Permit q CITY OF TIGARD PLUMBING PERMIT
8 COMMUNITY DEVELOPMENT Permit#: PLM2014-00115
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/16/2014
Parcel: 2S 102DC06500
Jurisdiction: TIGARD
Site address: 13862 SW 90TH AVE
Project: Edgewood No.2,Lot 14 Subdivision:GERTZ HOMES AT EDGEWOOD NO.2 Lot: 14
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:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 04/16/2014 $31.27
Specifics: 1 12%State Surcharge- 04/16/2014 $8.70
Plumbing
Type of Use SF 41 ea Minimum Fee Adjustment- 04/16/2014 $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. •te of O . Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will ex. .- • wor is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requir=: you to fo • the rules adopted by the Oregon
Utility ■ : • ca ion .-,ter. Those rules are set forth in OAR 952-001-0010 through OAR '52-001-0090. . may obtain a copy of the rules
or ect questions to O by g 503.232.1987 or 1.800.332.2344.
I=sued By: 1k Permittee Signature: V v�-1
/ '
Call 503.639.4175 by 7:00 a.m.for the next available inspection te.
This permit card shall be kept in a conspicuous place on the job site until comple' n oft - project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures FOR OFFICE USE ONLY
Received
. City of Tigard Date/By: `7'// //7 (j U) Permit No.: CLi ,9-a(I-66//S
III
'1 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review 1 Jy �r�,
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.: ` (�j�G''5/7)_ca.ZcE(�
T I GA R D Inspection Line: 503.639.4175 Date Ready/By: furls: 163 See Page 2 for �v
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK 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
` 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: 1.. fg0 2._ 5� ct 0 °� if ,,J„..-, Catch basin or area drain 18.76
City/State/ZIP: Drywell,leach line,or trench drain 18.76
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 l ± Fixture or item:
Tax map/parcel no.: Backflow preventer
/ 31.27
DESCRIPTION OF WORK Backwater valve 12.51
NC-`--, Clothes washer 25.02
Dishwasher l 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
-ROPERTY OWNER [ ❑ TENANT Expansion tank 12.51
Name: Ge.)-A`2 A���s Fixture/sewer cap 25.02
1 Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone I 1- .7)39C 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
CON RACTOR Water closet 25.02
nL Water heater 37.52
Business name: (� w��j�/�(�J Y�4� Water piping/DWV 56.29
Address: of l#12;c2) .,
� 0 L lZ S I Other: 25.02•
City/State/ZIP: i, . , (c)1_1 11-)C Co 2____ Subtotal
Phone:6)3) (99 p ' Fax:( )
Minimum permit fee: $72.50 701-CO
i Plan review (25%of permit fee) -
CCB Lic.: / 0 +1 Plumbing Lic.no.:
State surcharge(12%of permit fee) ?-20
Autho ' natu.e: I TOTAL PERMIT FEE 'g/.ad
((�� This permit application expires if a permit is not obtained within 180 days
Print name. x �(�/\\Z(L pt. Date: Ilo J after it has been accepted as complete.
I/ `Fee methodology set by Tri-County Building Industry Service Board.
1.\Building\Pmniu\PLMU-PermitApp.doc ,•1 4• 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-151100' 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
❑ Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
engineer.
-Jacuzzi/Whirlpool
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive Thru 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
❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage Domestic non-food that meet the qualifications above.
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 fees assessed for the sewer increase must be paid before the
Water Extractor
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
13862 SW 90TH AVE, TIGARD, OR, 97223
Residential - Plumbing
399 Plumbing final
2014-04-17 00:00:00
PLM2014-00115
PASS - No C of O
Violation Summary:
Inspector Contractor