Permit (10) CITY OF TIGARD PLUMBING PERMIT
' 1 COMMUNITY DEVELOPMENT Permit#: PLM2019-00063
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/21/2019
T r I:t r g Parcel: 2S112AB00300
Jurisdiction: Tigard
Site address: 7350 SW LANDMARK LN
Project: Landmark LLC Subdivision: None Lot: None
Project Description: Replacing existing 3/4"backflow next to water heater.
Contractor: MP PLUMBING CO Owner: B-1 LANDMARK LLC
PO BOX 393 BY PRENTISS C HICKS TR
' CLACKAMAS, OR 97015 429 A NW SKYLINE BLVD
PORTLAND, OR 97229
PHONE: 503-655-9161 PHONE:
FAX: 503-655-1726
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 02/20/2019 $31.27
Specifics: 1 12%State Surcharge- 02/20/2019 $8.70
Plumbing
Type of Use: COM 41 ea Minimum Fee Adjustment- 02/20/2019 $41.23
Plumbing
Class of Work: OTR
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
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: "CZ.' Permiittee Signature: ! V")
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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
Building Fixtures
�sM1 ``k FOR OFFICE. LSE O\Ll
City of Tigard �� pZ ) ( �/ P ,ryza7-1 . 6,3
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Rev /
'A Oa Phone: 503.718.2439 Fax: 503. 9 t.01 Plan 10W DatrJBy; Other Permit No.:
T I G A R n Inspection line: SQ3.639.4175 Date Ready/By: lurk: la See Page 2 for
Internet: www.tigatd-or.gov ., -.. ;V,,fg leo% J Notified/Method: Supplemental Information
j3' +`l'; 7 y,,,,,11,,-,,,,;,b44,,„,.,,,,„,,-$1.16
10 t e u,, y �_...,.' .," • # `ta G":;''',,I, 7 It %,,., 1 n awc e�.ss i.�.w a "rfi'k4
,,k,:„4,,:lTM.,4 ,ia11 rs '' ,$a , '� ., 1 J.,„ (f s „ae ,, .sx it zz: 'D a r i ,.y
o New construction ❑Demolition
For special information use checklist.
Description I Qty. I Ea. I Total
)Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
`"' `?r 'is SFR l bathY)f xtip r , d M a° 0,11;1 i i 1' COVISr . 5, ,-Nrs,,, ( ) 312.70
❑1-and 2-family dwelling geommercial/industrial
SFR(2)bath 437.78
o Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder yy 0 Other Fire sprinkler( sq.ft.) Page 2
'4�,r" ?6 •„1., $�1;t;vF h;$� ° t .a '.` N, •yp.1 t1
� V i 1 j7 III 'in tl 6 >ict` �aNr,-,,, .t`,'y;:, Site utilities:
Job site address: 1350 S11) ‘...and.rA8r K. I a n e1 Catch basin or area drain 18.76
City/State/ZIP: --� �r d p, a a(� Drywell,leach line,or trench drain 18.76 ,
1 / � - //'I-- / Footing drain(no.linear ft.:_) Page 2
Suite/bidgJapt.no.: I Project name: l - J„ Litki iptetf
Manufactured home utilities 50.03
Cross street/directions to job site: (.I.- " 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 1
Ma
. ` e Backwater valve 44,1 ,,i cis q14,0, ,i sr!A 4 ,ks SA+�)6'
,, ea v,' 12.51
Clothes washer 25.02
PC.Q.' IZ.Ze1S� 3 iq" 'fact- t Dishwasher 25.02
lei,')* )cO ( In t), .P r Drinking fountain 25.02
Ejectors/sump 25.02
i b " brit '' • eks.,lr`.«• ,c-,,,,,v,::6,4' ,',4'®4,4' 1 7 "t`t`iIl ; Expansion tank 12.51
Name: FixtureJsewer 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
w�t#r rn ,�. 14. xe9l >ts t? { � µ` e p k i s pA ti Inter ceptor/grease trap 25.02
ti, Ur.s., len. r lie..... M..,�
2
Business name: rnV Vttn\r ,C Medical gas(value:$_) Page 1
Contact name: Primer 12.51
�,eelek,� �a\,t q .r Roof drain(commercial) 12.51
Address: I 5,30 t3at 'UQ. Sink/basin/lavatory 25.02
City/State/�ZIP::�r,la�cxarvIa/S 3 0 2 gip k5 Solar units(potable water) 62.54
Phone: c /% .cS ! tem` 'x::( ) Tub/shower/shower pan 12.51
E-mail: �1 .e� 4 2) f iA 7 ra Wan., n • �m Urinal 25.02
/ �' ni K ' �E fjt, ie 1y r';� 't 'Ld e -FY r1 k
Water closet 25.Q2
�{ °skaff " yin ..;� ttPFsi 8°�. d>,.ilei��'d-f.«. ! Y a Y' i.Y.c1}t TfS n'a"'k1�+4i
�°y � ' ",,"'-� •� Water heater 37.52
Business name: mc) 'c\Wcn CC) Water piping/DWV 56.29
Address: ' 533 0 se G'k De Other. 25.02 1
City/State/ZIP: Q c m S ' V i(-2%. (11 C)t Subtotal S :c',
Phone:(5:S)1055,OO l lQ i Fax:( ) Minimum permit fee: $72.50 -7g
,aD'
CCB Lic.: 500„) Plumbing Lie.no.: 3- 11 p3 Plan review (25%of permit fee) t�
LOS,
4/,
State surcharge T %L PERMIf T
fee)E
Authorized signature: / TOTAL PERMIT FEE I�° '�""
Print name: Y l Q e1 e ll „Q1.41 1 ,vne t Date' a/j q i'ci Thls permit application expires If a permit is not obtained within ISO days
l A (J after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
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