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Permit
IN II CITY OF TIGARD PLUMBING PERMIT :. COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00443 TIGARD DATE ISSUED: 12/2/2008 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S102DC 05300 SITE ADDRESS: 13812 SW HALCYON TER ZONING: R -4.5 SUBDIVISION: GERTZ HOMES AT EDGEWOOD LOT: 003 JURISDICTION: TIG PROJECT: GERTZ HOMES AT EDGEWOOD Project Description: Install backflow of irrigation system. 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 COMPANY, INC. Description Date Amount 19200 SW 46TH AVE TUALATIN, OR 97062 [PLUMB] Permit Fee 12/2/2008 $36.25 [TAX] 12% State Surch 12/2/2008 $4.35 Phone : 503- 692 -3390 Total $40.60 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. Specialt• , odes and all other applicable laws. All work will be done in accordance with approved plans. This permit j1l-e5 ire if fk is no tarted within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law require ou t• ollow • les adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through AR 952- 001 -01 6 O. ou may obtain copies of these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued B i / a / /' i A&`A— Permittee Signat X1 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 completi• 1 • e project. Approved plans are required on the job site at the time of each inspection. Plumbing Permit Application • Building Fixtures FOR OFFICE USE ONLY City of Tigard EEiew' p� L J� Permit No.: 11111 n 13125 SW Hall Blvd, Ttgard, OR 97223 / Phone: 503.639.4171 Fax: 503.598.1960 DateBy. Other Permit No.: Inspection Line: 503.639.4175 Date Read /B Ju ris: ® Se Pa e 2 for TIGARp Ready /By: / B Internet www.tigard or.gov Notified/Method: �f Supplemental Information - - , TYPE OF WORK" " , . ' FEE * `SCHEDULE ilfl construction ❑ Demolition For special information use checklist Description I Qty. I Ea. Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft for each utility connection) "' : 'CATEG OF CONSTRUCTION .' -; ' " " SFR 1 b 4 ;;; " ''w � .. . ' : ., (1) bath 249.20 ,and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 El Accessory building ❑ Multi- family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 > ' m < 4 , "JOB, SITEsINFORMAT , IO / N, `, AND LOCATION,' :,LAN.: , '' q '` S u ti l iti es Job site address: t ;' ' 3 O / 2. , S 'v ' /1.4 L £ i.� K © - I III ►2 \ � Catch basin or area drain 16.60 City/State /ZIP: J 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: Lot no.: Water service (no. linear ft.: _) Page 2 Tax map /parcel no.: Fixture or -- t Abs. , ion -va1w- 16.60 '' " ' `' DESCRIPTION-.OF ` " WORK ° Backflow preventer -( Page 2 Z 5 PrcA - y V.l"1 -L� °�' -- ,1- L, ,, /1 Zi- -601 16.60 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 , ' y- ,'"(2(PROPERTY -', ' ° , I' a ,. „r: I' . Ei. TENANT,+ Ejectors /sump 16.60 Name: j 1k aelil 4'1 r2.e Expansion tank 16.60 Address: Fixture /sewer cap 16.60 City /State /ZIP: Floor drain/floor sink/hub 16.60 Phone:) {dcj' Z. - 3 Fax: ( ) Garbage disposal 16.60 Hose bib 16.60 7EVAPPLICANT ` , ,, . , , " ' ❑ °.CONTACT" PERSONS s ; .,,A ' 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 " CONTRACTOR =' ' Water closet 16.60 Business name: (2 , • (...." L/A 1 ,, (1/ 40 j q .. r ( . 4 Water heater 16.60 Address: �,.t g Sl.. -L aat 24 Other: City /State /ZIP: Z Subtotal l i �� cp Minimum permit fee: $72.50 Phone: (60b) ' $ ..,-. , O 5 Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lic.: c , L ctr Plumbing Lic. no.: Plan review (25% of permit fee) Autho • = i ture: ! State surcharge (12% of permit fee) �{ • � TOTAL PERMIT FEE l Print na-- :.i0 i 0 t • PA 4' P2 -t4 11- "( Dater 21z.../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. 1.\Building\Permits\PLMF- PermitApp.doc 12/27/06 440- 4616T(10 /02 /COM/WEB) Plumbing Permit Application - City ofTigaid - • Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: S1te `Utilitiesg Qty_= Fee,(ea) i Total . $411are.Footage ,._ Permit Fee 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 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 valuation '. Permit Fee• - ' .' 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 'Fee ea Total; , 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 Inspection of existing plumbing or each additional $100.00 or fraction thereof, to and including $50,000.00. specially requested inspections - per hour 72.50 Subtotal: $50 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. Commercial Fixture Work: - Plan Review'for Plumbing Installations°, 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 Quantity by'(Fi %lure) Work Performed. greater, except systems designed and stamped by licensed '` - engineer. Fi xture Type:z ° ° ., . - „ � • °Replace Previous ' Capped ' Added:. Existing : ❑ 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 .:,-, Isometric or Riser Diagram -, ° •' Eye Wash ❑ n 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: i \ Building \Permits\PLM -Perm tApp.doe 12/27/06 TIM A. AUFENTHIE dba T &R Building Services 6948 8660 Rogue Lane, Wilsonville, OR 97070 ,, p (503) 318 -6313 FAX (503) 682 -4466 CCB# 116054 NEW 0 % ❑ EXISTING , 4 1 . PNWS -AWWA BACKFLOW ASSEMBLY TEST REPORT ❑ REMOV ` PROPERTY '1 _q P jR 4 S (I L I ic,J C. ❑ REPLA y e � -- OWNER: (PHONE: MAILING ADDRESS: {, y cnY 17" I `Y1, STATE 4 ASSEMBLY 3p ? 14 R eR ADDRESS: ❑ R.P.B.A. D.V C . . ❑ R.P.D.D ■ .D.A. ❑FBA. ❑ s.t'E.�. ❑ A.V. B. ❑ AIR GAP, SIZE: Lill 0 MAIZ 1 L . 1 i .4 —. MODEL:: 350 WATER ! t dA I ' t; � RIAL PURVEYOR: "� 7 I I MBER: 1 t G2 04— 5 ASSEMBLY LOCH ON. �.. 4Iik. I I) , 4 Il 71` (� 011 , / r o c.A1 S REDUCED PRESSURE ASSEMBLY \ .. P.V.B.A. / S.V.B.A. INITIAL TEST #1 CHECK : - AIR. CHECK PASSED/6 0 PRESS DROP ( A) CHECK #1 INLET - FAILED INITIAL OPENED AT (B) TIGHT ,N. - .)-- (Li . OPENED AT: PRESS DROP TEST MIN 2 PSID PSID DAT� � LEAKED ❑ j 2 i V RESULTS BU — PSID PSID PSID MIN 3 PSI TIGHT t� DID NOT FAILED SYSTEM RELIEF VALVE IL ❑ LEAKED ❑ PSID OPEN ❑ ❑ PSI COMMENTS REPAIRS AND/OR PARTS REDUCED PRESSURE ASSEMBLY AFTER REPAIRS #1 CHECK r , P. V.B.A. / S TEST PRESS DROP (Al i CHECK # �L`A DATE: AFTER RELIEF t OPENED AT PRESS DROP , OPENED Bt [ TIGHT ❑ - PSID REPAIRS BUFFER MIN Z PSID t CHECK #2 A - B r MIN 3 PSt , TIGHT ❑ PSID PSID PSID . PASSED ❑ IN COMPLETING AND SUBMITTING TIES TEST REPORT, THE TESTER CERTIFIES THAT THE ASSEMBLY HAS BEEN TESTED AND MAINTAINED IN ACCORDANCE WITH ALL APPLICABLE RULES AND REGULATIONS OF THE ATER SYSTEM, AND STATE REGULATIONS. GAUGE CALIBRATION DATE l 12 LL ETECTOR METER READING . TESTER SIGNATURE 1 - TIM A. AUFENTHIE - I . . # : - I ` TESTERS NAME PRINTED 8660 Rogue Lane, Wilsonville, OR 97070 / �, GAUGE # s ._A iec TESTERS ADDRESS T & R Building Services t PHONE #1 2 P COMPANY NAME D A 44 3 REPORT RECEIVED BY: (REPRESENTATIVE OF OWNER) 4,11 SERVITORED WHITE Water System Copy PINK - Customer Copy YELLOW - Tester copy : ---.)-----_ . .. , CITY OF TIGARD BUILDING DIVISION A . ..... PERMIT #: PLM2008-00443 D ATE ISpl?: 12/212008 Phone: (503) 639-4171 "PO I et\ , ( --- Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FOR DATE: 12/9/2008 TIME: 7:02AM PAGE: 22 SITE ADDRESS: 13812 SW HALCYON TER CLASS OF WORK: SUBDIVISION: GERTZ HOMES AT EDGEWOOD LOT #: 003 TYPE OF USE: PROJECT NAME: GERTZ HOMES AT EDGEWOOD DESCRIPTION: Install backflow of irrigation system. ....”---. 6 OWNER: GERTZ CONSTRUCTION COMPANY, INC., PHONE #: 03-692-3390 CONTRACTOR: TERRA-SOL LANDSCAPING PHONE #: 503-691-6105 Inspection Request Scheduled For: Date: 12/9/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message r ij 14 1 s ir 395 Miss. inspection ,. 078886n01 603-691-6105 N iw il e (--s9) P L frt -c....--Q . Correctfons/Comments/Instructions: - AX■fia _______,/..-r■LC (.-- j --- -e-- -€ ,4e 69 vs 05 34- (03'3 2, ( .. i ) .., ? .. , . ti PASS fl PARTIAL APPROVAL n CANCEL NO ACCESS - fl FAIL I I CALL FOR INSPECTION ADDITIONAL FEES AS ESSED _ Inspector: Date: Phone #: (503) 718- • , . _ , •