Permit •
y CITY OF TIGARD PLUMBING PERMIT
`• COMMUNITY DEVELOPMENT Permit #: PLM2009 -00129
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/29/2009
. Parcel: 1 S135AB01004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 120
Subdivision: Lot: 0
Project: Ameriprise Financial
Project Description: Install (1) ejector, (1) water heater, (1) sink, and (1) ice machine.
Owner: FEES
LINCOLN CENTER LLC Quantity Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555
CALIFORNIA ST 49TH FL 1 ea Ejectors /Sump 05/29/2009 $16.60
PHONE: 1 ea Ice Maker 05/29/2009 $16.60
1 ea Sink 05/29/2009 $16.60
1 ea Water Heater 05/29/2009 $16.60
Contractor: 1 12% State Surcharge - 05/29/2009 $8.70
MILWAUKIE PLUMBING CO Plumbing
PO BOX 393 6 ea Minimum Fee Adjustment - 05/29/2009 $6.10
CLACKAMAS, OR 97015 Plumbing
PHONE: 503- 655 -9161
FAX: 503 - 655 -1726
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344
1
Issued By: J -( O n ,6t� 1 Permittee Signature: Q ,411! Ca , I l ^\
^ �}( Call 503.639.4175 by 7:00 a.m. for an inspection that business day. SIC A J `J
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.
- Pltllnbing Permit Application
Building Fixtures RECEIVED i (>li O F l(. l (i 0.1..1
,, Received
Pe
City of Tigard 1 )ete/By, nr ,it I y
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='. 13125 SW Hall Blvd.,. Tigard, ORMAY3 26 2009 " "r! p 2 �p
Plea Review Other Perm No.: , s S. � Phone: 503.659.4171 Fax: 503.598.1960 �IC W`l'
• Date/13y;
, I'1 �51f,f) Inspection Line: 503- 639'4175ni 1 i OF TIGARD Date Ready /By; Jana• See Page 2 far
Internet: www.tigard-orgov a 1t Notified /Methat; g (, Su , lementallnformation
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ICI New constriction ❑ Demolition special i nfi rrtadon use cherklisx
Description I Qty. I Ea. I Total
I SI Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
Va r ca "R.4. id 4; idrW .. rr t .�,,,i a;:,'."'tl ri " iiararr,,,,.7a ry ,.:e:U,. :tn
vrr �l nraw. �j b1t . ,sfN'r'�I;iRi"kF+..r
�me t�I a mlgar imilmia ,761..6k;; mm4h�ti),wa4&U0 .l:;ia. ut . 1 + � r na SFR (1) bath 249.20
❑ I- and 2- family dwelling i_4 Commercial /industrial SFR. (2) bath 350.00
❑ Accessory building El Multi-family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other -
� • ,r v vrca r n, aa k k ililPFLF0f 7rHK; t !Vf rpi ¢; "IxN . " r k 7 N Fifesprinklc 4 0.) 5 2
r( s ,Il, Rage
l e l )80,1%..k:'.! k + ; 8 + 41 II �l� {I
. to /atwmy;:,,veara;,c.kNri.6fntiw. ace.. �sw .nauS1r9t #�i,ii;>wmt'at'aa.'• +i�i,;:rnFrte, h�,uftiKl2b¢' ?iN1 Site utilities
Job site address: I 021- j G'i-O 41 e xr Catch basin or area drain 16.60
City /State/ZIP: ll t) i,� ��t(�_ C1 � `' Drywell, leach line, or trench drain 16.60
t ,`
Suite' Idg, /apt. no.: c ? Project name: ty '4 ") ,!)y1 Sr, Footing drain (no, linear fl,; _ ) Page 2
r� Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
o E 7 A g • ' f ' ' • Rain drain connector 160641
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear Il.: Page 2
Subdivision: l Lot no,: Water service (no. linear ft.: _) Page 2
Fixture or item
Tax map /parcel no -: i ` • `a
t�ti rraR,snrla „yes ar kiw(5�t; Absorption valve 16.60 `
0 1 x ' l s 'af a s e
i ' .bh,t, +. aai wf14( :,,klaa ' i t ,; a dial! ia ' / r . 'r ; I ., ti a , i, Backflow pRwcnter Page 2
L lt,\,\ \ SW tyn Y\g,t.0 ■`l;lfC��l 1 1 Ch SP • r Backwater valve 16.60
1 '• --Ga Clothes washer 16.60
Dishwasher _ 16.60
*4,94' nas4dsaitsw r,t Isla FF p s swry sytr.'a ^ #,�;n kcal f (y yy Drinking fountain 16.60
MI' r
l ;:a 1 � ld ar rp aki. ' e43r ki``Ftag.Rt .ti,� Ag h,•: dar I �g 1 .
„� xs�sra. ,.� ak'w. r t.�t�t.W. iS4siiii f�-s � ta a• Ejxtoralsump ` - 16.6(
Name: Expansion tank 16.60
Address: Fixture /sewer cap 16.60
r
City /State /ZIP: Floor drain/tloor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60 .ti0 __
rt : y r I ra safr ro!m�vxr. r..; r t u t o}c., Fiore bib _1166..6600
r t;t .•, i'Zl �..
61 :. flrpriuia • :;am „ma � is aa6t aa4roz6tdz lee maker I 16.60
Business name: _ lntenxptor /grilse Imp 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City/State /ZIP: Roof drain (commercial) 16.60
Phone: ( ) I Fax: : ( ) r n basin/lavatory _- 1 16.60
Tub/shower /shower pan 16.60
E -mail CiA\t 4 , • • .. / t "- , Urinal 16.60
r i�' I�' Jn .4.44'9 4 to
> 4 fr 'yl'Y1, ., l�E� SI '�9 IPM � t` ; ,'k � �q t 12 , , RT � Water closet I 6.60
Business name: a • x d Water heater + 16.60
Other:
Address: ut Ai.
Subtotal
C Ci ___(rte.
City/State/Z1F: l xcte volyi f Minimum permit fee: . 72.50 t7
' hone: CD )� S -' Rs 1 Fax: (91)) L ' - f 1 C( Residential backtlow minimum permit fee: 536.25 A d, .
CCB Lie.: 70 a Plumbing Lic, no.: ) _ f-'��`� Plan review (25% of permit fee)
. State surcharge (12% of permit fee) ,' 7 6
Authorized signature: i a TOTAL PERMIT FE
Print name: , f . ' T • a , I This permit application expires if a permit is not obtained within
' 180 days after it has been accepted as complete.
*Fcc methodology set by 'I n- County Building Industry Service Board.
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" Plnmbini Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su i i ression S stems:
" , ' is tit ' a +r y f4 aAgR " t 'f "'' ' , ? i r., ty .. 7 r+ a uw4 r wrrm : •' 1r4r q �r +1 rtK`^"�5 nti't3't , '{ t. t ttl "S oil ; ' t'@ t t s f 't u'
���� '� p �"4i;r'i y� a h �� ,
ya Y" 6' .:..:a ;,�s 'gah ,�`.� ift� �dp i; 1 q�� r ra4, iii12. 1 i,nr '' ',.,t0 �'��. Y „ ,, ::. hdie "NLated�d1' 4,41 b.'
i fmc:c•rl1Wr, �. :5#t�l�ai'� �ta isro,,.., 15;4!gigi..o-...�rL�l�iiqtnr*YaY , . 1.,, ..J,..I. GP1,. . �rw� W
., „�,c,•.a�
Footing drain • l a 100' 55.00 0 to 2,000 $115,00
Footing drain - each additional 100' 46.40 Mill 2,001 to 3,600 $160.00
Sewer - 1st 1(1(1' 55'°°
3,601 and d grc $220.00
7,201 and greater $309.00
Sewer - each additional 100' 46,40
Water Service - Ist 100' - 55.00 - Medical Gas S stems:
Water Service - each additional 100' 46.40 r4'{a� r�:,s tw u, p� u t p 'I'E" ui lap ' } t Q t ] M
� � 'r �, �'iti ! 4�(l 1 �� dR d � ,'A1YA 1 ' '
Storm & Ram Drain - 1st 10(1' 55.00 $1' wk rout ,.,. .. R u $n7 t 2 i
$1. 00 to $5,000.00 Mutimum fcc $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
i�ppr w✓f tttaia� y „ a 111 111 l � aµ _ , to . d r rt; R additional $100.00 or fraction thereof, to and
imk.,?;,1, ;;;,la, .;,,....;.,:......�.,. , {,•- :,it�f �`.lu `A» r f ;Z{kS�OA s naik{ including $10,000.00.
Commercial Back Flow Prevention Device 46.40 510,001.00 to $25,0(0 $148.50 for the first $10,000.00 and $1,54 for
Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to
minimum .entlit fee $36.25 27.55 and including $25,000.00.
Rain Drain, single family dwelling - 65.25 $25,001.00 to $50,000.00 $379.50 for the first 525,000.(X1 and $1.45 for
r:+ch additional $100.00 or fraction thereof, to
Inspection of existing plumbing or
s.eciall :•uested insiections - . hour 72.50 and including $50,000.00.
$50 and up $742,00 each additional fo $ 1 0 0 .0 0 or fraction 0 and thereof.
for
Subtotal:
each additional $ 100,00 or fraction thereof.
C r.,., r a; S +01t""nix r "'x'""rr 1 1`7 4t'� al''. STP oGi« y
Commercial Fixture Work: w pp , ' f' [[ � � AA4 ; r , r 2 W L, , i
� OYOYI 11Mi, ,Y +rflv4 „t l ( . vnvAVM1Mv4.: NA 1 •��I. �.irnvin4u,u��h�nlhvlwA �'fl'4 .
Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following.
please indicate work performed by fixture, Failure to Please check all that apply,
accurate' re + ort fixtures could result in increased sewer fees *. ❑ Any new commercial building with water service 2" and
-- tems designed and stamped licensed
cn s
aY...,, / ,. LL 11. • .:...... ?. . _ �nr:. ty`m rr4' � .P:al. greater, except sys n1� by '�>�� �1 � t ��J'ri ,� i . ,. �;. � y E $ � , ! os � f e)CC GJi nc (1 r ' n '
1!i 14 5 4 '' ' d Sltl bq =,,:=AlA ,q ,rry , + 1ircY4 . , i 4i .' .:': F 1 605 r� II +00x01 " engineer, •
� yi - , ''''' lr,L ,",,, ,,' "r� x a'.r tl ❑ plumbing any p
,,liana +,riVt�'i �i.�tiP1NIMYh_ "!,��u, 1mi'.�.'��v���; 48 , l i1• • �; . New exterior lumbin site utilities for an complex structure
Baptistry /Font a defined in OAR918 - 780 - 0040.
Bath =1 ub /Shower 0 Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash -Each Stall _ ❑ Any complex structure as defined in OAR91 8
- Drive Thru
Cuspidor /Water Aspirator Submit 1 sets of plans with any of the above.
Dishwasher -Commercial
- Domestic q� ,' "'�;5 S suvt44 ,x'( '. i '""�u' tr ,it ' "wa d, 7rr lqx.
Drinking Fountain '.4,) &t ka„„ `„&LI s s
u m�� w, r u -- ? ti:k S r 8s l i
Eye Wash .. • Isometric or riser diagram is required for new buildings
Floor Drain /sink - 2" that meet the qualifications above.
Car Wash Drain
Garbage - Domestic _ Comments regarding fixture work:
Disposal -Commercial
- Industrial
Ice Mach. /Refrig. Drains • J -
Oil Separator (Gay Station)
Roc. Vehicle Dump Station
Shower -Gang •
-Stall
Sind. - Bar /Lavatory il
- Bradley *Note: If the fixture work under this permit results in an
- Commercial Increase of sewer EDUs, a sewer permit will be Issued and
- Service , fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be Issued.
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal _
Other Fixtures: f-.. �� 2....
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: Att t _ Dui
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: (Vie-Vern TIME: PAGE:
SITE ADDRESS: i()) SW Gnk *,�).5 a.i, nv /AO CLASS OF WORK: A/..-7-
SUBDIVISION: LOT #: TYPE OF USE: Ce-M
PROJECT NAME: A '' ( (. 'i c Y,aL.
DESCRIPTION: i £r -npfz_ s YN K , � . Scn , .Akcc, 1 Dee
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 6M/0 Pour Time:
Code # Inspection Description Confirm # Contact # Message
3 O PL,„ ,.4 PQH44 .A) 6sv- 7°2
Corrections /Comments/ Instructions:
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PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: °�—e "A Date: — /e3? Phone #: (503) 718-