Permit (16) CITY OF TIGARD PLUMBING PERMIT
111 •' COMMUNITY DEVELOPMENT Permit#: PLM2017-00013
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/19/2017
T t r. IZ I) g Parcel: 1S 135AB00900
Jurisdiction: Tigard
Site address: 10200 SW GREENBURG RD 250
Project: Fidelity National Title Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Adding(1)break room sink.
Contractor: POWER PLUMBING CO Owner: LINCOLN CENTER LLC
PO BOX 19418 BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97280 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503-244-1900 PHONE:
FAX: 503-244-8825
FEES
Quantity Description Date Amount
1 ea Sink 01/19/2017 $25.02
Specifics: 1 12%State Surcharge- 01/19/2017 $8.70
Plumbing
Type of Use: COM 47 ea Minimum Fee Adjustment- 01/19/2017 $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 questionsCip0101.,
to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: ed( '
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.
JAN-13-2017 16:56 From: To:5035981960 Page:1/2
. ,
Plumbing Permit Applicai :ti;
1 7 il.,
Building Fixtures 1 ,
FoR 01,-Fich LI SE (...)1.1 A.
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City of Tigard Reoeived
Date/By; / /9 /-1 ICDP, I'm"' •L ,/,7-10e1:1/3
1111,:_- 13125 SW Hall Blvd.,Tigard.OR 97323 , =i :, ..,: t.=iS'.l Flan Review
I ' Phone; 503.718.2439 Fax 50,48.1960'' ' ' ' '" Date/By: Other Permit No,: 14.32,900-60oAel .
Inspection Line: 503.6394175t t,t t. ,,,.,,,,-i.r.c,.,:-., nil,.,,,i:„‘.,s.;,,,yst
Dale Ready/ay: lark I Si See Pagetal fionrf soon
-I.I‘.•-'A l''D Internet: www.tigard-or.gov il.,., .!:: Notified/Method/ I Supplemental
,,avl.,5:1T:,,,w,. ""r6V1P-CK'''2 `p
'k '. N y 17!,i,r;SIMMt 715:i4lititt^:§diEiT4g;,ilt o;„v tip .. . .-t...
'q,...k',.:',i;,::,.;',.:...vea lale.•2•AL.."..1. u..i: i. ,6 ..Its,...- ,.-.1,.q ,- -,..-.4,..--,-;.- ..,ch.eckii;t:
El New construction 0 Demolition For special informal° use
Description J Qty. I Ea. I- Total
gAddition/alteration/replacement 0 Other: New 1-2-fandly dwellings(includes 100 ft.for each utility connection)
lrelSV31,35,;,47V;:raireargttoterdif44§1t-kij lqiii:4R1gra.727i•:'Z'.;;ZZjik SFR(1)bath
_SW(2)bath r 433711,7708 - I
ID 1.and 2-family dwelling ,X1 Commercial/industrial
SFR(3)bath 50032
0 Accessory building 0 Mulli-family ---- -
- Each additional bath/lcitehen 25.02
El Master builder 0 Other: Fire sprinkler( sq.ft.) -
Page 2 -- Va
It',16intVita.4.0igtrfti..Wilig4.:4WAT.iffeakCiiiale .J1_4 utilities
Job site address: 02_00 Svki 61-02-44b 4-4111 19""A"
Dry4 well.leach line,or trench drain _ 18.76
City/State/ZIP: Pe#1-1(tfrid, ok 17z13 - Footing drain(no.linear ft.:____D Page 2
Suite/bldglapt.no.: 2s-t) Project name: Manufactured home utilities 50.03
Cross street/directions to job site: ADEL-11-51 .A)4.774 L -6-ize... 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.: / 61 3 6-1973 009e0 Backflow preventer 3127
-
alritiraeOrlt?:71iii..-1;-7-74...1.11-18.'....r."' .grIligili° • ' k. '' • `, OU "4.e4
Backwater valve 1231
,•,...,,.,...%,,,`,. Clothes washer 25.02
tadeljel (i) Abf4 rooky, 511:1&-- Dishwasher
25.02
Drinicing fountain 25.02
_
Ejectocs/sump 25.02
- -
-7,0,-1.-$‘14,1r5 Expansion tank
teXcEiXtrttic9:11BlidYtaitsliiitgaliral.MEXIFT.,E., fig-N.. 4tW,;% -.,. 1231
Fixture/sewer cap
Name: 25.02
---
25.02
Floor drain/floor sink/hub
Address:
-- .---... Garbage disposal 25.02
_-_.
City/State/Z1P: Hose bib 25.02
-- -
Phone:( ) Fax:( ) Ice maker 12.51
25.02
r Interceptor/grease trap
',iiiterl'eacIP'....-/IMEINSEM FiViliVflit. ,:9-7FAk*A *- al ______
value:$ ) Page 2
0 ,
Business name: 0 A g r Phi" ' „...,. "7417._ gas(value:$
Contact name:__Lowe I ()01,u I sr
- Roof drain(commercial) 12.51
Address: PO(5av lei,8, Sink/basin/lavatoiy 1 25,02 zo.pj,
City/State/ZIP: Dv-I-1441d, oie_ 9/agt Solar units(potable water) 62.54 -
-
Phone:(SD3) .7, Liq-ilo 6 I Fax::(p3) 2.1#1-Frzs---- Tub/showerjshower pan 12.51
final 21.02
E-mail: see-0.te b• ., /. i 14,1•77 /lel • _i• - "At ---- ...... .
Water closet 25.02
PiWn..4, t'r'rPTM7.rr!5r,W:7•V,S ;tr.'aj
;W -772 '
PBusiness namc: 1)m_Au_ /yaw.6,64,...._94_____Z,L. Water piping/DWV 56.29
-- _
Address: (-1,104/41,/Sol At u. //74,,,v _ /5/v-,,,(.... Other: - 25.02
City/State/ZIP: Ode 97Z23 - Subtotal 2S.07-
_
Piwne:(2)3) .21/11-/90 4 Fax:(S;)3) .2 Li,h/-17812_5- Minimum pennit fee: $72.50 7z•ST)
CCB Lic.: 5 Z""5-7 8,, Plumbing Lie.n°':...-3Y-ISD/416 - Plan review (25%of permit fee) ..---"--*
----;.,
Authorized signature: •ef.-. aifre C
YR-44A State surcharge(12%of permit fee)
TOTAL PERMIT FEE U.2.0
..
Print name: /.ix r.1 1 ' bS Date: / -This permit application cxpiren if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology eel by Tri•Comity Building Industry Service Board,
I:MuildimgetinitsTLMU-PermitApp.dot MON 44-461ar(lwovc0mwen) 1 i3
JAN-13-2017 16:56 From:
To:5035981960 Pa9e:2/2
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Residential Fire Suypression Systems:
Fee Schedule: .�.� r�.x,�y' ��_-�••--� etd*�tr K:��-��. a,�'."�"='•'
" ,'i!rt:?I E 'y'Y�t�;YbR-'dee( )s 1. 4., x rSVIiii age•a i r',«' el mlttFe .. •�5: :.,;`+,,,:a c-`, a.,
4'"r
wSit`yea.�.tilltXe`"�,z :"��a �3��?�;..a�±��..���..,��. ��,�,��,,,: �,�,.� $121.90
50.03 0 to 2,000
Footing drain-1+100' 2,001 to 3.600 $169.69
Footing drain-each additional 100' 37-52 3,601 to 7,200 $233.20
Sewer-1st 100' 6234 7,201 and greater $327.54
Sewer-cach additional 100' 37.52
Water service•1st 100' 62.54 ' — Medical Gas Systems:
37.52 alua u. .r ,v 'tA' rei. itg �...M •
Water Service-each additional 100' v w S FFIlF : ailiti't Fee`: ,YN .`�:irr.:,c_ ! .i.'V-' ,n
t10I1• w:�a:wtli.
Storm&Rain Drain-lst 100' 62.54 ,$1.00 to$5.000.00 Minimum fee$7250
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
r each additional$100.00 or fraction thereof,to
011
.�K- ,�,....,r*e�: "1'�Fees: + :�iF n . �� ''iJ l and inetudri $lo,2290.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $14850 for the first$10,000.00 and$154 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 char le-2 hours) each additional$100.00 or fraction thereof,to
90,00/hr and including$50.000.00.
Reinspection Fees "$50,001.00 and up $742-00 for the first$50,000.00 and$1.20 for
ucharge
review forrevisions90.00/hr each additional$100.00 or fraction thereof.
(minimum charge-112 hour) each
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*. w� 'mss. „q. ,y.��, a;�^�• c.+ .-^:wr M ;a
,•`•1 eV re ir. fob:.P,liSnbing.Instiilatio lVigi
QuunLty by Flrttut a Type .:a`, ,..
Fixtiiie 7 pe for . Replace( Plan review is required for any of the following.
Caoi0.. , Adaea Relocate Plan
Please check all that apply.
Baptistry/Font 0 Any new commercial building with water service 2"and
Bath 1U-Jacuzzi/Whirlpool
greater,except systems designed and stamped by licensed
Jactnzri/Whirlpool - engineer.
Car Wash -Each Stall , ❑ New exterior plumbing site utilities for any complex structure
-Drive Tfuu as defined in OAR918 780 004U-
Dis i Dishwasher
Aspirator - ___ ❑ Medical gas and vacuum systems for health cart facilities.
Dishwasher -Dommercial 0 Any multipurpose fire sprinkler system.
-Domestic r 0 Any complex structure as defined in OAR918.780 0040.
Dr;nkinaktwtaitt
Eyc Wash Submit 2 sets of plans with any of the above
Floor Drain sink -2" _
inNECEL
Car Wash Drain ❑ Isoimetric or riser diagram is required for new buildings
Garbage -Domestic-non-food that meet the qualifications above.
Disposal -Domestio-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/lav -Non-food related / _
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-clothes lo�� increase of sewer EDUs,a sewer permit will be issued and
Water fees assessed for the sewer increase must be paid before the
Water Closet-TT oilet plumbing permit can be issued.
Urinal
Other Fixtures: ...
http://www.ligand-or.gov/documenLcentcr/Building/PLMF_PermitApp.dS
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
10200 SW GREENBURG RD 250, TIGARD, OR,
97223
Record Type:
Commercial - Plumbing
Inspection Type:
399 Plumbing final
Result:
PASS- NoCofO
Comments:
1. Plumbing final - approved
Violation Summary:
Tel: 503.718.2439
Inspection Date:
Record ID:
PLM2017-00013
Inspector:
Don Sylvester
Inspector Contractor