Permit CITY OF TIGARD PLUMBING PERMIT
III Permit #: PLM2009-00168
_, COMMUNITY DEVELOPMENT
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/26/2009
.TIGARD, GARD, Parcel: 2S102DC01500
Jurisdiction: Tigard
Site address: 9070 SW EDGEWOOD ST
Subdivision: Lot: 0
Project: Gertz
Project Description: Connect to sewer
Owner: FEES
GERTZ CONSTRUCTION CO INC Quantity Description Date Amount
19200 SW 46TH AVE
TUALATIN, OR 97062 100 If Sewer Service 06/26/2009 $55 00
PHONE Plumbing
12% State Surcharge - 06/26/2009 $8 70
Plumbing
18 ea Minimum Fee Adjustment - 06/26/2009 $17.50
Contractor: Plumbing
OWNER
PHONE.
FAX'
Type of Use: SF
Class of Work: ALT 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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503 246 6699 or 1.800 332.2344
Issued By: Permittee Signature:
(s oL ,),,___ RAVA_N 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.
Plumbing Permit Application
, . , „. . Building Fixtures RECEIV ED Receive FOR O ' O \Ll°
City of Tigard
Date/By d Permit No • ) � V
U 13125 SW Hall Blvd , Tigard, OR 97223 / ► �,t...1.1 m r r Q ��I "'
Phone 503 639 4171 Fax 503 598 1960 U N 2 2UUJ Plan Review �, '�
A
Date/By Other Permit No l J 1 1 �Q' n oci _� J
`
�
Inspection Line 503 639.4175 r or s x CI /t+ 11�
TIGARD D ate Ready/By ! I( ® See Page 2 for
Internet www tigard- or.gov CITY OF TIGARD Notified/Method. Supplemental Information
.t%?=i,;s.r a;J'A`'-yv,:at:- �'sx'�z.' �_„;. -,o- „w'.kw.m.: .s `�.:a+:afv:- .9'- >��:e§�r.`, .-,: =;^.�q'�..� -rr's� '�.. :�� :.`ca ^;:.�.saa: �;.a= .='•.'�.°xc.;< >, . •x%.-
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_ < » - �„�'-t. � � , -r x,t . _.T,a:,....�� ��,�.,. x ,,.,,� a�,�_�:�•. ,.._„ « _ °;�,��. ":,�.:4e, .:P , ` r..�����s ,>e�� ,,.,.��,..,� >5�,�: �;�„��aa- c;�,�,
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty I Ea I Total
❑ Addition /alteration/replacement ❑ Other:
New 1-2-family dwellings (includes 100 ft for each utility connection)
�- �7 K 3 a�, / - e�,�p ♦ "'°Sd3r. -. .� A .' :. .. x'* - „w�„a:.-rt�:. . aaF.';mb: � rv� . 3'F.
., �.w,�'`” >� a., '��p� ` - �,.,... A,. w� =• -� :.,�',`�, �..,,�;�.�'- `��.,i SFR (I) bath 249 20
❑ 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350 00
❑ Accessory building ❑ Multi - family SFR (3) bath 399 00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other
�..:, . < 's" �:v,-,, Fire sprinkler ( sq ft) Page 2
, - . - JOB, q; SI * i -ti OC1115R.a r' '„ - :,=-
°' «a., , .. ., „-- .,: ... -:,„ - - S ,,i --, , a., `° ; aS ;.4,;i. Site utilities
Job site address' Q j ° a cQ f t1 () 0Q Catch basin or area drain 16 60
City /State /ZIP. l �1 V Drywell, leach line, or trench drain 16 60
Footing drain (no linear ft . ) Page 2
Suite/bldg. /apt. no.: Project name. g
Manufactured home utilities 110 00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16 60
Sanitary sewer (no linear ft tIOO 1 Page 2 5F.,_ 06
Storm sewer (no linear ft . ) Page 2
Subdivision Lot no. Water service (no linear ft.' ) Page 2
Fixture or item
Tax map /parcel no..
„:r...:.- �_� ,. „,,�; �aa,: < �.;:,., . ffa .
- °'>rkr - °M.:;:.>£ Absorption valve 16 60
- � ,: r M _ =:. l' T)ESCRIY'1'IOr O Wi5V .;., ,. -, „F ' 'i'` 4 a, w. ,.- >a,Y ._> , x p .�, ^ � : ;. ” .....;.� t: a Backflow preventer Page 2
_;x'A"� . �n z�iK:': "�_e:✓A�^s' -'..�, �F.�rs - ',^ rxis�w-��s.,r: .3s�:•�� 'rc..:`..v t - _ ?.
Backwater valve 16 60
1 V nn Vu e 1f /V V ' ` ) c Clothes washer 16 60
Dishwasher 16 60
vi5',,- , M,•. w:.. , , „�r�--, �"-� <„ r•. ;...� s a=,- . . Drinking fountain 16 60
w "`',❑ 'TI'.t �OW . E R. a :�9 �. .�..w »x.:.,, '. ,� �• . ,,..n<.. d.
. „-,m:— ,, _ .:. 7.. . °' '' �- . I �-' _ 1?ENA 1 T �'�� n
_� Ejectors/sump 16 60
Name'
Expansion tank 16 60
Address Fixture /sewer cap 16 60
City /State /ZIP Floor drain /floor sink/hub 16 60
Phone: ( ) Fax ( ) Garbage disposal 16 60
h- , ._ ,, F ,::��. itl x 4 i; .: ; Hose bib
x� y - :: ; ® APPI�IC NtT.: w a . 4 ; . ..: r • -,x 16 60
t ,_ :° 4 .. .:, _.. . - C] =corr e r olv ' `:
.. �, . � - s:��:r _,.: t ._, ,,,,,,,4„-t:•.-,,,,,,,,,,,,, ., 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
r;,. -a- Y .' ._, Urinal 16 60
",, �. f!, g`'; CONTRACyTO$;!:W =, i ., ... .' t ..° ,, :W.,,
r ;:„,
<.. ,;<.. . , ., s ;"= 'an ~z Y .< ., Rayµ.:.. { °: Water closet 16 60
Business name" Water heater 16 60
Address: 0 WO "er Other
City /State /ZIP:
Subtotal
Minimum permit fee $72 50
Phone ( ) Fax: ( ) Residential backflow minimum permit fee $36 25 _
CCB Lic.: Plumbing Lic. no.• Plan review (25% of permit fee)
State surcharge (12% of permit fee)
Authorized signature - _ FEE__? r 20
TOTAL PERMIT F
Print name'K.eAj -'cse Z— Date &-2 6 - a7 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tn-County n- Coun
`n.J Building Industry Service Board
1 \Budding\Pernms\PLMP- PermnApp doc 12/27/06 /�{} 440- 4616T(10 /02 /COM/WEB) I °C n- , �\
Plumbing Permit Application - City of Tigard `
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
e'¢ nab -s„�. ••5. N,. ' G:i.. ;s��., _ - �a '
"s.'' 7 $ "riry � } v I �•�pg' - �� Ri�il •• .pas •�. 5 i3.` ✓ ^.:
«, ; -a: ° ;, ° x : ' : ° Fee,- ea " „ aTotal > ! €t ^_
$iteaSUt htlo �t,.:. 4 =1 , c� < .,: ,. w : , .: :. v';< r. ,:
.,.,,.�.�.. ,..... .. _ :����.��z.., .�..,,� ��;� ., h.. -- ����w S� t tareWFo�o�age:� Perm�atFe�r,
Footing drain - 1 b ' 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 :
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 $5,001 00 to $10,000 00 $72 50 for the first $5,000 00 and $1 52 for each
YR; n t r additional $100 00 or fraction thereof, to and
- Fixture 0i' }Item, .Q w ee ea) 1 Total
`^ ` =.,'ii �? ; ' k , ntur �...,: �s' 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
Commercial Fixture Work: : °Plan'Revewfo_ PluriiagInstl'lahons „ s'r
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
greater, except systems designed and stamped by licensed
='F iiiture` ;'a ., e pry.= y'_. -:.: w e" f J ,, engineer.
C1 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``'.w „; YSQ III t -A Rise Ill ,I T1I • ?.;;' ' " -•n
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
\Bu Idmg\Permrts\PLM- PermttApp doc 12/27/06