Permit (207) CITY OF TIGARD PLUMBING PERMIT
111 74 '' COMMUNITY DEVELOPMENT Permit#: PLM2019 00216
T(GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/21/2019
Parcel: 1 S 135AB01004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 650
Project: Marcus and Millichap Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Interior plumbing for TI:Capping(1)sink;Adding(1)2"hub drain; Relocating(1)dishwasher and(1)sink.
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: 503-412-4800
503-692-4139
FAX: 503-691-2328
FEES
Quantity Description Date Amount
1 ea Dishwasher 05/21/2019 $25.02
Specifics: 1 ea Floor Drain/Floor Sink/Hub 05/21/2019 $25.02
1 ea Primer 05/21/2019 $12.51
Type of Use: COM 1 ea Sink 05/21/2019 $25.02
Class of Work: ALT 1 ea Water Heater 05/21/2019 $37.52
Type of Const: 1 12%State Surcharge- 05/21/2019 $15.01
Occupancy Grp: Plumbing
Stories:
Total $140.10
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 503.232.198 .:81. Z234-4--
Issued By: ` Permittee Signature: i
''l/ Ar-Call 503.639.4175 by 7:00 a.m.for the next available inate.
III This permit card shall be kept in a conspicuous place on the job site .impletion of the project.
Approved plans are required on the job site at the time of=.ch inspection.
• Plumbing Permit Application io
Site Utilities ��� V 1 012 011•1( I: 1 SI. 0\1 l
City of Tigard Received %� J
?//J • - Permit No.: / lam-
le 13125 SW Hall Blvd.,Tigard,OR 97223 p 419 Date/By: jj 't om f �, �y
P Plan Review
I Phone: 503.639.4171 Fax: 503.598.1Wo (A O Date/By: Other Permit No.: ti C-Zc/q_± r
i `Ic I Inspection Line: 503.639.4175 �\ \ON / /i [(•"�
QF v\S Date Ready/By: loris: 65 See Page 2 for
Internet: www.tigard-or.gov \( 0°N Notified/Method: ;�", Supplemental Information
TYPE OF WOR1C�jv\\'O\NFEE* SCHEDULE
0 New construction 0 Demolition For special information use checklist
Description 1 Qty. I Ea. I Total
®Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
I-ated 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
„,,,,,t,,.„4, JO 1111VF9WIO1M AND. LOCATION Site utilities:
Job site address: or Catch basin or area drain
2Za 5 4 c,(4,.-e-.4 13�1�Cr- 2� Drywell,leach line,or trench drain ■�-
City/State/ZIP: '-C 6.441. tl(L W ✓ q'7-Z.Z 3 Page
Footing drain(no.linear ft.:_) 2
Suite/bldg./apt.no.: toTb I Project name: Mitt U
S 4-it'l,"f t'CGiGI� Manufactured home utilities 50.03
Cross street/directions to job site: f Manholes 18.76
3 ,,1 (or" co to wa >O Rain drain connector18.76
L
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.: 6/3740o/e)(;) -' Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve12.51
Clothes washer 25.02
ö 1 S'M d-4,/f(r44 re,5. fLC./ato.-F•c...., Dishwasher
0 25.02 0,,,...5-;,C,,i.
4,5 4 e-,1 1.3 f =h'a..t w/T(n ..t e.,,t C i lel,rP.e.f Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Address:
- Floor drain/floor sink/hub 0
i 's.0,
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
pi.APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ )
�
pick( 801,w,...,801,w,..., e(�JMtA (e, Primer �l � I2.51 REMContact name: Af S• C/ft,-✓E a$.a
Roof drain(commercial) NM
12.51
Address: (S�i qo 5-4.4C p0L` tL� Sink/basin/lavatorylid25.02 023740
City/State/ZIP: Tv,c-1C-fii„1 + 0i ei70 6 Z Solar units(potable water) 62.54
Phone:((„2,3 ) (De/2 -Lit i Fax: :5-6.& ) 641 - p,3 t e Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
{-114/,4 (v 144,041,1N5 . r 6•^� iiiIN
Water closet 25 02
CONTRACTOR
Water heater 37.52
Business name: RAYBORN'S PLUMBING INC
Water pipingDWV 56.29
Address: P.O.Box 69 Other. 25.02
City/State/ZIP:Tualatin,OR 97062J Subtotal /Z S-.01
Phone:(503)692-4139 Fax:(503)691-2328 Minimum permit fee: $72.50
CCB Lic.:87852 Plumbing Lic.no.:34-I66PB Plan review (25%of permit fee)
State surcharge(12%of permit fee) /5-.. (;r (
Authorized signature: Aiel
TOTAL P_ :u
Mi�i6ii a%i
lI
�� Date: This permit application expires if a permit is not obtained within 1110 days
�' _. after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
•
Fee Schedule:tResidential Fire Su s s ression S stems:
1���1�' F' '' _"'�'-�, `� E .'^�C'`s a � i � rk}#ra*`
.,..r.44 .� n"'
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 a eater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas S stems:
Water Service-each additional 100' 37.52
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
and includin• $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 char:a-1/2 hour and includin:$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 ch. •e-2 hours each additional$100.00 or fraction thereof,to
Reinspection Fees - 90.00/hr and includin:$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 char:e-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 re r ort fixtures could result in increased sewer fees''� : 5 f r� ' s r -r
� � � � _�.s `
' '� � � � Plan review is required for any of the following.
Please check all that apply.
�� � 1 _";
0 Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall
0 New exterior plumbing site utilities for any complex structure
Drive Thru as defined in OAR918-780-0040.
Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial
0 Any multipurpose fire sprinkler system.
Domestic ' ❑ Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: digiP
4"
0 Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the s ualifications above.
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig.DrainslArgif‘omments regarding fixture work:
Oil Separator(Gas Station) / eiA"EA
1 5
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink: -Lav/Bar non-food related j.
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Pennits\PLMF PermitApp.doc 08/04/2011 2
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
10220 SW GREENBURG RD 650, TIGARD, July 5, 2019 at 7:54:14 AM
OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2019-00216
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor