Permit CITY OF TIGARD
PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 - 00164
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/27/2007
PARCEL: 1S135AB-03400
SITE ADDRESS: 10260 SW GREENBURG RD 250 ZONING: C -P
SUBDIVISION: LINCOLN CENTER /LINCOLN TOWER LOT: 014 JURISDICTION: TIG
PROJECT: JOHN L SCOTT
Project Description: Plumbing TI - other fixtures: (1) drinking fountain, (1) coffee supply & (1) primer. Per contractor all
fixtures are existing.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS; 1 TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 3
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Owner: FEES
EQUITY OFFICE PROPERTIES TRUST
ONE SW COLUMBIA ST #300 Description Date Amount
PORTLAND, OR 97258 [PLUMB] Permit Fee 4/27/2007 $99.60
[TAX] 8% State Surcha 4/27/2007 $7.97
Phone : Total $107.57
Contractor:
MP PLUMBING CO
P.O. BOX 393
CLACKAMAS, OR 97015 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 655 -9161
FAX 503- 650 -7050
Reg #: LIC 5002
PLM 3 -17PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: f .11 a ( Permittee Signature: h / _ . � N om`
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
am: 04/23/2007 14:35 #052 P.002/003
z • Plumbing Permit Application rills op H( 1 I I f)\
City of Tigard ,, Received J D 7
13125 SW Hal] Blvd., Tigard, OR 9,7 \k, Date/I3 : 7 as
Plan Review
Phone: 503.639.4171 Fax : 960 '3'314 •. +.' \ Other Permit No. a a
24- Hour Inspection Line: 503.639 /
Internet: www.ci.ti ard.or.us P ` \ <� s � I Date Ready/By: 7 / ,y, ® See Page 2 for
g J , ® Notibed/Mcthod:7 01 Supplemental Information
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g � ° For special in tion use checklist
❑ New construction ...,--s.. I U e �tio : J P orma
e I
Description Qty. Ea. Total
/1 Addition /alteration/replacement C` \\ $ Ili
....--t C. _ New 1- 2- family dwellings (includes 100 ft. for each utility connection)
� n r' y#, '� ".�,» A f��� f i+tC- 1 ' r "�� ,9�^ 'i•^I JP�" " , �y� e.. o ,1 e k�� � �ir� t. $' a '� ' 1 SFR 1
.: ,ti x - ns s ¢ i. ` t i+ s l it i `� ,: l bath
�. ; .'a ,' ` kite,, 1 a u1 t: t trw s� yrl '+ 'af , .. � " t () 24920
El 1- and 2- family dwelling V) P/ Commercial/industrial SFR (2) bath 350.00
El Accessory building ❑ Multi - family SFR (3) bath 399.09
❑ Maste builder Each additional bath/kitchen 45.00
❑ Other
F Y �. g�, 7 Fire sprinkler( sq. ft.) Page 2
� ,: lt ..'1' t�?i s 1-1{ { S 1 ,t 1 gz L r ''�7 ? �1 {{ '4 . )` !�
i.l���e� ��3S3ei+��:: eL�.>.$k�.�•Ecr: / a euec 76�i�v�� +'�5r,n"x_��*�4',�� 4��['+? ei� Site utilities
Job site address: 1 4 �i %S.�Y7 .� Catch basin or area drain 16.60
Ci / State/ZIP: /' 1 1 _ Drywall, leach line, or trench drain 16.60 ■
4!ldg. /apt. no.: 1� Project name: , „ �; , .. Footing drain (no. linear ft.: ) Page 2
job site: , l\ �/��� Manufactured home utilities 110.00
Cross street/directions to
J e�""' 4.- c_. t7' "TWIT -. Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) " Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Lot no.: Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: /6135A 03400 Fixture or item
1, A y`� v ° ti Abso don valve 16.60
r mrs G n T " t° l 3t s a 6 a ,. a�ri, t q p g
i . . .s.,(0.' a hOev :; v _ . 4 . A ' x '' , r 2 :,. .1 p. l , % . c x I vi Bacicflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60 �� ,y,„ Dishwasher r 16.60
ly k • u 1 . f � z `� ri' �i f, Efi fNf � s l �t Drinking fountain 16.60
'.a d. a .mot... m o .3,.. :"..: a 4.2 ...t1s,..u'S1..:±7. 1 f ,..,1;: ' ir. am',,S &ti Ejectors /sump 16.60
Name: / 17 - / if Expansion tank 16.60
Address: Fixture/sewer cap 16.60
City/State/ZIP: Floor drain/floor sin ub 1 16.60 f ,
Phone: ( ) Fax: ( ) Garbage disposal 16.60
.: , r 4 b r a P my p: e r" t "IT ti " { " xS 7 i Hose bib 16.60 � i / I I
Business name: MP PLUMBING CO. Ice maker / 16.60 , /
Interceptor /grease trap 16.60
Contact name: TAMI Medical gas (value: $ ) , Page 2 ��
Address: PO BOX 393 Primer / 1 16.60 �/
City/State/ZIP: CLACKAMAS OR 97015 Roof drain (commercial) 16.60 j
Phone: (503) 655 -9161 + Fax: : (503) 650 -7050 Sink/basin/lavatory 16.60 / .,, fp
Tub/shower /shower pan 16.60
E -mail
Urinal 16.60
iitkr i w lr � i �- i t { :mr f q ii a r`,iat �s GL a "a ` � i �101.1t x
.. ;f„. i r w ol.*! ,__ l; t� . ,. _.e itl,
t r.�?: A. ti 2r � l .r1 k Water closet 16.60
Business name: MP PLUMBING CO. Water heater 16.60
Address: PO BOX 393 Other: /1 , �f r f . , 9.
/ / Subtotal ir' (Q�
City / State/ZIP: CLACKAMAS OR 97015 �,
Minimum permit fee: $72.50
Phone: (503) 655 -9161 Fax: (503) 650 -7050 Residential backflow minimum permit fee: $36.25
CCB Lie.: 5002 Plumbing Lie, no.: 3 -17PB Plan review (25% of permit fee)
•
Authorized signature: Li/ri 0 // State surcharge (8% of permit fee) °1
�" TOTAL PERMIT FEE 107,
Print name: TAMI GEORGE Date: •�g .07 This permit appllcadon expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
is\ Building \Pcmits\PLM- PermisApp.doc 06/05 440 .46161(10 /02/COM/WEB)
,
om: 04/2312007 14:35 #052 P.002/003
c opy,
Plumbing Permit Application
FOR 01 1L( I • USE O \t 1
City of Tigard DatB 7 23 V Petatitxo.:
Pct 7 -ie
13125 SW Hall Blvd., Tigard, OR 97243 ` `' y
n Rev icw
Phone: 503.639.4171 Fax : . 503: 5 98.1960 ;. e /�arIr, f 3 I Pio pa �� y , _� Other Permit No. �g
� A „ 7 ._
24- Hour Inspection Line: 503. 39.41 3 ;-sc 'a
= ," .
Internet www.ci.tigard.or.us.k , , - ,w • ' Date Ready/13r ,/ di r v� �j S See Page 2 for
Alf 07
r Notified/Method: / A Supplemental Information
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j } / Fo special 0 New construction , , `[] lYt�ialition p dal lnjormation use checklist
Descri.tion S Ea. Total
E1 Addition/alteration/replacement * y IN 'Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
� F
" 'C 4 ui rte?.- , r.itzi: anti tabs' x.I; F. "...+ Er aci d ip wi w{ s u ;/ ro ol
, � , a s 1 ) '• � r l a ., 4it t � .itin slit I t SFR (1) bath 249.20
1:1 1- and 2- family dwelling - J [/ Commercial/industrial SFR (2) bath 350.00
Accessory building SFR (3) bath 399.00
❑ ry g ❑ Multi - family
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other
Fires sprinkler ( s . R
a�'.'1 5 9 AZ "' .-., q .x..E b Lw SRdil � k. i'. { Si e t E i -tx' - q p Q ft.) Page 2
t
g g ,2 3 1 t # -, �{� �� 4 "i 'I§ 3 i3k 0 y ' "- „gat �,u t
" ki�� " 4 - N.`u�v�,LabsG:, wx 1i1..?c t.�a74r P '' �� CiLM �ul5�a�F��Lv�e..��ZL� Site utilities
Job site address: , , �, / /�i��L�AJ! // ' / t/� Catch basin or area drain 16.60
Ci / State/ZIP: / / .' - Drywell, leach line, or trench drain 16.60
�.ld /a t no.: ' Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: pi} 1,--
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) - Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Lot no.:
Water service (no. linear ft.: 1 Page 2
Tax map /parcel no.: /5] 35)9-6--03490 Fixture or Item •
P+c ,,'"c"c '�� ''" r s{ �.r^ G''1t , . I s" > v y G - +u, -s^` ,r^'� -n s Absorption valve 16.60 44 r " f � •_ .:•r� -:.??a ' 1�k • .'T.^*'� . Y.aI r ; `'.ti Backfl ow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 1 16.60 1d, z
j1J t 31� i y v+ yG F ,�� , i
[ in `� eya . -. '° . . s Drinking fountain !! 5555����
N t ? .' j % si 11:.. u � L -z ' +1 « .:" {p ia L -. ` 14i i�1 �` , k �,, t .. a: ` a t E, 16.60
Name: Q illre • Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City/State/ZIP: Floor drain/floor sin f.'.' 16.60 rims
m
Phone ( ) Fax ( ) Garbage disposal _ 16.60
2 4 u j V,, 4 " r1`-t . � So-.si « .� f f ? s r 4t t � s M i Hose bib 16.60
a.. ti " # . �, ^ .. •`�y 'Ta v �t 9 1 S a, - ,f irm, s e'i 1 .: c k a y 11111
a"� ••�r�.,•'h�e�t�"u ��.,,.;,. �... < . ..,, �" ,,. -: 1°e.T +, , ..:s.�:�rt�. � � ?.�?tS.xt`� , t��,_.�',.. �€ E;S,. {;� Ice maker : / 16.60 .■ , '%
Business name: MP PLUMBING CO.
Interceptor /grease trap 16.60
Contact name: TAMI Medical gas (value: $ ) Page 2 j
Address: PO BOX 393 Primer / 16.60 / 1 j, �
City/State/ZIP: CLACKAMAS OR 97015 Roof drain (commercial) 16.60
Phone: (503) 655 -9161 i Fax: : (503) 650 -7050 Sink/basin/lavatory / 16.60 I 4,6P......
Tub /shower /shower pan 16.60
E-mail:
'1'�'rw tza 1+. '"{' , s a t.1 t 3^• 7 '�
` a -.r, Urinal 16.60
`:'t a 'a? _S� � r. � . ' k -:fb, ,_ ! ... u. . t^;�[y,° •. °' u� 4. . F u'7
:�� ? 54 s . � 1'!t '�" ?,.�",•c�a,°�: u''iu��1i.`;�it� �;taa a'� .....�k..,SS4'e! Water closet 16.60
Business name: MP PLUMBING CO. Water heater 16.60
Address: PO BOX 393 Other: / , J J (: .1 , ilr,5l :,, �'l
City / State/ZIP: CLACKAMAS OR 97015 Subtotal »/ (p
Minimum permit fee: $72.50
Phone: (503) 655 -9161 Fax: (503) 650 -7050 Residential backflow minimum permit fee: $36.25
CCB Lic.: 5002 Plumbing Lic. no.: 3 -17PB Plan review (25% of permit fee)
Authorized signature: 1 • Icier State surcharge (8% of permit fee) ��
TOTAL PERMIT FEE Im
Print name: TAMI GEORGE Date: 1/.2'3 .07 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
i:l BeildingTemits \PLM- PcrmitApp.doe 06/05 440 -46t6T(10/02 /COM/WEB)
'om 04/23/2007 14:36 1#052 P.003/003
Plumbing Permit Application - City of Tigard COPY
Page 2 - Supplemental Information
Fee Schedule: y �{ Residential Fire Su. e ression S stems:
d � � +Mi n kT1`N1 , . Aging k , .. I% , ,r.F!' >> . t napa rn� c wptC� ,, � 3 .. r` 1 -"S 4f }
oir :..,b> - .'..% ` ani:titan lisza,
ii trtk �:: a:t0,; t• ' Ll i .-;gin.t r. ! -ITt:L , Ix 9: � ?1`
.ate �w 9. 4� � -d�
Footing drain - 1' 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 1,200 $220.00
Sewer- 1st 100' 55.00 7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas S stems:
Water Service- each additional 100' 46.40 y It " ' a i +,r>' F ���` " ,, �, �'"' 1 ;' Y W k fi = It ��
Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $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
,5 -V,49 Wi 4 : ` a y,EA ,T -tR} 47 . i 1: "r'i r .i< al71 11 I additional $100.00 or fraction thereof to and
including $10,000.00.
Commercial Back Flow Prevention Device 46.40 r $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $134 for
Residential Backflow Prevention Device each additional $100,00 or fraction thereof, to
(minimum permit 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 $25,000.00 and $1.45 for
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
and including $50,000.00.
specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: each additional $100.00 or fraction thereof.
PGe l'C ' 9 a� j .,rn ,rs� ,� c.^ u rrArga,, ": F
Fixture Work: { a ; , :,3 � .: C T �tt r f atta, k "MA �r
• Are you capping, adding or replacing fixtures? If "yes ", . A "complex structure" is defined as an installation of a plumbing
please indicate work performed by fixture. Failure to system that meets any of the following criteria.
accuratel re , ort fixtures could result in increased sewer fees *. Please check all that apply.
I, 't *'ii a" i" 2 `,!a ,a DZ , ' r T x i v iM � : .��' l , , r�>} i..��__y- nil ❑ Any new commercial building.
.t . + ,, vi; �, . �`"', f' r T rea - 7 �- n , ,m - z�, : _ y � x " ❑ Any new exterior plumbing site utilities.
"` . 7 irrd. sr_; • } ° � .4 � t f f 1 s 3 y � ,� ' ', t4 r ' A commercial building with installation, alteration or addition
B:.tis. /Font of nine (9) or more new or relocated plumbing fixtures.
Bath - Tub /Shower - - - -.4 ❑ Medical gas and vacuum systems for health care facilities
- Jacuzzi/Whirl . • of - - - -a providing services to human beings.
Car Wash -Each Stall _ -_ -_ ❑ Plumbing installations, alterations or additions to food service
-Drive Thru MINN - - - facilities where hew plumbing fixtures, including interceptors,
Cus . idor/Water As • irator - W- are being installed for the food service area.
Dishwasher - Commercial &_ /- ❑ Any new residential building containing three (3) or more
- Domestic ■■•1 IMEIFAIMINI dwelling units.
Drinkin: Fountain -- -=NW-
E e Wash -Mi _A ❑ Any NFPA 13 -D multipurpose fire sprinkler system.
Floor Drain/sink - 2" - - _(MO -
3 ., ,__' Submit 2 sets of plans with any of the above.
jt°r ( a t. hd ui `k�au A ca -n`x- ° 1 v u--, iz . r r ' r ' n ° s
Car Wash Drain - _ -r -- t;< 4.tZs�: ,'': k; ; � Ik. Yt+f ' 1.t 4.'�� -i! -,.-1 .s? -i: fF 7
Garbage - Domestic --IIII► -- • Isometric or riser diagram is required for new buildings
Disposal - Commercial MIME three (3) or more stories in height.
- Industrial - -:1
Ice MachJRefri •. Drains - _-W1♦
Oil Se.arator Gas Station - -_LMIMIll - Co ii ii -nts- regarding- fix- •
Rec. Vehicle Dum. Station - -_ -- fi 2 l �� kge A`A � d er , j�
Shower -Gang '
- -_'� / (J Gt/ it
I � I���\� 11 ' ,R11 f1 rorta,:_ „.y��/ i 1' 4. / �� j...„
Sink OXf avatory - -_:_ - : radley f " ,
_ Emu �Inl ' • l .
-e eroia! - ,. -�'__ iv -d. ! . C-+4.
- Service -_ _- • {I • 4 A .1 ° . .1 . •
Swimm r - -__
in: Pool Filter M - n ,-
Washer - Clothes laMiMi IIIIMA * N ote: the fixture work under this permit r ults in an
Water Extractor "' P
Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and
Urinal - - IIPMEI - fees assessed for the sewer increase must be paid before the
Other Fixtures: _ - AIM - plumbing permit can be issued.
i:\ BuildingTermits \PLM•fermitApp.doc 07/06/05