Permit CITY TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00075
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/21/2007
PARCEL: 1S125DC-05100
SITE ADDRESS: 09903 SW 74TH AVE ZONING: R - 4.5
SUBDIVISION: WEIGELA TERRACE LOT: 003 JURISDICTION: TIG
PROJECT: WEIGELA TERRACE
Project Description: Backflow preventer 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
19200 SW 46TH Description Date Amount
TUALATIN, OR 97062 -8770 [PLUMB] Permit Fee 2/21/2007 $36.25
[TAX] 8% State Surcha 2/21/2007 $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 •'• is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon I. - requires you . • low rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 throu.. OAR 952 - 0001 -1 10. You may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.234.
Issued By: .. Permittee Sig :ture:; ,,
Call 503.639.4175 by 7:00 a.m. for an inspection that business d y.
This permit card shall be kept in a conspicuous place on the job site until co p -tion of the project.
Approved plans are required on the job site at the time of each inspection.
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City Of Tigard D aze / By� / (1 Permit MSS? \ l� /U 7-a 0 f
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a 13125 SW Hall Blvd, Tigard, OR A9723,3 3 W fan Revtew
ill ,•.. Phone: 503.639.4171 Fax: 5�)3'598.1960�� Y litCD
pate/By. Other Permit No.:
Inspection Line: 503.639.41 ''''
.. ! G A, !Z t7' PT m j . o' ' T VY nicer Date Ready/By: Juris: ® See Page 2 for
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- Internet: ww.tigard or.gov , y 4 . Notified/Method: Supplemental Information
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' TYPE OF WORK ' „,..�� ,` x t
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ISI ew construction ❑ Demolition For special information use checklist
,,`` Description I Qty. f Ea. 1 Total
❑ Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
e -0t . t , ,, • tryCAT EGORY O Fe CONSTRUCTION t ` SFR (1) bath 24920
1- and 2 -family dwelling 0 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
' a ?° _ . 1. JOB; SITE INFORMAI
TON ND y LO CATNK'x T & ' k
..',.A x�r. +a�+'n.a�;�#',r .. ... n�;� ,, a•. n. ,. � A ,. i� ,.. -.,.n, IOa,., r"��"a$.V� l site utilities
Job site address: C 0'3 `j ui t7 `P rr___ 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
Cross street /directions to job site: Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
• Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.:
Water service (no. linear ft.: _) Page 2
Tax map /parcel no.: Fixture or item
•sorption valve 16.60
'. rf.« . , ;; a,04 / E e' - ; .-k§ ,17 OF V WORK',_ . ,, 5 I r : ; so 3 Back flow preventer Page t
-G' F--'J V[ J - 'S)--L (o A7 :c,�•�...; . 16.60
Clothes washer 16.60
Dishwasher 16.60
'1`)3':' " t, PROPERTY OWIHER m`ts «l i a a 41 " Y -;I ❑t TENANT [` iP t`° Drinking fountain 16.60
�.... ,,... {. gi 1 t n. 'a ..Pm Ejectors/sump 16.60
Name: 0, Z3 ._, 1 n -
e'"V ! Expansion tank 16.60
Address: Fixture /sewer cap 16.60
Cit Y /S IP: Floor drain/floor sink/hub 16.60
Pho e ) 1� ✓ / V0 • Fax: ( ) Garbage disposal 16.60
+� - 4 . �r +�?ir ;, Hose bib 16.60
'� i " zG 1 , :z ,: „ APPLICANT , A r � , r, . , `, 3 yr ; •,, ,i ® CONT ACTS PERSON i X
d , r,lC'iw�','v`x .m 1 -:, x �t . -w.. rs. ,� n..'A. • cr*.ar. >,. .
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
C> ''';';'X'''''-`;'.-:'''' �, ; ;,CONTRACTOR 's, Ri . i:;� 5 r o:' ? & , rv '
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k, it t: ,,, W ater closet 16.60
Business name:' • 113'QS Mr Water heater 16.60
Ad s: 2.'I�;.S 5 LA3 Ff �t leg c Other:
ity /State/ZIP: "'- ` `r -t om I "1 4'70 Co 2__ Subtotal
Minimum permit fee: $72.50
hone ) 4P9,, 0� Fax: ( ) Residential backflow minimum permit fee: $36.25
CB Lic.: ` �j' (4I i 9 Plumbing Lic. no.: Plan review (25% of permit fee)
A thoriz t signatur:: 14 State surcharge (8% of permit fee)
\ _ o;�:.k ■ I I • _ TOTAL PERMIT FEE
Print' ` Dat-.• J 40 Th is permit application expires if a
1 (, ♦ r Y1��ZVL Pe PP P permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
L\Buitding\Pennits\PLM -P- . itApp.doc 1. 26/06 440- 4616T(10/02JCOM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
• 3 • i R �^ Y"+"R"� � i i'>`�R"'#+� Of'" ". ..q" d'
Satetviiiitle3 ` z , v tz I Qty: Fee(ea) Total .� uare Foota a ' kP.,erm>tt 'ee ,�
Footing drain - l 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 7,201 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 , �. w , „zzry
wValuatler t 4 'a Piith <t Fee: 4; 4. �0:4 V
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
55,001.00 to 510,000.00 $72.50 for the first $5,000.00 and 51.52 for each
Fxxit lre P��t�ffi ,' Q t 4 -Feel (ea) 4j Tota1 F additional $100.00 or fraction thereof to and
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 Backflow 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
each additional $100.00 or fraction thereof to
Inspection of existing plumbing or and including $50,000.00.
specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: each additional $100.00 or fraction thereof
Fixture Work: ' UM . >.g r,
, .Pl Revlewfor Plum
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 *. ❑ Any new commercial building with water service 2 "and
{`t i L qt Quaoh by (Fixture) Work Performed , greater, except systems designed and stamped by licensed
Fat T y pe s � � �� a�� �.�,��.� � '� "�� ��� engineer.
� -�Reptace *� ":
r�. ro` veil , � Erevlous, Capped,N traded ?tF sung, ❑ 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 Fra TY.r a r4 i� a ,
Drinking Fountain •, win; et11Cot lserY lagra11 . 41 vZ ,. '
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 P
- Service plumbing permit can be issued.
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal - •
Other Fixtures:
i:\ Building \Permits\PLM- PermitApp.doc 0927/06