Permit CITY OF TIGARD PLUMBING PERMIT
1111 ,' COMMUNITY DEVELOPMENT Permit#: PLM2020-00266
T(GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/08/2020
Parcel: 1 S 135AB01004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 570
Project: Maxim Healthcare Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Replace existing plumbing fixtures: (1)2"floor drain,(1)sink,(1)primer and(1)water heater,
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
1 ea Floor Drain/Floor Sink/Hub 07/08/2020 $25.02
Specifics: 1 ea Primer 07/08/2020 $12.51
1 ea Sink 07/08/2020 $25.02
Type of Use: COM 1 ea Water Heater 07/08/2020 $37.52
Class of Work: ALT 1 12%State Surcharge- 07/08/2020 $12.01
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $112.08
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 callin 503.232.1987 or 1.800.332.2344.
Issued By: i �,, _ i: �- Permittee Signature: 114 ,��7 � (7%,1-._7—�-,���i
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
City of Tigard BE ddV e / 7/-- ^ 4.00 Permit Ni5L-41�"�.-90" '6
lig,� 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: 4L l r
' Phone: 503.718.2439 Fax 503.598.196(uJUN 2v 2020 DateiBPlan view OtherPennitNo.:
DatuBy:
T t E.a RD Inspection Line: 503.639.4175 P Date AeadytBy: kris 64 See Page 2 for
Internet ww�e.tigard-or.gov' C.•S y n¢- I^ 173� Notitied'Alethod: Supplemental Information
TYPE OP lkORk 1 '' s FEE" SCHEDULE
❑New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
0 Addition/alteration/replacement ❑Other. New I-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ I-and 2-flintily dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building ❑Multi-family SFR(3)bath 500.32
- Each additional bath/kitchen 25.02
❑Master builder El Other. Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 10220 SW GREENBURG RD Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:TIGARD, OR 97223 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.:570 Project name: 20-223 Manufactured home utilities 50.03
Cross street/directions to job site: / I t-yt I M A- ---n4 C 61 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: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
TENANT IMPROVEMENT, MAXIM HEALTHCARE Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑.PROPERTY OWNER. _ 0 TENANT Expansion tank 1251
Name. Fixture/sewer cap 25.02
Floor drain/floor sink/hub 1 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: POWER PLUMBING CO. Medical gas(value:S_) Page 2
Primer 1 12.51
Contact name: MIKE WARREN
Roof drain(commercial) 12.51
Address: P.O. BOX 19418 Sink/basin/lavatory 1 25.02
City/State/ZIP: PORTLAND, OR 97280-9418 Solar units(potable water) 62.54
Phone:( 508 244-1900 Fax::( 503 244-8825 Tub/shower/shower pan 12.51
F-mail: SERVICE@POWERPLUMBINGCO.COM Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 1 37.52
Business name. POWER PLUMBING CO. Water piping/DWV 56.29
Address: 6611 SW MULTNOMAH BLVD Other: 25.02
City/State/ZIP: PORTLAND, OR 97223 Subtotal (pp,07
Phone:( 503)244-1900 Fax:( 508 244-8825 Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.: 52378 Plumbing Lic.no.:g �3/4150PB State surcharge(12%of permit fee) Z,0/
Authorized signature: FtA ft.e T�^��t �..Zf.L-t-i �"G-1 TOTAL PERMIT FEE //z. of
B MWELL name:KRISTI ELL Date:6-23-2020 This permit application expires if a permit is not obtained within I80 days
after a has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
1:1Building'PermitsTLMU•PernstApp.dac 10'01!09 4404616T(10/07ROM.-WEBt
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 $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 $327.54
Sewer-each additional 100' 37.52
Water Ser ice-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional IOW 37.52 Valuation: Permit Fee:
Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000 00 Minimum fee$7250
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
Other Inspections or Fees Qty. Fee(ea) Total 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*. Plan Review for Plumbing Installations
Quantity by Fixture Type. Plan review is required for any oldie following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Rdoente
Baptistry/Font ElAny new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure
-Drive Thru as defined in OAR918-780-0040.
CuspidorlWaler Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ 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 arty of the above.
Floor Drain/sink: -2" t
3" Isometric or Riser Diagram i
❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach/Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station) ALL FIXTURES PULL AND REPLACE
Rec.Vehicle Dump Station PLEASE CALL MIKE WARREN WITH QUESTIONS 503-936-5929
Shower: -Gang
-Stall
Sink: -Lay/Bar non-food related
-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
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
1:\Building\Permits\PLMF_PennitApp.doc 08/04/2011 2