Permit CITY OF TIGARD PLUMBING PERMIT
.11,1.,,,,,
11v ' COMMUNITY DEVELOPMENT Permit#: PLM2019-00228
Date Issued: 05/30/2019
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 1S125DB03700
Jurisdiction: Tigard
Site address: 9494 SW 74TH AVE
Project: Gerritz partition,Lot 1 Subdivision: GERRITZ PARTITION Lot:
Project Description: Installing(1)backflow preventer for landscape irrigation.
Contractor: AUSTIN BROWN LANDSCAPE Owner: JOHN GERRITZ ENTERPRISES INC
PO BOX 14441 BY GERRITZ, JOHN M
PORTLAND, OR 97293 9500 SW 74TH AVE
PORTLAND, OR 97223
PHONE: 503-320-7280
503-887-7795
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
Type of Use: SF 41 ea Minimum Fee Adjustment- 05/30/2019 $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 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: A
li
- Permittee Signature: C �;1.� C C�\C(Th
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 Application fi '�c ;r \_ `-' ,- ao i --cx)
Building Fixtures RECEIVED
FOR OFFICE (.SE 011.1'
City of Tigard MAY 2 9 2019 Received
11 13125 SW Hall Blvd.,Tigard,OR 97223 Plate/By. � '1({ j Permit N �<`(\ y.� -,�'VV�
g Phone: 503.718.2439 Fax: 503.598.1PlanIII
Review �� `.�YQ
1 1 G A li 17 Inspection Line: 503.639.4175 G Y OF TI GAR D Date/By: Oder Permit No E � -C '�
Internet: www.tigardar.gov BUILDING DIVISION DateReeady/By: loris: H S�page2for �1 tli�?`
Notified/Method:
Supplemental Information
I New construction
FEE* SCHEbULE_
0 Demolition For special information use checklist
❑Addition/alteration/replacement 0 Other: Description Qty. Ea. Total
New 1-2-family dwellings(includes 10013.for each utility connection)
)+;GORY OF CQNSTRUCTION SFR(!)bath
312.70
1-and 2-family dwelling
0 Commercial/industrial SFR(2)bath
437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
❑Master builder Each additional bativkitchen 25.02
0 Other:
IOU SITE INFU TI011fFire sprinkler( sq.ft.) Page 2
'`. AND' LOCATION Site utilities:
Job site address: 9`1 's t ,�j} c-Pi Catch basin or area drain
`-�' 18.76
City/State/ZIP: r ' DryWell,leach line,or!,each drain
1 rJ c.� '4 t ! . [ 3 18.76
Suite/bldg./apt.no.: Project name: Footing drain(no.linear ft.:_) Page 2
,�i f!' Manufactured home utilities
Cross street/directions to job site: 50.03
t Manholes 18.76
1Y�y �v-) Rain drain connector 18.76
Sanitary sewer(no.linear ft.:- ) Page 2
Storm sewer(nolinear ft.: ) Page 2
Subdivision: ft---
Water service(no.linear ft.: ) Page 2
I Lot no.: II Fixture or item:
Tax map/parcel no.: 1 ` la ?..7c
Backflow
f i
31.27
�r'� ktt °. ea ,.r. i'4
e a Backwater valve
IJ�yG Ly I �.(;�a 7 y¢ +¢"+ Clothes washer 12.51
�� st ]V��� 25.02
Y Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump
`` o,Atli i A. '. `-' 25.02
.T'r,1'' Expansion tank 12.51
Name: CP e,se Y i in Y 4th S"f'u ta-„ t-t t . Fixture/sewer cap
. 25.02
Address: 3 C' S - Floor drain/floor sink/hub 25.02
�J S �" Garbage disposal
City/State/ZIP: 1,61 k U. aS /� 25.02
Phone ( ) �` J07 Hose bib 25.02
t �L07 "j Fax:( Ice!Walter
`" 1:~" ... 7 .. 4 �:m�(:),..a . � ' 12.51
"4 ', °. Medical
ga (value:
se trap Page 2
Business name: c ,,t i (� �. 1.1 4 Medical gas $ ) 2
Contact name: -5-h�� 1/4_4",,,,,c
CT Primer 12.51
r(i
Address: Z ZZ S C t4 SL £/c V-
/ /y/ Roof drain lav tory(commercial) 25.02
c� Y'°' 7 {� Sink/basin/lavatory 25.02
City/State/ZIP: Lic ,e { S L!tv,L. Cir , ('j(3�
'-`t�'rSolar units(potable water) 62.54
Phone:(5l ) 7 �.:.� ' ( Fax::
Tub/shower/shower pan 12.51
&mattQ�nS p1�(r►► d�,►w f '►ver p Y` 1 flJr.� ..,_ U 25.02
tt x � i ' r �.
Water loser
-1;......„':-, .w-.„..,....w x '. i k4:114P47:;� .',7,,,,,5,0,5::, 25.02
ak."'a+eT:c-µ."�k..,e.h�� `w. .',7.-,„,-*--4--� . - ...Y�a, j 3� ..�'��"tl',`�S. '
Business name: y Water heater 37.52
4'►!'r"' t.� `t`a�1.�t LavV "�' :.C( r i}t, Water piping/DWV
Address: +( (� 56.29
` Co-) < Other. 25.02
City/State/ZIP:
<26,,..4-, f C31 )vs-t. Subtotal ),
Phone:( ) t V'1^-1-1ax:k:.lf �F- ( t ) �^l�' Minimum permit fee: $72.50
CCB Lic.: J,.- ft I Plumbing Lic,no.: g --2(a, Pfau review (25%of permit fee)
l State Surchazge(12%of permit foe)
Authorized signature: TOTAL PERMIT FEE
Print name: /7� Date: ) This permit application expires if a permit is not obtained within 180 days
�` � l S'y,3#7^ 1 after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
440-0GI6T(1002/COMJweB)
1:1Guiding\Permins,PLMU-PermitApp,doc 10101/09