Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2015-00066
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/11/2015
Parcel: 1S135AB04500
Jurisdiction: Tigard
Site address: 10250 SW GREENBURG RD 101
Project: Bike Storage Subdivision: 1991-055 PARTITION PLAT Lot: 1
Project Description: CAP(1)floor drain and(2)sinks;ADD(1)2"floor sink and(1)water heater for TI.
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
3 ea Fixture/Sewer Cap 03/11/2015 $75.06
Specifics: 1 ea Floor Drain/Floor Sink/Hub 03/11/2015 $25.02
1 ea Water Heater 03/11/2015 $37.52
Type of Use: COM 1 12%State Surcharge- 03/11/2015 $16.51
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $154.11
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 direc estions to c NC by calling 503.232.1987 or 1.800.332.2344.
Issu By: Y / AO , 'L Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection ate
This permit card shall be kept in a conspicuous place on the job site until comp ion of the project.
Approved plans are required on the job site at the time of each inspection.
FROM :MCKINSTRY FAX NO. :5033316906 Mar. 05 2015 02:44PM P1
Plumbing Permit Applicati ECEIVEP
ttal( ,)tl 11 i I tit t)\I 1
Building Fixtures
MAR 5 2015 Date : ro ,CS •%�- Pernik Fi fi.,� Q 0664
City of Tigard plan SOX 02D/-5�00-•a ,
� 13125 SW Ball F31vd"'Tigard,OR 97223gI6or, p►nn R,cview ()that Permit x
i Phone: 503'718.2439 r'ax: 503Ci:1 I VF EIGARD 1'""/13y &ePa�e2lor
Inspection Line: 503,639,4175 � J *T Dare Rcady/By: bn plerocntal for
I I,• t,n T /� ` NntlScd(Method: r ry; ^^Sr{rr l i t ! } rj I I 41jr(111 r 1rri�ti
Internet; www'ti•ard or Gov I 1 1 ,�} , r r t r I t,r)l f`'i.1�{ 'r'ti� ) 1 {, lS� }! i(�' ✓4 I�1JKi?,�,jLLilb�f}:i
:11.:'';,Y nm,,l,u_ ,11%,/k;4rFrf d!i,rlL!.+I)r°�t;Ijr4 .01,!riVit ,i01j"ary Pl ,747,,Jgi 0 ±µ,,,,,!IF1)Jl,�.,,'iIlr7ehhL'.„„,,i}fa,4:`�?rtr„,,r4„,. ) }�niim.,ff.� 11,..01,„....1..... ,,
ri ,,.t',' 1',,f'„, Cell{lilit,r,l),!III,�I,rl'1:I71k?il)fi,••:)vt-7,ttL .i^'r...k17A,�ti,!.1 ',10)}ILlkl�iGIL''111�7�.rtv;,M'6.4: r.,.S'II„ ,l II' .,.�4,1
r For�ua!lnjonrtadon use checklist.
❑New construction
❑Demolition 1)esceiption 1 Qty. Ea. Total
IN Addition/alteration/replacement ❑Other Ncw 1.2-family dwellings(includes 100 ft,for caul ulilit connection)
c.v 7 r.rrt 6r J i � r 312.70
' - ',t;i r .+ Iltii;Fri ':1171 r ):rfl,,.•n' )7 �;}:t+ ri(�(ir�lrlit at/q,j t/r 3,K, ,,pn1 rSFR(1)bath
r r j; r ), ''! i r N. I ' ' li: :'1,Y Pi t r, r+ N 1V SFR.(2)bath 437.78
d Ir'l.1Cri.?,:'(.I}N,r'„!',,11rLiri�V rmr,ivnr�,L, S i 5u rC Ibt.rrbt, ,'.'In Lilil�liAh d�l.atl4ra mlL}r,anr,,,,.:.f_.r.
❑ 1-and 2-family dwelling ®Commercial/Industrial SFR(3)bath 500.32
0 Accessory building ❑Multi-family '
Each additional bath/kitchen
- .n i _ -
25.02•
P
El Master builder ❑Other. � Fire sprinkler( sq.ft,) Page
r H N ` ',T r) uf', It h"'r U717, it nl aai ake,u i riM inVI S !i Se utiities:
-
ia
d r rf irt ;;'ct' tM ,7' ,,i.6d ah,a .fi r i l81�1..rt'1Nt1.rrtrulaa 7 J}6}(i'Lf $A ,,)r 1{fi h.f('rMiIl 1.N) Catch basin or area dram 18.76
Job site address:10250 SW Greenburg Road Drywall,leach Tine,or trench drain 18.7h
City/StateJ7TP:'Tigard,OR 97223 y Footing drain(no.linear ft.:) Page 2
Suite/bldg./apt.no.:101 Project Pro ect name:Bike Storage,Suite 101 Manufactured home utilities 50.03
-
Mattttoles 18.76
Cross street/directions txh.job sip: 18.76
Rant drain connector
Sanitary sewer(no.linear ft.'`) Page 2
Storm sewer(no.linear It: ) Page 2
. �Waler service(no.linear R,:_ ) Page 2
Subdivision: Lot no': fixture or item: '
Hackflow preventer 31.27
Tax map/parcel no.: r ,, r Backwater valve 12.5 I
^n; ;.i,,,,,ID ,.,L..,,,ri;':,;, "''.r;r,),6 , ,•pgrm:rN),r,Kp^;;n'ri7A�L)+?ulJ(hh'{;'�'tn;'T'I>„); tMN}t+'1'!fl"�71 itj{(ryy�T�a;f+iTATI�{�1j FI •�;1lly�
4� ;rrt.,,,,6,:?.;;;;;;;;I ' 'Ir t f,, r',Ildrl'1fai t r' _111 !9. frt`Y!4II .47 LL' k k frt!.i {SI }t :L , 25,02
,';:,�' •a ".C, gd f�r,�,.5 i 1.}..}naJ7ur•�^u;. f•n. �/1,+b ,,fh�v� r +�r,� Clothes washCr
Demo 2 sinks,a floor sink and water heater.Install one new floor sink and Dishwasher 25.02
1 small water healer.
Drinking fountain 25.02
Bjeotors/sump 25.02
rt J ii,w,q,; f 1{'I'+' ri��?,ht'{;:::(.;:.-i t tl ,/g re,i;,,��f:Apiir ;")r'wt s 9 rt �:n, r l i i,?1,,*T''rk°i�:°q'+ Hxpattaion tank , - ..
1 �) { pp a i /�' �1���ry1'��, tgq11�I��qq{{ � ,,`7' ,{ �+n� 4 12 51
,�Ir:rr1 S!'bHl!rnlle,r„fl a ray.r1rt4�:7Mhr,fa;rgdirlMn:r(L{}�ut1•,n9>*$ ,l1Jl�, ,1!�a �Iti ICP(!tfa>'ra'2`,'. �h'S r j a ,,>''�M.�jd', i/l�yrt�!a'{�k -°
Fixture. -3-/scwcr cap 25.02
Name:Shorenstcin Properties LLC Floor drain/floor sink/hub / 2.5.02
Address:235 Montgomery Street, l lour _ Garbage disposal 25.02•
City/Stxte/Z1P:San Francisco,CA 94104 Hose bib 25,02
Phone:(415)772-7000
Fax ( ) Ice maker 12.51
'z'!'1';}; rt;,' .,t 1:•I f t r,r .^ I, 'x rl .r r i{{,{I4rt ejI nr'r,',m �4 ,,,fg 1., � 2 Interceptor/grease
torfglcase trap
25.02
1rr r,,},r, 0+. d''hr,.'•r at nre„,(�r,', ,,uk1 t'r+l r}h{am +/rrL f}rb{ r!g .,.{ :imN fl'4 l:Atr rJ+� t,.. Iwr i tif
Medical gas(value:$ ) Page 2
Business name:McKinstry Co Primer age 12.51 2
Contact name:Antonija Ktizanae Roof drain(commercial) 12'51 _
Address:16790 NE Mason Street,Suite 100 Siak/basin/lavatory 25.02
r
City/State/ZIP:Portland,OR 97230 Solar units(potable water) 02.54
Fax:;(503)331.(1906 Tub/shower/shower pan 12,51
Phone:(503)331-0234 25.02
E-mail antonilak*mekinstry cunt
r N, : r,a , u rl Ull a •)' ;u A r i ,,r ;1310;ft,6 {I{1• h ;9;,ii1:}
Water closet 25.02
p,r 'i Ir:1,.': !'tl l. :i.:;;til ,411 an! .( , 1S.a)i t4i; ine4:1:,.,l�lUi i*,n!IlaV74, 11ikil,:',i0T,:iR ?slLjitR
water heater 1 :37.52
Business name:McKinstry Co. Water piping/DWV 56.29
Address:16790 NE Mason Street,Suite 100 Other. 25.02
Subtotal 3 7,
City/State/Z.IP:1'ortland,OR 97230
503 331-690G Minimum permit fcc: 572.50
Phone:(503)331 0234 Fax:( ) Plan review (25%of permit fcc)
CC:R Lie:17281.1 Plumbing l.ic.no.:37-22 PR Stmt surcharge(12%of permit ix) ,,Authorized xignahlr . / ( TOTAL PERMIT FEE
Date: Zj! f 1 5- t Mis permH application expires If a permit is not obtained within IRO days
Print name:Antunija Krizanac _ LL 4 ( after k has been accepted as complete.
--. • - 'Tee methodology art by Tri-County Building Industry Service Bomd.
I.11uildinePennits 1PLMU-PermItApp.doc 10f01A09 440.4616TCo/u2/C0M/WEH)
FROM :MCKINSTRY FAX NO. :5033316906 Mar. 05 2015 02:45PM P2
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Schedule: Residential Fire Su• •resslon S stems:
Fee c 14 , ,.,,;,,, ,1,1_;,if4 -451q .r::74.�,�, I� { ('I t
..,,�,r .x T^rn,,.,,,,.ry.^r. ry y7rt� ,, ,,,, ,d,w, t• ,11J".iixiilt,1 ✓rl (�r ((,(i '.'r 4�7 '1,� d lw�t "� ' ��7 Ilf'b'r'I I'7]1�}il ir' ,jl' A'
r,t ' r'I i�..',,1 ,, ! flrl. �'! ! il�� ,y7, �I '��,t � Ti..}'^�,� l.sa tali(. S�}3 !;,t4�,nr c. eL,,lr�. LiAu.41n,`f,1 �.{,4 1.1y.i.{Ultl l:!-.i 1 ,.�
,, , , ,: ,, ,,r;rt 1istr.l6, ].Rill].,,1,4, it..i>. i ,'_.,,,,®„ ,i_ .,,
i.5,::,:, !1 r,.��.;.,•Lpb�,.4 ,C,.de,(IIArI +-r,.r,,, i,ILl,i� 0to2,000 $121.90
�Nooung drain-1"100' SOA3 ,
37.52 — y ,60 to 3,200 $169.29
Footing drain-each additional 11x1' 3,601 to 7,200 $233.20 _.
Sewer-1st 100' MEI 62,54 7,201 and greater , $327.54
Sewer-each additional 100' IliEll
Water Service-1st 100' — 62.54 Medical Gas S stems:
Water Service-tech additional 100' 37,52 ,, ;n;r y;�1'i1;1,4,; r, 'i'ili,i'7;;,',)t it ir +�i'o`i�rc!1iid"l{ � l'I' „4r, 1)l1
ufi!
.
1:114, �',.1 ,,:,:I,.•l'si;�r .1i ,i.s it„1 .w .l.Q,,;�:,!unt'i'!1.,' ..C2, ; s0;44.-.., S�f^dh' •
t
62,54
Storm&Rain Drain-1st 100' � $1.fN1 to 55.0110.00 Minimum fee$72.50
Storm&Ram Drain each additional 100' 37.52 55,001.00 to$10,000.00 $72.50 for the first 55,000.00 and$1.52 for
o , ;l V ,,r'1i•:h?"r iyY each additional$100.00 or fraction thereof,to
;,�-,U t , ;,,7 , i { -l t1,14 l� :1: , 40,7.4jte,'t:r ,{Y 4S,LA,i� M (( and includin $10,000.00.
' .,��.�,,.,1,h �,i ��„1>,.F X11,'�)�°�i1 i,,,,�ii•1�„f,.IMJ4r1;,Fr'dxLB�r,,A'�1rt1',.6,e�,.lily,,,t.i~rii�rSfil}u u2N
Inspection of existing plumbing or for $10.001,00 to$25,001.00 $1411.50 for the first$10,000.00 and$1.54 for
which no fcc is specifically indicated 90,00/hr each additional$100.00 or fraction thereof,to
minimum char c–1/2 hour and including$25,000.00.
Inspections outside of normal business I 90.00/1u $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 Pees 90.00/hr and including$50,000.00.
90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
OOPor
Additional plan review for revisions each additional$100.00 or fraction thereof
(minimum charge–1/2 hour
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes”,
please indicate work performed by fixture. Failure to
accurate! report fixtures could result in increased sewer fees* „1• J. ,ui,•1„�, i�x 1� 3�+$.�IY�.t'�I�H
t f r �,fir 1)i,i} ,it Clx dP•,!.'i Tpi Icr'i,t;61 , i','1 , H a' ,i 7f i• ' it ar
tttttr/� n�1'1( l 'i t 7 i'' r ' 1 lYP+"Lrl�� � � i t r'!r i ;:i4, { r•!'41,,-ttL.:t,°.4,il';;� ,1,l I",l dvYt,:' „ 1,
(,1 `I• "ll� ll ' I / 1 r tillil(:�Yi i 111(t N l 1
t, , �,H,`; i 'li` d' +1 l r .� 1 i d i� 1 ii i! Plan review is required for any of chef following.
1'k'�`,)il:' t S-''.1 i-■ W,IA 4;.1111101 �1 'l.t.Tear ,.� vki�ii it ;.`.lio+,
Baptistry/Pont,•iis ry ..,s I i , ,r, . Please check all that apply.
Baptistry/Pont Cl Any new commercial building with water service 2"and
Bath -Tub/Shower greater,except systems designed and stomped by licensed
-Jacuzzi/Whirlpool engineer.
Car Wash -Each Stull . 0 Now exterior plumbing site utilities for any complex structure
-Drive Thru as defined in OAR918-780-0040.
Cuspidor/Water Aspirator
Dishwasher -Commercial — CI Medical gas and vacuum systems for health care facilities.
-Domestic [I Any multipurpose fire sprinkler system.
-Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040,
Eyc Wash
Floor Drain/sink -2” I I Submit 2 sets of plans with any of the above.
,1: t ir�,r,th,,„�er'a,'n∎i ifIjl r,FF , t?si°��'{y lurt+',,I,�r,�r"4C 1'i"i 1; wl..
';;,r,d A'll,i;,t i i,i rh i '1 , s;f rtf',f{Fa,' ,•b'r, + -4.,1t�,'ti.!liegki:1`hlf.1 L.4
in''iU p'!i✓'J.��i.,.a�.lP u.n,+',,�-v,�1l d,n?r r, ,,.7uni1) �n.
Car Wash Drain ■ Tsometric or riser diagram is required for new buildings
Garbage -fxrmestic on-fiord that meet the qualifications above.
Disposal •Domestio--ff related
-Commercial–food related
-industrial-food related
ice Maelt./Refrig,Drains
Oil Separator(Gas Station) _ Comments regarding fixture work:
Rec.Vehicle Dump Station _ .
Shower -Gang r.
Stub
-
Sink/Lav -Non-food related
-Bradley .
-Commercial-food related
-Service 2 ./tom , �J--.-
Wahe
Swimming Pool Filler , wNute: if the fixture work under this permit results in an
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 'roiled .
urinal plumbing permit can be issued.
Other Fixtures: .
W,\Prnjects\N-RUtusscIl Construction\101800 Bike Storage Ste 101 4 Lin!Oln\001 ConstruCtior Permits\PLMF-PermitApp.doc
ill Accumulative Sewer Tally
"Tenant Name: Lincoln Center-Bike Store SWR#
Site Address: 10250 SW Greenburg Rd.,Ste. 101 PLM# 2015-00066
Parcel#: 1S135AB04500
Fixture Value I'n\I t n Previous t:redits Capped l'ixturc Fixture New New
x;due count capped#s value count added# added value total#s t∎.r:d values
Baptistry/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
lloor Drain/Sink: -2 inch 2 0 I 2 1 2 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 3/411P) 16 0 0 0 0 0
-Commercial(to 5 I-1P) 32 0 0 0 0 0
-Industrial(over 5 I-IP) 42 0 0 0 0 0
Ice Machine/Refrigerator Drain I 0 0 0 0 0
Living Unit 16 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:
-Lav/Bar-Non-Food Related 2 0 2 4 0 -2 -4
-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 3 6 1 2 -2 -4
Current Fixture Value -4 divided by 16= -0.250 Current EDU 1 EDU= $4,900.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -4 divided by 16= -0.250 over (under) $ (1,225.00)
Enter EDU Change Here -0.250
Notes: .25 EDU CREDTT
Authorized Name/Signature: Dianna I lowse Date: 3/10/2015
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\.SewerTallySheet_4900._070114.xlsx