Permit (53) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2016-00482
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/27/2016
Parcel: 1 S 135AB03400
Jurisdiction: Tigard
Site address: 10260 SW GREENBURG RD 600
Project: Maccoll,Busch,Sato Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Interior plumbing:Adding(1)domestic dishwasher,(1)2"floor drain,(1)lavatory,and(1)water heater.
Contractor: RAYBORN'S PLUMBING INC Owner: LINCOLN CENTER LLC
PO BOX 69 BY SHORENSTEIN PROPERTIES LLC
19990 SW CIPOLE RD 235 MONTGOMERY ST, 16TH FLOOR
TUALATIN,OR 97062 SAN FRANCISCO, CA 94104
PHONE: 503-692-4139 PHONE:
FAX: 503-691-2328
FEES
Quantity Description Date Amount
ea Dishwasher 09/21/2016 $25.02
Specifics: 1 ea Floor Drain/Floor Sink/Hub 09/21/2016 $25.02
1 ea Sink 09/21/2016 $25.02
Type of Use: COM 1 ea Water Heater 09/21/2016 $37.52
Class of Work: ALT 1 12%State Surcharge- 09/21/2016 $13.51
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $126.09
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 1.800.332.2344.
Issued By: „<a75/7/717
Permittee Signature: , /4t/
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.
From:Raybo rns Plu mming INC 503+6914-2328 09/13/2016 15:02 4426 P.001/002
Plumbing Permit Appli tj , f, �-'
Site Utilities " '' FOR 01lICL- t;SE ONE
Cityof Tigard c Received
131SW Hall Blvd.,Tigard,OR 9 3 t3 �U Date By: �� l�P Permit No.: /)l ) ^t. -eocael
ca
gfr
° Plan Reviewm Phone: 503.639.4171 Fax SO .59S 1960 i Date By: Other Permit No.*
^0� 4Inspection Line: 503.639.4171 -TI.,,ARD _> ,r N1
Date Ready/By: // Juris: fa See Page 2 for
Internet: www.tigard-or.gc v"; (I ` 4 Notified/Method: l y ,u. Supplemental information
TYPE OF WORK FEE* SCHEDULE ',
El New construction ❑Demolition For special information use checklist.
Description 1 Qty. l Ea. [ Total
Eg Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
I-and 2-family dwelling f Commercial/industrial SFR(2)bath 437.78
1:1 Accessory buildingSFR(3)bath 500.32
❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
,,_ _;(,, ,„ '9 ,„#.. 4, FO.RlI TION ANP(LOCATIOl1i ' Site utilities:
Job site address: /002 60s ` ,> / a-(} Catch basin or area drain 18.76
VY C9 Y Ee to U Y5 h Gam' Drywell,leach line,or trench drain 18.76
City/State/ZIP: ! I cera. QP C , .? Footing drain(no.linear ft.: ) Pae 2
Suite/bldg./apt.no.: coo Project name: /+ f L g
(p ,�►'1__S](,�,,�/ A , Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
(;)64 Rain drain connector 18.76
-jC' L1 Ii 11/k Sanitary sewer(no.linear ft.:_) Page 2
�)14 g,r• Storm sewer(nn.linear ft.: ) Page 2
044'1Water service(no.linear ft.:^) Page 2
Subdivision: L rt,./
Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.5E
14 .S{,, �� n Clothes washer 25.02
-C -\: 1 _500(> 1 PtSin_Wcf,Skme Dishwasher 1 25.02
( j/1/44f.tr' J/e4r3 e•---, I t'4 ulo arct.i 1 Drinking fountain 25.02
Ejectors./sump 25.02
❑ PROPERTY OWNER 0 TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name:
Floor drain/floor sink/hub + 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 17.51
APPLICANT 0 CONTACT PERSON lntereeptor/grease trap 25.02
Business name: Qc'%o r IA's ���t Medical gas(value:S_) Page 2
R 1 Primer 12.51
Contact name: 3, --ect,t#e✓ccsr.„.. / )
{t.A--- Roof drain(commercial) 12.51
Address: 1 gCtC.0 0 . C t►.. _ r.� Sinkbasinilasatory / 25.02
City/State/ZIP: sQl c_d +,..- 2 9,/d6 Solar units(potable water) 62.54
Phone:(spa ) GQ.. ,, Cf �3 4 Fax::(9, l
3) cct/_AID Tub/shower/shower 12.51
E-mail: f t 1 1 oUrinal 25.02
2� Ykt�/100riAS . CC Water closet 25.02
CONTRACTOR
Water heater 1 37.52
Business name:R.A1'BORN'S PLUMBING INC
Water pipingDWV 56.29
Address: P.O.Box 69 Other: 25,02
City/State/ZIP:Tualatin,OR 97062 Subtotal
Phone:(503)692-4139 Fax:(503)691-2328 Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.:87852 1 Plumbin,Lic.no.:34-166PB --- C'
i�� State surcharge(12%ofpermitfee)
Authorized signature: ' fir."" 17.7.--=3•-'54,„01.-/
TOTAL PERMIT FEE/PC
Print name: L/ Date: _/y-/C. This permit application expires if a permit is not obtained wit to 180 days
� t� tHl �jt after it has been accepted as complete.
"Fee methodology set by i ri-County Building Industry Service Board.
From:Ftayborns Plummin g INC 503+697+2328 09/14/2016 15:57 #427 P.002/002
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(es) Total Square Footage: Permit Feer``.
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-Ist 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;
Stone&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 Inspections or Fees Qty Fee(ea) Tota! each additional$100.00 or fraction thereof,to
h 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 S742.00 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 ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918-780-0040.
Dishwasher -Commercial
-Domestic , Xs i
Submit 2 sets of plans with any of the above.
K
Drinking Fountain
Eye Wash Isometric or Riser Diagram
Floor Drain/sink -2" Yds + ❑ 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 a
•
-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 lumbin permit can be issued.
Water Extractor p g
Water Closet-Toilet
Urinal
Other Fixtures:
http://www.tigard-or.gov/city_hal l/departments/cd/docs/PLM F-PennitApp2doc
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10260 SW GREENBURG RD 600, TIGARD, OR,
97223
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
October 31, 2016 at 9:23:32
AM
PLM2016-00482
Don Sylvester
1. Adjust primer valve.
Violation Summary:
Inspector Contractor