Permit , CITY OF TIGARD PLUMBING PERMIT
'.. COMMUNITY DEVELOPMENT Permit#: PLM2022-00152
Date Issued: 4/28/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S101AA00101
Jurisdiction: Tigard
Site address: 12150 SW 68TH AVE
Project: Landmark Ford Used Car Building Backflow Subdivision: WEST PORTLAND HEIGHTS Lot: 9
Project Description: Installing backflow device at building required by water provider.
Contractor: POWER PLUMBING CO Owner: CORLISS, JAMES L&CORA K
PO BOX 19418 LEASE TO: FORD LEASING
PORTLAND, OR 97280 DEVELOPMENT COMPANY
PO BOX 23970
TIGARD, OR 97281
PHONE: 503-244-1900 PHONE:
FAX: 503-244-8825
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 04/28/2022 $31.27
Specifics: 1 12%State Surcharge- 04/28/2022 $8.70
Plumbing
Type of Use: COM 41 ea Minimum Fee Adjustment- 04/28/2022 $41.23
Class of Work: ADD Plumbing
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
Issued By: / Cd(10/ Permittee Signature:
Freie_aff
i
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 Application RECEIVED
Building Fixtures APR 14 2022Received ^ FOR OFFI('►LL ► SE ONLY
City of Tigard I ILLY OF I a.iAIIL Date/By: i1/)//a 2.. ( Pennit No. p a& -C�,(
III ea13125 SW I tall Blvd,Tigard,O��J It
,p Plan Review r �T
s Phone: 503.718.2439 Fax: SIY3. 1✓fi t'it �u� �n Date/By 4A./4 Other Permit No.:
Inspection Line: 503.639.4175
t I G 1 It h Date Read}By: See Page 2 for
Internet: www tigard-or.gov Noiified;Method:Y/ �. � Supplemental Information
TYPE OF WORK _ Q c c ' VA-/1yEE* SCHEDULE
0 New construction 0 Demolition For special infornmsion use checklist.
Description I Qty. I Ea. I Total
®Addition/alteration/replacement D Other: New 1-2-family dwellings(includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
IDI-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
0 Master builder ❑Other:
Fire sprinkler(_sq.II) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 12150 SW 68TH AVE Catch basin or area drain 18 76
City/State/ZIP:TIGARD, OR 97223 Dry'wcll,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name:22-574 Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no linear ft.:_1 Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.• ) Page 2
Subdivision. 1 Lot no.:
Fixture or item:
-- --_-------- ---- - --------- -._.. ------.-_.
'Fax map/parcel no.: Backflow preventer 1 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
LANDMARK FORD USED CAR BUILDING BACKFLOW Dishwasher _ 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name: Fixture/sewer 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
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:POWER PLUMBING CO. Medical gas(value:$ I Page 2
Primer 12.51
Contact name:JOSH CRUME Roof drain(commercial) 12.51
Address: P.O. BOX 19418 Sink/basin/lavatory 25.02
City/State/ZIP: PORTLAND, OR 97280-9418 Solar units(potable water) 62.54
Phone:( 503-244-1900 Fax: ( 503)-244-8825 -rub/shower/shower pan 12 51
E-mail.SERVICE@POWERPLUMBINGCO.COM Urinal 25.02
CONTRACTORWater closet 25.02
Water heater 37.52
Business name:POWER PLUMBING CO.
._ --_- __ - Water pipingrlWV 56.29
Address:6611 SW MULTNOMAH BLVD Other. 25 02
City/State/ZIP.PORTLAND, OR 97223 Subtotal
Phone:( 503-244-1900 Fax 15031-244-8825 Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lie:52378 l Plumbing Lie no: 34 150PB
c State surcharge(12%of permit fee)
Authorized signature J{ & 4,u..�� OTAL PERMIT FLI: �f� d
Print name:KRISTIE B�LL Dale. This permit application expires if a permit is not obtained within ISo days
4 14 2022 after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board
I tBuilding'Permits'PLMU-PermitApp doe IO'01,09 440-4616T(I0'02/COM,'WEB)
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 dram-I" 160' 50 03 0 to 2,000 $121.90
Footingdrain-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 Qty. Fee(ea) Total 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 S148 50 for the first$10,00000 and$1.54 for
which no fee is specifically indicated 90 n0ir each additional$100.00 or fraction thereof,to
(minimum charge—1/2 hour) and including$25,000.00.
Inspections outside of normal business 90(5/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",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*. Plan Review for Plumbin: Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
Baptistry/Font ❑ Any new commercial building with water service 2"and
-- greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
-Jacuzzi/Whirlpool
Car Wash -Each Stall ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator _ ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: -Commercial ❑ Any multipurpose fire sprinkler system.
-Domestic ❑ Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eve Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
3" Isometric or Riser Dia_ram
❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach!Rcfrig Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station PLEASE CALL JOSH CRUME WITH QUESTIONS 503-936-5669
Shower: -Gang
-Stall
Sink -Lay/Bar non-food related - -
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures: t
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