Permit CITY OF TIGARD PLUMBING PERMIT
114
t COMMUNITY DEVELOPMENT Permit#: PLM2015-00338
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/07/2015
Parcel: 1S 135AB03400
Jurisdiction: Tigard
Site address: 10260 SW GREENBURG RD 710
Project: Axiom Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Interior plumbing:Capping(2)sinks,(2)dishwashers,and(2)water heaters; Installing(1)sink, (2)dishwashers,
and(1)water heater;Replacing(4)lavatories,(5)toilets,and(2)urinals.
Contractor: MCKINSTRY COMPANY LLC Owner: LINCOLN CENTER LLC
16790 NE MASON ST., STE. 100 BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97230 235 MONTGOMERY ST, 16TH FLOOR
SAN FRANCISCO, CA 94104
PHONE 503-331-0234 PHONE:
FAX: 503-331-6907
FEES
Quantity Description Date Amount
2 ea Dishwasher 10/07/2015 $50.04
Specifics: 4 ea Fixture/Sewer Cap 10/07/2015 $100.08
5 ea Sink 10/07/2015 $125.10
Type of Use: COM 2 ea Urinal 10/07/2015 $50.04
Class of Work: ALT 5 ea Water Closet 10/07/2015 $125.10
Type of Const: 1 ea Water Heater 10/07/2015 $37.52
Occupancy Grp: 1 12%State Surcharge- 10/07/2015 $58.55
Stories: Plumbing
Total $546.43
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 -'.2341.
Issued By: •• mittee 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.
Plumbing Permit Application
ISI3 ,a • vo
Building Fixtures FOR OFFICE USE ONLY
City of Tigard Received Permit No.: /311 : �� 13125 SW Hall Blvd.,Tigard,OR 97223 c-VANIA) DateBy: `/ v,�� 5'-' I
. Phone: 503.718.2439 Fax: 503.598.1968 Plan Review
Date/By: Other Permit No.:
TIGARD Inspection Line: 503.639.4175 1 ?��� Date ReadyBy luris See Page 2 for
Internet: www.tigard-or.gos 6-c .titied/Method: 77-c Supplemental Information
k:favie, TYPE OF WORK ,iii aks FEE* SCHEDULE
❑New construction ❑Demoli l , 1NliSt For special information use checklist
Description I Qty. I Ea. I Total
®Addition/alteration/replacement ❑Other0 New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION ` u � sA SFR(1)bath 312.70
❑ I-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
= *N JOB SITE INFORM:ITION AND LOCATION Site utilities:
Job site address: 10260 SW Greenburg Road Catch basin or area drain 18.76
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.:710 1 Project name:Axiom Suite 710,Lincoln 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
Backwater valve 12.51
�
`�� DESCRIPTION OF WORK , > k
Clothes washer 25.02
Demo(2)sinks,(2)dishwashers and(2)water heaters
Dishwasher 25.02 5-0.0/
og Install(1)sink,(2)dishwashers and(1)water heater Drinking fountain 25.02
Remove and replace all bathroom fixtures,4 lavatories,S toilets and 2 urinals Ejectors/sump 25.02
El PROPERTY OWNER ® TENANT Expansion tank 12.51
Name:Axiom Fixture/sewer cap 25.02 /w,
Floor drain/floor sink/hub 25.02
Address:same
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
® APPLICANT ® CONTACT PERSON Interceptor/grease trap 25.02
Business name:McKinstry Co Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Tria Day -
- Roof drain(commercial) 12.51
Address: 16790 NE Mason Street,Suite 100 Sink/basin/lavatory 5 25.02 125.10
City/State/ZIP:Portland,OR 97230 Solar units(potable water) 62.54
Phone:(503)278.3917 Fax::( ) Tub/shower/shower pan 12.51
E-mail:triad @mckinstry.com Urinal 2 25.02 50.04
Water closet S 25.02 J J5 1 p
CONTRACTOR
Water heater 1 37.52 37.52
Business name:McKinstry Co. Water piping/DWV 56.29
Address:same ,-9Elsee:-Toilet
City/State/ZIP: Subtotal ' '7,b a
Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCB Lic.:172811 Plumbing Lic.no.:37-22PB Plan review (25%of permit fee)
State surcharge(12%of permit fee) 5-5
Authorized signature: / /5(70 TOTAL PERMIT FE L/1,-K
Print name:Tria Day Date:10/6/15 This permit application expires if a permit is not obtained thin 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doe 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:
i Utilitte ` Qty. Fee tea) 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 $ uaLlon- i f f W ; 0@� n
Storm&Rain Drain-1st 100' 62.54 Ll
$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
'or Qty- Fee lam) 'dtal - each additional$100.00 or fraction thereof,to
'(?terrip >>5tahsee " 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:
Other Fixtures: I
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/
Work performed Capped Added Relocate Re 14000i.Ptt ll nbmg Installations
Baptistry/Font Plan review is required for any of the following.
Bath Tub/Shower Please check all that apply.
Jacuzzi/Whirlpool ❑ Any new commercial building with water service 2"and
Car Wash -Each Stall greater,except systems designed and stamped by licensed
-Drive Thru engineer.
Cuspidor/Water Aspirator ❑ New exterior plumbing site utilities for any complex structure
Dishwasher -Commercial as defined in OAR918-780-0040.
-Domestic 2 2 ❑ Medical gas and vacuum systems for health care facilities.
Drinking Fountain ❑ Any multipurpose fire sprinkler system.
Eye Wash _ ❑ Any complex structure as defined in OAR918-780-0040.
Floor Drain/sink -2"
3" Submit 2 sets of plans with any of the above.
-4"
Car Wash Drain =. .mI` E
Garbage IsCiett�GOR>tser;Dragra
arbage -Domestic-non-food lln
Disposal -Domestic-food related ❑ Isometric or riser diagram is required for new buildings
-Commercial-food related that meet the qualifications above.
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station)
Rec.Vehicle Dump Station Comments regarding fixture work:
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter
Washer-Clothes
Water Extractor *Note: If the fixture work under this permit results in an
Water Closet-Toilet increase of sewer EDUs,a sewer permit will be issued and
Urinal 2 fees assessed for the sewer increase must be paid before the
W:\Projects\N-R\Russell Construction\104385 Axiom Suite 710,Lincoln' ower\001 Mechanical Construction\Permits\Plumbing\PLMF-
PermitApp.doc
Accumulative Sewer Tally
N
Tenant Name: AXIOM SWR# N/A
TtG A R 13 Site Address: 10260 SW GREENBURG RD SUITE 710 PLM# 2015-00338
Parcel#: 1S135AB03400
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s value count added# added value i )tal#s total values
Baptistry/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
:ye Wash 1 0 0 0 0 0
Hoot Drain/Sink: -2 inch 2 0 0 0 0 0
-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 Disposal:
-Domestic(to 3/4 I IP) 16 0 2 32 2 32 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:
-Lav/Bar-Non-Food Related 2 0 2 4 1 2 -1 -2
-Bradley 5 0 0 0 0 0
-Com/Scry/Util-Food Related 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 O
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 4 36 3 34 -1 -2
Current Fixture Value -2 divided by 16= -0.125 Current EDU 1 EDU= $5,100.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -2 divided by 16= -0.125 over (under) $ (663.00)
Enter EDU Change Here -0.130 *
*Round EDUs to the nearest 1/100th: a count ending in.005 shall be rounded up to.01,and a count ending in.014 or less shall be rounded down to.01.
Notes: ***CREDIT***
Authorized Name/Signature: BRANDEN TAGGART X2449 Date: 10/7/2015
Building Division
Note: The property owner shall retain the ORIGINAI.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 rallyShcet_5100_070115.xlsx