Permit (188) 71 CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit it: PLM2019-00326
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/14/2019
Parcel: 1 S 135AB04500
Jurisdiction: Tigard
Site address: 10250 SW GREENBURG RD 110
Project: MiaDonna Subdivision: 1991-055 PARTITION PLAT Lot: 1
Project Description: Plumbing fixtures for tenant improvement: CAP(1)2"floor drain,(7)non-food related sinks&(1)clothes washer;
ADD(1)dishwasher,(1)clothes washer,(1)ice maker&(1)water heater.
Contractor: POWER PLUMBING CO Owner: LINCOLN CENTER LLC
PO BOX 19418 BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97280 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503-244-1900 PHONE:
FAX: 503-244-8825
FEES
Quantity Description Date Amount
1 ea Clothes Washer 08/14/2019 $25.02
Specifics: 1 ea Dishwasher 08/14/2019 $25.02
g ea Fixture/Sewer Cap 08/14/2019 $225.18
Type of Use: COM 1 ea Ice Maker 08/14/2019 $12.51
Class of Work: ALT 1 ea Water Heater 08/14/2019 $37.52
Type of Const: 1 12%State Surcharge- 08/14/2019 $39.03
Occupancy Grp: Plumbing
Stories:
Total $364.28
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 1.800.332.2344. 7 i
Issued By: Permittee Signature: /-74 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 Apalication
RECEIVED
Building Fixtures AUG 1 2 2019
k`oR OFFICE t.SE ONLY
City of Tigard Received -
a 13125 SW Hall Blvd.,Tigard,OR 97223 CITY OF TIGARD !arelB: ���y PermitNgt?ay ,
a Phone: 503.718,2439 Fax: 503.598.196aIN
UILDING DIVISIS Ilan Review
v�9` 3��
TIGARD Inspection Line: Date/B : Other Permit No.:
Internet: Line:g 503.639.4175 Date Ready/By:
Notified/Method Anis: See Page 2
for
a
� � Supplemental Information
❑New construction*1011"a"ral!: 41.77-711747-67474:1,611„W' t � -..::-e; - 1 " = �r
0 Demolition For s,ecral in ormation use checklist. ��
...
0 Other: Qt . Ea Total
NewSFR 1- bath 2-family dwellings(includes 100 ft.for each utility connection)
to SFR(1)bath 312.70
❑ 1-and 2-family dwelling :� Cammercialrndustrial SFR(2)bath
437.78
❑Accessory building 0 Multi-family SFR(3)bath _
500.32
❑Master builder Each additional bath/kitchen 25.02
0 Other:
f *o"SOB,,5 >tAr O t Fire sprinkler( sq.ft.) Page 2
" L AT*41y� ._ " ,,- .; Site utilities:
Catch basin or area drain 18.76
Job site address:10250 SW GREENBURG RD
City/State/Zip:TIGARD,OR 97223 Drywell,leach line,or trench drain
18.76
Suite/bldg-/apt.no.:110 Project name:19-094 et • Footing drain(no.linear ft.:__) Page 2
M
Cross street/directions to job site: '� Manufactured home utilities 50.03
Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Subdivision: Water service(no.linear ft.: ) Page 2
Lot no.: Fixture or item:
Tax map/parcel no.:
Backflow preventer 3127
? bOtici *Iva', ; ' , 1,','':, i lI Backwater valve
� : �� I: tea" � -" �'�� "�� � 12.51.
TENANT IMPROVEMENT,MIADONNA Clothes washer
1 25.02
Dishwasher 1 25:02
Drinking fountain 25.02
Ejectors/sump
plt(Pi 'OAC l 1 t r25.02
rr y, i� ,,,i,-;�a Expansion tank
Name: 12.51
Fixture/sewer cap 9 25.02
Address: Floor drain/floor sink/hub
25.02
City/State/ZIP: Garbage disposal 25.02
Phone:( ) Hose bib ® 25.02
Fax
A, ( ) Ice maker 1 12.51
'`� �� ,T+�� , ( Interceptor/grease trap 25:02
Business name:POWER PLUMBING CO
Medical gas(value:$ ) Page 2
Contact name:MIKE WARREN Primer _
12.51
Address:P.O.BOX 19418 Roof drain(commercial) 12.51
City/State/ZIP:PORTLAND,OR 97280 Sink/basin/lavatory 25.02
Phone:(503)244-1900 Solar units(potable water) 62.54
Fax::
E-Mail:SERViCE@POWERPLUMBINGC (5042444825_(5042444825_�� � Urinal lubisiscommiskowerrat- - -- -_ --_
25.02
O.COM
_. ali ! Water closet _
z "s, rr 25.02
r Water heater
1 37.52
Business name:POWER PLUMBING CO
Address:6611 SW MULTNOMAH BLVD. Water piping/DWV 56.29
City/State/ZIP:PORTLAND,OR 97223 Other:
25.02
Phone:(503)244-1900 $72.al �► aill
Fax:(503)244-8825 Minimum
CCB Lic.:52378 permit fee: $72.50
Plumbing Lie.no.:34-150PB Plan review (25%of permit fee)
Authorized signature: * isle * r State surcharge(12%of permit fee)Aloi, Q. 34.c 7
Print name:KRISTIE 1 RAMWELL TOTAL PERMIT FEEMagi
Date:8-12-19 This permit application expires if a permit is not obtained within ISO days
after it has been accepted as complete.
*Fee methodology set by ni-County Building industry Service Board.
1:1BuildingTermirslPLhIU-PermaApp.doc 10101X14
440-4616T(I0102KCOM, s)
Plumbing Permit Application - City of Tigard
Page 2-Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
i }�es '. _Ah 'L/ * � �i' '
Footing drain-I°100' 50.03 Oto 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
Sewer-each additional 100' 37.52 7.201 and greater $327.54
Water Service-1st 100' 62.54 Medical Gas S stems
Water Service-each additional 100' 37.52 '411141(1
:Storm&Rain Drain-1st 100' 62.54 $1 ,t ,
.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
'rlI each additional$100.00 or fraction thereof,to
Qth t'
10 i;. Oi>I OIeast,
e - - ='' 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*.
��� A, .
Ottantlt'by Fixture Type �5 �1`/.'`ia ''12O e tol iu`f binderT stall; ions
Fixture Type for nti lelace/
Work performed. "i ti- Caplied= Added`� Relocate Plan review is required for any of the following.
Baptistry/Font Please check all that apply.
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 0 Medical gas and vacuum systems for health care facilities.
-Domestic 1 0 Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" 1 Submit 2 sets of plans with any of the above.
-3"
-41
Car Wash Drain. ry .. n _ n !"
Garbage Domestic-non-food 0 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 MachiRefrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station PLEASE CALL MIKE WARREN WITH QUESTIONS
Shower -Gang
503-936-5929
-Stall THE 2"OTHER"FIXTURES ARE CLOTHES WASHER. 1 D C
Sink/Lav -Non-food related 7 rtGyJ"
-Bradley AND REFRIGERATOR WATER SUPPLY
-Commercial-food related 1�� ti
-Service / C
Swimming Pool Filter
Washer-Clothes 1 1 *Note: If the fixture work under this permit results in an
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:.
C:\Users\Laura\DesktopWermit Applications\TIGARD PERMIT APP.doc2
Accumulative Sewer Tally
= 14 Tenant Name: MiaDonna SWR# N/A
T v k D Site Address: 10250 SW Greenburg Rd,Suite 110 PLM# 2019-00326
IParcel#: 1S 135AB04500
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s value count added# added value total#s total values
Baptisery/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 1 2 1 2
Drinking Fountain 1 0 0 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 1 2 0 -1 -2
-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 HP) 16 0 0 0 0 0
-Commercial(to 5 HP) 32 0 0 0 0 0
-Industrial(over 5 HP) 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:
-Lay/Bar-Non-Food Related 2 0 7 14 0 -7 -14
-Bradley 5 0 0 0 0 0
-Com/Sery/Util-Food Related 3 0 0 0 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer-Clothes 6 0 1 6 1 6 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 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 9 22 2 8 -7 -14
Current Fixture Value -14 divided by 16= -0.875 Current EDU 1 EDU= $5,800.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -14 divided by 16= -0.875 over (under) $ (5,104.00)
Enter EDU Change Here -0.880 *
*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: .88 EDU CREDITS
Authorized Name/Signature: Dianna Howse Date: 8/13/2019
Building Division
Note: The property owner shall retain the ORIGINAL 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\SewerTallySheet_5800_070119.xlsx