Permit _ CITY OF TIGARD PLUMBING PERMIT
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11 COMMUNITY DEVELOPMENT Permit#: PLM2013-00029
T(GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/22/2013
Parcel: 1 S135AB01003
Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD 500
Project: Myatt&Bell Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Relocate(1)sink and replace(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 Sink 01/22/2013 $25.02
Specifics: 1 ea Water Heater 01/22/2013 $37.52
1 12%State Surcharge- 01/22/2013 $8.70
Type of Use: COM Plumbing
Class of Work: ALT 10 ea Minimum Fee Adjustment- 01/22/2013 $9.96
Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
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, • • woe k". suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility ■ stification 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 dir ct questions to OUNC • g 503.232.1987 or 1.800.332.2344.
Iss ed By: — /i 01 /A-cAr._41 Permittee Signature:
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 Applica 'on
Building Fixtures ECEIVED Y
of Ti and FOR OFFICE USE ONLY'
Re`ei`ed 2
City g Date/By: / 01",_ /,3 ,h rellint No.:1't1-1,Aoi3-eco�9
13125 SW Hall Blvd.,Tigard,OR 9 2 2 2013 Plan Review �(�� �
C Phone: 503.639.4171 Fax: 503.598.1960 Other Permit No.:I°Llf
Date/By:
Inspection Line: 503.639.4175
TIGARD CITY OF TIGARD Date Read /B Joris: ® See Page 2 for
Internet: www.tigard-or.gov , - Notified/Method: Supplemental Information
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❑New construction ❑Demolition For special information use checklist.
Description ( Qty. I Ea. I Total
® Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
ATEGORY OF CONSTRUCT101111 SFR(1)bath 312.70
❑ 1-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 El Other: Fire sprinkler(_sq.ft.) Paget
JOB SITE INFORMATION AND LOCATION iii. Site utilities:
Job site address:10300 SW Greenburg Road Catch basin or area drain 18.76
City/State/ZIP:Tigard,Oregon 97224 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.:500 I Project name:Myatt Bell 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
Relocate(1)existing sink along wall approximately 5 feet.Replace existing Dishwasher 25.02
water heater with new. Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ® TENANT ': Expansion tank 12.51
Name:Myatt Bell 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:( 1 Ice maker 12.51
® APPLICANT ® CONTACT PERSON Interceptor/grease trap 25.02
Business name:McKinstry Co Medical gas(value:S ) Page 2
Primer 12.51
Contact name:Janel Lipe
Roof drain(commercial) 12.51
Address:16790 NE Mason Street Suite 100 Sink/basin/lavatory ` 25.02 ,ZS Oy
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
II CONTRACTOR .iiimm Water closet 25.02
Water heater 37.52 37.
Business name:Same as above Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50 7A.50
31 ��n p� Plan review (25%of permit fee) -
CCB Lic.:172811 Plumbing Lic.no.: 1 f.! State surcharge(12%of permit fee) e'..70
Authorized signature: TOTAL PERMIT FEE ei.
Print name Janel Lipe Date: 42/..yZ (3 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\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(I0/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: 1, Permit Fee:
Footing drain-151 100' 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 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$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", 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: - I Replace greater,except systems designed and stamped by licensed
I Previous Capped Added • Existing engineer.
Baptistry/Font
Bath -Tub/Shower ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Jacuzzi/Whirlpool
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive tall ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR9I 8-780-0040.
Dishwasher -Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash Isometric or Riser Diagram
Floor Drain/sink -2" ❑ Isometric or riser diagram is required for new buildings
that meet the qualifications above.
Car 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 -Bar/Lavatory 1 _ -
-Bradley
-Commercial *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 plumbing Extractor P g p ermit can be issued.
Water Closet-Toilet
Urinal
Other Fixtures:
\\mckinstry\portland\Construction\Projects\705 OR SPG Hard Cards\20132710I6 Myatt&Bell\Permits\71016-PLMB Permit Application.doc