Permit CITY OF TIGARD PLUMBING PERMIT
2 : COMMUNITY DEVELOPMENT Permit #: PLM2013 -00092
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/20/2013
• Parcel: 1 S 135AB01003
Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD 265
Project: Reliance Standard Subdivision: METZGER, TOWN OF Lot: 9
Project Description: (1) sink replacement and (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 03/20/2013 $25.02
Specifics: 1 ea Water Heater 03/20/2013 $37.52
1 12% State Surcharge - 03/20/2013 $8.70
Type of Use: COM Plumbing
Class of Work: ALT 10 ea Minimum Fee Adjustment - 03/20/2013 $9.96
Type of Const: Plumbing
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 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
/ /
a lling 503.232.1987 or�1.800.332.2344.
Issued By: ` P /;��/ ( /// , 7 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 Application 7/010
Building Fixtures i ' EIS FOR OFFICE USE ONLY
B
City of Tigard i- 2 Date /B y a-0 I ( 3 Permit No.: pot .4)/ 3-600.7.3--
• 13125 SW Hall Blvd., Tigard, OR 97223 2 ® 201 Received
Date/By:
= Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Other Permit No.
f2,/ • .l ate /By: / I P 3013 - 000 4 , 1 7
Inspection Line: 503.639.4175 cI1 1 OFTIG' S Date Read /B Ja ®See Page 2 for
Internet: www.tigard-or.gov T I G A It D and -or. rr'' r Ready /By: g
g g V ILDING DIVISI. ' d ified/Method: �� Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ 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)
CATEGORY OF CONSTRUCTION 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 ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 10300 SW Greenburg Road Suite 265 Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City/State /ZIP: Tigard, oregon
Footing drain (no. linear ft.: _) Page 2
Suite/bldg. /apt. no.: 265 1 Project name: Reliance Standard 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: 1 Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Disconnect existing sink and replace with new. Relocate water heater from the
Dishwasher 25.02
ceiling to under the counter. Drinking fountain 25.02
Ejectors /sump 25.02
❑ PROPERTY OWNER J ® TENANT Expansion tank 12.51
Name: Reliance Standard 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: Janel Lipe
Roof drain (commercial) 12.51
Address: 16790 NE Mason Street Suite 100 Sinkfbasin/lavatory I 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
CONTRACTOR Water closet 25.02
Water heater ' 37.52
Business name: Same as above Water piping DW V 56.29
Address: Other: 25.02
City/State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee: $72.50
Plan review (25% of permit fee)
CCB Lic.: 172811 Plumbing Lic. no.: 37 - 22PB
State surcharge (12% of permit fee)
Authorized signature � TOTAL PERMIT FEE
Print name: Janel Lipe Date: 03.,..2 43 This permit application expires if a permit is not obtained within 1 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 /09 440- 4616T( I 0 /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: j 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 I"nspections 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.
Quantit 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
- Tub/Shower as defined in OAR918- 780 -0040.
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive Stall ❑ 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" ❑ 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 ! f *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: In A...tr k,--
\ \mckinstry\portland \Construction \Projects \705 OR SPG Hard Cards\2013!71070 Reliance Suite 265 \Permits \71070 - PLMB Permit Application.doc
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
10300 SW GREENBURG RD 265, TIGARD, OR,
97223
Commercial - Plumbing
399 Plumbing final
04/09/2013 00:00
PLM2013-00092
PASS - No C of O
Violation Summary:
Inspector Contractor