U0.U0.
Inspections outside of normal business l0,(71/hr 525,001.00 to 550,000.00 $379.50 for the firs; $25,000.00 and $1.45 for
hours (minimum charge 2 hours) each additional $100.00 or fraction thereof, to
Reim:pig: ion Fees 90.00/hr and including 550,000.00. _ _
Additional plan review for revisions 90,00/hr
$50,001 00 and up $742.00 for the first 550,000.00 and 51.20 for
( ntittirvwn charge - 1/2 hour) each additional S100.00 or traction 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 se
Q wer fees *.
,� 1 , or, t -rte--- � .,.-, ,-- .., �••r° -°'°- ,
nisf�UatIOn
lure type fax )tsi>daa� Plan review is required for any of the following
.WOtk'aycrftirm�l. ; G�gtlrad AddeA l�titnu ; •
r +aptity,l o,n "" """" -""" Please check all that apply,
Bath rubt/Shower Any new commercial building with water service 2" and
- Jacut'9UWIuilpool - M......... -., .. greater, except systems dt. ign(xi and stamped by licensed
engineer.
Car Wash rash Stall
•tlrihk.Thru ❑ New exterior plumbing site utilities for any complex structure
C. /Water As Moor as defined in OAR918 -780 -0040.
Dishwasher - Commercial - Cal Medical gas and vacuum systems for health care facilities.
- Domestic ❑ My multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in 0A1018-780-0040.
F.Le Wash .�_..�......» _
Floor Drain /sink - 2" .. _ 41 Submit 2 sets of plans with any of the above.
- 4 ... ^(. ., 4�� 5i1!i` il '
.•». .................... ....... :L�i;il�lig I\,',i aI�'' 1 ET ibmOill. ,'1 ,101),1la f++,i ,i , rt ,ti.o'.l�it ASP
Car Wash Dram
• ..
Garbage unrncrait:••non food . Isometric or riser diagram is required for new buildings
Disposal - Domestic - food related that meet the ualifications above.
— Commercial -.food related
- Industrial -food related y - ._....
ice Mach, /Refri1. Drains
Oil Seya_•ator (Gas Station Comments regarding fixture work:
Rec. Velticle Station
Shower Jiang
..Stall ___. ._•
Siok/I: av - Non -food related _ ._,.____ _ m _. .. •..... M
-Bradley
. _.__.�.,.- .,...,...�.m•.._._..,
- Commercial -food related
- Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer Clothes
Water ter Extractor increase of sewer EDUs, 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: 5,77-77'
t:_\ UserslOwner \Downloads\PLMF- PerinitApp (1).doc 2
20 -d biS6£83£0S o0 buTc{titnTd apaosa0 IddST :C0 £T /8T /90
11114 Accumulative Sewer Tally
a
p Tenant Name: Greenburg Center " *CREDITS ** SWR # N /!\
TIGARD Site . ddress: 10763 SW Greenburg, Suites 100, 110 & 120 P1,N1 # 2013 -00193
Parcel #: 1S135BC00202
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped #5 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 4 8 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 I -1P) 16 0 0 0 0 0
- Commercial (to 5 I - 1P) 32 0 0 0 0 0
- Industrial (over 5 11P) 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:
- Lav/ Bar - Non -Food Related 2 0 2 4 0 - -
- Bradley 5 0 0 0 0 0
- Com /Sery /Util - Food Related 3 0 2 6 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 2 12 0 - -
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 10 30 0 0 - 10 - 30
Current Fixture Value -30 divided by 16 = -1.875 Current EDU 1 EDU = $4,665.00
Previous Fixture Value 0 divided by 16 = 0.000 Previous EDU
Change -30 divided by 16 = -1.875 over (under) S (8,770.20)
Enter EDU Change Here - 1.880
Notes: *"CREDITS"* 6/19/13, these credits were applied to P1,1\12013 00178. D:\
Authorized Name/Signature: ;Debbie :\damski Date: 6/19/2013
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 \Sewer Ihl 4(65.xls 07/01/12