Permit CITY OF TIGARD
PLUMBING PERMIT
1111 COMMUNITY DEVELOPMENT PERMIT #: PLM2007 - 00002
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/2/2007
PARCEL: 1S125DC-04900
SITE ADDRESS: 09887 SW 74TH AVE ZONING: R - 4.5
SUBDIVISION: WEIGELA TERRACE LOT: 001 JURISDICTION: TIG
Project Description: Residential backflow prevention device for irrigation.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
GERTZ CONSTRUCTION CO INC Description Date Amount
19200 SW 46TH
TUALATIN, OR 97062 [PLUMB] Permit Fee 1/2/2007 $36.25
[TAX] 8% State Surcharl 1/2/2007 $2.90
Phone : 503- 692 -3390 Total $39.15
Contractor:
TERRA-SOL LANDSCAPING
21685 SW HEDGES DR
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503 -691 -6105
Reg #: LIC 5019
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable
laws. All work will be done in accordance with approved plans. This permit will expire if work is not star 180 days of issuance, or if
work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rul- :. gr•1•tt by e Oregon Utility Notification
Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You - ay obtain '-s of these rules or direct questions
to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued :y: , � / / � / Permittee Signatu yl I A
Call 503.639.4175 by 7:00 a.m. for an inspection that busine -s day.
This permit card shall be kept in a conspicuous place on the job site until co - • of the project.
Approved plans are required on the job site at the time of each inspection.
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Plumbing Permit Application tlr� , /} 6 ► � olt O1 FICE, ■U U:V ' ' °7s . * ' °
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ti ro X, , ,. DateReceived ei / /lu97.- KeUO�
City of Tigard s Permit No.:
Y q 13125 SW Hall Blvd., Tigard, OR 97223 Y
v,. Plan Review
2 , , Phone: 503.639.4171 Fax: 503.598.1960 Date/By Other Permit No.:
T I G A Kt I7 Inspection Line 503 639.4175 Date Re See Page 2 tor
Notified/Method: ( S pl mental Int
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.r- 7 - F .. , . SCHEDULE �2 "2 ,, e Y 4 , i
11 Z1 New construction ❑ Demolition For special information use checklist
Description 1 Qty. ] Ea. 1 Total
❑ Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 11. for each utility connection)
'• 4 4 ` i i " CATEGORY.Y OFiCONST RUCTION ,�, ''.` , x t yam,
�-.., ; _ . �,�� SFR(l)bath 24920
-tom ∎ - and 2 -family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other Fire sprinkler ( sq. ft.) Page 2
" , x i`' dOB SITE. INFORM /67110 (eAND`LA
OCN 4
a ' t ''''` , „ t
..� „., �... '�1u �..,,.. ., ; , Site utilities
Job site address:
• --? vi- -■- Catch basin or area drain 16.60
City / State/ZIP: Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street /directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: f Lot no.: Water service (no. linear 11.: ) Page 2
Tax map/parcel no.: Fixture or_item
° x ▪ r .i t , DESCRIPTION OF WORK `�. = e1 A rM a
Absorption valve --,, 16.60
. ▪ � x .. � �� ..� � �, � s . _ . _ . - � �. w�e, r ,r� "�'�'� Back flow preventer Page 2
" JA : 16.60
Clothes washer 16.60
Dishwasher 16.60
, q; $. a P!ROPERTIr O.WNERi' a+ ,� l!'.,. ❑ TENANTV# Drinking fountain 16.60
h
Co (" ' "} Ejectors/sump 16.60
Name: ~ W (A., C, t
Z Expansion tank 16.60 . .
Address: Fixture /sewer cap 16.60
City /State/ZIP: /r -- Floor drain/floor sink/hub 16.60
Phone V)2_ � 0 Fax: ( ) Garbage disposal 16.60
4C r� m; APPL[CANTI i J •; w m. '4 ❑ ,GONTACTlPERSON Hose bib 16.60
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) Fax:: ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E-mail: Urinal 16.60
''''''''.:77.11;,;':''',7 . ff• ti ''CONTRACTOR. 4 >. v `` 1 fi ;`
r �.� s � � Water closet 16.60
Business name: 604JA. -6,-L itzi MO S (A,Mr10 I tAk Water heater 16.60
Address: `p� li�� 1�r (�,, Other: S Da__
City /State/ZIP: � � \ ' • °). (' L
Subtota l
Minimum permit fee: $72.50 7,
Phone:`O �) (• l Fax: ( ) . Residential backflow minimum permit fee: $36.25 t
CCB Lic.: 60 l 9 Plumbing Lic. no.: Plan review (25% of permit fee)
4 State surcharge (8% of permit fee) y0
Author' atur • :l / TOTAL PERMIT FEE 7, B
Print name: V: , i )
or) YV� r1 Y � , V1A, A`1 Date: / 2- 0') This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
Lkauilding\Permits\PL M -Pe mitApp.d.. 06/26/1. 440- 4616T(10/O2JCOM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
� } � te' r.�w ,� _.,+ s
Qty• . Fee; Totel> Pel'mH ee On g, r
S1te hUtlLf►es . ,.. , : _ y . S uare Foota a.
Footing drain - 1 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer - 1st 100' 55.00 7201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40 :r4 a #.
Valuation § ' , Pertm.; a , � . �, � „
Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
, q ty .`., Fee (ea) Tot a additional $100.00 or fraction thereof to and
tiFixture or,Iten to 1 , pc � 4 < k .
including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Back flow Prevention Device each additional $100.00 or fraction thereof to
(minimum permit fee $36.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
Inspection of existing plumbing or each additional $100.00 or fraction thereof to
specially requested inspections - per hour 72.50 and including $50,000.00.
Subtotal:
550,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Fixture Work: Plan' R` evHewforgPlymkiiingInsfallahon
Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees *. El Any new commercial building with water service 2" and
r � " € P ° Qn ti by (Future) Work Performed greater, except systems designed and stamped by licensed
tom.,fi e , R 4 x r , engineer.
,tsFature its f � i i t `t +` .. iReplace yk
;._Added „w',Exishna , ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font _ as defined in OAR918- 780 -0040.
Bath - Tub/Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash - Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic
Drinking Fountain r -., x 13 9 WV U 17 , 11 . 15 r,A arli fe 7, V
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain /sink - 2" that meet the qualifications above.
-3"
-4"
Car Wash Drain Comments regarding fixture work:
Garbage - Domestic
Disposal - Commercial
-Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
- Stall *Note: If the fixture work under this permit results in an
Sink - Bar/Lavatory increase of sewer EDUs, a sewer permit will be issued and
- Bradley fees assessed for the sewer increase must be paid before the
- Commercial
- Service plumbing permit can be issued.
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
is Building \Pennits\PLM- PermitApp.doc 09/22/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: pLM ?007..00002
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11212007
Phone: (503) 639 -4171 . r,4p u yp i p�j' I#
Inspection Requests (24 Hrs.): (503) 639 -4175 .-' �i 11.
INSPECTION WORKSHEET FOR DATE: 1/4/2007 TIME: 7:00AIvl PAGE: 11
SITE ADDRESS: 09887 SW 74TH AVE CLASS OF WORK:
SUBDIVISION: WEIGELA TERRACE LOT #: Q01 TYPE OF USE:
PROJECT NAME: WEIGELA TERRACE
DESCRIPTION: Residential backflow prevention device for irrigation.
OWNER: GERTZ CONSTRUCTION CO INC, PHONE #: 503-692.3390
CONTRACTOR: TERRA -SOL LANDSCAPING PHONE #: 503. 691..6105
Inspection Request Scheduled For: Date: 1/472007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 04/809-0/ 503- 691 -6105 N
Corrections /Comments/ Instructions:
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PASS PARTIAL APPROVAL ❑ CANCEL NO ACCESS
FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
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Inspector: r Date: 1 'T v7 Phone #: (503) 718 - z4 1 2