Permit CITY OF TIGARD PLUMBING PERMIT
IN r • COMMUNITY DEVELOPMENT Permit#: PLM2015-00323
T WARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/23/2015
Parcel: 1 S135AB03400
Jurisdiction: TIGARD
Site address: 10260 SW GREENBURG RD 375
Project: Spec Space Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Interior plumbing:Capping(1)dishwasher.
Contractor: MCKINSTRY COMPANY LLC Owner: LINCOLN CENTER LLC
16790 NE MASON ST., STE. 100 BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97230 235 MONTGOMERY ST, 16TH FLOOR
SAN FRANCISCO,CA 94104
PHONE: 503-331-0234 PHONE:
FAX: 503-331-6907
FEES
Quantity Description Date Amount
1 ea Fixture/Sewer Cap 09/23/2015 $25.02
Specifics: 1 12%State Surcharge- 09/23/2015 $8.70
Plumbing
Type of Use COM 47 ea Minimum Fee Adjustment- 09/23/2015 $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 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 1.80;e — 44.
Issued By: Perms"ee ignature:
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 / / .ti.'l( )',,
Building Fixtures
of Tigard D Received FOR OFFI('EPeTS'EN`ONLY _
■ 13125 SW Hall Blvd.,Tigard,O� E1�� �Y /��/ i 1-N122GL 5- 2j 3
jig I Plan Review
Phone: 503.718.2439 Fax: 503B91i Permit Other Peit No.:
Inspection Line: 503.639.4175 4t 3 ` Date Rea /B brio: RI See Page 2 for
T I GA RD Internet: www.tigard-or.gov ,_ 201 Notified/Method: Su emental Information
For special information use checklist.
❑New construction OD
Description 1 Qty. 1 Ea. 1 Total
I Addition/alteraltion/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
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
Site utilities:
Job site address: )Co ,(O 0 , k.).„) C.y�� b V( (./\
Catch basin or area drain 18.76
City/State/ZIP: '2' �� 0 of-7 22.-6
Footing 1.leach line,or trench drain 18.76
Footin drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: 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
Clothes washer 12.51
25.02
Y& O C C V2� Ck i Sk1 IA)c.0 1-41Ar PI'Oncl l ( CC n -a k.�'r
Dishwasher 25.02
gjv . .- 3-75- \v t LI r.0 a1,y' So'!-e 3 ED Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I GTTENANT M Expansion tank 12.51
Name: M t,6U..e �.Cv�� Fixture/sewer cap f 25.02 �S p4
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
13/,./.....tPPLICA t CONTACT PERSON 'f Interceptor/grease trap 25.02
Business name: 1"`e tttn0,r Medical gas(value:$ ) Page 2
Contact name: ' ,r.m q .o Primer 12.51
Roof drain(commercial) 12.51
Address: `(0 7 to )s Mcrc,kvi 3\/,42 Sink/basin/lavatory 25.02
City/State/ZIP: To r 1_1 cvi t4 I 0 a /23( Solar units(potable water) 62.54
Phone:(c.b 3)2_-71 .�°i i'i Fax::( ) Tub/shower/shower pan 12.51
E-mail: -t c d Q.YAc_IN.►1) Vr .Corn Urinal 25.02
. _ ___ _ .,. Water closet 25.02
CONTRACTOR.
-- Water heater 37.52
Business name: MCK't A45 Water piping/DWV 56.29
Address: lb -7 ct O ,AAc,scvl Other: 25.02
City/State/ZIP: Voy-\-`CMot OP q, �6 Subtotal ,)5,0},
Phone: l Fax: Minimum permit fee: $72.50 .
( 3) 27X- .soi(1 ( )
CCB Lic.: i 7 Z y 1, Plumbing Lic.no.: 37 v im' C� Plan review (25%of permit fee)
State surcharge(12%of permit fee) F70
-70
Authorized signature: S� , ,_i / TOTAL PERMIT FEE �/_�j
7.y..‘ / `�� Q ) This permit application expires if a permit is not obtained within 180 days
Print name: t Date: I i� after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\PermiMPt.Ml1-PermitApp.doc 10/01/09 440-4616T(10/02/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: 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 S stems:
Water Service-each additional 100' 37.52
Yalu
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
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",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*. 1
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
B tist F rov � ❑ Any new commercial building with water service 2"and
ry' greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
-Jacuzzi/Whirlpool
Ea ❑ New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall
Ea as defined in OAR918-780-0040.
-Drive tall
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: -Commercial ❑ Any multipurpose fire sprinkler system.
-Domestic , ❑ Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
-
Floor Drain/sink: -2"
3"
• Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the s ualifications above.
Disposal: -Domestic food related _
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -LavBar non-food related _ -
-Bradley -
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filer increase of sewer EDUs,a sewer permit will be issued and
Washer-clothes fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet-Toilet plumbing permit can be issued.
Urinal -
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
Accumulative Sewer Tally
III i " Tenant Name: LINCOLN TOWER/SPEC SPACE SWR# N/A
Tic A Iz t> Site Address: 10260 SW GREENBURG RD SUITE 375 PLM# 2015-00323
Parcel#: 1S135AB03400
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 (1 0 0 0
Cuspidor/Water Aspirator 1 0 0 0 0 0
Dishwasher: -Commercial 4 0 0 0 0 0
-Domestic 2 0 1 2 0 -1 -2
Drinking Fountain 1 0 0 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 0 0 0 0
-3 inch 3 (1 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 0 0 0 (1
-Commercial.(to 5 HP) 32 0 0 0 0 0
-Industrial(over 5 HP) 42 0 0 0 _ 0 0
Ice Machine/Refrigerator Drain 1 0 0 0 0 O
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 (1
Shower: -Gang(per head) 1 0 0 0 0 0
-Stall 2 0 0 0 0 0
Sink:
-Iav/Bar-Non-Food Related ) 0 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 I 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
TO'I':11,S 0 0 1 2 0 0 _ -1 -2
Current Fixture Value -2 divided by 16= -0.125 Current l aU 1 EDU= $5,100.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -2 divided by 16= -0.125 over (under) S (663.00)
Enter EDU Change Here -0.130 *
*Round EDUs to the nearest 1/100th: a count ending in.005 shall be rounded up to.01,and a count ending in.014 or less shall be rounded down to.01.
Notes: ***CREDIT***
Authorized Name/Signature: BRANDEN TAGGART X2449 Date: 9/23/2015
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'Pally\Sewer'I'allySheet_51(N)_070115.xlsx