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Permit q CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT COMMUNITY PLM2011 -00356 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/01/2011 c Parcel: 1 S 135AB01004 Jurisdiction: Tigard Site address: 10220 SW GREENBURG RD 150 Project: Sleep Medicine Network Subdivision: METZGER, TOWN OF Lot: 9 Project Description: Install eye wash station. Replace garbage disposal, sink & an under - counter 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 Garbage Disposal 12/01/2011 $25.02 Specifics: 1 ea Sink 12/01/2011 $25.02 1 ea Water Heater 12/01/2011 $37.52 Type of Use: 1 Misc Other Fee 12/01/2011 $1.00 Class of Work: 1 12% State Surcharge - 12/01/2011 $10.63 Type of Const: Plumbing Occupancy Grp: Stories: Total $99.19 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 Noti liter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or dire• questions to OU C by calling 503.232.1987 or 1.800.332.2344. Iss ed By: / / Permittee Signat. e: � — 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. 12/01 /201 1 1 5: 33 5033316907 MCKINSTRY PAGE 01 / 01 , . rlumbine Permit Applieatiou IVED RE CE . - Building Fixtures FOP. OFFICE 11S1: O .„ NI.N• - City of Tigard 9 P • T■In : ' DEC 1 2011 R D:Z/B7' i IfiZLIMAII erm" . - olell- w• • 13125 SW 1-lall Bhrd,. Tigard, OR 97223 1 4 Phone: 503,09.4171. Fax: 503.5981960 . 11 • . . Plan RcViEW Othe Datcaly . r Permit No.: 131„,11211 i - MO . TIGA.ni") Inspection Line: 503.639,4175 CITY OF 'TIGARD Datc Ready/13y: _ • S - km; ' 1i7 ee Page 2 fir AA? • Internet: www.tigard-cr.gov , 1 ■ I IVISION N • . Su. IctnentatInformattan :1.;'i;•1',1+V'..,;+;;(i.:..0.i',.',..;.;' ••,;•;,!.: •,.. ,::•: :••:•H:•• :,:•:; • ;': ,,: li!itl•:r,''`P3't,,'' : ••: : .:'.7.':';:6,..:'! ) ••';‘■ , .!i:.';:•!;;';;;.;,..•:,■'4:!;,;'.. ), ..: , :,•'''•;: , '"7: . :'' .. : ". • ••• •••'•!:•'!•':''•: " • '':::.•, • , -• .:: • ''.- , •.:••:•:•!:, •'• ;'• '''".....•••••.•• ":" '"''''' ' • •••''':- -,••• ' '"' ''••• '; '' ' ""'' • : ' ' '''' -"•:'.' Fur s ee i ,1. in ormri Ilse cheeklisi: 0 New construction ' • 0 Demolition Dcscri .tion. linill La.. Total El Addition/alteration/replacement • • Cl Other: New 1- 2 dwellings (includes J00 ft. for each utility connection) (N.. • ; :'g 4 r,...;A■!!; fi.:■ :iati6eAWioi:!'rtit,N*tijijdttCiN::,"'■ ',..' : i. i:' :.:' :', :'...: 'i ' i u .; SFR (I) bath : . . . . • 312.70 . . . • ,. . • . . /1 ` 7 ' 1' 14' - . •' . . .11111. 437 'MOM 7N. 0 1 - and 2-family dwelling • ; • . S Commercial/industrial SFR (2) bath • -- SFR (3) bath ' 500.32 1111111111 ''. • 1 0 Accessory building . . © Multi..-laniily " = Each additional bath/kitchen • '0 Master builder • . - D Other. ' Fire sprinkler (___•__ siv f•) .. ME Page 2.•. _J i0'':04'i*:0i,*),W#.04,*'i iktii :..•::, • ....:::::!:,i:••'.1i i•:i; Site utliitiem • . catch basin or area drain • 18,76 • . Job site address: 10220 SW GREENBURG ROAD - - ' - Drywall, leach iine, or trench drain • 18.76 • • - • ; ),.) City/State/ZIP: TIGARD, OR 97223 Footing drain (no. fincar It: „.___) ' 111.1 Page 2 . Suite/bldg./apt. no.: 1,51) Projectnarric; SLEEP MEDICINE NETWORK Manufactured; hothe utilities • 50.03 • ' • ' . - ' ------.. Cross stmet/directions to job site; Manholes 15.76 . ; ---------- - . 4:99■.? Rain drain connector . 18.76 - I ' i • 7‘-'*-------- Sanitary sewer (no. linear ft.: _) i . peArIMA 1- Lkvad.00 t 1 - u u . -- Storm scwcr (no, linear It: ___) Page 2 • - Page 2 = ___.- Water service (nn. linear ft ; - Page 2 • Subdivision: - I Lot no.: 01002 Fixture or item: Tax map/parcel no.: I S135AB 0 itil Bacirflow preventer III 31.27 1 i,tk1i1110& :! ;oe . :: •: . a": „;;! ..,,..,,,• 82ckwatcr valve 12,51 25.02 111111.111 INSTALL EYE WASH STATION, GARBAGE DISPOSAL, SINK & FAUCET, Dishwasher Illn 25,02 ' UNDER COUNTER WATER HEATER. fountain 25.02 MCKINSTRY JOB #70700 Ejectors/sump 25.02 ;;•;:•;:',•;;`•:;;!; ;:: ;.:11!i ::' :VillWili.Si:' . 7 Expansion tank ;;;;;;;;;;;;;;ciPii .....,%;;,.;;; .,„„..,,;„„; • '.....k,.,,,,,,;•,,, ....;.;;;:„;;„;;;;;;,;•. •;,.; .t.„: „;;;;,;,-•;,•:;;: ..:: ...... ..■;,• , ,;; • ..^.••;;.;;;;; ;;,;,..;;;„;.;:::, 12.51. Fixture/sewer cap 25.02 ' Name: SLEEP MEDICINE NETWORK -- Floor drain/floor sink/huh 25.02 Address: - - Garbage disposal 25.02 City/State/ZIP: Hose bib MI 25.02 • _ Phone: ( ) Fax: ( ) Tcc maker 12.51 25.02 . :i ,. -;„,„,..,: la . „.:,.; : Interceptor/grease n Business name; MCKINSTRY COMPANY, LLC Medical gas (value: $ ) Page 2 Primer 12.51 Contact name: DIANE PARKE Roof drain (commercial) . IMIKEIMIIIIII • Address: 16790 N.E. MASON sTREET, SUITE 100 Sink/basin/lavatory 25.02 City/State/ZIP: PORTLAND, OR 97230 Solar units (potable water) 62.54 .._ Phone: (503) 331.2465 Fax; : (503) 331.6907 Tuh/shower/showcr pan 12.51 Urinal • ; E-mail.; dianep@mckinstry.com 25.02 ,„ • Water closet 25.02 :!i;■!;i1; - ... : ' •'. ';'•'...,.. ;::•:,:;: •;'••;•;;;;:• ,..•:.....'. ME 37.52 MIN Business name: MCKINSTRY COMPANY; LLC Water pipine/DWV • 56.29 11111 - Address; other: Eyewash Station 1 25.02 - City/State/ZIP: Subtotal Iplimb Phone: ( ) A Fax: ( ) -- Minimum permit fee: $72,50 ,--, Plan review (25% of permit fee) .--'-' Authorized CCB Lie.: 172511 A . 1? 'Tilling Lic. no.; 37 ... - State surcharge TOTAL permit fee) o- 3 siguaorffirrtfir il A_ - PERMI T FEE This permit ti it appllennn expires If n permit is net obtained within 180 days Print name: Dia Pa ke Date: jc) ater it has been accepted as complete, "Pee methodology scr by Tri Building industry Service Board. i• \BoildiopIPermitsIPLMI.T-Pertoltnoti dric 10/01/09 440 I 0102/COMIWUD,1 12/01/2011 14:40 5033316907 MCKINSTRY PAGE 03/04 Piumbini Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: - • .. Residential Fire Suppression Systems: l!' im p i. n, ; l 9t*iii. SI �E;i ep ') : . ..... i'c �" L7 i e . .. 11� i1 � �.'' Footing drain - 1" 100' . 50.03 • 0 16 2,000 • $121.90 • .•Footing: drain -each additional 100' ' 37.52 2.001 to.3,600 $169,69 :• 3.601 to' 7,200 ' Sewer - 1st 100' 62,54 7.201 and�grcatcr • $327.54 Sewer - each additional 100' - 37.52 . Water ScrviEc.,' 1st 100' ' 62:54 Rain Drain - each additional 100' 37.52 Water Service. -each additional 10 Medical Gas. SteCtlS; ... _ . . 3 ,7.52 {{�� y 'y . • ..''•YI'1kllYS'la !.f• • '-a- ]j "jf °: "' •NI' k��'i:r' '�w "' • • foci etc Rain Drain - 1st 1,00' .1TY' ^ � ! .i � li: a X14 1 Y , ii 1 '• T • S 0 ) Minimum'fee 572.'50 Storm ;:,;,, 62.54 • $5,001.00 to $1 • • • $72:60 for the first $5 0 d $, 11. 52 f r & y ., d 51 52 for I" t 5 a "! • clich additional 1 • ;: tl 'ier•Oliiiie6 udin 'i ,� ; eCS`" '? ,, :r,Sc�),�, ; Teta . . . , fi 00,00or'f7action thcreof,.to • : and incl $9:0.000.00. inspection of existing plumbing odor $1(1.001 i00 to $25.00000 3148.50 for the first $10,000,00 and $1,54 for • whieh•no fcc is •specifically indicated 90,00 /hr caoh additional $100,00 or fraction thereof, to ' (minimum charge -1/2 hour) and including $25,000.00. 1 • Inspections outside of normal. business 90.00/hr $25,001.00 to 550.000,00 "$379.50 for the first $25,000;00 and $.1.45 for hnursJtninimum charge - 2 hours) •each additional $100.00'or fraction }hereof. to Rcinspcction Fees . 90.00/hr and including $50,000.00. . Additianat.plaazev.iew. for revisions, ...... 90.00 /hr $50,001.00 and up ' 5742,00 for. the first .$50.000.00 and $1.20 for minimum charge -1/2 hour) . each additionat$100.00 or fraction {hereof, Snbtotnl: 1 • • • • . Commercial Fixture Work: . . Are you capping, adding or replacing fixtures? If "yes ", . _ . please indicate work performed by fixture. Failure to y i accurately report fixtures could result in increased' sewer fees *. f It t' 11 111 Iowirn i a1a>b111it rJfICS' , ! J If �, ,!: Plan review y the follows ::. t ;,' :; ; :!::..0 •uhiittty,bv:.(Fixture):w ease e. i Gw is required for an :of following. ork'Pet'fmarred: 1 G siii;"re�'E';yll'e3 I!! •G' u taco l ': Pi heck all that apply. '�:: ��';: �'�� 1P`rCVili'�s" ;Cap � ' ; ,aP ❑ Any new commercial with water service a tistry � Ailitcyj Txisiin l bildi ith t i 2 I and B (Font _ greater, except systems designed and stamped by licensed • Bath -Tub /Shower - engineer. ! •Jacuzzi/Whirlpool — ❑ New exterior plumbing site utilities for any complcit structure ' Car Wash -Each Stall as defined in 0AR918- 780 -0040_ • -Drive Thru ❑ Medical gas and vacuum systems for health care fac Cus idor/Water As irator ❑ Any multipurpose fire sprinkler system. JI . Dishwasher - Commercial _ _ ❑ Any complex structure as defined in OAR918- 780 - iO40. - Domestic Drinkin • Fountain Submit 2 sets of plans with any of the abovei Eye Wash i Floor Drain/sink " ;:,;;!: 'r � . i:ii!� ' ' � iii. "i,r�� .. a � i.11:.l..,,�:�1 Ir,i - C Isometric or riser diagram is required fornew buildings Car Wash Drain • that meet the ttalif above. Garbage - Domestic l Disposal - Commercial I. • _ - Industrial ice Mach./Refri €. Drains Comments regarding fixture work: ice Separator (Gas Station) - • Rec. Vehicle] um. Station Shower • -Gang • -Stall • Sink. - Ear/Lavatnry i =Bradley - Commercial l - Service Swimming Pool Filter *Note: if the fixture work under this permit resiiilts in an Washer - Clothes increase of sewer EDUs, a sewer permit will be issued and water 'Extractor 1 fees assessed for the sewer increase must be paid before the Water Closet - Toilet plumbing permit can be issued. 1 Urinal Other Fixtures: \ \pofp02 \f]ata\PDX - Mechanical Construction \SPG -Dept 7051Projects \- 9PG SERVICE -HART) CARD PRO3.ECTS \70700 Sleep Medicine Network \Permit \PL.MF- Pcrm.itApp. doe