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Permit u CITY OF TIGARD PLUMBING PERMIT ' COMMUNITY DEVELOPMENT Permit#: PLM2015-00002 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/06/2015 Parcel: 1 S135AB00900 Jurisdiction: Tigard Site address: 10200 SW GREENBURG RD 450 Project: Pollmeier Subdivision: METZGER,TOWN OF Lot: 9 Project Description: Capping(1)sink&(1)dishwasher. Being relocated to suite 740. Credits from these capped fixtures applied to PLM2015-00003. 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 Dishwasher 01/06/2015 $25.02 Specifics: 1 ea Sink 01/06/2015 $25.02 1 12%State Surcharge- 01/06/2015 $8.70 Type of Use: COM Plumbing Class of Work: ALT 22 ea Minimum Fee Adjustment- 01/06/2015 $22.46 Plumbing 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 questi OUNC by clling 503.232.1987 or 1.800.332.2344. Issued (2c,,,qt_eit.41L Pe rmittee Signature: Call 503.639.4175 by 7:00 a.m.for the next available inspectio This permit card shall be kept in a conspicuous place on the job site until completion of the projec. Approved plans are required on the job site at the time of each inspection. Plumbing Permit Application t Fi Building Fixtures b RECEINV FOR 011.ICE l Sl: ON1.1 City of Tigard Received ©�� �J Date,By: r Permit No.: OLWe94/5^0UDOA. • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review a Phone: 503.718.2439 Fax: 59.Ipr.1966 2015 Date/By: Other Permit No.: Inspection Line: 503.639.4175 HH _ TIGARD Date Ready/By: luris: H See Page 2 for Internet: www.tigard-or.govt` Notified/Method: ��(� l �, Supplemental Information TYPE .O2 tfi^0[2ICN� `���t(\� FEE* SCHEDULE ❑New construction ti111L ]Demoiltion Ill For special information use checklist Description [ 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 ® m Comercial/industrial SFR(2)bath 437.78 ❑Accessory building ❑Multi-family SFR(3)bath 500.32 Each additional bath/kitchen 25.02 ❑ Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFOR%LATION AND LOCATION Site utilities: Job site address: 10200 SW Greenburg Road Catch basin or area drain 13.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP:Tigard,OR 97223 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.:-.70450 I Project name: Patti ft EA-- 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 Cap and remove 1 sink and 1 dishwasher from suite 45and reinstall in suite 740 } Dishwasher 1 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name:Shorenstein Properties I.LC Fixture/sewer cap 25.02 - Floor drain/floor sink/hub 25.02 Address:235 Montgomery Street,16th Floor Garbage disposal 25.02 City/State/ZIP:San Francisco,CA 94104 Hose bib 25.02 Phone:(415)772-7000 Fax:( ) Ice maker 12.51 ® APPLICANT ® CONTACT PERSON Interceptor/grease trap 25.02 Business name:McKinstry Co Medical gas(value:$ ) 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 City/State/ZIP:Portland,OR 97230 Solar units(potable water) 62.54 Phone:(503)331-0234 Fax::(503)331-6906 Tub/shower/shower pan 12.51 E-mail:antonijakamckinstry.com Urinal 25.02 Water closet 25.02 CONTRACTOR Water heater 37.52 Business name:McKinstry Co. Water piping/DWV 56.29 Address: 16790 NE Mason Street,Suite 100 Other: 25.02 City/State/ZIP:Portland,OR 97230 Subtotal Phone:(503)331-0234 Fax:(503)331-6906 Minimum permit fee: $72.50 7a.50 CCB Lie.: 172811 Plumbing Lic.no.:37-22PB Plan review (25%of permit fee) - State surcharge(12%of permit fee) q.)U Authorized signature: vv/ go, TOTAL PERMIT FEE IR,aD • Prin[name:Antonija Rrizanae Date: l l I I 1_9 I (C J 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. 1:1Building\Permits\PLMU-PermitApp doe 10/01/09 440-4616T(10/02JCOM/WEB) 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- I' 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 _ $32754 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 Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to Other Inspections or Fees 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 accurately report fixtures could result in increased sewer fees*. Quantity by Fixture Type Plan Review for Plumbing Installations Fixture Type for Replace/ Plan review is required for any of the following. Work Performed: Capped Added Relocate q Y Baptistry/Font Please check all that apply. Bath Tub/Shower ❑ 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 Thru ❑ 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 1 ❑ Any multipurpose fire sprinkler system. Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040. Eye Wash Floor Drain/sink -2" Submit 2 sets of plans with any of the above. -3" Isometric or Riser Diagram Car Wash Drain Garbage Domestic-non-food ❑ Isometric or riser diagram is required for new buildings Disposal -Domestic-food related that meet the qualifications above. -Commercial-food related -Industrial-food related Ice Mach./Refrig.Drains Oil Separator(Gas Station) Comments regarding fixture work: Rec.Vehicle Dump Station Shower -Gang -Stall Sink/Lav -Non-food related -Bradley -Commercial-food related -Service 1 Swimming Pool Filter *Note: If the fixture work under this permit results in an Washer-Clothes P water 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: W:\Projects'N-R\Russell Construction\100984 Pollmeier Ste 740 5 Lincol2\001 Construction\Permits\PLMF-PermitApp.doc Accumulative Sewer Tally lig tenant Name: Pullimcier SWR# N/.1 Site.\ddress: 10200 S\V(Greenburg Rd#450 PLM# 2015-00002 Parcel#: 1S 1 35AB00900 Fixture A:dill Pr..v Ious Previou, t:redits (:upped I:ixturc Fixture New New .. value cot HIT .ipped#5 . due count added# added value total#s i tal values Baptisers/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: -I?ach Stall 6 0 0 0 0 0 -Drive through 16 0 0 0 0 0 Cuspidor/Water.1spirator 1 0 0 0 0 Il Dishwasher: -Commercial 4 0 0 0 0 11 -Domestic 2 0 1 2 0 -1 -2 Drinking Fountain I 0 0 0 0 11 l Ive Wash I 0 0 0 0 Il Floor Drain/Sink: -2 inch 2 0 0 0 0 Il -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 I)isposal: -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 Living Unit 16 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/B:+r-Non-Food Related 2 0 1 2 0 -1 -2 -Bradley 5 0 0 0 0 0 -Com/Sere/Util-Food Related 3 0 0 0 0 0 Swimming Pool Filter I 0 0 0 0 0 Washer-Clothes 6 0 0 0 0 0 Water Extractor 6 0 0 0 0 0 Water(loser-Toilet 6 0 0 0 0 0 Urinal 6 0 0 0 0 0 Previous EDU Count 0 0 Gapped EDU Crccln 0 TOTALS 0 0 2 4 0 0 -2 -4 Current Fixture Value -4 divided by 16= -0250 Current IiDU 1 EDU= $4,900.00 Previous Fixture Value 0 divided by 16= 0.000 Previous IiDU Change -4 divided by 16= -0.250 over (under) S (1,225.00) Enter EDU Change Here -0.250 Notes: ,.*CREDITS*"" Authorized Name/Signature: Debbie Adamski Date: 1/6/2015 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:ABuilding\Sewer'rally\Scwet f allySheet_491 N.1._1170114.xlss