Permit (187) CITY OF TIGARD PLUMBING PERMIT
I COMMUNITY DEVELOPMENT Permit#: PLM2016-00578
13125 SW Hall Blvd.,Ti Date Issued: 11/29/2016 •
•
TiC� and OR 97223 503.718.2439Alll� 9
Parcel: 1 S 126DC03300
Jurisdiction: Tigard
Site address: 9900 SW GREENBURG RD 110
Project: Server Logic Subdivision: LEHMANN ACRE TRACT Lot: 4-5
Project Description: Relocate existing sink.
Contractor: K&C PLUMBING INC Owner: ATHERTON REALTY PARTNERSHIP
PO BOX 2124 2100 S WOLF
OREGON CITY,OR 97045 DES PLAINES, IL 60018
PHONE: 503-518-0234 PHONE:
FAX: 503-518-1100
FEES
Quantity Description Date Amount
1 ea Sink 11/29/2016 $25.02
Specifics_ 1 12%State Surcharge- 11/29/2016 $8.70
Plumbing
Type of Use: COM 47 ea Minimum Fee Adjustment- 11/29/2016 $47.48
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct.. •OUNC by calling 503.232.1987 or 1.800.332.2344.
Iss ed By: Permittee Sig ature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the Job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures RECEIVED
Received / ^/d_ rLf7,0/e
City of Tigard Date/By. L/ �g 6 (,�.t(/, Permit No.. 057$' •
• 13125 SW Hall Blvd.,Tigard,OR 9722Nin V 2 2 2016
Plan Review
Phone: 503.718.2439 Fax: 503.5,9_,8.1 960 Date/By: Other Permit No.: Pa(j/6-�j0�?�3
1
I I i,.\I:I> Inspection Line: 503.639.4175 UI-C Y OF... '.0.44U-
IIGARD j DaYteReedy/By: kris. la See
ee Page 2 for
Su entente'Info
rmadooInternet: www.tigard-or.gov 111 oiNNotified/Method: '3 ,,,,,,,s e ,,, t46 rr w i.• a4 , +,• t } C ' ; aEs ). c -,'V "�� ,:
z,., .,-. yr ° .0. 4 a., �5 ",Ft ., '',1..5 ; •• R ' .. = ,
0 New construction 0 Demolition For special information use checklist
Description I Qty, I Ea. I Total
®Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
`` ¢sa,a/..r.'--.`f-4;',',4,'-.r.,7,-.:^ ' .!x ,&4 ., 1.1.= '.,, ,,oi "�" e_r _` ` mMgr' s SFR(I)bath 312.70
❑ 1-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
�. ',,,gy7pp�t� 'r` g Fire sprinkler( sq.ft.) Page 2
�. 5* {°t`, '45, -,2.`-:-0:. "_s,e`.b.f s[ C`',-,.. ...i..��. . �o .'... .g1../0 sut�. l.4`c Site utilities
Job site address:9900 GREENBURG RD Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:TIGARD OR 97223
Footing drain(no.linear ft.: Page 2
&itedg./apt.no.: i e.-0 1 Project name: 6-f,&) L Loa, G 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
„bA .1;41,40,4,,,,,....1.,..4, Backwater valveis* i � s.l fru t , '' 12.51
,
Clothes washer 25.02
RELOCATE EXISTING SINK ROUGH IN TO NEW LOCATION Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
: .. ° i w 3 ' `` " Expansion tank 12,51-'3f7::,1`26,-!•';,,,,..',,i,.. . -. . iZetri A t-a,. ,,P
Name: 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
,�Aee,"i,....-46,e, #,f s > � M . %a ? ,1; Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 1 25.02 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail:li(�1/NC►y ibp rtJ - 0,„....L.1 . 0_,, vt� Urinal 25.02
1� fv anWater closet 25.02
t ,„ ,.r,,'''.',',:,',,,?,,,,i,,,\,-...-c,ONTRA ‘,.,,, ,k.,,-.',,, f, ,:�� i/tib Water heater 37.52
Business name:K&C PLUMBING,INC Water piping/DWV 56.29
Address:PO BOX 2124 Other: 25.02
City/State/Z1P:OREGON CITY,OR 97045 Subtotal 25.02
Phone:(503)A 94 -7f f -`7 U 72. Fax:( ) Minimum permit fee: $72.50 72.50
CCB Lic.: 166699 Plumbing Lic.no.:PBS
Plan review (25%of permit fee)
State surcharge(12%of permit fee) 8.70
Authorized signal �.,_ TOTAL PERMIT FEE 81.20
Print name:. IJSS CEPICA Date:11-22-16 This permit application expires if a permit is not obtained within I80 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I V3uildingIPennits\PLMUm
•PnitApp doc 10101/09 440.4616T(10/02/COM WI B)
Plumbing Permit Application - City of Tigard
Page 2-Supplemental Information
Fee Schedule: Residential Fire Su s r ression S stems:
•
..' .i= _14 t'.. ,, `" t...,,d &.o_.....-..: .x. +�- l':..a ..f.'•_,-..,,, si,,..v.' . .,.K... , r `ix? fir.;'.
Footing drain-l'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 00 $233.20
Sewer-1st 100' 62.54 7,201 and:rester $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 sa rir t vt r .�i • ,, .0*.tri-
Storm&Rain Drain-1st 100' 62.54 ' ,", 4 .' " . .'" . ' • . ;' - .'�, `"` '�:s•
$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
-A.Y t ,, "" rtir• � ; ! g'`' M+` each additional$100.00 or fraction thereof,to
�," .i..4-..1 , ....- -,r.. . ., 3:.:...a7,-,0^:?,-'11, ....A-,.P..4rrl .� _:?_�� ; Kr p 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 char:e-112 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 char c-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 char;e-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* y
,('(x .Sf4 x MO "��.TYlle i '"�i ,..49[.°, -, J .Y,',. . t • c a lt;-i! u'i
wait � Plan review is required for any of the following.
`� Please check all thatapply.
Baptistry/Font
0 Any new commercial building with water service 2"and
Bath -Tub/Shower
-Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru 0 New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities.
-Domestic 0 Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit'sets of plans with any of the above.
-3"
t
Car Wash Drain Y'` tir ?2.4',..^
Garbage Domestic-nan-food
0 Isometric or riser diagram is required for new buildings
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrj .Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall `.
Sink/Lay -Non-food related / 1
-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: i
Macintosh HD:Users:blkcmb2:Downloads:PLM` PermitApp.doc 2
CITY OF TIGARD RECEIPT
i 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIi:,11<'.I)
Receipt Number: 407673 - 11/29/2016 guwo `4A-t f`•-k- A,
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PLM2016-00579 Sanitary Sewer 230-0000-43101 $62.54
PLM2016-00579 12%State Surcharge-Plumbing 100-0000-24001 $8.70
PLM2016-00579 Minimum Fee Adjustment-Plumbing 230-0000-43101 $9.96
Total: $81.20
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Trust Account 2016-00002 DADAMSKI 11/29/2016 $81.20
Payor: Polygon WLH LLC
Total Payments: $81.20
Balance Due: $0.00
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