Permit CITY TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 - 00074
TIGARD, 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/21/2007
PARCEL: 1S125DC-05000
SITE ADDRESS: 09895 SW 74TH AVE ZONING: R - 4.5
SUBDIVISION: WEIGELA TERRACE LOT: 002 JURISDICTION: TIG
PROJECT: WEIGELA TERRACE
Project Description: Backflow preventer for irrigation.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
GERTZ CONSTRUCTION CO INC
19200 SW 46TH Description Date Amount
TUALATIN, OR 97062 -8770 [PLUMB] Permit Fee 2/21/2007 $36.25
[TAX] 8% State Surcha 2/21/2007 $2.90
Phone : 503- 692 -3390 Total $39.15
Contractor:
TERRA -SOL LANDSCAPING
21685 SW HEDGES DR
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503 -691 -6105
Reg #: LIC 5019
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Q.R. - :-cialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This pe i x ire if work s not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oreg law requires o� o f. low rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 thr ugh OAR 952 - 0001 -0 00. You may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332 2344.
Issued By: ��� Permittee Si taure. 1 .
• v • •
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until co • leti. n of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Applica!fl' � � p 3 f 5?-''
it 0l ! ICE USC " t1 r { ; 4d .4
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City of T i g a r d ` � e w , Permit No \ D 4 7 - o 0 7'7
4 13125 SW Hall Blvd., Tigard, OR 97223 } 7
Plan Revi
o Phone: 503.639.4171 Fax: 503.598.19 ^' .
L 1 Other Permit No.:
Inspection Line: 503.639.4175
al C A RI?:. Dffi ReadylBy. lens ® See Page 2 for
4' Internet www.tigard-or.gov 1 ` 1 I_ +J Notified/Method Supplemental Info W )
° Information
: ° h , k. 5 q i , f' ' w r i. .., i' .n .K ro 1' a." ,.r i � xi' , T r .� ' g ' r r - v s 'e� -v, i`s .avu-. '
y �..! 5,z„ ;e, ": r- ;,,,,,, a r .. ,s TYPE f O F V K 4 ,4r, ,c _ s ,. 'A . � ..=,, ,; , ''A : f i° .FEE * SCHEDULE . f 7 a f y ' fi r , `� t ` . 3,. :,.:. ,
' ' Fo special information use checklist
'�,ew construction ❑Demolition sP I
Description 1 Qty. 1 Ea. 1 Total
❑ Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
t ��a ; . g: CAT : EGORY OF CONSTRUCTION ; ""aira idae . SFR (1) bath 249.20
and 2-family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other
�, :. ATIO r t Fire sprinkler ( sq. ft.) Page 2
u '.r,_ . JOB S 1TE "INFORIVIATION -AVD L OCN,•� t�.�
y ,, n - � +• � SRC utilities
Job site address: 9 g C .s (_,...J 424 Catch basin or area drain 16.60
City / State/ZIP: 9 "� Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street /directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: 1 Lot no.: Water service (no. finest-1U ) Page 2
Tax map /parcel no.: Fixture or item
16.60
4 4? / , , 1 a - r ,, 4 "` 1)ESCRIeTION WORK". 1 44' , � i c �W Backflow prevent Paget
tee- UJ --- - .-1, (// FZ7 t 9-f \, ac water valve 16.60
Clothes washer 16.60
Dishwasher 16.60
`+ � " ROPERTY iO `; ' -A;' it TENANT ` • :' Drinking fountain 16.60
=. �', '7. ,. ,r, . - + .. F:, ,„ „, . _ ,,, , i d 4 1 ' .'?i. N„ 'Y - ..,._ .. �Y„x � . ..4X? ,'93�9,�" ...Y
M y ` 0 t .,'..'t, E ta n 16.60
Name: Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /Stat IP: Floor drain/floor sink/hub 16.60
Phon )
~� (01 •. C 1 / Fax:( )
� Garbage disposal 16.60
�. _ < k a
- 3 t ' ;. ,'r a t �s AP P „ L'I'CAN r T a to ' ' '�, ` 4, h CONTA,CT- N PERSON3ei� Hose bib 16.60
,
`" Ice maker 16.60
Business name: Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) 1 Fax:: ( ) Sink/basin/lavatory 16.60
1 Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
,. . ;,, b. - "z: r y A,,, ,% K i, CONTRA TOR , ; r L � s I- - , a 4 Water closet 16.60
Business name "Fs(2,30...t. r s 05 bCD lArVji Water heater 16.60
Address: �i („,L3 �;'RQ"4(Z�j Other:
City /Scat . .; \ C;(5-70(0 2.--- 2.--- Subtotal
��" Minimum permit fee: $72.50
r_
Phon : ' ) l�4 l r l OS.---N Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Li .: = . j �`% Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Autho '. atu e: , op. y "\ TOTAL PERMIT FEE
Print name•,' k'� W
1 ' ' a V P & Date: 07 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 \PLM- PumitApp.doc 06/26/06 4404616T(!W02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: .__ Residential Fire Suppression Systems: _
-1 • g • M • x „'ti#� '+W&"� °"r5'"v�2d:hY M � a.,rw�Gt mp
S1 CsUt111t1eS r .; a # QtY,v' Fee'(ea) p w T t § Square, 'oota e s n. e&' nits Ce c ` a l w
Footing drain - i 100' 55.00 010 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer - 1st 100' 55.00
7,201 and greater _ $309.00
Sewer - each additional 100' 46.40
Water Service -1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40 ,,, ra
ev aluation « �P�rmlt�ec�„
Storm &Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Dram - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
Fix ire Or IteYtl ," °„�, ,. ` Qty Fee (ea) t , Tota1 additional $100.00 or fraction thereof to and
including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Back flow Prevention Device each additional $100.00 or fraction thereof to
(minimum permit fee $36.25) 27.55 • and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
Inspection of existing plumbing or each additional $100.00 or fraction thereof to
specially requested inspections - per hour 72.50 and including $50,000.00.
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof
Fixture Work: P1anRevlewfo Pluinleng Installahons�
Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees * . ❑ Any new commercial building with water service 2" and
' ' fr'� 31 - 0 i puaotit b
y y (Fixture) WorkiPerformed
"
greater, except systems designed and stamped by licensed
;
F t une Type d� E?r l � r� a r� � Replaee engineer.
-15,44 •SPrerious..4 ..�
rcapped. . Added.4 , Fsisili ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi /Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash - Each Stall ❑ Any complex structure as defined in OAR918 780 - 0040.
-Drive Thru
Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic oi';RI
v . . - . r . r
Drinking Fountain z I SOnric letSeI`; ia s grdm;1 4 R ?,
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain /sink - 2" that meet the qualifications above.
-3°
4
Car Wash Drain Comments regarding fixture work:
Garbage - Domestic
Disposal - Commercial
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
- Stall *Note: If the fixture work under this permit results in an
Sink - Bar/Lavatory increase of sewer EDUs, a sewer permit will be issued and
- Bradley fees assessed for the sewer increase must be paid before the
- Commercial p
Service plumbing permit can be issued.
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal •
Other Fixtures:
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