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Permit (37) II CITY OF TIGARD PLUMBING PERMIT l�.' COMMUNITY DEVELOPMENT1114 Permit#: PLM2017-00501 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/07/2017 T I ;R. Parcel: 1 S 135AB00900 Jurisdiction: Tigard Site address: 10200 SW GREENBURG RD 150 Project: Corvel Healthcare Subdivision: METZGER,TOWN OF Lot: 9 Project Description: Interior plumbing for TI:Capping(1)dishwasher and(1)sink; Relocating(1)dishwasher and(1)sink. Contractor: RAYBORN'S PLUMBING INC Owner: LINCOLN CENTER LLC PO BOX 69 BY SHORENSTEIN PROPERTIES LLC 19990 SW Cl POLE 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 12/06/2017 $25.02 Specifics: 2 ea Fixture/Sewer Cap 12/06/2017 $50.04 1 ea Ice Maker 12/06/2017 $12.51 Type of Use: COM 1 ea Sink 12/06/2017 $25.02 Class of Work: ALT 1 12%State Surcharge- 12/06/2017 $13.51 Type of Const: Plumbing Occupancy Grp: Stories: Total $126.10 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: A s `------Permittee Signature: Cf 1+1' 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. r: Is ambing Permit Application '" ,- 1 , S;It ,,,-,,.s Building Fixtures " 101z o f I I( 1 t,s l: o\i,\ City of Tigard ( ` ed DatteeB (49-is Permit No.: L)1 7ya i 13125 SW Hall Blvd.,Tigard,OR 9 r Plan Review �`�� Ll V� : ■ Phone: 503.718.2439 Fax: 503. 1,'1 '.t O'�‘ Date/By: Other Permit No.:/g4fdv, 7 G]i 1 I t;-1:, Inspection Line: 503.639.4175 IQ. $Date Ready/By: Juris: 65 Seee//Page 2 for Internet: www.tigard-or.gov - �;„„red/Method: , Supplemental Information El New constructionu ❑De t # For special information use checklist • Description Qty. Ea. 1 Total 0 Addition/alteration/replacement ❑Other ' ,t New 1-2-family dwellings(includes 100 ft.for each utility connection) , .- "�..> r- '�_ 1 1 .... -- ,-'--:; • SFR(1)bath 312.70 0 1-and 2-family dwelling [p Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 ❑Accessory building ❑Multi-family Each additional bath/kitchen 25.02 ❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 a' r G ` ..-",1 ,% �5 r1- �.l ( .£. -°=..-1','..,,4.-'' .t�;r fr i't) `-,'•.: '°',,,°4 ._:d$ Site utilities: Job site address: ',p 2,00 5,,,J G,",i„� R, Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP: 'Ts.;1,-kJl o + ty-¢ Q'r Z t) Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.:5.j , If 0 I Project name: Co(t j c L- tfiL-Cetre_- 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 Backwater valve 12.51 _v. : �_.. ,"_ _ a Clothes washer 25.02 R e,H,j.t- 1 etc,Gt 5.,.k l /'G C O t a.•1t- ( (3rte.14 S."K Dishwasher , 25.02 ;-j c..1-, A OP x c!t (.15e- o.1-t,/ . te..,.4 Je- Drinking fountain 25.02 I. 015%...o4.11•1: """ re(ac 8,8e. I '.56.vlt•fL8/ Ejectors/sump 25.02 Ic y t. a a414 :74 ,, +�'' L t Y as ;�a s r, Expansion tank 12.51 Name: Fixture/sewer cap(S:nk 1 a„.3) 25.02 ,�„r Floor drain/floor sthk/hub 25.02 Address: Garbage disposal 25.02 City/State/ZIP: Hose bib. 25.02 Phone:( ) Fax:( ) Ice maker I 12.51 ('j,>j IC� F I CONTACT` , Interceptor/grease trap 25.02 Medical gas(value:$ ) Page 2 Business name: (Z�ly,3��� ��d.�3tN Cr Primer 12.51 Contact name: 4 A Ai 1 44A t.0 e aso,,.) Roof drain(commercial) 12.51 Address: ® 25.02 Z (59 q•� $� C i P p t. � f� CI""7 O b 2 Sink/basin/lavatory I 'S City/State/ZIP: 71/41.0.4-03 tom.! d a Solar units(potable water) 62.54 Phone:(,o3)(05 2-Gf f 3 i Fax::(so 3 )Col 1 - Z s 2 3 Tub/shower/shower pan 12.51 Urinal 25.02 E-mail: .0,.N) Qv CZG �Ptn). egt o n . . Water closet 25.02 CONTRACTOR Water heater 37.52 Business name: 25^`7 1,,,,11rr. s ?IAel,afnn.- Waterpiping/DWV 56.29 Address: ,'i41 o S.,t c Spate re-d Other: 25.02 City/State/ZIP: ''[-d o'!.-A ., 1 n/ D9'704/2 Subtotal C 1 d.,S ej Phone: 3 ) (R 2 - cos g Fax:(SQ3 ) i 2 3 Z 0 Minimum permit fee: $72.50 CCB Lic.: t - t$'Z Plumbing Lic.no.: 3 e f l(o(o�t3 Plan review (25%of permit fee) V State surcharge(12%of permit fee) j�r Authorized signature: TOTAL PERMIT FEE 1�(m. i0 Print name: Date: This permit application expires if a permit is not obtained within 180 days 4�S (,}-44,0e04 �, ACG?Ale? after it has been accepted as complete. `Fee methodology set by Tri-County Building Industry Service Board. ,Building'Permits\PLMU-PermitA➢p.doc 10/01/09 440.4616T(10/02/COM/WEB) Plumbing Permit Application - City of Tigard Ree 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site;Utilities QN'. Fee(ea) Total Square Footage«- Permit lice; 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 Sewer-1st 100' 62.54 3,601 to 7,200 $233.20 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 87a1u1iti©lri•- 'ermit dee: 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 Other"I>iispeetloigiks d'Fees • Fee(ea) Ta '' each additional$100.00 or fraction thereof,to 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 (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 tall ❑ Any multipurpose fire sprinkler system. Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918-780-0040. Dishwasher -Commercial Domestic I I Submit 2 sets of plans with any of the above. Drinking Fountain Eye Wash Isometricor Riser Diagram Floor Drain/sink -2" ❑ Isometric or riser diagram is required for new buildings 3 that meet the qualifications above. 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 -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 Water Extractor plumbing permit can be issued. Water Closet-Toilet Urinal Other Fixtures: http://www.tigard-or.gov/city hall/departments/cd/docs/PLMF-PermitApTdoc 1111 s Tenant Name: CORVEL HEALTHCARE Sewer Tally SWR# N/A TI G n R D Site Address: 10200 SW GREENBURG RD SUITE 150 PLM# 2017-00501 Parcel#: 1 S 135AB00900 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 1 2 0 -1 -2 Drinking Fountain 1 0 0 0 0 0 Eye Wash 1 0 0 0 0 0 Floor Drain/Sink: -2 inch 2 0 0 0 0 0 -3 inch 5 0 0 0 0 0 -4 inch 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: -Lav/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 0 0 0 0 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 2 4 0 0 -2 -4 Current Fixture Value -4 divided by 16= -0.250 Current EDU 1 EDU= $5,500.00 Previous Fixture Value 0 divided by 16= 0.000 Previous EDU Change -4 divided by 16= -0.250 over (under) $ (1,375.00) Enter EDU Change Here -0.250 * *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: ***CREDIT*** Authorized Name/Signature: BRANDEN TAGGART X2449 Date: 12/5/2017 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: 10200 SW GREENBURG RD 150, TIGARD, OR, 97223 Record Type: Record ID: Commercial - Plumbing PLM2017-00501 Inspection Type: Inspector: 399 Plumbing final Don Sylvester Result: PASS - NoCofO Comments: 1 . Plumbing final approved. 2. Vent through roof complete from previous inspection. Violation Summary: Inspector Contractor