Permit lifi„F,4-1- CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2015-00425
t r.f K„ Date Issued: 12/17/2015
TIGARD. 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 1 S135AB03400
Jurisdiction: Tigard
Site address: 10260 SW GREENBURG RD 550
Project: KPD Insurance Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Replace existing break room sink
Contractor: POWER PLUMBING CO Owner: LINCOLN CENTER LLC
PO BOX 19418 BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97280 235 MONTGOMERY ST, 16TH FLOOR
SAN FRANCISCO, CA 94104
PHONE: 503-244-1900 PHONE:
FAX: 503-244-8825
FEES
Quantity Description Date Amount
1 ea Sink 12/17/2015 $25.02
Specifics: 1 12%State Surcharge- 12/17/2015 $8.70
Plumbing
Type of Use: COM 47 ea Minimum Fee Adjustment- 12/17/2015 $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 on r OUNC by calling 503.232.1987 or 1.800.332.2344.
Iss ed By: A It'4_4y Permitte Signature: -
Call 503.639.4175 by 7:00 a.m.for the next auaittble 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.
DEC-16-2015 03:50 From: To:5035' 81960 Paee:1/2
Plumbing Permit Application
Building Fixtures RECIV
� . ... r )R CrfF
I(a. Ise'ONLY.
IIIgCity of Tigard Received t®� . / LN /4 60ya
d'1,G 6 2015 Date/B : „ Pcmtit No
+ 13125 SW Hall Blvd.,Tigard, 3
Phone: 503.718.2439 Fax: 503.598"1960 Plan Review id�
Date/By: Other Permit No.: ,S.0 8 p
7:1,�A R 1? Inspection Line: 503.639.417.5...-i-1
Internet: www,tigard-or. ovOh TO ^' `R®, /7 T brill
r v �� J Supplemental Information
Pate Ready/By:
Notified/Method:,
•_ r • ' TYP.: 1 •a 4 / •/E' H. . • FEE"tSCi/PLiULE
❑New construction 0 Demolition For•a dal i' onnasion use checklist
_Description Qty. Ea. Total
0 Addition/alteration/replacement 0 Other: New I-2-1Tumil dwellings( eludes 100 ft.for c ch unlit
r`:' CATEGO tY OF•.CONS�1•RUCI'ION SFR(1)bath cach
cone
,.. .. ..... colon
El1-and 2-family dwelling - ACommercial/industrial SFR(2)bath _ 437.78
Accessory - SFR(3)bath 500.32
❑ Y buildin g 0 Multi-family
0 Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler( sq.ft.) Page2
FI;E. 1!1 Rk..ATIQN'.AND'LOCATION ' Ger:
Site utilities:
_ _
Job site address: 1 Catch basin or area drain 18.76
a7.(D U SvU t�N U` Drywell,leach line,or trench drain 11
City/State/ZIP: -�I' a,�d, 0 e 9-1 z z3 g
Footing dram(no.linear R.:_) Pagee 2 2
Suite/bldg./apt.no.: Project name: K i,b L'�1�"
C15i/VlOL141.Q. Manufactured home utilities 50.03
Cross street/directions to job site: _ Manholes 18.76
Rain drain connecter 1836
Sanitary sewer(no.linear ft.: ) Page 2
' Storni sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.:,___) Page 2
Subdivision: Lot no.: Fixture or Item:
Tax map/parcel no.: Backflow prrvcnter 31.27
Backwater valve
' ': DESpOrTION OF!l?V.ORK ',, . - ` 12.51
CIothes washer _ 25.02
• ' ./ 1 .1 '• - /_, . ,ct.,C" reM Yr! .5•J‘14-&-. Dishwasher 25.02 -
Drinking fountain 25.02
Ejectors/sump 25.02
i ...,:i1. ,•0 PROYERTYi3OWNER '1 •.,,' 0 TENA '. E.rpansicm tank 12.51
Name: Fxture/sewer cap 25.02
-Address: - Floor drain/floor sink/hub 25.02
Crubage disposal 25.02
City/State/ZiP:
Hose hib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
.....c:Ap'. , .. . , • ,;. ,;;�:ID:CON, 0"PERSON."..., Interceptor/grease trap 25.02
Business name: PD i,� /14,,,,,,b,',.7 T. (e
Medical gas(value:$,) Page 2
Contact name: ✓ _- Primer 12.51
Q Roof drain(commercial) 12.51
Address: PD 6DK , /11-1/ifit /nasi>vlavau ry -
r 25.02 25,62_
_
City/State/ZIP: /j 9-72e7.) Solar units(potable water) 12.54
Phone:(5 ) L/W )
Fax::(57 ) a Liy-g e L - Tub/show.-/shower pan 12.51
E-mail:5Qf.v �/
lie 6 yr 114_04 bit,
Urinal 25,02
/r r , -.•y' .�, !Cl7)cJp t Q]R., ( �� ., Water closet 25.02
/ Water heater 37.52
Business name: i , I aa .
Water piping/DWV 56.29
Address: (p .5W Ill if//yr. •,, / A)v Other: 25.02
City/State/ZIP: ( �/ 9)12 3 _ - Subtotal 25,e Z
Phone:(51)3) ,Qii ti- /f U'l Fax:(5!)3) ,2tizi- e 25- Minimum permit fee: $72.50 77.5-1,)CCB Lie.: 5z Z 37g Plumbing Lic,no.:3 y_/s7 pPlan review (25%r3
of permit fee)surcharge(12%of permit fee) 8.70
Authorized signature: 41,a,4.... .,5TOTAL PERMIT FEE g/101,0 ,/
Print name: I. y ��p s Dale: /-)1 1 - This persalt application expires if u permit is not oins v
! after it baa been accepted as complete.btaed within it{p day
`1-=mcthodoiogy yet by Tri-Cnunty Building Industry Service Board.
I:1Build,ng1Pertnds1PLM17Pe nitApp,doc 10/01AM 410-4616T(iOWA:QM/WEB)
DEC-16-2015 03:50 From: To:5035981960 Pa9e:2'2
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site(Utilities; , . .` Qty: Fcc(ea) Total,' . ' Square Footage:: ' Permit Fee: . , '
Footing drain-V 100' 50.03 0 to 2.000 $121.90 _
Footing drain-each additional 100' 37.52 " 2,001 to 3,600 $169.69
Sewer.]st 100' - 3.601 to 7,2(x1 5233.20
62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service•1St 100' r 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
..erk'ee ,
Storni&Rain Drain-1st 100' 62.54 Valuation:. . .Pniit, : �$1,00 to$5,000.0) Minimum fcc$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72-50 for the fust$5,000.00 and$1.52 for
,Other.ZnspeCtiollS,or Fees , `G•J•': Fee lea) Total '1 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 $141150 fon'the first$10,(X)(100 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1R hour) and includirt_$25,000.(0.
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 Foes 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*.
Quanut�by`Fixturr type iPla'n Revievv'for Pluinbtng Installations:
Fixture Type;fur' . , , Rcplacia/
Work Performed:` '. ,. ' Capped . ., Added Relocate Plan review is required for any of the following,
Baptistry/Font Please check all that apply.
Bath -TUb/Shower
0 Any new commercial building with water service 2"and
—
Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive That ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0)40.
Dishwasher -Commercial '- 0 Medical gas and vacuum systems for health care facilities,
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex stnicture as defined in 0AR918-780-0040,
Eye Wash
—
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3..
`; isometric or'Rise.Diagtalln
Car Wash Drain
Garbage -Domestic-Lion-fond ❑ 1SOrnetriG or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice MachiRcfrig.Drains
Oil Separator(Gas Station) — Comments regarding fixture work:
Rec.Vehicle Dump P-12/:) LI -I/l
Shower -Gang
-Stall
Sink/Lav -Non-food related _ I
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer.Clothes
Water Extractor _ increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet — fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
http;//www.tigard--or,gov/document_cen lerBuilding/PLMF,ycnnitApp.dN: