Permit CITY OF TIGARD PLUMBING PERMIT
2 COMMUNITY DEVELOPMENT Permit#: PLM2014-00038
T t GA R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/11/2014
Parcel: 2S102DC06700
Jurisdiction: TIGARD
Site address: 13806 SW 90TH AVE
Project: Edgewood No.2,Lot 16 Subdivision:GERTZ HOMES AT EDGEWOOD NO.2 Lot: 16
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: 503-692-3390
HONE: 503-691-6105
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 02/11/2014 $31.27
Specifics: 1 12%State Surcharge- 02/11/2014 $8.70
Plumbing
Type of Use SF 41 ea Minimum Fee Adjustment- 02/11/2014 $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, Sta= of •R. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will pire I wo is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requir s you to fo • the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR s52-001-0090. ou may obtain a copy of the rules
or direct estions fo QUNC b calling 503.232.1987 or 1.800.332.2344.
Issu By: Permittee Signature: k ., y
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 . e project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures RECEIVED FOR OFFICE USE ONLI
City of Tigard Received Date/By: (/ :s/ Permit N°.: Lt/p76/ nie63 S
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503. .E 6} 1 2014 Date/By: Other Permit No.:/1,-( 7-c9.6/3-6;f9/7/
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris ® See Page 2 for
Internet: www.tigard-or.gov t ' Notified/Method: Supplemental Information
OF TIGA
TYPE OF • ! : FEE* SCHEDULE
!;I III , C DIVISION For s ecialinormationusechecklist.
New construction • emolition
Description Qty. Ea. 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
Pk 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:
Job site address: , B V Op �.i) cio'a v Catch basin or area drain 18.76
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/diredions 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
C Water service(no.linear ft.:_) Page 2
Subdivision: I Lot no.: & Fixturew' •
Tax map/parcel no.: Backflow preventer / 31.27
DESCRIPTION OF WORK Backwater valve 12.51
- 25.02
• Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: �fr �� N v 'i__; Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: I� Hose bib 25.02
Phonej(� �')) 2- � V Fax:( ) Ice maker 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:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
■ y�' �'1w� f /` Water heater 37.52
Business name: ( j (2;42, x_.. 4 i t6 tAgno1 .� Water tin WV 56.29
P�P �
Address: a ( ') (2.0(1 i , far Other: 25.02
City/State/ZIP: ' 'r,7( + q 0' (l Z Subtotal
Phone: - ) (-0.-1 DC Fax:( ) P Minimum permit fee: $72.50 '7a.st)
Plan review (25%of permit fee)
CCB Lic.: 0 11 Plumbing Lic.no.: State surcharge(12%of permit fee) _70
Authoriz d si lure: •t - 1 TOTAL PERMIT FEE C'/•�U
r / J 11 This permit application expires if a permit is not obtained within 180 days
Print name. 00 I YYl IZ1/Li Ih l(� Date:W/ I I f after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
■
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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-Is'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
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
Bath: -Tub/Shower
greater,except systems designed and stamped by licensed
-Jacuzzi/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.
El 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
❑ 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 Filer increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase must be paid before the
Water Extractor p
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
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