Permit (53) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2017-00415
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/10/2017
Parcel: 1 S135AB04500
Jurisdiction: Tigard
Site address: 10250 SW GREENBURG RD 125
Project: Spec Space Subdivision: 1991-055 PARTITION PLAT Lot: 1
Project Description: CAP(1)2"floor drain,(1)non-food related sink and(1)clothes washer;ADD(1)2"floor drain,(1)water heater,(1)
primer;RELOCATE(1)dishwasher and(1)non-food related 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 Dishwasher 10/10/2017 $25.02
Specifics: 3 ea Fixture/Sewer Cap 10/10/2017 $75.06
ea Floor Drain/Floor Sink/Hub 10/10/2017 $25.02
Type of Use: COM 1 ea Primer 10/10/2017 $12.51
Class of Work: ALT 1 ea Sink 10/10/2017 $25.02
Type of Const: 1 ea Water Heater 10/10/2017 $37.52
Occupancy Grp: 1 12%State Surcharge- 10/10/2017 $24.02
Stories: Plumbing
Total $224.17
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: i Permittee Signature: ? /9-70
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 ._ ...
AnplicatiBEGI-IVEL
Building Fixtures p c T 1 0 2.017
City of Tigard Received
• 13125 SW Hall Blvd.,Tigard,OR 9 2PDateB : C /C / �' Permit N "1 �t.,s'
t TY OF FiGARE y 7 � �7-
1 ■ Phone: 503.718.2439 Fax: 501.59 iitiNG 1)1VISRONDm�y.1ew
I I G 1 k D
Inspection Line: 503.639.4175
7t1 i,i!!?�R0. 9! *? 1� OlhorfermitNo.:
Internet: Line:gard-or.gov Date Ready/By: to is: I ®See Page 2 for
Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction 0 Demolition For special information use checklist.
®Addition/alteration/replacement Description Qty. Ea. Total
❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ 1-and 2-family dwelling ®Commercial/industrial SFR(2)bath
437.78
❑Accessory building - SFR(3)bath 500.32
❑Multi-family
❑Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:10250 SW GREENBURG RD Catch basin or area drain 18.76
City/State/ZIP:TIGARD,OR 97223 Drywell,leach line,or trench drain 18.76
Suite/bldg./apt.no.:125 I Project name:17-781 5/5E C l Footing drain(no.linear ft.:_) Page 2
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: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
TENANT IMPROVEMENT Clothes washer 25.02
Dishwasher 1 25.02 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER , 0 TENANT Expansion tank 12.51
Name: Fixture/sewer cap 3 25.02 75.06
Address: Floor drain/floor sink/hub 1 25.02 25.02
Garbage disposal 25.02
City/State/ZIP:
Hose bib 25.02
Phone:( ) I Fax:( ) Ice maker
15.0
0 APPLICANT
0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:POWER PLUMBING CO. Medical gas(value:$_) Page 2
Contact name:MIKE WARREN Primer 1 12.51 12.51
Address:P.O.BOX 19418 Roof drain(commercial) 12.51
Sink/basin/lavatory 1 25.02 25.02
City/State/ZIP:PORTLAND,OR 97280 Solar units(potable water) 62.54
Phone:(503)244-1900 Fax::(503)244-8825 Tub/shower/shower pan 12.51
E-mail:SERVICE@POWERPLUMBINGCO.COM Urinal 25.02
CONTRACTOR Water closet 25.02
Business name:POWER PLUMBING CO. Water heater 1 37.52 37.52
Water piping/DWV 56.29
Address:6611 SW MULTNOMAH BLVD Other:
25.02
City/State/Z1P:PORTLAND,OR 97223 Subtotal 200.15
Phone:(503)244.1900 I Fax:(503)244-8825 Minimum permit fee: $72.50
CCB Lic.:52378 Plumbing Lic.no.:34-150PB Plan review (25%of permit fee)
Authorized signature: ( d.�u / f � '
State surcharge(12%of permit fee) 24.01
��" t f TOTAL PERMIT FEE 224.16
Print name:KRISTIE RAMWELL Date:10-9-I9- This permit application expires If a permit is not obtained within
180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\BuildmgWermitsWLMU.pemiltApp.doc 10/11/09 440-4616T(l0A)2/CoMwEa)
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
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 7,200 $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' 37.52 Valuation: Permit Fee:
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 $7250 for the first$5,000.00 and$1.52 for
Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
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 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 S 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 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*.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/
Work Performed: Capped Added Relocate Plan review is required for any of the following.
Please check all that apply.
Baptistry/Font
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 Thm 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 I 0 Any multipurpose fire sprinkler system.
Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" 1 I Submit 2 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 MachfRefrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang Other fixture is I new water heater
-Stall
Sink/Lav -Non-food related I 1
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
\Vasher-ClothesI increase of sewer EDUs,a sewer permit will be issued and
Water Extractorr
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures: I
C:1Uscrs\Laura\Downloads\PLMF_PermitApp(4).doc 2
g, .4 Tenant Name: spec spare Accumulative Sewer Tally
SWR# N/A
TIGARD Site Address: 10250 SW Greenburg Rd.,Ste 125 PLM# 2017-00415
Parcel#: 1S 135AB04500
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s value count added# added value total#s total values
Baptisery/Font 4 0 0 0 0 0
Bath: -Tub/Shower 4 0 0 0 0 0
-Jacuzzi/Whirlpool 4 0 0 0 0 0
Car Wash: -Each Stall 6 0 0 0 0 0
-Drive through 16 0 0 0 0 0
Cuspidor/Water Aspirator 1 0 0 0 0 0
Dishwasher: -Commercial 4 0 0 0 0 0
-Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 1 2 1 2 0 0
-3 inch 5 0 0 0 0 0
-4inch 6 0 0 0 0 0
-Car Wash 6 0 0 0 0 0
Garbage Disposal:
-Domestic(to 3/4 HP) 16 0 0 0 0 0
-Commercial(to 5 HP) 32 0 0 0 0 0
-Industrial(over 5 HP) 42 0 0 0 0 0
Ice Machine/Refrigerator Drain 1 0 0 0 0 0
Living Unit 16 0 0 0 0 0
Oil Sep(Gas Station) 6 0 0 0 0 0
Rec.Vehicle Dump station 16 0 0 0 0 0
Shower: -Gang(per head) 1 0 0 0 0 0
-Stall 2 0 0 0 0 0
Sink:
-Lay/Bar-Non-Food Related 2 0 1 2 0 -1 -2
-Bradley 5 0 0 0
0 0
-Com/Sery/Util-Food Related 3 0 0 0 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer-Clothes 6 0 1 6 0 -1 -6
Water Extractor 6 0 0 0 0 0
Water Closet-Toilet 6 0 0 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 3 10 1 2 -2 -8
Current Fixture Value -8 divided by 16= -0.500 Current EDU 1 EDU= $5,500.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -8 divided by 16= -0.500 over (under) $ (2,750.00)
Enter EDU Change Here -0.500 *
*Round EDUs to the nearest 1/100th: a count ending in.005 shall be rounded up to.01,and a count ending in.014 or less shall be rounded down to.01.
Notes: ***.5 EDU CREDIT***
Authorized Name/Signature: Dianna Howse Date: 10/10/2017
Building Division
'Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist,this document will serve as a voucher which must be
submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
I:\Building\Sewer Tally\SewerTallySheet_5500_070117.xlsx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10250 SW GREENBURG RD 125, TIGARD,
OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2017-00415
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor