Permit CITY OF TIGARD PLUMBING PERMIT
1111
s COMMUNITY DEVELOPMENT Permit#: PLM2015-00039
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/09/2015
Parcel: 1 S 135AB01004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 400
Project: Maxim Healthcare Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Replace(1)sink and install new water heater.
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 Sink 02/09/2015 $25.02
Specifics: 1 ea Water Heater 02/09/2015 $37.52
1 12%State Surcharge- 02/09/2015 $8.70
Type of Use: COM Plumbing
Class of Work: ALT 10 ea Minimum Fee Adjustment- 02/09/2015 $9.96
Type of Const: Plumbing
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: 1
Call 503.639.4175 by 7:00 a.m.for the next available inspecti .
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
Building Fixtures G i0 FOR OFFICE USE ONLY
City of Tigard ,� v1v ` Received
Date/By: Q if ;.��J Permit No.: I LNx 5 {� rj(f
Mil I e 13125 SW Hall Blvd.,Tigard,OR 203 plan Review f" rr
Phone: 503.718.2439 Fax: 503.598.196 [Q Date/By: Other Permit No.:,61/ /s-CUE'S/g
Inspection Line: 503.639.4175 Y �PS0 ate Ready/By: saris: H See Page 2 for•TIGARD Internet: w\cw.tigard-or.gov �Qj
[�( Qf W,VI otified/Method: Supplemental Information
TYPE OF WORK-- ` " `VNGptylM FEE* SCHEDULE
4''i For special information use checklist
❑New construction ❑demolition
- 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
❑ 1-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑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: 10220 SW Greenburg Road 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.:400 Project name:Maxim 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:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Remove and reinstall one sink.One new water heater. -
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER l ® TENANT Expansion tank 12.51
Name:Shorenstein Realty Services L.P. Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 10220 SW Greenburg Road,Suite 310
Garbage disposal 25.02
City/State/ZIP:Portland,OR 97223 Hose bib 25.02
Phone:(503)619-3100 Fax:(503)619-3110 Ice maker 12.51
® APPLICAN f ® CONTACT PERSON Interceptor/grease trap 25.02
Business name:McKinstry Co Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Antonija Krizanac
Roof drain(commercial) 12.51
Address: 16790 NE Mason Street,Suite 100 Sink/basin/lavatory 1 25.02 7- 07^
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:antonijak @mckinstry.com Urinal 25.02
VW; 1, i 3 ., Water closet 25.02
,k
..m„ .. .��`� ��... .. , ._.��, Water heater 1 37.52 3"�.S�
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 '742.-5-0
CCB Lic.: 172811 Plumbing Lic.no.:37-22PB Plan review (25%of permit fee)
State surcharge(12%of permit fee) ?-70
Authorized signatur TOTAL PERMIT FEE S.(.a-C)
` This permit application expires if a permit is not obtained within 180 days
Print name: ��� ��- nw` Date: Q.IS` (7 after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Pennits\PLMU-PennitApp.doc 10/01/09 440-4616T(10/02/COM/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-1s'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
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.Performed: Capped Added Relocate g'
Baptista/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 ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" _ I Submit 2 sets of plans with any of the above.
-3,'
Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings-Domestic—non-food
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
Swimming Pool Filter
Washer-Clothes *Note: If the fixture work under this permit results in an
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\101345 Maxim Healthcare Ste 4002 Lincoln\001 Construction\Permits\PLMF-PermitApp.doc
Location:
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Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10220 SW GREENBURG RD 400, TIGARD, OR,
97223
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2015-00039
Chip Barnett
Violation Summary:
Inspector Contractor