Permit (12) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2017-00017
Date Issued: 02/16/2017
T t C;p R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 1S 135AB04500
Jurisdiction: Tigard
Site address: 10250 SW GREENBURG RD-115
Project: Reflex Subdivision: 1991-055 PARTITION PLAT Lot: 1
Project Description: Adding(1)break room sink,(1)mop sink,(1)clothes washer&(1)water supply for ice maker. Replace(1)
dishwasher. Cap(2)sinks.
Contractor: RAYBORN'S PLUMBING INC Owner: LINCOLN CENTER LLC
PO BOX 69 BY SHORENSTEIN PROPERTIES LLC
19990 SW CIPOLE RD 555 CALIFORNIA ST 49TH FL
TUALATIN, OR 97062 SAN FRANCISCO, CA 94104
PHONE: 503-692-4139 PHONE:
FAX: 503-691-2328
FEES
Quantity Description Date Amount
1 ea Clothes Washer 02/16/2017 $25.02
Specifics: 1 ea Dishwasher 02/16/2017 $25.02
1 ea Ice Maker 02/16/2017 $12.51
Type of Use: COM 2 ea Sink 02/16/2017 $50.04
Class of Work: ALT 1 12%State Surcharge- 02/16/2017 $13.51
Type of Const: Plumbing
Occupancy Grp: 2 ea Fixture/Sewer Cap 02/16/2017 $50.04
Stories: 0 12%State Surcharge- 02/16/2017 $6.01
Plumbing
Total $182.15
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 dir-• •uestions • *UNC by calling 503.232.1987 or 1.800.332.2344.
I sued By: / Permittee 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
Building Fixtures ... ° Pt)lt ul l l( F 1 �i OvI \
Cityof Tigard 7 1 Received
g � `.U Date/Sy: /• /9 / 7 UVJ Pennit No.: PLMa�D/f��l7
13125 SW Hall Blvd.,Tigard,OR 9722. Pian Review
] 0 - Other Permit No.:
Phone: 503.718.2439 Fax: 503.598. ,,--,,A Date/By: o�ta).Qo?O/7 Lb0 3/
u ,.
Inspection Line: 503 639.4175 ,\t ;,„) s ;4 � • Date Ready/By �/2// ��/� .mss' ® See Page 2 for
Internet: www.tigard-or.gov C i r;,,1--.' Notificd/Method I! ( 7 l Sup kmeatal information
_ • . .. = . - oma. i C .A* _ _.... •, .._ t-^ _
❑New construction 0 Demolition For special information use chec4lisl.
Description 1 Qty. j Ea. ( Total
Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
Ar z.. r i ta p M SFR(1)bath 312.70
❑ 1-and 2-family dwelling Commercial/industrialSFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family Each additional bath/kitchen 25.02 'i
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 I
. ,,a,o' ti* i
.`� . t ':1; ,t jr_i ,... ,4„,.5 �: Site utilities:
i a.,• .�.: ....•w.E�siPS �x'!n,
Job site address: + Catch basin or area drain 18.76
ID Z?2 SO (pile e 20 a& Rep Drywell,leach line,or trench drain 18.76 CP
City/State/ZIP: -rut tr A a o t)aR. R}3.2 3 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: 116- I Project name: 1 j� -,)/ Manufactured home utilities 50.03 O
Cross street/directions to job site: Manholes 18.76
((
'f Li el t a Gil Sq..?I}-e-- 5.-
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
,'3 Backwater valve 12.51
.F .. • DE3C t O 1Q es ,;- _•, 'z r ... " _ 1 25.02 t5-.12_
AClothes washer
OD i SistlKl / /i'f,il ei.ki f W %
,% sect .e ...gay" / Dishwasher l 25.02 Zj O^z
i t e otno/Mrr „/e f-v /, •+t. - (e(,c4-4,/re)e i 7{>3?^F d Qb) Drinking fountain 25.02
(te++,i 2- Si,"k S r/ Ejectors/sump 25.02
i'i op itv ow IER t --...,,,It a t Expansion tank 12.51
Name: Fixture/sewer cap 'L 25.02 So
tlf
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker ( 12.51 ('ZS i(
0 APPLICANT 0 CONTAC' RSON Interceptor/grease trap 25.02
Business name: Medical gas(value:S ) Page 2
(Z,4'tr3. uA. -i P(Jd^a#0,4 G Primer 12.51
Contact name: t4,4 t S 4.0 wiz;At yy,)
Roof drain(commercial) 12.51 0,oc)/
Address: (g tia , s..,) c,'f o t_c. (2 ci Sink/basin/lavatory J).-- 25.02 -7.-c--12*--
City/State/ZIP: '1-u a(4.4;„ (;)(1 k' 0 to 2 Solar units(potable water) 62.54
Phone:(5-6S/ ()ff l 3? r
Fax::('j' )4p9 I -z 3 2 $ Tub/shower/shower pan 12.51
_Urinal 25.02
E-mail:
{(A4 5O ten'r 13gtn13,+ca.+n ,/ATT at..N(3 v(„/s .•d.•-. Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:
y aoR.�t J Qt u.hls tn,(. Water piping/DWV 56.29
Address: (G qq v ,5 c.i PO t`G (t.....0 Other: 25.02 ��, i;
City/State/ZIP: c Jrl,..."/IA) Diz I"76 Subtotal p *- /(D�j+/°.3
Phone:(5'03 ) (.,.gt„
G 2 -t{ 3 Cl Fax:(re.3 ) (Gs t - 2,??8 - Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.: t3 lei-L Plumbing Lic.no.:,fit.(-i(t 4 Pa
State State surcharge(12%of permit fee)
Authorized signature: �7
gn t TOTAL PERMIT FEE
Dale: t This permit application expires if a permit is not obtained within 180 days ��11 y�
Print name: ,{�
h� S 4 cdo pro,-) 41(b)t 7 after it has been accepted as complete. l pC'
*Fee methodology set by Tri-County Building Industry Service Board.
I:1,10,td,ngTermIts+PLMU•PermirApp.diu 10 0109 440-4616T(10'027 COM WEB)
Plumbing Permit Application - City of Tigatd
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression S stems:
Ase r, i,; .-,,t. ..;-...t x, ,:'n,,rte-* a,,` a ... 4 til r r 4144,1,4. ..
Footing drain-1"100' 50.03 0 to 2,000 $121.90
2,001 to 3,600 5169.69
Footing drain-each additional 100' 37.52 3,601 to 7,200 $23320
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-tach additional 100' 37.52 i y�r . f .
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
each additional$100.00 or fraction thereof,to
: lr ` c r !'-'71111.-,..1 -
5� 1 " tlKy„;1. _ C3)4( ,�. 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.
$50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
Additional plan review for revisions 90.00/hr each additional$100.00 or fraction thereof.
(minimum charge-1/2 hour)
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*. a.... :,
Quantity by Fixture Type„- _ j, , eylew fOr-flint .Installat
• tiop� s
Fixture Type fora Plan review is required for any of the following.
Capped Added' ,,.ne{ieale..
Work Performed: Please check all that apply.
Baptistry/Font 0 Any new commercial building with water service 2"and
Bath -Tub/Shower greater,except systems designed and stamped by licensed
-Jacuzzi/Whirlpool engineer.
Car Wash -Each Stall ❑ New exterior plumbing site utilities for any complex structure
-Drive or as defined in OAR918-780-0040.
Di
Cuspidor/Water Coirator
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic 1 0 Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040.
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain sink -2"
-3"
4 Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food that meet the qualifications above.
Disposal -Domestic-food related
-Commercial-food related
-Industrial-food related /
Ice Mach./Refrig.Drains >�/
Oil Separator(Gas Station) Comments regarding fixture work:
�p�
Rec.Vehicle Dump Station � T1'1/4�-L- �� -.0 wit 0-A_ - V
Shower -Gang ,,yv ..� �[lAu-at-litrii�2D V•/�-,e� So
-Stall Co uul i/ i,,,44) rr 1 111 e. ..ite
Sink/Lav -Non-food related 2. i 0
-Bradley IAA vtA d-
-Commercial-food related ,
-Service t
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes 1 increase of sewer EDUs,a sewer permit will be issued and
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet-Toilet
Urinal plumbing permit can be issued.
Other Fixtures:
C:\Users\Hans\Downloads\PLMF_PermitApp.doc 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10250 SW GREENBURG RD 115, TIGARD, OR,
97223
Record Type: Record ID:
Commercial - Plumbing PLM2017-00017
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor