Permit y p CITY OF TIGARD PLUMBING PERMIT
s COMMUNITY DEVELOPMENT Permit #: PLM2013 -00124
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/16/2013
Parcel: 2S102DC06000
Jurisdiction: TIGARD
Site address: 13839 SW 90TH AVE
Project: Edgewood No. 2 Lot 9 Subdivision:GERTZ HOMES AT EDGEWOOD NO.2 Lot: 9
Project Description: Installation of residential backflow preventer for irrigation.
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: 503 692 -3390
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 04 /16/2013 $31.27
Specifics: 1 12% State Surcharge - 04/16/2013 $8.70
Plumbing
Type of Use SF 41 ea Minimum Fee Adjustment - 04/16/2013 $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 • - Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will • if wor is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to folio the rules adopted by the Oregon
Utility Notific -'•• - nter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -00 : 00. ou may obtain a copy of the rules
or direc • estions to O C b .Alin• 503.232.1987 or 1.800.332.2344.
Ise ed By: , / J• _ Permittee Signature: L
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 comp - • • • • - project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures AEC „ ,
R
ji .4 City of Tigard eceived Date/By: - / /(p / 3 ( f � Permit No.: L[,/,, 5_ /,2,(
13125 SW Hall Blvd., Tigard, OR 97223 APR 16 2013 Plan Review
• Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.: `„ 27 5
Inspection Line: 503.639.4175 CITY OF TIGARD Date Read B Juris: ® See Page 2 for
TIGARD Internet: www.tigard- or.gov 1 � � Notified/Method: Supplemental Information
TYPE OF WO IIt1c FEE* SCHEDULE
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)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
-,- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
building SFR (3) bath 500.32
❑ Accessory g ❑ Multi- family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
1- 7 q u , q O M (t�, ,., Catch basin or area drain 18.76
Job site address: ( I , `�+`
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: Lot no.: Fixture-or em:
Tax map /parcel no.: ackflow preventer I 31.27
DESCRIPTION OF WORK ve 12.51
6 h 25.02 . ( .....2 n _7 „Oro Clothes washer 25.02
' V Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
PROPERTY WNER I ❑ TENANT Expansion tank 12.51
Name: (9 eA, 3 etsyn,c0_, Fixture /sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City /State /ZIP: Hose bib 25.02
Phone: 2 -.... Fax: ( ) Ice maker 12.51
Q 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
Business Hamer -a - G ik \ p 5 AA--13 1 l� Water piping/DWV 56.29
Address: a "1 ' S 5 `p t c c� A_ ` Other: 25.02
A
City /State IP: ; :1VI - ' 7 O(40Z_ Subtotal
Phon-1i „ , Fax: ( ) Minimum permit fee: $72.50
CCB Lic.: '‘0w. Plumbing Lie. no.: Plan review (25% of permit fee)
/ State surcharge (12% of permit fee)
Authori - • sr a
.ture: ture: p
`n n ql TOTAL PERMIT FEE O (. go
nam- : ; t � � m (� Y m tp je: ,� i r, 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.
I:\Building\Permits\PLMU- PermitApp.doc 10/01/09 440- 4616T(10 /02/COM/WEB)
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 - I 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
Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' 62.54
$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
p 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 * . Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate
Baptistry/Font ❑ Any new commercial building with water service 2" and
greater, except systems designed and stamped by licensed
Bath: - Tub /Shower
- Jacuui/Whirlpool engineer.
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
-Drive tall as defined in OAR918- 780 -0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system.
Domestic ❑ Any complex structure as defined in OAR918 -780 -0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: - 2"
3" Isometric or Riser Diagram
4 " ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage - Domestic non -food
Disposal: - Domestic food related
- Commercial food related
- Industrial food related
Ice Mach./Refrig. Drains Comments regarding fixture work:
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower: -Gang
-Stall
Sink: - Lav/Bar non -food related
- Bradley
- Com/Serv/Util food related
- Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs, a sewer permit will be issued and
Washer - Clothes
Water Extractor fees assessed for the sewer increase must be paid before the
Water Closet- Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF- PermitApp.doc 08/04/2011 2
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
13839 SW 90TH AVE, TIGARD, OR, 97223
Residential - Plumbing
399 Plumbing final
04/26/2013 00:00
PLM2013-00124
PASS - No C of O
Violation Summary:
Inspector Contractor