Permit PLUMBING PERMIT
CITY OF TIGARD
COMMUNITY DEVELOPMENT Permit#: PLM2015-00352
TIGARD 13125 SW Hall Blvd,Tigard OR 97223 503 718 2439
Date Issued: 10/15/2015
Parcel: 1S135AB03400
Jurisdiction: TIGARD
Site address: 10260 SW GREENBURG RD 170
Project: Specht Development Subdivision: METZGER,TOWN OF Lot: 9
Project Description Replace existing break room sink and garbage disposal
Contractor: JAMES ROOD PLUMBING INC Owner LINCOLN CENTER LLC
125 S 1ST AVE#542 BY SHORENSTEIN PROPERTIES LLC
HILLSBORO, OR 97123 235 MONTGOMERY ST, 16TH FLOOR
SAN FRANCISCO, CA 94104
PHONE 503-547-0491 PHONE
FAX 503-547-0492
FEES
Quantity Description Date Amount
1 ea Garbage Disposal 10/15/2015 $25 02
Specifics: 1 ea Sink 10/15/2015 $25 02
1 12%State Surcharge- 10/15/2015 $8 70
Type of Use. COM - Plumbing
Class of Work- ALT 22 ea Minimum Fee Adjustment- 10/15/2015 $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 • -; _• enter Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090 You may obtain a copy of the rules
or. -ct questions to •► C by calling 503.232 1987 or 1 800 332 2344.
ssued By: / . • Permittee Signatu
IP
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 Applic
l�'1,
i it
Building Fixtures n 1,oit,61 ri(i usi oNLI t
l',--1,r1'., Received
ti I , City of Tigard T 14 2015 Date/By. to is/S / Permit No• ,G �/ .3
13125 SW Hall Blvd.,Tigard,OR 9 2 Plan Review
,� Phone. 503.718 2439 Fax. 50 `)6F TIGARD Date/By. Other PermitNo.:4 ap�/s-�Qt/
T l G ARp Inspection Line. 503 639 41 Date Ready/By Saris Ed See Page 2 for
Internet: www.tigard-or.gov VILDIIVG DIVISION Notified/Method. Supplemental Information
2. ` . t ,cz w t z , 2 ;'kc,ili. s x w -.,. d
❑New construction ❑Demolition For special information use checklist.
Description Qty. Ea. j Total
w." Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft for each utility connection)
$ ' !"A g Q y�'C� i`�ri 6 a t SFR(1)bath 312.70
u�` M•�'S. €.LTii��':KU���.�r.a�§ �2 tv t:". �`.. �S Y���� ���`
El 1-and 2-family dwelling Commercial/industrial SFR(2)bath 437 78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
1 Each additional bath/kitchen 25.02
❑Master builder ❑Other:
� � � t � �<� �- ,�; Fire sprinkler( sq.ft) Page 2
"e Oft` 1t& 'A i1 6., e s- s R Site utilities:
Job site address: Catch basin or area drain 18.76
)0 � .„ T Drywell,leach line,or trench drain 18 76
City/State/ZIP: l 06-1 Footing drain(no.linear ft.: ) Page 2
(Suit:bldg./apt.no.: d 70 Project name: Ij ♦!'v,!fCC.. 7-I Manufactured home utilities 50.03
Toss 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: l Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
- � ',�`: s Backwater valve 12.51
t,.� Clothes washer 25.02
*.. i „ v I tY .11tL-k I, Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
.w. ffi'Am a, .P 11 �. 12 b Aa' 4 # ( &-� +^N "'4 J C "
- ;, i 04 ar ti Expansion tank 12.51
%>. 'ta £1p; �. ,.,,,�''?P ,, '40 t-, i,,>lt& �� At. '. .464,:.„(,?; P
Name:
Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 3 25.02 d5'-l3 ..
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
let, ' 4, '•,�� '1 ` IN ft"<' ` v �4 Interceptor/grease tra 25.02
4A4 `/A ',*"I iAMF kt: * +fie'l Ig*,ts:3't, fl1 'r '' ' .� trap
Business name:
Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address• Sink/basin/lavatory 25.02 C) ,
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12 51
E-mail. Urinal 25.02
kn ��ist4' r, ¢g a ,!4,'y ry4ry,�•� ,., AZ, k :i,,,,,,,:€.,,,,„ Water closet 25.02
;Pat drat 1v" $�"r 8'Y r1 7t c" , .x ASS 1e.
x„ -a.n t, !+ .r _ .aa ,r .�^ ;:, ��. Water heater 37.52
Business name: /+ -4 H.tot . ¢,` .', 1 E,� "l, y, Waterpiping/DWV 56.29
Address: i� ' .5".. is et, * suie �' Other: 25.02
City/State/ZIP: /tab 1 m pti to, Subtotal
Phone:(503) ' 0 V ! 4" Fax:(T0 ,) y`/ .„.0'+ ' Minimum permit fee: $72.50 tree) 7,2_5-0
! Plan review (25%of permit fee) ----------
CCB Lie.: /,9,,,,0/ Plumbing Lic.no.: cep State surcharge(12%of permit fee) g
Authorized signature: TOTAL PERMIT FEE • a"()Aim
Print name: � '� ,' Date: This permit application expires if a permit is not obtained within 180 days
t ^� ��' after it has been accepted as complete.
*Fee methodology set by Tn-County Building Industry Service Board
I\Ruildtng\i'armits\PLMU-PermsApp dac 10/01/09 440-4616T(I0/02/COM/WEt)
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: N e t Residential Fire Sul ression S stems:
+
; ltX o tkkaF'Yg 44.0 t; { ia' (�t7 g g e ,VtP k� g:-ryo'l jSi;A' _ ;•> g 1M . >f,§ � ' 1 'O tF`
Footing drain- 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 t,1;', ,°sip {:�" ,f • ° . tleA;lt;V a; 3,.,�y r� -' �i ,
r',1Vaa..:ac: OX1 d%a� i'' 1�� 1. '_•' 8,
Storm&Rain Drain-1st 100' 62.54 $1.00 to S5,000.00 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
..•i s • " .•''r• " ¢`a r iotal.',� each additional$100.00 or fraction thereof,to•
:t r e ES')'«, •q.. r ;,Aft , `.a�q 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$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*.
WANaa- H" '*`.;t, ,,w r ' e,;:43krRF:.E�s'+itze'Fentiv`•�'•'s�Ygeiah'+d.. x Yy, �+d•,�-"» i'9
t °r. yz. � , ,_, c2aaiifi"ty by l izlnr"4T}pe °' ivri n Re.V �+' - t�um.1iYnPUTSWI,..: ;-0-$.
1+�,X,}�U°t,'t0 t� ��fO; AMU,�T ra»r. rme;«r�.ay�u:a Mfg uu'. review a�•x ng. a`„q
,t,'N'4VAilli#pet f<ail d,;L; .. ," � . ` 1P t4i���, ,;o r BZxel 11t Plan review is required for any of the following.
Please check all that apply.
Baptistry/Font
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" Submit 2 sets of plans with any of the above.
-3"
.•r icg,TS,Y `G ALS,C,,r cc g ' "r Y'�}a
Car Wash Drain
Garbage Domestic{ion-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 regardin fixture work,.
Rec.Vehicle Dump Station Rc p,�p c`,_ 15 �, ,lC
Shower -Gang r" °`im t / e").pr-Stall ,p�j ry '()kw^ E �._ e=." v"'r e
Sink/Lav -Non-food related
-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.
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