Permit •i -4{
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CITY TIG a RD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2006 -00583
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/4/2007
PARCEL: 2 S 102 D C - 01601
SITE ADDRESS: 09100 SW EDGEWOOD ST ZONING: R -4.5
SUBDIVISION: GERTZ HOMES AT EDGEWOOD LOT: 014 JURISDICTION: TIG
PROJECT: GERTZ HOMES AT EDGEWOOD
Project Description: Site utilities (private)
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
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: 990 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
KEN GERTZ
19200 SW 46TH AVE Description Date Amount
TUALATIN, OR 97062 - [PLUMB] Permit Fee 5/4/2007 $472.60
[TAX] 8% State Surcha 5/4/2007 $37.81
Phone : 503- 692 -3390 Total $510.41
Contractor:
BRIAN CLOPTON EXCAVATING INC
PO BOX 509
WILSONVILLE, OR 97070 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 682 -0420
Reg #: LIC 50337
PLM 3 -517PB
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 started within 180 days of
issuance, or if work is suspended for more than 180 days ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503.246 6699 or 1.800.332.2344.
Issued By: ./ �/, Permittee Signature: .
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
11 10 Ket \I &epzrz-
Plunibine Permit Applica io .: .
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Site Utilities H E It .,,,,::-...1.,:.7;,,,, .01
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Received :-/ 9
Date/By. 9 -' ; Pemut , pi .7) rgee 0.05, 3
13125 SW Hall Blvd., Tigard, OR 97223
- 4 2007 Plan Revie
,,"I• ' 111
v ''f. Phone: 503.639.4171 Fax: 503 01TA`§OF TIGARD Date/By Other Permit No •
..;
4 i: Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/By: ions j gi See Page 2 for
_..i,, .•!,. •>. Internet: www.tigard-orgov Notified/Method: Supplement al Information
iz,5 , t4t1. i„:,,;_41,''' • ,.• 4: •"' -' " • ;',...4 _i',:,, i;:- ' ,••',,';',,k,'A• •,,,:-I'''''',i,' '',;','
"4 -'' , :!: , ‘"2, ' 1' ''::: ?:; :':: -,,',..--,;-; ),''' i 'Co.":..,1A*:'''r ;!■:`,. .4r ,- ..,,:, , ;---,,,, , t . :',.,. Fe.E. •ScFIPa LF.
0 New construction 0 Demolition For special information use checklist
Description I Qty. I Ea i Total
0 Addition/alteration/replacement 0 Other New 1- 2-family dwellings (includes 100 ft. for each utility , o .. ection)
c;i4dbli1; , ii - o; ' aiii■i0j**Tipi■I ; : . '',,,.::;, -, :'::.- 5 SFR (I) bath 249.20,
0 1- and 2-family dwelling 0 Commercial/industrial SFR (2) bath 350.00 ---
SFR (3) bath l. ' 399.00
0 Accessory building 0 Multi-Family
Each additional bath/kitchen .y, 4 .: 45.00
0 Master builder 0 Other: II: fs,,
.i. '
_ . ., , Fire sprinkler ( sq ft.) Pi. Page 2
INF94.MAT101,1:AIT.,4)c.,,v-pro,t,),,,q,,,,,,,,,,, Site utilities i
tv i
Job site address: eitp C) .5° Le.) 6.e e ,-,,,,.,,, c.r-0--e;) Catch basin or area drain 1.1 !'. 16.60
11
City/State/ZIP- ,--P e le-- Drywell, leach line, or trench drain It :1 4 4 11 16.60
• f 5
• Footing drain (no. linear ft.: ) 111All Page 2 111111
Suite/bldg./apt. no.: / Project name: ---,-.() i 0.- c O
,' c Manufactured home utilities ql II,:
110.00
Cross street/directions to job site: 41. i.
Manholes 16.60 itill
' Rain drain connector ' 16.60 0 ,,....... ,
Sanitary sewer (no. linear ft.: ) ga Page 2
CA ..0Stemw-sewer , -(rog-tierrarzftmArs*
Subdivision: Lot no.:
Water service (no. linear ft.: /20) Page 2' 4f1:Z 60
I
Fixture or item
Tax map/parcel no.:
W''':',%,.- ,,,,,Lkligaiikiikiiii,A3jfilVI,',,iq - 7„,'-• , 4;;;4,U ,ii Absorption valve 16.60
p•'•
+ 4., ■'tio 1 ,,,,, '1 , `-, •,,. , Ttr'It 7 ' ,,, tale'Cit: -, 44 ,14 t,v-^- , 1--gi:Ace Baekfiow preventer Page 2
p i t N --- ( -- e - .5/y5v4.."7---■ Backwater valve 16.60
'A( 0 cc-4 C ( Lc At e s, Clothes washer 16.60
Dishwasher 16.60
11 [4- ''''''''''''''-' :f Drinking fountain 16.60
Ejectors/sump 16.60
,-.
Name: /(1/4.1 6:-et.:{>____ ' e'ec.7*/)_.___ (c)--,v ' 7 ' CO t e--i= Expansion tank 16.60
Address: / 7 2_06 Sc--ci YG -z--. _ Fixture/sewer cap 16.60
City/State/ZIP: ,1,....„,' CX - 7' )C 'a" Floor drain/floor sink/hub 16.60
Phone. ( ) 44 2___- ,7 3 -(.. Fax: (Y)3) 6 y2.. --5 y 3 Garbage disposal 16.60
0 -, 1 ."%7,..V iii".::654,iir",i*i10i■iffrC') 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
Sink/basin/lavatory 16 60
Phone. ( ) Fax: : ( )
Tub/shower/shower pan 16.60
E-mail:
Urinal 16.60
; -` VOTOtq-;i'Z
942iP1,- ,-*i A.: ' 'i's'' 4, 0 he■WI's '', Water closet 16.60
Business name: (ct, Water heater 16.60
Address: ,A Other:
City/State/ZIP: ' -
. \ V Subtotal
• ■• \ Minimum permit fee: $72.50
Phone. 5r)* Cp SA • OVDC) Fax ( ) /Ni Residential backflow minimum permit fee: $36.25 7 ,,,,e-C•
CCB Lic.: Plumbing Lie. noA*3° / 7 -P/3, Plan review (25% of permit fee)
A State surcharge (8% of permit fee). 3 9
signature:
uthorize d
TOTAL PERMIT FEF 5:10 If(
Print name: /6, e , -? _ Dates,5 r-• 0 7 This permit application expires if a permit is not obtainect wun in
180 days after it has been accepted as complete.• : •
*Fee methodology set by Tri-County Building Industry Service Board.
i Vluildineennits\PLMU-PermdApp doe 06/26/06 440-46161(10/02/COMAVEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Yt tllltl ". �� ti �, Sy y.. '�-�'�t',a''`••s;� =' °. ;b� : a F.,-, a'� � ;q,� :. �s ;. - �.,���. � ,�
Totah, .��' ~: °�:n ��
53.9 ;,.. : S uare "'''note h w:Peramit ;; r'". ,L ,t�
' tl •.� ��9f � I� ee. .. F� `�;rs"�:� .e n ?f
Footing drain - 1 e 100' X 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 SS, Medical Gas Systems:
Water Service
each additional 100' o , 46.40 9.2 8
Storm & Rain Drain - 1st 100' / 55.00 ss--, $1 00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 9 46.40 4/ (.00 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
Fixtui C or It('IYI; ' ° " ' i
" "• # Q �r &t ` ``Fee'(ea)i ' Total additional $100.00 or fraction thereof, to and
_� a
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: Plan dtevic -vv for Plumbing tnstalla ih'ni z -
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
; s• Quantity, byi(Fixfuri) ailkPerformed: ='F greater, except systems designed and stamped by licensed
r, n; =;:; ..4 ,,; ,_ , °''' >Fa " 5; :Replace;' engineer.
S r, a t
utiea � ;�,ndaea' 's'Eiustin `"t�= ❑ 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 •h'' "'a ISOIDetl7C' O g �''b �'
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
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley *Note: If the fixture work under this permit results in an
- Commercial increase of sewer EDUs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued.
. Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures'
\Bwldmg\Permiu\PLM- PennitApp doc 09/22/06
CITY OF TIGARD
'BUILDING DIVISION PERMIT #: PLM2006 -00583
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/4/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 9/10/2007 TIME: 7:00AIM1 PAGE:
SITE ADDRESS: 09100 SW EDGEWOOD ST CLASS OF WORK:
SUBDIVISION: GERTZ HOMES AT EDGEWOOD LOT #: 014 TYPE OF USE:
PROJECT NAME: GERTZ HOMES AT EDGEWOOD
DESCRIPTION: Site utilities (private)
OWNER: GERTZ, KEN PHONE #: 503-692-3390
CONTRACTOR: BRIAN CLOPTON EXCAVATING INC PHONE #: 503 - 5310420
Inspection Request Scheduled For: Date: 91/0/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
330 Water service 055380 -01 503 - 939 - 2384 N
Corrections/Comments/Instructions:
S r
`1 I 10
Y II
Ca. v-e. e c y't— 9/17/0F
r oaAe c° le e_ 0r tea✓ COAlip 1 a- -0 -10/
PASS U PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS
I I FAIL CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: \cl' - ∎1 Date: 11) ) Phone #: (503) 718-