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Permit (62) CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit#: PLM2017-00014 and OR 97223 503.718.2439 13125 SW Hall Blvd.,Ti Date Issued: 02/14/2017 TlC A1FC� 9 Parcel: 1 S 135AB04500 Jurisdiction: Tigard Site address: 10250 SW GREENBURG RD 215 Project: Variant Subdivision: 1991-055 PARTITION PLAT Lot: 1 Project Description: Replace(1)dishwasher,(1)break room sink&(1)water heater. Install(2)water supply lines for coffee maker and chilled water dispenser. Contractor: RAYBORN'S PLUMBING INC Owner: LINCOLN CENTER LLC PO BOX 69 BY SHORENSTEIN PROPERTIES LLC 19990 SW CIPOLE RD 555 CALIFORNIA ST 49TH FL TUALATIN, OR 97062 SAN FRANCISCO, CA 94104 PHONE: 503-692-4139 PHONE: FAX: 503-691-2328 FEES Quantity Description Date Amount 1 ea Dishwasher 02/14/2017 $25.02 Specifics: 1 ea Sink 02/14/2017 $25.02 1 12%State Surcharge- 02/14/2017 $16.51 Type of Use: COM Plumbing Class of Work: ALT 50 Misc Other Fee 02/14/2017 $50.04 Type of Const: 1 ea Water Heater 02/14/2017 $37.52 Occupancy Grp: Stories: Total $154.11 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 No' • 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 di -'t questions to 6,NC by calling 503.232.1987 or 1.800.332.2344. I ued By: / f /IP , Permittee Signa re: i1111111 Call 503.639.4175 by 7:00 a.m.for the next available inspec'•n date. This permit card shall be kept in a conspicuous place on the job site un ' completion of the project. Approved plans are required on the job site at the time of each inspection. FrormR ay nor ns Plu mming INC 503+691+2328 01/19/2017 16:05 #515 P.001/004 Plumbing Permit Application RECEIVE!) Building Fixtures FOR OFFICE>LSE ONLY City of Tigard JAN9 2017 Received Q11111.4e910/7--64W° L Date/By- / i/ �7 Permit Na: L///�DI'C.u.�`P 13125 SW Hall Blvd.,Tigard,OR 972III ry / y PlLiaan Review Phone; 503.718-2439 Fax: 503.598. 1t ).,' Tit A 0 o i Phfl Re. Other Permit No,4A 6r40033S 1 t( is 11 t) Inspection Linc 503 639 4175 lly p1 Il S1Q�yate Ready/By: kris, W See Page 2 for www.tigard-or.gov itfied/Method Supplemental Information 7n r i- P_gy1crs YIOF YORK # For special information use checklist ❑New construction ❑Demolition Descri tion Q . Ea. Total II Addition/alteration/replacement 0 Other: New I-2-family dwellings(includes 100 ft.for each utility connection) CAT illiV of CQNSJ ltu 11.0 T SFR(I)bath 312.70 0 1-and 2-family dwelling X1 Commercial/industrial SFR(2)bath 437.78 ❑Accessory building 0 Multi-family SFR(3)bath 500.32 ❑Master builderEach additional bath/kitchen 25.02 0 Other Fire sprinkler( sq.ft.) Page 2 :TOB SITE 8NFf3)RJVIA'T'ION ATND LQCATIOINi Site utilities: r .,..:....: Job site address: t O C) SW Cr t2t e-/J g or-Lx., Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP: `t((.r.1 as,0 b Q 4-7 2 2 3 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: 02/5- Project name: (JAR((AN TManufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 4 L(loco t,-/s1 5 j j 4-e___ 2 t S 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: Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 T)ESCRJIP`ION OF WORK`: ac water va vc B k I 1251 Dishwasher / /44-4' Clothes washer 25.02 2e P ct- "6,e, u 4-4/"/"1-4^)/ 2. t' 1,a-C1-er 6 ' I....)S1-...t 1 ( e,re.d-ef- 1 D,Le. "(9/4c- 25.02 alj o 9- for caFFa. .+.,..Cte.r'r Drinking fountain 25,02 (A)5fa11 t f(C s9 qtr(e-J Gt ,TG,f Ejectors/sump 25.02 0 PROPERTY OWNER fl ENAN Expansion tank 12.51 Name: Fixturersewer 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 g,... .: © CONTACT PERSON Interceptor/grease trap 25.02 Business name: n,, Medical gas(value;$ ) Page 2 t0olt.j 5 /7104,4144 Primer 12.51 Contact name: 14{0}/..15 weasa.A1 - Roof drain(commercial) 12.51 Address: /qQ�O 5� Cts 0(..-C; 2� t 'P Sink/basin/lavatory l 25.02 ZS City/State/ZIP: To.5 Fi-T 1N 0(I, of-9-0 G 2 Solar units(potable water) 62.54 Phone: 2) ) (c .L -q(3,f I Fax::(5-03,)Get( _ 2 3 ze Tub/shower/shower pan 12.51 E-mail: 2 Urinal 25.02 Water closet 25.02 CONTRACTORe. Water heater 1 37.52 3 7 y Business name: ko'1..13bI.J 5 ?(J.,44/1L- Water piping'DWV 56.29 Address: 11 4 i o S W Ct o�-C. 4, Other: 6 {' t-tro t+-r (tet.,S 2- 25.02 y p .4 fro City/State/ZIP: 't OA lL cAll t, D t.- 4)}0(p,Z Subtotal A 3 Phone:(SD ) („4-U C((3 5 Fax:(S03) 6a I -- Z3 2 p Minimum permit fee: $72.50 r / CCB Lic.: Plumbing a�, f GP i,; S Plan review (25%of permit fee) sl `� 1 5-u Lie-no.: � �,�t• State surcharge(12%of permit fee) e�' IG' Authorized signature: �.� i ) TOTAL PERMIT FEE j 1 Print name: .1-(44/+S t( J( g,J Date: I t (`i jZdl? This permit application expires if a permit is not obtained withi-3T180 days /� (( after It has been accepted as complete. ti]lj�, *Fee methodology set by 1 ri-County Building Industry Service Board. IP:Bud4ing`,Pernits`:PLMti-Permf7App.due 10.04.09 440-4616T(1002,COM.WEB) From:Rayborns Plumming ING 502+691+2328 01/20/2017 10:27 #516 P.004/004 v Plumbing Permit Application - City of Tigard Page 2 -Supplemental Information Fee_ Schedule: Residential Fire Suppression Systems: #° .-t � "` 'rte ilmg� ' ... {.. Footing drain-I'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 Systems: Water Service-each additional 100' 37"5240 . t. ' a ' G tg' 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 # - =.�W r � h ` oga7 each additional$100.00 or fraction thereof,to mw, 1, , WASPA$ 1 .. E . 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 each additional$100.00 or fraction thereof. (minimum charge-1/2 hour) 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*. J Y q { Quan lar Fume Type ian ev i wifg.r� ..um wg.s# i101t ., .. Fixture Type for Rem/ Plan review is required for any of the following. Work Performed:: Capped Added, Relocate 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 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 Z sets of plans with any of the above. 3" isometric or Riser Diagram Car Wash Drain Garbage -Domestic-non-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./Refrig.Drains , Oil Separator(Gas Station) _ Comments regarding fixture work: 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 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: 13125 SW Hall Blvd. Tigard, OR 97223 City of Tigard Location: 10250 SW GREENBURG RD 215, TIGARD, OR, 97223 Record Type: Commercial - Plumbing Inspection Type: 399 Plumbing final Result: PASS- NoCofO Comments: 1. Provide seismic strap for water heater. 2. Plumbing final approved with correction. Violation Summary: Tel: 503.718.2439 Inspection Date: Record ID: PLM2017-00014 Inspector: Don Sylvester Inspector Contractor