Permit Er
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00079
Date Issued: 04/06/2012
T 1GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 parcel: 1S135A601003
Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD 195
Project: Fitness Center Subdivision: METZGER, TOWN OF Lot: 9
Project Description: Relocate (1) shower stall and add (1) shower stall and (2) hose bibs for TI.
Contractor: POWER PLUMBING CO Owner: LINCOLN CENTER LLC
PO BOX 19418 BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97280 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 - 244 -1900 PHONE:
FAX: 503 - 244 -8825
FEES
Quantity Description Date Amount
2 ea Hose Bib 04/06/2012 $50.04
Specifics: 2 ea Tub /Shower /Shower Pan 04/06/2012 $25.02
1 12% State Surcharge - 04/06/2012 $9.01
Type of Use: COM Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $84.07
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 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: O /
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.
APR /06 /2012 /FRI 08:40 AM POWER PLUMBING FAX No, 503 244 8825 P,001
Plumbing Permit Applicati r IVEI)
Building Fixtures FOR OFFICE usr, ()Nl,v tcl
City of T mud ., Tigard, O APR 6 2012 R,
III n 13 �f' z PermitN901/ /1 d0_Q 7 ? %
. 1,25 SW Hail Blvd., 97223
Phone: 5017182439 Fax: 503.5 Other Permit
Plan Revie
Inspection Line: 503.639.4175 OF `I'IGARD b it y � eeR 2 for 4' / " r
T I G A R D ww.tlgard-or.gov bate Reapy/a hes: Su See Page 2 for k
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method sat emenrat Iarormatton
P :. 1 I i- C k[ rfi. : r 1 1 fi f 7 J � :4�`r"Az`, ✓b i - i k."',,4 - k
L : 2 l / 1 p 4 , �i -• - • • . yT f . Alt _ .0-ii.-- . - I .7 i 1
0 New construction ❑ Demolition For spedol information use checklist
Descri . tion 943 . Ea. Total
ddition/altcration/rcplacement ❑ Other New 1- 2- lhmily dwellings (includes 100 ft. for each utility connection
/r, � ° =; , \ i e c 1 ._ 0 o r c., 'RIP : t u e' ' f I . _ ; ,-.. N .,1,;.. � SFR (1) bath 312.70 K4
❑ 1- and 2-family dwelling ► • , , octal industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi - family
Each additional bath/idtchen 25.02
❑ Master builder ❑ Other:
� 4s� ((� Fire sprinkler ( sq. ft.) Page 2
1 r. 1 - r :f /OJ - - 1 7A AC,)Z 0.� IL, {' �, [J'�n�u�TM�,i .Site utrhtle5:
l_ C. ... ... , =y R e.. .l_ 1.�. '�V+Vr . + it:'.c�� �
r Catch basin or area drain 18.76
Job site address: 1 $ 46 ■ ' A *Dr 1 . �ill
City/State/ZIP: D ll, teach line. or trench drain 18.76
T 4 t�v Gl 13 D - 3
s ) Footing drain (no. linear ft.: ) Page 2
Suite/bldgJapt no.: /q Project name: r ( Manufactured home utilities 50.03
Cross street/directions ections to job site r r,' - s S c e r 7Z- Manholes 18.76
Sj Ft•tt�0 p Rain drain connector 18.76
?� Sanitary sewer (no. linear R: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: , f 5 • / Q (f 3 Backflow preventer 31.27
) a'; r t,-T , , l � I'C) t 1 ff,�G) ti "r c• 1� f r ' ' Backwater valve 12.51
�..�_ ,, A, . �si .. rt 25.02
+ S-d p {� v -Pin J Dishwasher • 25.02
Drinking fountain 25.02
3 Ejectors/sump 25.02
r, :: -7.17:1757.-7,',.=: . t i 6 ` 1 y ? gy p, s g � -.. . , -,Tin f f, t-c -, I' �` ` � f T Expansion tank 1251
h . Forme/sewer clap 25.02
Name: L � .-. .. , _ H i / I I r y Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib Z 25.02 50 A LI
Phone: ( ) Fax: ( ) lee maker 12.51
r F�r (rVfi r T�' .`'''; ` 1 g, _ 'F 1'7741 % %5 Interceptor /grease trap 25.02
�•rL + "r __.. . �.._ _ + t e. i,i �,rk_.� i•. medical gas (value: S ) Page 2
Primer 12.51
Business name 1J(1�/ H.lA b hQ
Contact name:
0 V `I
Roof drain (commercial) 12.51
Address: P 6 15(/ 14 41 Sink/basin/lavatory 25.02
_... -_.._ - C i t y / S t a t e / Z I P : - -- ----. 0- • ÷ - - - - - - ... - - -- - Solarenits table -water ...__r__..62 -54 - ..._..._.......__ . - Phone: 09 ) 14WD- - • - -• - Fax:; -6Q3 4'y -g��5 - - _Tu• show - owcr- pan ............._... ��� ....
Email /k') 7! J t, D �� 25.02
U
� F-'-r- - ter^ -c- 1 ' ' ? , J .4 tt )k. { aE, p C'Ai. ms'6.';',. rY. '-4 Water C105et 25.2
e
F F�. , ' s �` , ,:',.....,.,.:Z,-,' 1 c C c: 4G t C 1 "1. 4 .•. 1 - v° .�r�
L- :' 'L.,, . , _ i i.��. : - .,. �'`- �..__:_ G..J'��?:..�J�''!a'c �1�'.a..Yc[k ,,,r, Water heater 37.52
Business name: P • Lan bcA.ci Water piping/DWV 56.29
Address: Sa-- --• Other: 25.02
City/State/ZIP: Subtotal '7 r 04
hone:( )'7 -C.1%.4- /COO Fax:( ) 2 . 4 9 _ 4 9 2 . 6 Minimum permit fire: $72.50
CCB L i c . : : / Plu.mbing Lie. no.: • I • ) P8 Plan review (25% of perutit fee) •
� � 3 7 x �---� 2•rb of fee) q
Authorized signature- TO (1 (AI. PERMIT pantie FEE g460_17
print name: )' '(1 ' c ep - Dam N/ / This p ermit application State surcharge aspires if a permit is not obtained within I80 days
after it has been accepted as complete,
*Fee methodology set by Tri•Coanty Build Industry Service Board.
r :te„aalna\ramerwi rat- nmiiApp.doc td/ot/09 44D- 461STpo/02/CONWEB)
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APR /06 /2012 /FRI 08:40 AM POWER PLUMBING FAX No.503 244 8825 P.002
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su 1 1 ression stems:
°�f_I�Ia !` �' _.... =. V ti L •� = �.� �� - _ .'. -F.' .__r. . ..:I { ;:�3 . . �. ii _:
1- _ �
Footing dram -1 100' 50.03 0 to 2,000 $121.90
Footing drain - each additional 100' _ ®_ 3 601 to 7,200 $233.20
Sewer - 1st 100' 62.54 7 01 and er $327.54
Sewer - each additional 100' 37.52
Water Service - 1st 100' 62.54 Medical Gas S stems:
Water Service -each additional 100' 1111.11 37.52 r 1 } r 5 3 M1 E i� r t_l t -11-:::.:.:-.1
Storm & Rain Drain -1st 100' 62.54Mium i72,250- _- --
$1.00 to $5000.00 I nim fee
Storm & Rain Drain - each additional 100' 37.52 $5,001.00 to $11,000.00 $72.50 for the r - $5,000.00 and $1.52 for
L0,1;1,,,:;- , r l t, it ` 2 - , ' . 1 1-'t each additional $100.00 or fraction thereof to
1 r --- P •,., and includin: $10,000.00.
Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 for the first 810.000.00 and $1.54 for
which no fee is specifically indicated /F f f >} II 90.00/hr ■ each additional $100.00 or fraction thereof to
minimum ch. :e -1/2 hour and includin: $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 $1AS for
hours minimum char :c -2 hours each additional $100.00 or fraction thereof to
Reinspection Fees 90.00/hr and includ; : $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 eh:: a -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
accurate . re 1 ort fixtures could result in increased sewer fees
�t ,VS 9,, „ ` t l ! - 1 :, „,. .. . 7. r ,17, L _ ,� I , I S � �.�1 kI/ l(ffl l l �fr r 41l ,-.1,;(.0_1 ,
y ro ?,� P - } ' . Y �. ! ': Plan review is required for any of the following
Please check all that apply.
Bath
Baptistry/Font - Tub/Shower - ❑ My new commercial building with water service r' and
dacrrrd/Wbblpool greater, except systems designed and stamped by licensed
engineer.
Car Wash -Each Stall
- Drive Thm CI New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918- 780 -0040.
j Dishwasher - Commercial ❑ Medical gas and vacuum systems for health care facilities.
- Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain I Q Any complex structure as defined in OAR918- 780 -0040.
Eye Wash
Floor Drein/sink - T' Submit 2 sets of plans with any of the above.
- 3"
-4" ' .,,r:, 4, f iiwi1 '' " (' � fit' , _ 1 1 - r :;
Car Wash Drain ` Ii nl' -..._
Garbage - Domestio food ❑ Isometric or riser diagram is required for new buildings
__. _
Disposal :._ .:Immestioffoodrelated. that meet the ' alifications above. _ _ .. -. -. -- ......._......... .. ..... _.
- Commercial -food related
_....._. _.... lndirsin. f riOlO iitcd ..._._ ............._.._....._ ........._
Ice MachJRefrip,Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Du s Stn ion
-
Shower -Gang
stall _ ! /
Sink/Lav -Non-food related
- Bradley
.Commercial -food related
- Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
I washer - Clothes increase of sewer EDUs, a sewer permit will be issued and
Water Extractor
WaterCloset Toilet fees assessed for the sewer increase must be paid before the
Urine plumbing permit can be issued.
' Other Fixtures: h n Sit' Fjr 1 S 7- I
http hal l/dcpartments /cd/docs/PLMF- PermitAppjdoc