Permit 11111 CITY OF TIGARD PLUMBING PERMIT
I COMMUNITY DEVELOPMENT Permit#: PLM2015-00118
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/23/2015
Parcel: 1 S 135AB00900
Jurisdiction: Tigard
Site address: 10200 SW GREENBURG RD 400
Project: Bridgewell Resources Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Interior plumbing:Capping(1)sink,relocating(1)dishwasher,and adding(2)sinks.
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 04/23/2015 $25.02
Specifics:. 1 ea Fixture/Sewer Cap 04/23/2015 $25.02
2 ea Sink 04/23/2015 $50.04
Type of Use: COM 1 12%State Surcharge- 04/23/2015 $12.01
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $112.09
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 1.800.3322144.
Issued By: Permittee Signature: dr
AvormaAllf
4.5
Call 503.639.4175 by 7:00 a.m.for the next available inspe tion date.
This permit card shall be kept in a conspicuous place on the job site until • •letion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application 135-4606• c 14-u e;(51 -- ,�
Building Fixtures �® FOR OFFICE I SE O\1.1
City of Tigard G C�1 V Received `� , ,lib
7 Date/By: "! X11 PermitNo.: a�rS _ }
III 13125 SW Hall Blvd.,Tigard,OR 97
m Plan Review
Phone: 503.718.2439 Fax: 503.598. 960 q .3 201`
Date/By: Other Permit No.:(3(4p d t y K °
Inspection Line: 503.639.4175 y / ry "~V"
T I G A R D A?R Date Ready/By: luris H See Page 2 for
Internet. www.tigard-or.glly �, I�� tified/Method Supplemental Information
•(. ' TYPE OF WORK CA 1 �a1 „a ,,, , , v 6y t 4
❑New construction ❑ n _ 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
❑ 1-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
building SFR(3)bath 500.32
❑Accesso ry 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:10200 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 I Project name:Bridgewel1,4ei14410_ Le��r ze3 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
`1.y a Y 'I, :;DESC1tIIinoN OF WORK z� , °' Backwater valve 12.51
"AA'''' '', < ` " 41.1, Clothes washer 25.02
Demo 1 sink,add 2 new sinks and relocate dishwasher. Dishwasher % 25.02 as 7l
.
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Fixture/sewer cap / 25.02 Name:Shorenstein Realty Services,
g.-S'f h
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 ( ) Ice maker 12.51
*` �d a 0 ,+® 0 14-6'k 1 : 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 2 25.02 .0 H
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:antonijakvmckinstry.com Urinal 25.02
CONTRACTOR Water closet 25.02
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 Jthj a
Phone:(503)331-0234 Fax:(503)331-6906 Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lie.: 172811 Plumbing Lic.no.:37-22PB
State surcharge(12%of permit fee) 1 .. 0 j
Authorized signa I --------- - TOTAL PERMIT FE I 1/ a i
Print name: P -1--o t�� Z Cs_c-- Date: Hi Z 0 S 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.
I:'BuildingWermits\PLMU-PermitApp.doe 10/01/09 440-4616T(10/02/COM/WEB)
.::- 7 11 q-7,--.O.9- )
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-1' 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
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
Fixture Type for Replace/ - ummg "
Work Performed Capped Added Relocate Plan review is required for any of the following.
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 ❑ 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 1 2
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes
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\102421 Bridgewell Suite 400,5 Lii oln\001 Mechanical Construction\Permits\PLMF-PermitApp.doc
Accumulative Sewer Tally
11 i-.7 Tenant Name: BRIDGEWELL RESOURCES SWR# 2015-00041
■
1 tG t> Site Address: 10200 SW GREENBURG RD SUITE 400 PLM# 2015-00118
Parcel#: 1S135AB00900
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 U
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 U
-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 U
-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 0
Rec.Vehicle Dump station 16 0 0 0 0 U
Shower. -Gang(per head) 1 0 0 0 0 0
-Stall 2 0 0 0 0 0
Sink:
-Lav/Bar-Non-Food Related 2 U 1 2 2 _ 4 1 2
-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 U 0 0 0 0
Water Extractor 6 U 0 0 0 0
Water Closet-Toilet 6 0 0 0 0 0
Urinal 6 0 0 0 0 U
Previous EDU Count 0 U
Capped EDU Credit U
TOTALS 0 U 1 2 2 4 1 2
Current Fixture Value 2 divided by 16= 0.125 Current EDU 1 EDU = S4,9UU.UU
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 2 divided by 16= 0.125 over (under) $ 637.00
Enter EDU Change Here 0.130
Notes:
Authorized Name/Signature: BRANDEN TAGGART X2449 Date: 4/23/2015
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:\Building\Sewer Tally\Sewer I allySheet_4900._070114.xlsx
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10200 SW GREENBURG RD 400, TIGARD, OR,
97223
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2015-00118
George Heimos
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10200 SW GREENBURG RD 400, TIGARD, OR,
97223
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2015-00118
Chip Barnett
Violation Summary:
Inspector Contractor