Permit CITY OF TIGARD PLUMBING PERMIT
• COMMUNITY DEVELOPMENT Permit #: PLM2013 -00039
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/06/2013
Parcel: 1 S 135AB01002
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 417
Project: Cypress Subdivision: METZGER, TOWN OF Lot: 9
Project Description: Install (1) 2" hub drain for HVAC condensation
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 Floor Drain/Floor Sink/Hub 02/06/2013 $25.02
Specifics: 1 12% State Surcharge - 02/06/2013 $8.70
Plumbing
Type of Use: COM 47 ea Minimum Fee Adjustment - 02/06/2013 $47.48
Plumbing
Class of Work: ALT
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, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility N ' en r. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or • ct questions to OUN ' g 3.232.1987 or 1.800.332.2344.
I sued 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.
Plumbing Permit Application R 7 61(
Building Fixtures R ECEIVE I
FOR OFFICE USE ONLY
u�
Received �/
City of Tigard C pp Permit No.:
NI a 131 SW Hall Blvd., Tigard, OR 97223 �E D 2 13 Date /By: ••I U ( 3 DLH cap/ 3 - 39
C Plan Revie 8 a ^ f ? 0C ., 3 •
f
Phone: 503.639.4171 Fax: 503.598.19 Other Permit No.: l� �D
C OF TIGARD D ate /By:
Inspection Line: 503.639.4175 Date Read /B luris: E5 See Page 2 for
TI G A R D Internet: www.tigard - or.gov BUILDING DIVISION Notified/Method: rr2 (e2 Supplemental Information
TYPE OF WORK FEE* SCHEDULE
I
❑ New construction ❑ Demolition For special information use check list .
Description I Qty. I Ea. I Total \
® Addition/alteration/replacement ❑ Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection) t
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
❑ I- and 2 - family dwelling ® Commercial /industrial SFR (2) bath 437.78
building SFR (3) bath 500.32
III
❑ Accessory g ❑ Multi family e
Each additional bath/kitchen 25.02 C
❑ Master builder
❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 10220 SW Greenburg Road Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City/State /ZIP: Tigard, OR 97224
Footing drain (no. linear ft.: _ ) Page 2
Suite/bldg. /apt. no.: 417/4 I Project name: Cypress 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
Install (1) new hub drain in an existing mechanical chase to capture the
Dishwasher 25.02
condensate from (2) indoor split system units and (1) water source heat pump Drinking fountain 25.02
Ejectors /sump 25.02
._ ❑PROPERTY OWNER I ® TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
- Name: Cypress 25.02
Floor drain/floor si u
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: James Meyer
Roof drain (commercial) 12.51
Address: 16790 NE Mason Street Suite 100 Sink/basin/lavatory 25.02
City/State /ZIP: Portland, Oregon 97230 Solar units (potable water) 62.54
Phone: (503) 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 37.52
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„`5
Plan review (25% of permit fee)
CCB Lie.: 172811 Plumbing Lic. no.: 37 -22PB
State surcharge (12% of permit fee) T.70
Authorized signature: TOTAL PERMIT FEE f .. Print name: Janet Lipe Date T..)u.zvrS T his permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
CA . y- ( 4, ✓ *Fee methodology set by Tri- County Buildin ndustry Service Board.
•
1:\ Building \ Permits \PLMU- PermitApp.doc 10 /01 /09 440- 4616T(1 0 /02 /COM /WEB) t
'1;4 a %t* p C
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 Qty. Fees Inspections Fee (ea) Total each additional $100.00 or fraction thereof, to
P 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: Replace greater, except systems designed and stamped by licensed
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 Thll ❑ Any multipurpose fire sprinkler system.
Cuspidor /Water Aspirator ❑ Any complex structure as defined in OAR918 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" 1 ❑ Isometric or riser diagram is required for new buildings
that meet the qualifications above.
- 4"
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
- 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 permit can be issued.
Water Extractor p g p
Water Closet - Toilet
Urinal
Other Fixtures:
W: \Construction \Projects \705 OR SPG\2012 - PROJECTS \951 I Cypress \110 Permits \951 I - PLMB Permit Application.doc
FROM :MCKINSTRY FAX NO. :5033316906 Feb. 05 2013 10:06AM 1
FAX TRANSMISSION
16790 NE Mason St.
Portland, OR
97230
PH: 503.278.3954
FAX: 503.331.6906
TO: City of Tigard
DATE: 02105/ 2013
ATT: pEBB %
FAX: (503) 598 -1960 PAGES: 2 incl. cover
RE: Permit #PLM2013 -00039
****** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Thank you!
3anel Ripe, Dept. Specialist
503- 278 -3954
503 - 331 -6906 fax
creez
The contents of this fax are confidential and intended for the above named recipient only, If you
receive this by mistake please contact the sender at the number listed above.
Accum : '' . -wer Tally Tall _
j 0 �7 Tenant Name: Cypress *SWR #
2013 -0001 • VOIDED .EE SEWER SWR ,2013 -00015 i
Site Address: 10220 SW Greenburg 41 TALLY PLM2012- 00367* PLM #12013-00039
■TiGi.It ;L;
Parcel #:;1S1 35AB01002 .
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped #s value count added # added value total #s total values
Baptisery/Font 4 0 0 0 0 0
Bath: - Tub /Shower 4 0 0 0 0 0
- Jacuzzi /Whirlpool 4 0 0 0 0 0
Car Wash: - Each Stall 6 0 0 0 0 0
- Drive through 16 0 0 0 0 0
Cuspidor /Water Aspirator 1 0 0 0 0 0
Dishwasher: - Commercial 4 0 0 0 0 0
- Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink: - 2 inch 2 0 0 1 2 1 2
- 3 inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 /9 - Car Wash 6 0 0 0 0 0
Garbage Disposal:
- Domestic (to 3/4 HP) 16 0 / J 0 0 0 ' 0
- Commercial (to 5 HP) 32 0 "� / 0 0 0 0
- Industrial (over 5 HP) 42 0 0 0 0
Ice Machine /Refrigerator Drain 1 0 J 0 0 0 0
`0 0
Oil Sep (Gas Station) 6 0 0 0
Rec. Vehicle Dump station 16 0 0 0 0
Shower: - Gang (per head) 1 0 0 0 0 0
- Stall 2 0 0 0 0 0
Sink: -
- Lav /Bar - Non -Food Related 2 0 0 0 0
- Bradley 5 0 0 0 0 0
- Com /Serv/Util - Food Related 3 0 0 0 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 0 0 0 0 0
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 0 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 1 2 1 2
Current Fixture Value 2 divided by 16 = 0.125 Current EDU 1 EDU = $4,665.00
Previous Fixture Value 0 divided by 16 = 0.000 Previous EDU
Change 2 divided by 16 = 0.125 over (under) $ 606.45
Enter EDU Change Here 0.130
Notes: 2/6/13, applicant changed hub drain size from 3" to 2 ". DA *SWR2013 -00015 to be voided as sewer credits were applied from PLM2012- 00367.*
Authorized Name /Signature: 1Shirley Treat /Debbie Adamski Date: 1 2/4/2013 1
. Building Division
Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher which must be
submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
I: \ Building \ Sewer '1 'ally \Sewer 1'allySheet- 4665.xls 07/01/12
�;.:r.��ts -:
•'3-
III E Accumulative Sewer Tally RE- t) . -- C_�
*� A"� SWR #
- '�"' Tenant Name: C;yprrss"'RI : \'ISI'.D 2/G/13 "'
� � �''i Site Address: 10220 S \VGrccnburg Rd., Ste. 417 PI .NI # 2012 -00367
TI ARRF?
Parcel #: 1 S 135AB - 01002
Fixture Value Previous Previous Credits Capped Fixture fixture New New
# value count capped #s value count added # added value total #s total values
Baptiscry /Font 4 0 0 0 0 0
Bath: - Tub/Shower 4 0 0 0 0 0
- Jacuzzi /Whirlpool 4 0 0 0 0 0
Car Wash: - Each Stall 6 0 0 0 0 0
- Drive through 16 0 0 0 0 0
Cuspidor /Water Aspirator 1 0 0 0 0 0
Dishwasher: - Commercial 4 0 0 0 0 0
- Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 0 0 0
Eye Wash 1 0 0 0 0 - 0
Floor Drain /Sink: - 2 inch 2 0 2 4 2 4 0 0
- 3 inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car\Wash 6 0 0 0 0 0
Garbage Disposal:
- Domestic (to 3/4 I IP) 16 0 1 16 0 -1 -16
- Commercial (to 5 I IP) 32 0 0 0 0 0
- Industrial (over 5 I IP) 42 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 0 0 0 0 0
Oil Sep (Gas Station) 6 0 0 0 0 0
Rec. Vehicle Dump station 16 0 0 0 0 0
Shower: - Gang (per head) 1 0 0 0 0 0
- Stall 2 0 0 0 0 0
Sink:
- 1.av /Bar - Non -Food Related 2 0 2 4 1 2 -1 -2
- Bradley 5 0 0 0 0 0
- Com /Scrv/Util - Food Related 3 0 0 0 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 0 0 0 0 0
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 0 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped IiDU Credit 0
'1•(71•:\1.5 0 0 5 24 3 6 -2 -18
Current Fixture Value -18 divided by 16 = -1.125 Current I {DU 1 EDU = $4,665.00
Previous Fixture Value 0 divided by 16 = 0.000 Previous 1 {D1_1
Change -18 divided by 16 = -1.125 over (under) S (5271.45)
Enter EDU Change Here -1.130
Notes: •' 'CREDIT" '2/6/13, REVISED FOR PI.M2013- 00039, (I) 2 "1I1.IB DRAIN Deb
Authorized Name /Signature: Shirley Treat Date: 12/19/2012
Building Division
vote: The property owner shall retain the ORIGINAL. sewer tally record. If credits exist, this document will serve as a voucher which must be
submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
I: \Building \Sewer Tally \Sewer IallyShcct- 4665.xls 07/01/ 12
• Accumulative Sewer Tally nd,A)4 L-
- 4
Tenant Name: Cypress SWIt #
Site Address: 10220 SW Grecnburg Rd., Ste. 417 PLM # 2012 -00367
TIGA-RD
Parcel #: 1 S 135AB-01002
Fixture Value Previous Previous Credits Capped Fixture Fixture Ncw New
# value count capped #s value count added # added value total #s total values
Baptiscry/Font 4 0 0 0 0 0'
Bath: - Tub /Shower 4 0 0 0 0 0
- Jacuzzi /Whirlpool 4 0 0 0 0 0
Car Wash: - Each Stall 6 0 0 0 0 0
- Drive through 16 0 0 0 0 0
Cuspidor /Water Aspirator 1 0 0 0 0 0
Dishwasher: - Commercial 4 0 0 0 0 0
- Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink: - 2 inch 2 0 2 4 1 2 -1 -2
-3inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash 6 0 0 0 0 0
Garbage Disposal:
- Domestic (to 3/4 HP) 16 0 1 16 0 -1 -16
- Commercial (to 5 HP) 32 0 0 0 0 0
- Industrial (over 5 1 -IP) 42 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 0 0 0 0 0
Oil Sep (Gas Station) 6 0 0 0 0 0
Rec. Vehicle Dump station 16 0 0 0 0 0
Shower: - Gang (per head) 1 0 0 0 0 0 .
- Stall 2 0 0 0 0 0
Sink:
- l.av /Bar - Non -Food Related 2 0 2 4 1 2 -1 -2
- Bradley 5 0 0 0 0 0
- Com /Serv/Util - Food Related 3 0 0 0 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 0 0 0 0 0
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 0 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 5 24 2 4 -3 -20
Current Fixture Value -20 divided by 16 = -1.250 Current EDU 1 EDU = $4,665.00
Previous Fixture Value 0 divided by 16 = 0.000 Previous EDU
Change -20 divided by 16 = -1.250 over (under) S (5,831.25)
Enter EDU Change Here -1.250
Notes: "`CRF.DTI'* "
Authorized Name /Signature: Shirley Treat Date: 12/19/2012
Building Division
Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher which must be
submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
I:\ Building \ Sewer Tally \Scwcr'I'allySheet- 4665.xls 07/01/12
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
11117 SW GREENBURG RD, TIGARD, OR,
97223
Commercial - Plumbing
399 Plumbing final
2014-03-28 (null)
PLM2014-00039
FAIL
1. Provide 3/4" Y fitting on bathroom tail piece for water heater T & P.
Recall when ready.
Violation Summary:
Inspector Contractor