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Permit . : CITY OF TIGARD , I COMMUNITY DEVELOPMENT Plait g7 PLUMBING PERMIT Permit PLM2014-00056 T I( A R.n 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/03/2014 Parcel: 1 S135AB04500 Jurisdiction: Tigard Site address: 10250 SW GREENBURG RD 212 Project: Miadonna Subdivision: 1991-055 PARTITION PLAT Lot: 1 Project Description: Adding(1)breakroom sink for TI.3/4/14:Reprinted permit to include(1)water heater and(1)primer. Contractor: MCKINSTRY ELECTRICAL LLC Owner: LINCOLN CENTER LLC 16790 NE MASON STREET SUITE 100 BY SHORENSTEIN PROPERTIES LLC PORTLAND, OR 97230 555 CALIFORNIA ST 49TH FL SAN FRANCISCO, CA 94104 PHONE: 503-278-3954 PHONE: FAX: 503-331-6907 FEES Quantity Description Date Amount 1 ea Primer 03/04/2014 $12.51 Specifics: 1 ea Sink 03/03/2014 $25.02 1 ea Water Heater 03/03/2014 $37.52 Type of Use: COM 1 12%State Surcharge- 03/04/2014 $9.01 Class of Work: ALT Plumbing Type of Const: Occupancy Grp: Stories: Total $84.06 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 :I I 32.2344. Issued By: ' 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. FROM :MCKINSTRY RE FAX NO. :5033316906 Mar. 03 2014 04:05PM P1 CEIV Plumbing Permit Application D Building Fixtures MAR -3 2014 I t)1i 1,1 1.1( 1 ( '`I 1).1 1 City of Tigard Y OFTIGARD 1�00NBd n� 13125 SW Hall Blvd.,Tigard,O: DatoJB ; Permit Nop Aele Qoa6 Phone; 503.639.4171 Fax; 501 :. ,S NG DIVISION Plan Review OUrer!'ermitNo.: ` I I •1t I laspec hen Line: 503.639.4175 lice /B -- dY y: El gee Pago 1 for Internet www.tigard-orgov Noutied/Mot od: Supplemental Information 1 . '.r.;i,. -,,mp..,n�1jn�1'j�In, `i'i','le "r',{I:I Ie ;1 .NY. r. _, s �.1 t � 1,' 1„ 4 t )3M! r i i( '.iM1r' 11{.i,tt u ,.��1'.1 � 'rf n 1..,I. l t' ,rm�ry �,, 1 ,•1, 1 , ''1 I, r 4 , � { I � ak��' ,t f 1, ,,. +� ,i q'J, ,Sk. sw;', , II t f ,; P 1, ,.,4 , , ••'1I�,; ,:+d Z cM;,;,' i,tl + 111,,, f' s' � .t , :, ,, ,t 1 , r 1 a,!1• ,,� Itr, , i ,:,; 41,:. „)1.x,,tic,; ,6l,il,..ly�t,l4.��,d.>., i,i,f7�,u,i111s,• .t't..!ai, 1,11,,,, 4, ,%.:,,),,,,;;s r,i t�"�s, yd., ,, �.I,,•d�tti„.;i,,'l,c 4!fs;l,�,,rt+,�PS,ab.p..,, ❑New construction ❑Demolition % Furseecial LE/arati,on rue checklist Deacn ion � Total pi >f%I�f r1 _ I Qty. I Put Addition/alteration/replacement ❑Uthcr. • 1 New 1-2-family dwellings(includes 1 ,, , MI 1 , < 4 �I „ � , ;,� Y �( 10011.foreauhudlitYcotneotion) (� ,1 I� i �,�ri,.l'..1 .1fGa,..If1 4 , ,�1 }I (, '� 1 :4 f IL•fti SFR(1)bath 312,70 : 1 ,,1.,Ir,t's`.,1,.a, , 1, `�, i 5 161n_,anti a.,.�il.>i ;h,,,.Pl'i'I, ❑ 1-and 2-family dwelling _,Commcr'rtdustrial SFR(2)bath 437.78 • 0 Accessory building ❑Multi-family SFR(3)bath 50032 Each additional bath/kitchen 25.02 ❑Master builder ❑Other Fire sprinkler( sq.ft) Page 2 r. 1, Y..17 f l 1 ,,t z ,3i t 1:1 , ,fli w1 R{.,,1',;rte i P, R;;i ,Tnh`1`., g .1 , , t . 1�- t d I , ,� { o f1Alye: 1 t1 qq ,) ,Itf I t 1 ,.;u�N `f .. „4.,I. 11,,.N6. .�;,,. }dd. i. 9.1�dlp,:abatF'�t„I,11n�ti!4a,V,V,AfI.}li..,Y.,1ty,if„e1. �..h,lbl, llir te.Uldrtloa: Job site address: 1 d 2.$0 cS� G,, �1pV 7 Catch basin or area drain I R.76 ^ City/State/ZIP: ` 0(Z_ Irk. D'ywell,leach line,or trench drain 18.76 yr Footing dr3itl(no.linear t,:.) Page 2 Suite/bldg./apt no.: Project name: 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 newer(no.linear f}.:�) Page 2 • Water service(no,linear ft.:^) Page 2 Subdivision: -1 Lot no.: Fixture or Item: _ Tax neap/parcel no,: 151 ► f,* Ott Backflow preventer 31.27 1 , gi .• 4' • ;1 f I 1 T.. , � , ( �,QtW ,�� i,i 1 a`1 Backwater valve 12.51 .,n. , •: (,1 1 ,, ?ar, ,5.,,,,i A I.3,..I.t. ti,,i M ,Mir.„ l;;teii,,, 1•h,;d ,a $ H l,,,,6, clothes washer 25.02 L G`' Lb&d`' W��ll' ke a Andy S„ _ Dishwasher 25.02 7 CuQ I) HMV pej'(vt 4- Drinking fountain 25.02 1!1 t LA ••0 5 •I!l 4 k „w1. 11 n { E jecorts/sump. ... 25.02 1 1 1 � I 1 {! rp, `,;;; ,1 I 1 11U,'', r,:. 1 d3 1t ;,T∎ '.,R. , Fxpansiun tank 12.51 L d;l .•,I,m,:,..L46 S,,U „1•1,•s,'M W •1ld;y 1„l hllt.a y ull , nx,dN,!E:�ECl Y$0 M1`.,i'9V,ErM..l » - Name; Fixturc/scwer cap 25.02 j i>.. w•- Floor drain/fluor sink/hub 25.02 Address: Gatbage disposal 25,02 City/State/ZIP; Hose hib 25.02 Phone:( ) Fax:( ) Ice tnaket - - 51 12.51 ,,, t 1, 1 1 ,,�Ir s}r'�:::∎K 41si' V,i' Itgpll,rice s ..uG In sa lslNlcl}� -' ^ 1..,' , , ` '`1,.; 7.1', , .1.∎. ;4M1.f../1'^!rr d1i ;'111oi,, ;,;, ,,.aii,:MI{14.,,,�i,..to re1,,9h,i700,;,,0f9il�{�I�' InlerCCptor/gretutc trap 25.02 Business name:McKlnstry Co Medical gas(value:$ )• Page 2 Contact name: 1 AI i p v--r;1-CAA-CA-C- .. Roof drain(commercial) 12.51 Address:16790 NE Mason Street Suite 100 . Sink/basin/lavatory I 25.02 2-...5., �,t, City/State/ZIP:Portland,Oregon 97230 Solar units(potable water) 62.54 Phone:(S113)11793964. S -, - -.4..1 Fax::(503)331-6907 Tub/shower/shower pan 12.51 Email:janell@meklnstry.com Urinal 25.02- ,.?;.,.,,,t.r r` 4;I 'I Cl 1916 t{w 11i�flptill 1➢R 1;�1 h1 1M*,,,1 Waler closet ,',,I f )..,•,,._ si.,L..,,, !o.np 4,;,(,r,i3, �;11M.u1,.,«',)e) n�1+1., ,i3O.1.!.>.+� ZI.H91.,?,;aM:i',g,!d,q'.;tr %tor heater 25.02 Business name:Same as above ( 37.52 '51. Water piping/DWV 56.29 Address: Other -. 25.02 City/State/ZIP: Subtotal T)5'. 'lc- _ Phone:( ) Fax:( ) Minimum permit fee: $72.50 CCB Lie.: Plumbing Lie,no.: Y Plan review (25%ofponmit fee) State sutvharge(12%of permit fee) 41-ti j Authorized signatur , r TOTAL PERMIT FEE Ai d't,'25 Print name:Ighttuat 4 w 4 i:v A k' 11 rn i,� I Ditte: 5! 'I 1 Thls pulpit application expires Na permit le mu obtained wlthia ISO days �` .J LLJJ after It has been accepted u corapkte, •Fec methodology act by'in-County Building industry Service Hoard. 1:VlldldttiV'ernut+,PI.MIT-P,amrnm.ln- mrontmo ..,. ...__..__. _. CITY OF TIGARD PLUMBING PERMIT a COMMUNITY DEVELOPMENT Permit#: PLM2014-00056 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/03/2014 T[t�.A R.D g Parcel: 1 S135AB04500 Jurisdiction: Tigard Site address: 10250 SW GREENBURG RD 212 Project: Miadonna Subdivision: 1991-055 PARTITION PLAT Lot: 1 Project Description: Adding(1)breakroom sink for TI. Contractor: MCKINSTRY ELECTRICAL LLC Owner: LINCOLN CENTER LLC 16790 NE MASON STREET SUITE 100 BY SHORENSTEIN PROPERTIES LLC PORTLAND, OR 97230 555 CALIFORNIA ST 49TH FL SAN FRANCISCO, CA 94104 PHONE: 503-278-3954 PHONE: FAX: 503-331-6907 FEES Quantity Description Date Amount 1 ea Sink 03/03/2014 $25.02 Specifics: 1 12%State Surcharge- 03/03/2014 $8.70 Plumbing Type of Use: COM 47 ea Minimum Fee Adjustment- 03/03/2014 $47.48 Plumbing Class of Work: ALT Type of Const: Occupancy Grp: Stories: Total $81.20 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. Issued By: Permittee Signature: '-4`'i Lig Call 503.639.4175 by 7:00 a.m.for the next available inspecti• 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. Ph CITY OF TIGARD SEWER CONNECTION PERMIT COMMUNITY DEVELOPMENT Permit#: SWR2014-00014 TWA R.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/03/2014 Parcel: 1 S 135AB04500 Jurisdiction: Tigard Site address: 10250 SW GREENBURG RD 212 Project: Miadonna Subdivision: 1991-055 PARTITION PLAT Lot: 1 Project Description: Adding(1)breakroom sink for TI. Contractor: Owner: LINCOLN CENTER LLC BY SHORENSTEIN PROPERTIES LLC 555 CALIFORNIA ST 49TH FL SAN FRANCISCO, CA 94104 PHONE PHONE: FAX: - FEES Description Date Amount Specifics: Sewer Connection Fee 03/03/2014 $624.00 Type of Use: COM Class of Work: ALT Install Type: Building Sewer Fixture Units: Number of Dwelling Units: .13 Total $624.00 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. e— 0 Issued By: i �`L i �` Permittee Signature: _ �,f ,0 Call 0 �175 by 7:00 a.m.for the next available inspection •ate. This permit card shall be kept in a conspicuous place on the job site until com• - on of the pr.je t. Approved plans are required on the job site at the time of each inspection. N-ii Accumulative Sewer Tally Tenant Name: MIADONNA SWR# SWR2014-00014 Site Address: 10250 SW GREENBURG RD PLM# PLM2014-00056 t c Parcel#: 1 S 135AB04500 Fixture Value Previous Previous Credits Capped Fixture Fixture New New tl 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 -3inch 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 0 0 0 0 -Commercial(to 5 HP) 32 _ 0 0 0 0 0 -Industrial(over 5 HP) 42 0 0 0 0 0 Ice Machine/Refrigerator Drain 1 0 0 0 0 0 Living Unit 16 0 0 0 0 0 Oil Sep(Gas Station) 6 0 0 0 0 (1 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 0 .. 1 2 1 2 -Bradley 5 0 0 0 0 0 -Com/Serv/Util-Food Relatcdl 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 0 0 1 2 1 2 Current Fixture Value 2 divided by 16= 0.125 Current EDU 1 EDU = $4,800.00 Previous Fixture Value 0 divided by 16= 0.000 Previous EDU Change 2 divided by 16= 0.125 over (under) $ 624.00 Enter EDU Change Here 0.130 Notes: Authorized Name/Signature: BRANDEN TAGGART X2449 Date: 3/3/2014 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. 1:\Building\Sewer Tally\SewerTallySheet_4800._070113.xlsx Plumbing Permit Application ' wilding Fixtures 4.111, FOR OFFICE USE ONLY City of Tigard � Received / ,p il 13125 SW Hall Blvd.,Tigard,OR 97223 �� Date/By:• 3//y /)�, Permit No.: ROM(-64.z Mill Phone: 503.639.4171 Fax: 503.598, Plan By: Date/By: Other Permit No.:Revie TIGARD Inspection Line: 503.639.4175 O�Q Date Ready/By: � tY fit'3 Internet www.tigard-or.gov t� Juris: Supplemental See Page 2 for v k otified/Method: Supplemental Information TYPE OF WORK ,,''f` .t�ti\ '' FEE* SCHEDULE ❑New construction ❑Demohtio �O' �lV For special information».a+checklist. ®Addition/alteration/replacement ❑Other: �,� l�� Description I Qty. I Ea. I Total New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTICi6 OVA° SFR(1)bath ,._�. 312.70 ❑ 1-and 2-family dwelling ®Commercial/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: 10250 SW Greenburg Rd Catch basin or area drain 18.76 City/State/ZIP:Tigard,OR 97223 Drywell,leach line,or trench drain 18.76 Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.:212 I Project name:MiaDonna 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: Lot no.: Fixture or item: Tax map'parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Add a new break room sink Clothes washer 25.02 Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ❑ PROPERTY OWNER ® TENANT Expansion tank 12.51 Name:MiaDonna Fixture/sewer cap 25.02 Address: Floor drain/floor sink/hub 25.02 Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone:( 1 Fax:( ) Ice maker 12.51 ® APPLICANT CO CONTACT PERSON Interceptor/grease trap 25.02 Business name:McKinstry Co Medical gas(value:S ) Page 2 Contact name:Antonija Krizanac Primer 12.51 Roof drain(commercial) 12.51 Address: 16790 NE Mason Street Suite 100 Sink/basin/lavatory 1 25.02 L.)._ City/State/ZIP:Portland,Oregon 97230 Solar units(potable water) 62.54 Phone:(503)331-0234 Fax::(503)331-6907 Tub/shower/shower pan 12.51 E-mail:antonijak(ei mckinstry.com Urinal 25.02 CONTRACTOR �� ,; Water closet 25.02 °` �.4• b Water heater Business name:Same as above 37.52 Water piping/DWV 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal '- . Phone:( ) Fax:( ) Minimum permit fee: $72.50 1A-56 CCB Lic.: fij 8'r Plumbing Lic.no.: -< 7.� g Plan review (25%of permit fee) 1 ' /0 State surcharge(12%of permit fee) t Authorized signature: -.(J� TOTAL PERMIT FEE Print name:Antonija Kriz ac This permit application expires if a �f�s 1 Date:2/27/2014 PP p' 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� I:\Building\Penuits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) -4- �'S^I 1705-. Xt) 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- 100' 50.03 0 to 2,000 51_1.90 Footing drain-each additional 100' 37,52 2,001 to 3,600 $169.69 Sewer-1st 100' 3,601 to 7,200 $233.20 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 S1.00 to 55,000.00 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 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", Plan Review for Plumbing Installations please indicate work performed by fixture. Failure to Plan review is required for any of the following. accurately report fixtures could result in increased sewer fees*. Please check all that apply. Quantity by(Fixture)Work Performed ❑ Any new commercial building with water service 2"and Fixture Type: Replace greater,except systems designed and stamped by licensed Previous Capped Added Existing engineer. Baptistry/Font Bath Tub/Shower ❑ New exterior plumbing site utilities for any complex structure -Tub/Shower i/weirlpool as defined in OAR918-780-0040. Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities. -Drive Thll ❑ Any multipurpose fire sprinkler system. Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918-780-0040. Dishwasher -Commercial Domestic Submit 2 sets of plans with any of the above. Drinking Fountain Eye Wash Isometric or Riser Diagram Floor Drain/sink 2" ❑ Isometric or riser diagram is required for new buildings that meet the qualifications above. Car Wash Drain Garbage -Domestic Disposal -Commercial -Industrial Comments regarding fixture work: Ice Mach./Refrig.Drains Adding one(1)new breakroom sink Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower -Gang -Stall Sink -Bar/Lavatory -Bradley -Commercial *Note: If the fixture work under this permit results in an -Service increase of sewer EDUs,a sewer permit will be issued and •Swimming Pool Filter Washer-Clothes fees assessed for the sewer increase must be paid before the Water Extractor plumbing permit can be issued. Water Closet-Toilet Urinal Other Fixtures: C:\Users\antonijak\Desktop\71379-Plumbing Application.doc 2