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Permit • • CITY OF TIGARD PLUMBING PERMIT • C COMMUNITY DEVELOPMENT Permit #: PLM2012 -00340 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/20/2012 Parcel: 1 S 135AB00900 Jurisdiction: Tigard Site address: 10200 SW GREENBURG RD 110 Project: Fidelity National Title Subdivision: METZGER, TOWN OF Lot: 9 Project Description: Cap (1) sink and relocate 10' to new location, replace with new fixture and add (1) 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 Fixture /Sewer Cap 11/20/2012 $25.02 Specifics: 1 ea Sink 11/20/2012 $25.02 1 ea Water Heater 11/20/2012 $37.52 Type of Use: COM 1 12% State Surcharge - 11/20/2012 $10.51 Class of Work: ALT Plumbing Type of Const: Occupancy Grp: Stories: • Total $98.07 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: , !ll ��� ���[[[ 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. • • Plumbing Permit Application 7070 Building Fixtures RECEIVE FOR OFFICE USE ()NIX City of Tigard NOV 2 012 Received /� 0 13125 SW Hall Blvd., Tigard, OR 97223 2 O Date /By: # o �� ermit NoPL,y„� /a _403 yo C Plan Review IN Phone: 503.639.4171 Fax: 503.598.196Q, OPTIGARD Other Permit No.: l Date /By: Inspection Line: 503.639.4175 ISIO Nate Read /B +164 ® See Pa e 2 for ''`' "''D g g BUILDINGDN y y: g Internet: www.tl and -0r. ov otified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist Description I Qty. I Ea. I Total ® Addition/alteration/replacement ❑ Other: New I- 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. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: 10200 SW Greenburg Road Catch basin or area drain 18.76 Drywell, leach line, or trench drain 18.76 City/State /ZIP: Tigard, Oregon 97224 Footing drain (no. linear ft.: _ ) Page 2 Suite/bldg. /apt. no.: 110 I Project name: Fidelity Title 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: I Lot no.: Fixture or item: Tax map /parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 Demo and remove (1) existing sink. Alter plumbing lines to the new sink location Dishwasher 25.02 (approx 10 feet from original location) and install new sink. Drinking fountain 25.02 Ejectors/sump 25.02 ❑ PROPERTY OWNER I ® TENANT Expansion tank 12.51 Name: Fidelity Title Fixture/sewer cap / 25.02 . Floor drain/floor sink/hub 25.02 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: McKinstry Co Medical gas (value: $ ) Page 2 Primer 12.51 Contact name: Janet Lipe Roof drain (commercial) 12.51 Address: 16790 NE Mason Street Suite 100 Sink/basin/lavatory 1 25.02 City/State /ZIP: Portland, Oregon 97230 Solar units (potable water) 62.54 Phone: (503) 278 -3954 Fax: : (503) 331 -6907 Tub /shower /shower pan 12.51 E -mail: janell @mckinstry.com Urinal 25.02 Water closet 25.02 CONTRACTOR Water heater I 37.52 Business name: Same as above Water piping/DWV 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal Phone: ( ) Fax: ( ) .27-g2/1 Minimum permit fee: $72.50 CCB Lic.: 172811 / / /4/g Plumbing Lic. no.: 3 .2PB"" Plan review (25% of permit fee) State surcharge (12% of permit fee) Authorized signatur • TOTAL PERMIT FEE Cfi 0 7 Print name: Janel Lipe Date: 11.19.12 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. 1:\ Building \Pcnn its \PLMU -Perm itApp.doc 10/01/09 440.461 6T(I01021COAUWEB) 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 - 1' 100' 50.03 0 to 2,000 $121.90 Footing drain - each additional 100' 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer - 1st 100' 62.54 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 first $5,000.00 and $1.52 for Other ec Ins tions or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to Inspections and including $10,000.00. Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for which no fee is specifically indicated 90.00/hr each additional $100.00 or fraction thereof, to (minimum charge - 1/2 hour) and including $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 $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 ", please indicate work performed by fixture. Failure to Plan Review for Plumbing Installations accurately report fixtures could result in increased sewer fees *. Plan review is required for any of the following. Quantity by (Fixture) Work Performed Please check all that apply. Fixture Type: Replace Pp y Previous Capped Added Existing ❑ Any new commercial building with water service 2" and Baptistry/Font greater, except systems designed and stamped by licensed Bath - Tub /Shower engineer. - Jacuzzi/Whirlpool ❑ New exterior plumbing site utilities for any complex structure Car Wash - Each Stall as defined in OAR918- 780 -0040. - Drive Thru ❑ Medical gas and vacuum systems for health care facilities. Cuspidor/Water Aspirator ❑ Any multipurpose fire sprinkler system. Dishwasher - Commercial ❑ Any complex structure as defined in OAR918 780 - 0040. - Domestic Drinking Fountain Submit 2 sets of plans with any of the above. Eye Wash Floor Drain/sink - 2" - Isometric or Riser Diagram 3 ❑ Isometric or riser buildings diagram is required for new buildin - g q g Car Wash Drain that meet the qualifications above. Garbage - Domestic Disposal - Commercial - Industrial Ice Mach. /Refrig. Drains Comments regarding fixture work: Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar /Lavatory - Bradley - Commercial -Service *Note: If the fixture work under this permit results in an Swimming Pool Filter Washer - Clothes increase of sewer EDUs, a sewer permit will be issued and Water Extractor fees assessed for the sewer increase must be paid before the Water Closet - Toilet plumbing permit can be issued. Urinal Other Fixtures: \\ mckinstry\portland \Construction\Projects \705 OR SPG Hard Cards \ - SIT SERVICE -HARD CARD PROJECTS \70969 Fidelity Suite 110\Permit \70969 - PLMB Permit Application.doc