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Permit
CITY OF TIGARD PLUMBING PERMIT III COMMUNITY DEVELOPMENT Permit#: PLM2020-00147 T I GAR,D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/15/2020 Parcel: 1 S 135AB03400 Jurisdiction: Tigard Site address: 10260 SW GREENBURG RD 1050 Project: Sentry Subdivision: METZGER,TOWN OF Lot: 9 Project Description: Interior plumbing:Capping/relocating(1)dishwasher,(1)sink,(1)2"floor drain/sink,and(1)water heater. 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: 503-692-4139 PHONE: FAX: 503-691-2328 FEES Quantity Description Date Amount 1 ea Dishwasher 04/07/2020 $25.02 Specifics: 1 ea Fixture/Sewer Cap 04/07/2020 $25.02 ea Floor Drain/Floor Sink/Hub 04/07/2020 $25.02 Type of Use: COM 1 ea Sink 04/07/2020 $25.02 Class of Work: ALT 1 ea Water Heater 04/07/2020 $37.52 Type of Const: 1 12%State Surcharge- 04/07/2020 $16.51 Occupancy Grp: Plumbing Stories: 1 ea Fixture/Sewer Cap 04/10/2020 $25.02 0 12%State Surcharge- 04/10/2020 $3.00 Plumbing Total $182.13 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. Issued 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 Site Utilities .��'"p i OR o 1-1t. 1. I SI. OM City of Tigard G t✓ Received • 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: 4//7/17 PennitNo.: /Qi11 R 2a d/q J Phone: 503.639.4171 Fax: 503.598.1960 Ap R 8 232n cute By:e v Other Permit _ ^'KEG t i t,\It n Inspection Line: 503.639.4175 C�vc�n'(.�j/, Internet: www.tigatd-or.govy pF TIGARD Date Ready/By:ho :7, Supplemental See Page 2 for Ca\( Notinedr'Method: � TYPE OF WORK BUILDING DI�1PION_ Information FEE* SCHEDULE ❑ New construction 0 Demolition For special information use checklist. CEI Description Qty. Total Addition/alteration/replacement ❑ether �` �', ». ^ New 1-2-family dwellings(includes 100 ft,for each utility connection) CATEGORY OF CONSTRUCTI'IN LI 'J w SFR(1)bath 312.70 I-and 2-family dwelling Commercial/industrial SFR(2)bath 437.78 -- ❑Accessory building 0 Multi-family SFR(3)bath 500.32 ❑ Master builderEach additional bath/kitchen 25.02 0 Other. Fire sprinkler( sq.ft.) Page JOB SITIi INFORMATION AND. LOCATION B - Site utilities: Catch basin or area drain j(2, , 5�/ lrlres�..to o v j,o i8.76 Job site address: City/State/ZIP: . l i rr�L a p �,7 -.+ D leach line,or trench drain 18.7E Sui te/bidg.lapt. no.: Pro'ect name: Footingoting drain(no.linear ft.:_) _ Page 2 fd.�� 1 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.: ) Page 2 Water service(no.linear ft: ) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 `�/ p/� Clothes washer 25.02 . . 1 i«f riS)a ria5 /l�le - � SI P kwS�R' Dishwasher I e / 25.02 0 K l 11 ub C7.MCt...�-- I \Aja:vieY y riCie Drinking fountain 25.02 Ejectors/sump 25.02 ❑ PROPERTY OWNER I 0 TENANT Expansion tank 12.51 Name: Fixturersewer cap 25.02 p Address: Floor rkaiNFloor sinWhub (� 25.02 / sso. City'State/ZIP: Garbage disposal 25.02 Hose bib 25.02 Phone:( ) Fax:( ) Ice maker C7 .►PPLICANT12.510 „ 0 CONTACT PERSON Interceptodgrrasc trap 25.02 Business name: RuLy\oO r t.s_rS '�i �.�,�,r ,�„ Medical gas(value:$_) Page 2 +v t Contact name: / c. Ptimer 12 51 pel� � / 3 k (commercial)ff Roof druin Address: I 1 q .5�/ c 0I- 9, _ 12.51 t SinW'basinrlavatrnY 25.02 0 City/State/ZIP r J CA Q 7C,`� Solar units(potable water) 62.54 Phone:(e5 ) 6rt.. -4 t3ei Fax: :(Sb3) 64,/_ .g Tub/shower/shower pan 12.51 E-mail: A 4 f e CO Yy/` N K bdS, GCt,�. Urinal 25.02 �, CONTRACTOR Water closet 25.02 Business name: RAYBORN'S PLUMBING INC Water heater 37.52 4? Water piping,DW V 56.29 Address: P.O. Box 69 Other: 25 .02 City/State/ZIP:Tualatin,OR 97062 Subtotal l6i Phone:(503)692-4139 I Fax:(503)691-2328 Minimum permit fee: 572.50 CCB Lic.: 87852 Plumb' Lic.no.:34-I66P6 Plan review (25%ofpennit fee) Authorized signature: State surcharge(12%ofpermit fee) let,5/ TOTAL PERMIT FEE / Print name !A I Date: Ll�247 I This permit application expires if a permit b not obtained with n ISO days 7 After It has been accepted as complete. *Fee methodology sct by'Fri-County Building industry Service Board. ' Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee(ea) Total ` Square Footage. Permit Fee: Footing drain-l" 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 S327.54 Sewer-each additional 100' 37.52 Water Service-Ist 100' 62.54 Medical Gas Systems: Water Service-each additional 100' 37.52 Valuation: Permit Fee' Storm&Rain Drain-1st 100' 62.54 S I.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 S1.52 for Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to Pand including$10,000.00. inspection of existing plumbing or for $10,001.00 to$25,000.00 S148.50 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 S25,000.00. 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 90.004u- $50,001.00 and up S742.00 for the first S50,000.00 and S 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", Plan Review for Plumbing Installations please indicate work performed by fixture. Failure to Plan review is required for any of the following. accurately report fixtures could result in increased sewer fees*. Please check all that apply. Quantity by(Fixture)Work Performed 0 Any new commercial building with water service 2"and Fixture Type: Replace greater,except systems designed and stamped by licensed Previous Capped Added Existing engineer. Baptistry/Font Bath -Tub/Shower 0 New exterior plumbing site utilities for any complex structure as defined in 0AR918-780-0040. -Jacuzzi/Whirlpool Car Wash -Each Stall 0 Medical gas and vacuum systems for health care facilities. Drive e Tara ❑ Any multipurpose fire sprinkler system. Cuspidor/Water Asp Thr ❑ Any complex structure as defined in OAR918-780-0040. Dishwasher -Commercial •Domestic. Submit 2 sets of plans with any of the above. Drinking Fountain Eye Wash Isometric or Riser Diagram Floor Drain/sink -2" t -p ❑ Isometric or riser diagram is required for new buildings that meet the qualifications above. 4'. Car Wash Drain Garbage -Domestic Disposal -Commercial Industrial Comments regarding fixture work: Ice Mach./Refrig.Drains Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower -Gang -Stall Sink -Bar/Lavatory ( I " -Bradley -Commercial *Note: If the fixture work under this permit results in an -Service increase of sewer EDUs,a sewer permit will be issued and Swimming Pool Filter fees assessed for the sewer increase must be paid before the Washer-Clothes _ plumbing permit can be issued. Water Extractor Water Closet-Toilet Urinal Other Fixtures: http://www.tigard-or.gov/city_hallldepartments/cd/docs/PLMF-PermitAp doc Plumbing Permit Application , g S n / ��✓S/ 3 i;1 ^ ,.LurL,} {ECEI�)VC L )OK (}FPR"t,: 1ti4: t)A't_1 City of Tigard Received IIII 7 Permit No.: Obey 20.. , RI 13125 SW Hail Blvd.,Tigard,OR 97223 APR 1 2020 Date/By: 7" / /�!' a ilf I Phone: 503.639.4171 Fax: 503.598.1960 Plan Review 8 DatdBy: Other Permit No. a ,,it# Inspection Line: 503.639.4175 CITY OF TIGAR F I C A I:dl ate Ready/By: Luria: ® See Page 2 for Internet: www.tigard-or.gov BUILDING DIVISI I iMoiified/Method: e % Supplemental Information TYPE OF WORK FEE` SCHEDULE • 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) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 I-and 2-family dwelling . Commercial/industrial SFR(2)bath 437.78 ❑Accessory building 0 Multi-family SFR(3)bath 500.32 ❑Master builderEach additional bath/kitchen 25.02 0 Other: Fire sprinkler( sq.It) Page 2 ..r",x f,,, F.._ O S1Tlr INFORMATION AND LOCATION Site utilities: Job site address: 10.a60 �C'f/ G.yee,, �.10 J r� [� Catch basin or area drain ig_76 R K Drywell,leach line,or trench drain 18.76 City/Slate/ZIP: t / � Footing dmin(no.linear ft.:�) Page 2 Suite/bldg./apt. no.: /050 Project name: I jf y Lr/ Manufactured home utilities 50.03 Cross street/directions to job Vb 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: I Lot no.: Fixture or Item: Tax map/parcel no.: d,d d R�+c'JL,1,"Y� Backflow preventer 3 L27 DESCRIPTION OF WORK Backwater valve 12.51 I S LA.W.. ��c �V. I 0,5� etS4... . Clothes washer25.02 J Wet Dishwasher / 25.02 25 a1 I Stn`14,J I u �YCtrs J I Wegzir e- ' Drinking fountain 25.02 Ejectors/sump 25.02 0 PROPERTY OWNER 0 TENANT Expansion tank 12.51 Name: Fix ture'sewercap 25.02 -d Address: Floor drain'tloorsink/hub / 25.02 $,aA Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone:( ) Fax:( ) Ice maker 12.51 a APPLICANT ❑ CONTACT PERSON Interceptor'greasc trap 25.02 Business name: •�J 1C r vt_r.� pi„,,tJwv_.�4,�5 Primer gas(value:$_) Page 2 Contact name: �() / 1251 a'�� c .c Roof drain(commercial) 12.51 Address: I p0 t {� ` S Wr t~r �t Lam, Sinkbasirvlavatory i 25.02 .01, City'State/ZIP' 1 .tom © . 1:i7;y`Z Solar units(potable water) 62.54 Phone:(cam) Cif. -Li 13/ Fax::( ) 0/ .,g Tub/shower/shower pan 12.51 E-mail: /I d 4.e (-Z_, yrky104,0vLs„ G 0 t..-.._ Urinal 25.02 CONTRACTOR Water closet 25.02 Water heater / 37.52 37 c,/ Business name:RAYBORN'S PLUMBING INC Water piping DWV 56.29 Address: P.O.Box 69 Other: 25.02 City/State/ZIP:Tualatin,OR 97062 Subtotal i 1.7 6,.. Phone:(503)692-4139 Fax:(503)691-2328 ( Minimum permit fee: S72.50 Plan review (25%of permit fee) CCB Lic.:87852 Plumb' Lic.no.:34-I66PB ' State surcharge(12%ofpermitfee) /t Authorized signature: TOTAL PERMIT FEE ';e�/r/"" Print name:A� ,__®/� Date: L This permit application expires if r permit is not obtained withindays er" i""/_ r'J after it has been accepted as complete. •F e i odology sei by Tri-Cou y Building Indus Service Board. Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty• Fee(ea) Total Square Footage: Permit Fee: ' Footing drain-I' 100' 50.03 0 to 2,000 S121.90 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 Valuation: Permit Fee: Storm&Rain Drain-1st 100' 62 54 $1.00to$5,000.00 Minimum fee$72.50 Storm&Rain Drain-each additional 100' 37.52 S5,001.00 to$10,000.00 S72.50 for the first$5,000.00 and$I.52 for Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to P and including S10,000.00. Inspection of existing plumbing or for $10,001.00 to$25,000.00 S 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 S 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 S50,000.00 and S 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", Plan Review for Plumbing Installations please indicate work performed by fixture. Failure to Plan review is required for any of the following. accurately report fixtures could result in increased sewer fees*. Please check all that apply. Quantity by(Fixture)Work Performed 0 Any new commercial building with water service 2"and Fixture Type: Replace greater,except systems designed and stamped by licensed Previous Capped Added Existing engineer. Baptistry/Font 0 New exterior plumbing site utilities for any complex structure Bath -Tub/Shower as defined in OAR918-780-0040. -Jacuzzi/Whirlpool Car Wash Stall 0 Medical gas and vacuum systems for health care facilities. -Each Stall 0 Any multipurpose fire sprinkler system.-Driv Cuspidor Water Aspirator 0 Any complex structure as defined in OAR9I 8-780-0040. Dishwasher -Commercial -Domestic. t Submit 2 sets of plans with any of the above. Drinking Fountain Eye Wash Isometric or Riser Diagram Floor Drain/sink -2" t ❑ Isometric or riser diagram is required for new buildings that meet the qualifications above. -4-' Car Wash Drain Garbage -Domestic Disposal -Commercial -IndustrialComments regarding fixture work: Ice MachiRefrig.Drains Oil Separator Station) Rec.Vehicle Dump Station Shower -Gang -Stall Sink -Bar/Lavatory t 1 -Bradley -Commercial *Note: If the fixture work under this permit results in an -Service increase of sewer EDUs,a sewer permit will be issued and Swimming Pool Filter fees assessed for the sewer increase must be paid before the Washer-Clothes plumbing permit can be issued. Water Extractor Water Closet-Toilet Urinal Other Fixtures: h ttp://www.tigard-or.gov/city_hal l/departments/ed/docs/PLM F-PermitApp2doc