Permit CITY OF TIGARD PLUMBING PERMIT
:IN.,--
1 ' COMMUNITY DEVELOPMENT Permit#: PLM2022-00091
T1 Cs'AB.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 3/15/2022
Parcel: 2S 112AB00300
Jurisdiction: Tigard
Site address: 7350 SW LANDMARK LN 100
Project: Landmark LLC Subdivision: None
Lot: None
Project Description: Replacing 35 ft.of water service.
Contractor: COUFFLEY HOME SERVICES Owner: B-1 LANDMARK LLC
15331 32ND AVE SE BY PRENTISS C HICKS TR
MILL CREEK,WA 98012 429 A NW SKYLINE BLVD
PORTLAND, OR 97229
PHONE: 856-465-5390 PHONE:
FAX:
FEES
Quantity Description Date Amount
35 If Water Service 03/14/2022 $62.54
Specifics: 1 12%State Surcharge- 03/14/2022 $8.70
Plumbing
Type of Use: COM 10 ea Minimum Fee Adjustment- 03/14/2022 $9.96
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
1
1
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
j Issued By: .7x0. Permittee Signature: (%P_ 5 f ,
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. !J
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.
D dab
Plumbing Permit Applicatt tllE EI M E
Building Fixtures FEB 15 2022 FOR OFFICE USE ONLY
City of Tigard Received
r4TY OF TIGARD Date/By: ,..i 0 ii� r...2 Permit No.: �//� �7yi�_ Jt l f
13125 SW Hall Blvd.,Tigard,OR 972 DIVISION
( Plan Review , I/C{T G�CJ l r
Phone: 503.718.2439 Fax: 503.59� (QING UIVIc7IQ� Date/By: it Other Permit No.:
Inspection Line: 503.639.4175
TIGARD DateReadyBy: _funs: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: I/1 /�
3 t[/:I) � Supplemental Information
TYPE OF WORK jt e y,lI ! ✓9 FEE* SCHEDULE
0 New construction 0 Demolition For special information use checklist.
Description I Qty 1 Ea. j Total
®Addition/alteration/replacement ❑Other: New I-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ I-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
ElAccessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:7350 SW Landmark Ln Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97224
Footing drain(no.linear ft.:__) Page 2
Suite/bldg./apt.no.: (co 1 Project name:Landmark Lane Water Servi 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.:35) 1 Page 2 6;3,5-Zt
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Replacing 35 ft of water service
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name:BI Landmark Lane Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:7350 SW Landmark Ln
Garbage disposal 25.02
City/State/ZIP:Tigard,OR 97224 (lose bib 25.02
Phone:(503)292-6226 Fax:( ) Ice maker 12.51
® APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name:Couffley Home Services dba Mr RooterPlumbing Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Heather Mills
Roof drain(commercial) 12.51
Address:PO Box 789 Sink/basin/lavatory 25.02
City/State/ZIP:Gladstone OR 97027 Solar units(potable water) 62.54
Phone:(503)653-5301 Fax::(503)653-5376 Tub/shower/shower pan 12.51 1
E-mail:permits@mrrooterportland.com Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name:
Water piping/DWV 56.29
Address:Same as above Other: 25.02
City/State/ZIP: Subtotal ( S-t?
Phone:( ) Fax:( ) Minimum permit fee: $72.50 . 01
Plan review (25%ofpermit fee)
CCB Lic.:237818 Plumbing Lic.no.:PM29
Authorized signs re: / n �i
State surcharge(12%of permit fee) $', 7l7
r7 G_c-- `' TOTAL PERMIT FEE.. $I
Print name:Heat Mills Date:2/15/2022 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Td-County Building Industry Service Board.
I\Building\Permits\PLMU-PermitApp.doe 10/01/09 4404616T(10/02/COM/WE13)
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-1"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 $72.50 for the first$5,000 00 and$1.52 for
Other Inspections or Fees Qry• 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$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: G�
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.
Baptistry/Font Please check all that apply.
Bath Tub/Shower ❑ 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 ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3"
Isometric or Riser Diagram
Car Wash Drain
Garbage Domestic-non-food El 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 increase of sewer EDUs,a sewer permit will be issued and
Water Extractor
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
O:\Permits\Permit Applications\City of Tigard Plumbing Permit Applicati2n.doc