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Permit
CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit #: PLM2012 -00246 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/27/2012 : I1GllRD 9 Parcel: 1 S135AB03400 Jurisdiction: Tigard Site address: 10260 SW GREENBURG RD 300 Project: Alton Sakai Subdivision: METZGER, TOWN OF Lot: 9 Project Description: Cap (1) non -food related sink, (1) diswasher and (1) 2" hub drain for water heater; add (1) non -food related sink, (1) diswasher, (1) water heater and (1) 2" hub drain for water heater. No sewer EDU increase or credit. Contractor: RAYBORN'S PLUMBING INC Owner: LINCOLN CENTER LLC 19990 SW CIPOLE RD BY SHORENSTEIN PROPERTIES LLC TUALATIN, OR 97062 555 CALIFORNIA ST 49TH FL SAN FRANCISCO, CA 94104 PHONE: 503 -692 -4139 PHONE: FAX: 503 - 691 -2328 FEES Quantity Description Date Amount 1 ea Dishwasher 08/27/2012 $25.02 Specifics: 3 ea Fixture /Sewer Cap 08/27/2012 $75.06 1 ea Floor Drain /Floor Sink/Hub 08/27/2012 $25.02 Type of Use: COM 1 ea Sink 08/27/2012 $25.02 Class of Work: ALT 1 ea Water Heater 08/27/20.12 $37.52 Type of Const: 1 12% State Surcharge - 08/27/2012 $22.52 Occupancy Grp: Plumbing Stories: Total $210.16 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: D•ti /9" / C 7o•d 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. .503 691 2328 Rayborns Plumbing 01:15:19 p.m. 08 -23 -2012 1 /3 Plumbing Permit Application TF1! Building Fixtures RECEIVED 4`tVTT�!, D 1OIt ()I-1•1(.-1-: t S1: (IN IN City of Tigard Received N o. 13125 SW Hall Blvd., Tigard, OR 97)2�i i l 2 3 2012 Dare*: al 13 PL1atpr - v0 4J Plan Review ■ Other Permit No. 8 Phone: 503.639.4171 Fax: 503 Q�TIG Datd Uf es� 01 a... DOi �{ - Inspection Line: 503.639.4 CITY Date Read B a B See 2 (or Internet: www.tigard- or.gov Notified "Method: . TYPE OFi taPill �/ 1 Sopplemental Pa e Information 10 1`1 FEE' SCHEDULE • ❑ New construction ❑ Demolition For spedal information use checklist. Description I Qty. I Ea. I Total Addition/alteration/replacement ❑ Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY 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. R) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: lob site address: I 0 2. is O Sw 6a.s.Er &axe, KR Catch basin or area drain 18.76 Drywell, leach line, or trench drain 18.76 City/State/ZIP: .1's600..O Q R... 9 722-3 Footing drain (no. linear fl.:_) Page 2 Suite/bldg. /apt. no.: 3 oel J Project name: Ai rEt J SA K AT Manufactured home utilities 50.03 Cross street/directions to job site: L 1 I C tD lad 10 4 � 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: l Lot no.: r Fixture oritem: Tax map /parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 CI tejef.0 i CA P ON E Ssw4r I Lib-,f Dishwasher i 25.02 IS. O2- ADD O N StAIL 4 w/H A lg.L.J Drinking fountain 25.02 Ejectors/sump 25.02 ❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: Fixture/sewercap 3 25.02 7.5.66 Floor drain/floor sinkrhub j 25.02 215 O Z. Address: Garbage disposal 25.02 City/State /ZIP: Hose bib 25.02 Phone: ( ) Fax: ( ) Ice maker 12.51 ❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 Business name: Medical gas (value: S _ ) Page 2 - Primer 12.51 Contact name: r Roof drain (commercial) 12.51 Address: Sink/basin/lavatory 1 25.02 2$.o • City/State /ZIP: Solar units (potable water) 62.54 Phone: ( ) Fax: : ( ) Tub/shower/shower pan 12.51 E -mail: Urinal 25.02 Water closet 25.02 CONTRACTOR - • • Water heater I 37.52 _ 37.5A Business name: RA T g0itn4 r S PL2u,g //114 1444. Water Pip 8 r in / DWV 56.29 Address: Q © g b l Other 25.02 City /State/VP: A. LJ4?'L Ai i 0 4, 9 70 6z- Subtotal f 87.bef Phone: (Slit& 6 la - iii .3 9 Fax: du ) 6¢t -2222 Minimum permit fee: $72.50 / CCB Lic.: g 7 ,-Plumbin Lic. no.: 3 q -�6 Plan review (25 %ofpennit fee) State surcharge (12% of permit fee) 22.52 Authorized signature: 40'1 a , TOTAL PERMIT FEE �l 20.g Print name: .3-A /h s c �� p Date: gl ! � This permit application era bs if a permit Is not o complete. within 180 days slier It has been accepted as complete. "Fee methodology set by Tri-County Building Industry Service Board. l i Prunits'PLMU- PmnitApp.doc 10'01 09 440- 1616T(10.02.COM'WED) eloli -503 691 2328 Rayborns Plumbing 01:15:54 p.m. 08 -23 -2012 2/3------ Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities- Qty. Fee (ea) Total Square Footage: . Permit Fee: Footing drain - I" 100' 50.03 0 to 2,000 $121.90 Footing drain - each additional 100' 37.52 2,001 to 3,600 $ 169.69 Sewer - 1st 100' 62.54 3,601 to 7,200 S233.20 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 Valuation' Permit Fee:' Storm & Rain Drain - 1st 100' 62.54 $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 rust 55,000.00 and $1.52 for Other Inspections or Fees . Qty. Fee (ea) Total • each additional $100.00 or fraction thereof, to and including $10,000.00. Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 for the first S10,000.00 and $1.54 for which no fee is specifically indicated 90.00/hr (minimum charge - 1/2 hour) each additional $100.00 or fraction thereof, to and d including $25,000.00. 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 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 ", Plan Review for Plumbing Installations please indicate work performed by fixture. Failure to Plan review is required for any of the following. accurately report fixtures could result in increased sewer fees * . Please check all that apply. Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and Fixture Type: Replace greater, except systems designed and stamped by licensed Previous Capped Added Exteaaa engineer. Baptistry/Font eC er ❑ New exterior plumbing site utilities for any complex structure Bath - Tub/Shower as defined in OAR918- 780 -0040. Jacuzzi/Whirlpool ❑ Medical gas and vacuum systems for health care facilities. Car Wash -Each Stall ❑ Any multipurpose fire sprinkler system. Drive Thru ❑ Any complex structure as defined in OAR9 I 8-780-0040. Cuspidor/ Water Aspirator Dishwasher - Commercial - Domestic j j Submit 2 sets of plans with any of the above. Drinking Fountain Eye Wash or Riser Diagram Floor Drain /sink - 2" / I AV I ❑ Isometric or riser diagram is required for new buildings Jfvf- : 4„ that meet the qualifications above. ar Wash Drain Garbage - Domestic Disposal - Commercial Industrial Comments regarding fixture work: Ice Mach-'Refrig. Drains Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink ��l1 //, B t" - Bradlradley 0 - Commercial 1 1 *Note: If the fixture work under this permit results in an `` ��' - Service increase of sewer EDUs, a sewer permit will be issued and Swimming Pool Filter fees assessed for the sewer increase must be paid before the Washer - Clothes Water Extractor plumbing permit can be issued. Water Closet - Toilet Urinal Other Fixtures: http : / /www.tigard- or.gov/ city_ hall /dcpartments/cd/docs/PLM F- PermitApp2doc CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit #: PLM2012 -00246 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/27/2012 : I1GllRD 9 Parcel: 1 S135AB03400 Jurisdiction: Tigard Site address: 10260 SW GREENBURG RD 300 Project: Alton Sakai Subdivision: METZGER, TOWN OF Lot: 9 Project Description: Cap (1) non -food related sink, (1) diswasher and (1) 2" hub drain for water heater; add (1) non -food related sink, (1) diswasher, (1) water heater and (1) 2" hub drain for water heater. No sewer EDU increase or credit. Contractor: RAYBORN'S PLUMBING INC Owner: LINCOLN CENTER LLC 19990 SW CIPOLE RD BY SHORENSTEIN PROPERTIES LLC TUALATIN, OR 97062 555 CALIFORNIA ST 49TH FL SAN FRANCISCO, CA 94104 PHONE: 503 -692 -4139 PHONE: FAX: 503 - 691 -2328 FEES Quantity Description Date Amount 1 ea Dishwasher 08/27/2012 $25.02 Specifics: 3 ea Fixture /Sewer Cap 08/27/2012 $75.06 1 ea Floor Drain /Floor Sink/Hub 08/27/2012 $25.02 Type of Use: COM 1 ea Sink 08/27/2012 $25.02 Class of Work: ALT 1 ea Water Heater 08/27/20.12 $37.52 Type of Const: 1 12% State Surcharge - 08/27/2012 $22.52 Occupancy Grp: Plumbing Stories: Total $210.16 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: D•ti /9" / C 7o•d 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.