Permit CITY OF TIGARD PLUMBING PERMIT
14 2; COMMUNITY DEVELOPMENT Permit #: PLM2011 -00293
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718.2439 Date Issued: 09!21/2011
Parcel: 1 S 135AB03400
Jurisdiction: Tigard
Site address: 10260 SW GREENBURG RD 710
Project: Axiom Subdivision: METZGER, TOWN OF Lot: 9
Project Description: Remove and replace or relocate fixtures. Add new 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 503 - 619 -3200
FAX: 503 - 331 -6907
FEES
Quantity Description Date Amount
1 ea Floor Drain /Floor Sink/Hub 09/21/2011 $25.02
Specifics: 1 ea Ice Maker 09/21/2011 $12.51
1 ea Primer 09/21/2011 $12.51
Type of Use: COM 1 ea Sink 09/21/2011 $25.02
Class of Work: ALT 1 ea Water Heater 09/21/2011 $37.52
Type of Const: 1 12% State Surcharge - 09/21/2011 $13 51
Occupancy Grp: Plumbing
Stories:
Total $126.09
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 Notif . • -- • er. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090 You may obtain a copy of the rules
or direc . uestions to OU • by ing 503.232 1987 or 1 800 332.2344
Issue. By: Permittee Signature: '^
Call 503.639.4175 by 7:00 a.m. for the next available inspe ion 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 s °`Il ° '- � z f9 n - i tnH s v s p..
i ld>ing Fixtures r � � a4 i ' N r i; ., .,
r ' � r , i FOR OF " US +O ' ,i
, � y q � iS , r9' ,v .:.. I?k,F u.: + a ° ` x`fi �s . ..,d vs ,
CQ' I Ci of Tigard 5 t + ate/By / ,a / / / l� (�Q J
Tigard 1' ;r / �/ • Permit No G �9
13125 SW Hall Blvd., Tigard OR 97 223 ✓�^ �=
Plan Review
4 t Phone 503.718 2439 Fax 503.598 1960 Other Pert No
' �r �' Inspection Line: 503 639 4175 SEP 21 2011 Date /Ry
TIG °ARD Date Ready/By funs H See Page 2 for
t . , Internet www tigard or.gov Notified/Method Supplemental Information
n K . ? >, ,,�.. .,,3 3r;; tea;; e �,r;. . (AV*, .r, a ,. Ms' - •' i ;' _ ��r -`=`=
t;' � `,',` .. 'Sri• „ ,:. E * ` x,i
"� ` � ' >EE 8 • FIEDiJLE�
>�- �' u,TYPE OE<�WORK � � �i' „ ���. C ,.
❑ New construction ❑ Dem pI Lai tl I IL.?! i For special information use checklist.
— Description Qty Ea Total
® Addition/alteration /replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft for each utility connection)
T„ T ; CATEGORY ,OF CONST TION ?, F ' R (1) ba 312 70
❑ 1- 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
i : , ,' Ql �
>.:���, ,a.,•��— F es;
"•<, - «. 1TE ORMATION AND LOCATION Site utilities:
°- J
Job site address: 10260 SW Greenburg Road 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.: 7 i 0 I Project name: Axiom Expansion 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: Lot no.: 03400 Fixture or item:
Tax map /parcel no.: l S135AB Backflow preventer 31 27
;� ; . �. , t' :;3� ; ` (;s3,° t > :„ ; -' lkwater valve 12 51
; ESCRIP ,�TION'�'O,F•,�WORK �, - ": "..' '` Backwater rte =�u :�.�..... ` a:.M,.,r.. -J. .. ___ ' n.�r<, ., ..., CIOtileS WaSheC 25 02
Demo and replace existing break room sink. Replace existing water heater
Dishwasher 25.02
mounted under sink. Dnnking fountain 25.02
McKinstry Job #70656 Building Permit #BUP2011 - 00185 Electors /sump 25 02
.., • ., , _.,, .._ Expansion tank 12.51
`s ®'?'PROPERT (JWNER 1 ® ":TENANT.,
Name: Axiom 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 I 12 51
RR::. ` . : ;; ,: ` 5 ,, , -- E Int erce for /grease tra . 25.02
I ,',� ® ,,.>„ ' LIG A N T;' ;;�� ' h ,,, .CP ,,,CT ` � P - P
Business name: McKinstry Company, LLC
Medical gas (value. $ ) Page 2
Primer 1 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
1 ''':'• CON_ TRACTOR'
- �r " fI .�.:•��s _,E- _ . _... Water heater 1 37 52
Business name: Same as above Water piping/DWV .i-- 56.29
Address: Other 25.02
City /State /ZIP: Subtotal
Phone: ( ) Fax: ( )
Minimum permit fee $72 50
Plan review (25% of permit fee)
CCB Lie.: 172811 Plumbing Lic. no.: 37 - 22PB
State surcharge (12% of permit fee)
Authorized signature: 4 ��- TOTAL PERMIT FEE /726 . 09
/' / This permit application expires if a permit is not obtained within 180 days
Print name: Diane Pay : J �q { Date: /z,1 / L�/' - t 1 after it has been accepted as complete.
6 // *Fee methodology set by Tn- County Building Industry Service Board
1 \Buddma\ Permits \PLMU- PermnApp doe 10/01/09 440- 4616T(10/02/COM /WEB)