Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2022-00153
Date Issued: 4/28/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S101AA00101
Jurisdiction: Tigard
Site address: 12000 SW 66TH AVE
Project: Landmark Ford New 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
P 0 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: ALT 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: l/ ( LgJkJLI
Permittee Signature: Grk D U1 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 Applicat EIVE (i)
Building Fixtures APR 1 /1 2022 roR orrluE. I.-`I ()NI.‘
City of Tigard Received `i��a77� pt_� aU�� -�) 53
UateBv. Permit No.: _._..
• 13125 SW Hall Blvd.,Tigard,OR 9741 I Y 01- I IUNI1h
Phone: 503.718.2439 Fax: 503.5 Plan Review
t4JILU!NU DIVISION
Daicke Other
Line: 503.639.4175 J IIV4] rr V l/9" ) fa'i i G 1 I,DDate Ready!B % 1:3 '--
Intemet. www.tigard-or gov Notified'Method. 2'C f Supplemental Information
TYPE OF WORK QM:A114.33 7)l 3/01,, FEE* SCHEDULE
0 New construction 0 Demolition For special information use checklist
Description I Qty. I Ea. I Total
®Addition/alterationlreplaccment ❑Other. New I-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
0 I-and 2-family dwelling ®Commercial/industrial SFR(2)hath 437.78
CIAccessory 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: 12000 SW 66TH AVE Catch basin or area drain 18.76
Urywell,leach line,or trench drain 18.76
City/State/ZIP:TIGARD, OR 97223
- ------- Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name:22-576 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 fl.: ) Page 2
Subdivision: Lot no.: Fixture or item:
Lax map/parcel no.. Backflow preventer 1 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
LANDMARK FORD NEW 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
Address: Floor drain/floor sink./hub 25 02
Garbage disposal 25.02
City/State/ZIP:
llose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
0 APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name POWER PLUMBING CO. Medical gas(value.$ ) 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: ( 503i-244-8825 Tub/shower/shower pan 12 51
E-mail.SERVICE@POWERPLUMBINGCO.COM Urinal 25,02
CONTRACTOR Water closet 25.02
-- Water heater 37.52
Business name POWER PLUMBING CO. Water piping/DWV 56.29
Address 6611 SW MULTNOMAH BLVD Other: 25.02
City/State/ZIP PORTLAND, OR 97223 fee-":-
Phone:( 503-244-1900 Fax:( 503-244-8825 Minimum permit�ee: $72.50)
CCB Etc. Plan review (25%ofpemnit fee)
52378 Plumbing Lie.no: 34-150PB
I i r� �
State surcharge(12%of permit fee)
Authorized signature: -t { y0 /`�S/` 4«LGeG�G TOTAL.PERMIT EEL 1,I.
Print name:KRISTIE BRAMWELL( t Date:4-14-2022 I This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
'Fee meihodotot{v set by Tri-County Building Industry Service Board.
I\Building\Permils'PLMU-PermiiApp doc 10•01'09 440-4616T(101/22OM/WSB)
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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" I OU. 50 03 0 to 2,000 $12190
Footingdrain-each additional 100- 37,52 2,OU I 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 $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",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*. Plan Review for Plumbing 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
❑ Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
-Jacuzzi/Whirlpool
Car Wash: -Each Stall El New exterior plumbing site utilities for any complex structure
as defined in OAR918-780-0040.
-Drive Thru
0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator
Dishwasher: -Commercial ❑ Any multipurpose fire sprinkler system.
-Domestic 0 Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
3" Isometric or Riser Diagram
0 Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig.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: .LavBar non-food related
€r -Bradley
-Com/ServlUtil 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 fees assessed for the sewer increase must be paid before the
`> Water Extractor
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures: 1
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