Permit �.n
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2011 -00201
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/28/2011
Parcel: 1 S135AB01003
Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD 400
Project: Kforce Subdivision: ASHBROOK FARM Lot: PTS 1, 2
Project Description: Relocate break room sink and undercounter hot water heater.
Contractor: MCKINSTRY COMPANY LLC Owner: LINCOLN CENTER LLC
16790 NE MASON ST., STE. 100 BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97230 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 - 331 -0234 PHONE:
FAX: 503 - 331 -6907
FEES
Quantity Description Date Amount
1 ea Floor Drain /Floor Sink/Hub 06/28/2011 $25.02
Specifics: 1 ea Water Heater 06/28/2011 $37.52
1 12% State Surcharge - 06/28/2011 $8.70
Type of Use: COM Plumbing
Class of Work: ALT 10 ea Minimum Fee Adjustment - 06/28/2011 $9.96
Plumbing
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 ado. -d by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -:09'. You may obtain copy of the rules
or direct qu- • OUNC b calling 503.232.1987 or 1.800.332.2344.
Issued By: 410 j e / 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.
Plumbin Permit A lication
Building Fixtures CEO
• FOR +OFiFICE `USE JONIW
t City Of Tigard Date/By: � 8 / / I Permit No.: „l -co� WY
'i 13125 SW Hall Blvd., Tigard, OR 97AIN 2.8 ?f Plan Review
Phone: 503.718.2439 Fax: 503, .1960 • ' ` D Other Permit No.: .
C ate/By:
TIGAR1 Inspection Line: 503.639.4175 nn
T/ Date Ready/By: luris: El See Page 2 for
Internet: www hoard or gov BUILDING D Notified/Method: Supplemental Information
�' I i , 1 ° , : TYPE OW
F OR N D ' O R 3 1 g 113 /FEE *SCHEDULE
❑ New construction 0 Demolition For special information use checklist.
Description Qty. Ea. 1 Total
® Addition/alteration/replacement ❑ Other: New 1- 2- family. dwellings (includes 100 ft. for each utility connection)
i t ' trCATEGORI OF CONSTRUCTION SFR (1) bath 312.70
❑ I- and 2- family dwelling ® Commercial /industrial SFR (2)bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi- family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: (034 (' Greenburg Rd. Catch basin or area drain 18.76
City /State /ZIP: Tigard, OR 97223 Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: _) Page 2
Suite /bldg. /apt. no.: 400 Project name: K -FORCE 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
0 0 Water service (no. linear ft.: _) Page 2
Subdivision: Lot no.: 03400 Fixture or item:
Tax map /parcel no.: 1S135AB Backflow preventer 31.27
,R ; if , �: DESCRIPT ION OF WORK 12.51
Backwater valve
�_" ' ' "' ` ' ' ". Clothes washer 25.02
Relocated existing break room sink and undercounter hot water heater. Dishwasher 25.02
• Drinking fountain 25.02
McKinstry Job #70609 Ejectors /sump 25.02
t %PROPERTI' OWNERk ® TENANT Expansion tank 12.51
�� � ,. ...__ tea,
Name: K -FORCE
Fixture /sewer cap 25.02
Floor drain /floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State /ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) lee maker 12.51
® APPLICANT _ 3a r " ►� -CONTACT PERSON , ' Interceptor /grease trap 25.02
i
,4• 2 fly,.. � . .. ,& " • -,g � - : ,
Business name: McKinstry Company, LLC Medical as (value: $ ) Page 2
Primer 12.51
Contact name: Diane Parke, Project Coordinator
Roof drain (commercial) 12.51
Address: 16790 N.E. Mason Street, Suite 100 Sink /basin/lavatory 1 25.02
City /State /ZIP: Portland, OR 97230 Solar units (potable water) 62.54
Phone: (503) 331.2465 Fax: : (503) 331.6907 Tub /shower /shower pan 12.51
E -mail: dianep @mckinstry.com Urinal 25.02
" Water closet 25.02
7.. , : ,., " CONTRACTOR , iii
_ ' :' . .. e ail,, ,.- �,.�,1. Water heater f 37.52
Business name: McKinstry Company, LLC Water pP 1 m WV 56.29
Address: Same as above Other: 25.02
City /State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 7A-
CCB Lic.: 172811 Plumbing Lic. no.: 37 -22PB Plan review (25% of permit fee)
State surcharge (12% of permit fee) .
Authorized signatur
e e4A_ a _i TOTAL PERMIT FEE t .010 bhg J p /Prlttt name_ Diane P t » This permit application expires if a permit is not obtained within 180 days
Date: after it has been accepted as complete.
/ *Fee methodology set by Tri- County Building Industry Service Board.
1:\ Building \ Permits \PLMU- PermitApp.doc 10/01/09 440.46 t 6T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 •- Supplemental Information
•
Fee Schedule: Residential Fire Suppression Systems:
Site,'Utilit es g Qty: F ;(ga)A , Tota " ' Square Faotage „ ; ° "er + ee.
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 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
Storm & Rain Drain - 1st 100' 62.54 V luation ; P ermitlFee. a ' ,
$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
4 T otal each additional $100.00 or fraction thereof, to
0ther inspect Ong o , � _ QtY ; a Pe el(ea) M k t 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
' j` Quanhty by Fixture Type ,3 Pl II IZevie\ _ Or P1aIYl l 1 111>ista l i�AO>11S 't
F ure T.ype for/ i
PagMli eplace/
l! Plan review is required for any of the following.
Wor =k Performed , ,;; PPS, s;, E Added Relocate
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 ❑ Medical gas and vacuum systems for health care facilities.
- Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918- 780 -0040.
Eye Wash
Floor Drain/sink - 2" Submit 2 sets of plans with any of the above.
-3"
0 .Ysometrcor R><ser><a r
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage - Domestic- non -food
Disposal - Domestic -food related that meet the qualifications above.
- Commercial -food related
- Industrial -food related
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station Relocate only existing sink
Shower -Gang
-Stall
Sink/Lav - Non -food related Rel
- Bradley
- Commercial -food related
- Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
' Washer - Clothes
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:
W:\PDX - Mechanical Construction \SPG - Dept 705\Projects \ - SPG SERVICE -HARD CARD PROJECTS \70609 K- Force \PLMF - PermitApp.doc