Permit (180) CITY OF TIGARD PLUMBING PERMIT
'. COMMUNITY DEVELOPMENT Permit#: PLM2018-00390
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/14/2018
T f C,��Tt.1 t 9 Parcel: 1 S 135AB01003
Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD 195
Project: Body Balance Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Install water cooler.
Contractor: POWER PLUMBING CO Owner: LINCOLN CENTER LLC
PO BOX 19418 BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97280 235 MONTGOMERY ST, 16TH FLOOR
SAN FRANCISCO,CA 94104
PHONE: 503-244-1900 PHONE:
FAX: 503-244-8825
FEES
Quantity Description Date Amount
73 Plumbing Permit 08/14/2018 $72.50
Specifics: g 12%State Surcharge- 08/14/2018 $8.70
Plumbing
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
I 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 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 O by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: 1✓
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 Applicatio R 4CEIV EI l
1
Building Fixturesrik FOR OFFICE 1 SE O:yt.t'
City of Tigard A116 1 4 2018 Received , /y "� ,`r-/ Permit44P.4/7,20/6(-4,570
NI III13125 SW Hall Blvd.,Tigard,OR 97223 Date/By:
11` Phone: 503.718.2439 Fax: 503.598.)p9{ly Plan Review Other Permit No.:
Inspection Line: 503.639.4175 sl)i I^ � � Date/
T t G A It t7 Internet: www(Igor/or.gov yy {{'� (('' t t St ate Ready/By: Tuns: ® See Page 2 for
a «riiU' ��I9i ,i°I�'��'� b ftl ILD1NG.D Y (fied1Method: Supplemental Inform
' ,,, �IN(�1 ra ii�liiiA�1114',a r,TI�PE Olt WO ,' '1' E SCHEDULE C at
u eat ion
0 New construction 0 Demolition For special information use checklist.
Description I Qty. I Ea. I Total
®Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
'' ��i'a i' t it1u ; '1 ,..,...11,1'..,,,,',„,,i'OV S ONSTRUCTIOI ',,,',,c,'7':
,', , ''r'I 4 SFIt(1)bath 312.70
❑ 1-and 2-family dwelling Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMA,TTION AND LOCATION , ! Site utilities:
Job site address: 10300 SW GREENBURG RD Catch basin or area drain 18.76
CitylState/ZiP: TIGARD,OR 97223 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: 1 l Project name:18-930 !J 0 1.)7 igr 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.:y) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
"�� ID..E�GRI ON or WORK Backwater valve 12.51
�" ,T .. .., i° " Clothes washer 25.02
Dishwasher 25.02
TENANT IMPROVEMENT,BODY BALANCE Drinking fountain 25.02
Ejectors/sump 25.02
„ ,a 0 7t OPER- :OWNER "t;lull , ,1'T ❑ „,,,,„AIVT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
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
wx i A : '+ CONTA i � u toi
k, Interceptor/grease trap 25.02
Business name:POWER PLUMBING CO Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:MIKE WARREN
Roof drain(commercial) 12.51
Address:P.O.BOX 19418 Sink/basin/lavatory 25.02
City/State/ZIP:PORTLAND,OR 97280 Solar units(potable water) 62.54
Phone:(503)244-1900 Fax::(503)244-8825 Tub/shower/shower pan 12.51
E-mail:SERVICE@POWERPLUMBINGCO.COM Urinal 25.02
Water closet a .a :��Wg 1 r, s w[-N � U rq" '� 25.02o $41111,,,,#;„6,,j,"0:4 fl , 1,,t ,,..p. , , ,, y-
T... Water heater 37.52
Business name:POWER PLUMBING CO WaterPitPin WV 56.29
Address:6611 SW MULTNOMAH BLVD. Other:WATER COOLER I 25.02
City/State/ZIP:PORTLAND,OR 97223 Subtotal
Phone:(503)244-1900 Fax:(503)244-8825 Minimum permit fee: $72.50
CCB Lie.:52378 Plumbing Lic.no.:34-150PB Plan review (25%of permit fee)
Authorized signature: - r
State surcharge(12%of permit fee)
< ( TOTAL PERMIT FEE
Print name:KRISTIE BRAMWELL Date:8-4 jt-1P~'($ 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.
1:tBuilding\ermitAPLMU-PermitApp,ioc 10/01/19 440-461611I0/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2- Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
� iii 1fi ., �'7 }4 Foot e kf l '.
Site t , 26 b�"4 .I�M' 4 t @@ Ea) s`, Total $4440 Foo pt 11P : I; r
Footing drain-1"100' 50.03 0 to 2,000ee� ;� a
$121,90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer I st 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
allxition: hPQ '� 'e :
ilNnk� k ,Stom &Rain Drain-1st 100' 62.54
$1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain each additionalt100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
ether ii>l �"' ,,tions Olt,' ees "Qty. F' '' ) Total i,, each additional$100.00 or fraction thereof,to
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 .41Plan Review for PlitinbingjI stallations..
Fixture Type for Replace! Plan review is required for anyof the following.
Work Performed: Capped Added. Relocate 9
Baptistry/Font Please check all that apply.
Bath -Tub/Shower 0 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 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain 0 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.
g �e ,t�metriew , erD ram 41,141-
Car Wash Drain
Garbage Domestic-non-food b 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 regarding fixture work:
Rec.Vehicle Dump Station ADDING WATER COOLER SUPPLY,NO WASTE
Shower -Gang
-Stall CALL MIKE WARREN WITH QUESTIONS
Sink/Lav -Non-food related 503-936-5929 THANK YOU
-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: 1
C:\Users\Laura\Desktop\Permit Applications\TIGARD PERMIT APP.doc2