Permit CITY OF TIGARD PLUMBING PERMIT
Ir . COMMUNITY DEVELOPMENT Permit#: PLM2015-00308•
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/16/2015
TIGARD Parcel: 1 S135AB03400
Jurisdiction: TIGARD
Site address: 10260 SW GREENBURG RD
Project: Lincoln Tower Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Replacement of existing bathroom fixtures on 2nd,9th and 12th floors: (12)lays,(6)urinals and(15)water closets.
Contractor: RAYBORN'S PLUMBING INC Owner: LINCOLN CENTER LLC
PO BOX 69 BY SHORENSTEIN PROPERTIES LLC
19990 SW CIPOLE RD 235 MONTGOMERY ST, 16TH FLOOR
TUALATIN, OR 97062 SAN FRANCISCO, CA 94104
PHONE: 503-692-4139 PHONE:
FAX: 503-691-2328
FEES
Quantity Description Date Amount
12 ea Lavatories 09/16/2015 $300.24
Specifics: 6 ea Urinal 09/16/2015 $150.12
15 ea Water Closet 09/16/2015 $375.30
Type of Use: COM 1 12%State Surcharge- 09/16/2015 $99.08
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $924.74
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 ma obtain a copy of the rules
or direct questions to OUN by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: I
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.
Plumbin Permit A licatio CEIVEP
FOR OFFICE I SF. (>\Ll
Building Fixtures SEP 16 2015 Received 9,i' , PermitNo, ,�i Dv3•�
City of Tigard Date/By:
13125 SW Hall Blvd.,Tigard,OR 97223 1/ A u,r Plan Review Other Permit No.:
'!'j�'C1
OF ['WAKE) Date/B
i Phone: 503.639.4171 Fax: 503.5 fur s: it See Page 2 for
BUILDING DIVISION Date Ready/By: Supplemental Information
Inspection Line: 503.639.4175 Notified/Method:
T I G A K D Internet: www.tigard-or.gov FEE* SCHEDULE
TYPE OF WORK For s,ecial in ormation use checklist.
Total 10111 Ea.
❑New construction
❑Demolition Descri.tion
Other: New I-2-family dwellings(includes 100 each utility connection)
T. Addition/alteration/replacement ❑ SFR(1)bath 312.70 MI
CATEGORY OF CONSTRUCTION SFR(2)bath _ 437.78
CommerciaUindustrial SFR(3)bath 500.32
❑ 1-and 2-family dwelling
❑Multi-family Each additional bath/kitchen
25.02
❑Accessory building
❑Master builder Page 2
❑Other: Fire sprinkler( sq•ft•)
JOB SITE INFORMATION AND LOCATION 18.76
Catch basin or area drain _
i 18.76
Job site address: /, Q A ��_ /I i' Drywell,leach line,or trench drain _
O ' '3 Page 2
Footing drain(no.linear ft.: )
' :�. ■ 50.03 Project name: Manufactured home utilities
Suite/bldg./apt.no.:■ j
Cross street/directions to job site: 18.76
Manholes
18.76
Rain drain connector��i' 4 u G • I- . Sanitary sewer(no.linear ft.:_)
Page 2
Storm sewer(no.linear ft.:_) _
Page 2
Water service(no.linear ft.:_)
Page 2 -
Lot no.: Fixture or item: 31.27
Subdivision: Backtlow preventer
LS 77/J&` �l ?, 12.51
Tax map/parcel no.: �C • Backwater valve
DESCRIPTION OF WORK s,/• 25.02
LL .4 Clothes washer
U r I 25.02 Mill
/,� f Dishwasher _
Drinking fountain 25.02 -
.. _
25.02
�� Ejectors/sump _
� • ,` , � I � �_, � 12.51 0 TENANT Expansion tank _
PROPERTY OWNER 25.02 -
Fixture/sewer cap 25.02 -
' i , r � ! -'��v MIN drain/floor sink/hub 25.02 111111111 Address: s' Garbage disposal
25.02
Hose bib IIIIIIIIIIII
12.51 -
Phone:( ) 25.51 E
Interceptor/grease trap
❑ CONTACT PERSON Page 2 -
I. � �. Medical gas(value:$ )
12.51 -
�� �' ' 12.51 -
Contact name: Roof drain(commercial)
�- 25.02 -orM Sink/basi lavato
City/State/ZIP:/Sta ' / O ' e6� Solar units(potable water) 62.54 City/State/ZIP: Tub/shower/shower pan IIIII
Mill. 25.02
Phone: ''p ) �,' 25.02
_'1 '4 ---- • Water closet
37.52
CONTRACTOR 56.29
CESSWIP
I. 1111 Water piping/DWV IIIIIII AV, Other. 25.02 .
Address:/in('0 S • >> Subtotal
0 1y - Minimum permit fee: $72.50 tal
i Fax:($l)3) 641 ��J°"' Plan review (25%of permit fee)
Phone:(;S ) ��-- 66 ` State surcharge(12%of permit fee) ",O,
_.�lumbing L. .no.: 3 1(-
CCB Lic.: ��g5� TOTAL PERMIT FEE r i'
Authorized signature: /" This permit application expires if a permit is not obtained within 180 days
�/ Date- i after it has been a cepted as complete.
,�
/ .� / *Fee methodology set by Tri-County Building Industry Service Board.
440-4616T(10/02/COMI WEB)
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V Building\Pennits\PLMU-PermitApp.doc 10/01/09