Permit (87) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2019-00229
Date Issued: 05/30/2019
-Cl+G1.RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S125DB12700
Jurisdiction: Tigard
Site address: 9504 SW 74TH AVE
Project: Gertz Partition,Lot 2 Subdivision: GERRITZ PARTITION Lot: 2
Project Description: Installing(1)backflow preventer for landscape irrigation.
Contractor: AUSTIN BROWN LANDSCAPE Owner: JOHN GERRITZ ENTERPRISES INC
PO BOX 14441 515 NW SALTZMAN RD PMB 800
PORTLAND, OR 97293 PORTLAND, OR 97229
PHONE: 503-887-7795
PHONE: 503-320-7280
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 05/30/2019 $31.27
Specifics: 1 12%State Surcharge- 05/30/2019 $8.70
Plumbing
41 ea Minimum Fee Adjustment- 05/30/2019 $41.23
Type of Use: SF 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 expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow 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. �'
Issued By: `Permittee Signature: � -T\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 completion of the project.
Approved plans are required on the job site at the time of each Inspection.
Plumbing Permit Applicat' 1 clic' f-6 MST ),of - -0 01'
BuildingFixtures '�C E I V E D
MAY FOR OFFICE LASE O\1.1"
City of Tigard 2 9 2019 Received -
13125 SW Hall Blvd.,Tigard,OR 9 Date/By: = 'ICJ i e ���' Permit No � �( 1
OF TIGARD Plan Review
:14 = Phone: 503.718.2439 Fax: 503 t Date/By: Other Permit Nop,�.
Inspection Line: 503.639.4175 I3 i l�.i NG DIVISION � �
11 C MID
p Date Ready/By: loris: H See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
h - - --- 'YFR--OF-WDIlIC-- . :--_ -._-_ FEE*SCHEDULE- -
For special information use checklist
l]New construction 0 Demolition
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 10(1 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
I I-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
❑Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: � ( f Catch basin or area drain 18.76
� SI
Drywell,leach line,or trench drain 18.76
City/State/ZIP: 10, ,,,r d v 0. `1 A::7Footing (no. -) Page drain linear ft.: Pa e 2
Suite/bldg./apt.no.: I Project name: e.,. re,t' .4- Manufactured home utilities 50.03
Cross street/directions to job site: 51 °f C� - %y` , .c+,5 - �� Manholes 18.76
•k Rain drain connector 18.76
Sanitary sewer(no.linear Il:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: .+ I Lot no.: 2 Fixture or item:
Tax map/parcel no.: 151 0*(3 tail U o Backflow preventer 1 31.27
D:; e+ t a ` t t�s Backwater valve 12.51
Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/stump 25.02
ROP)EIZ'4' X_... .•' y s � Expansion an 12.51
Name: d, ,e t )1.- L 4,va �A,,,� 14 O ti„.,,, Fixture/sewer cap 25.02
- Floor drain/floor sink/hub 25.02
Address: '1 3 S* S+K ie. Si. '�, it,p../(7„
� Garbage disposal 25.02
t
City/State/ZIP: �-A Vo....
5v ,J la , Oct.,,), C C /it
Hose bib 25.02
Phone:( ) 3,-1.A.) '' e). 0 } Fax ( ) 1
,,,g7,-.Y.--'
� -� .�.g * � Ice maker 12.51
....m.•.2, 11" 01, ,a "° s ,T Interceptor/greasetrap 25.02
Business name: C yr - 1.4(''''' Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: -5 0.A.,,,,,-, -NA, v Y
Roof drain(commercial) 12.51
Address: .333 S. s ie., S } jes V_/,itfL Sink/basin/lavatory 25.02
City/State/ZIP: -t_c b�4 t .)S'- -ls 0,) 03 is7 Solar units(potable water) 62.54
Phone:(1 3 t7 R 4 Fax::( ,,.�. ) Tub/shower/shower pan 12.51 4.
E-mail y�t3�mw VN1tcr A s i..' ,P.,. J !'W i , CR.!, . Urinal 25.02
�. 0f Water closet 25.02
�a .> . _ :,-,Z.-e,, Water heater 37.52
Business name: R(40�1.,i,,...1. 4.1.0 'AiN)fX 1 s
y-..., Water piping/DWV 56.29
Address: f.6 �,k V,e5 ! c Other: 25.02 15.;;!1%.-
City/State/ZIP:
�O.f `!
0 vt. ii t�' c(. Subtotal 3 �'j
Phone:( �`-() %''y „ -'1 el 8'- Fax:(----'") Minimum permit fee: $72.50 r
CCB Lic.: ! E Plumbing Lic.no.: �( t Plan review (25%of permit fee)
`z y State surcharge(12%of permit fee)
Authorized signature: ),./.,.,,,n r ,....batt.t,,,,e-
TOTAL PERMIT FEE
Print name: "SV4 . � � �. Data. 1. ��j This permit application expires if a permit is not obtained within 180 days
t r after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
l BuildinglPermits1PLMU-PermitApp.doc 10/01109 440-4616T00/07/COM/WEB)