Permit ,, CITY OF TIGARD PLUMBING PERMIT
11 4 COMMUNITY DEVELOPMENT Permit #: PLM2012 -00213
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/31/2012
Parcel: 2S102DCO3900
Jurisdiction: Tigard
Site address: 13895 SW ANDREW TER •
Project: Tran Subdivision: MCDONALD WOODS Lot: 12
Project Description: Irrigation backflow device
Contractor: TERRA -SOL LANDSCAPING Owner: GERTZ CONSTRUCTION CO INC
21685 SW HEDGES DR 19200 SW 46TH AVE
TUALATIN, OR 97062 TUALATIN, OR 97062
PHONE: 503 - 691 -6105 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 07/31/2012 $31.27
Specifics: 1 12% State Surcharge - 07/31/2012 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 07/31/2012 $41.23
Plumbing
Class of Work: OTR
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 ex." - • ., is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires yo• to fo •■ the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. 1
Issued By: ' {•/ Permittee Signature:
•
Call 503.639.4175 by 7:00 a.m. for the next available Inspection date.
This permit card shall be kept In a conspicuous place on the Job site until completion of e project.
Approved plans are required on the Job site at the time of each Inspec • .
Plumbing Permit Application
v z'..
REC E 1
Building Fixtures FOR OFFICE. USE ONLY
R eceived
Ci of Tigard i f f P ermit No
v 131 SW Hall Blvd., Tigard,OR 97223 JUL 31 20 / bate/B y : 7/�/ �oZ ��yap Doai3
Plan Review
0 Phone: 503.718.2439 Fax: 503.598.1960 CRY 1644 s ate/By: Other Permit No S� / /�00 /9�
Inspection Line: 5013.639.4175 di r - , yr
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rlcnlin irate Rea /B [�® See Pa e 2 for
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Internet: www.tigard - or.gov BUIL. t (3 DI,rr f l y p t ified/Method: -/ 1' o Supplemental g Information
TYPE OF WORK S � FEE* SCHEDULE
:.New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
1 Addition/alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
t1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi- family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( _ sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
13' " C ' I-3 ��Z w � L Catch basin or area drain 18.76
Job site address: i 3 JI.I.J n1 gift--
Drywell, leach line, or trench drain 18.76
City/State /ZIP:
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: _) Page 2
Subdivision: I Lot no.: • ure or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK a 12.51
�- ,� 1 Clothes washer 25.02
ACd \(ice L&)J - - L�JLt (,t VV t-of.. Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
"' - Fixture /sewer cap I 25.02
Name: tg2u TEA
... L-14979 Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City /State /ZIP: Hose bib 25.02
..
Phone Fax: ( ) Ice maker I 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) I Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52 I
Business name( �Qn �01 _ ` IN'CS VW1 I k1� Water piping/DWV 56.29
Address: 2 ( co S 5 S W (TtLO bl ICS �o 1 Other: 25.02
City /State /ZIP: 7 , 0 I ) Cc`, c1 70 (, Subtotal
Phone: , ) (p9 - , Fa ( ) Minimum permit fee: $72.50 2CZ s5
Plumbing Lic. no.: Plan review (25% of permit fee)
CCB Lic.:
501 g State surcharge (12% of permit fee) 8. Z0
Authorized s. lure: TOTAL PERMIT FEE
g ad
Print name: 111 t7 1 t71 (T. N1.Yn A .N I D a t e: ry l] L This permit application expires if a permit is not obtained within 180 days
/ 1 after it has been accepted as complete.
*Fee methodo set by Tri- County Building Industry Service Board.
1:1 Building \Permits'PLMU- PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) a y3 ! 0
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee:
Footing drain - 1 100' 50.03 0 to 2,000 $121.90
Footing drain - each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer - 1st 100' 62.54 7,201 and greater $327.54
Sewer - each additional 100' 37.52
Water Service - 1st 100' 62.54 Medical Gas Systems:
Water Service - each additional 100' 37.52
Storm & Rain Drain - 1st 100' 62.54 Valuation: Permit Fee:
$1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 37.52 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for
Other Inspections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to
and including $10,000.00.
Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
which no fee is specifically indicated 90.00/hr each additional $100.00 or fraction thereof, to
(minimum charge - 1/2 hour) and including $25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
hours (minimum charge - 2 hours) each additional $100.00 or fraction thereof, to
Reinspection Fees 90.00/hr and including $50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
(minimum charge - 1/2 hour) each additional $100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes ",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees * .
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/ Plan review is required for any of the following. Performed: Capped Added Relocate
Please check all that apply. y g
Baptistry/Font
Bath - Tub /Shower ❑ Any new commercial building with water service 2" and
- Jacuzzi/Whirlpool greater, except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918- 780 -0040.
Dishwasher - Commercial ❑ Medical gas and vacuum systems for health care facilities.
- Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918 -780 -0040.
Eye Wash
Floor Drain/sink - 2" Submit 2 sets of plans with any of the above.
Isometric or Riser Diagram
Car Wash Drain s ❑ I or riser diagram is required for new buildings
- Domestic-non -food g q g
Disposal - Domestic-food related that meet the qualifications above.
- Commercial -food related
- Industrial -food related
Ice MachJRefrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav - Non -food related
- Bradley
- Commercial -food related
- Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer - Clothes increase of sewer EDUs, a sewer permit will be issued and
Water Extractor P
Water Closet Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
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