Permit - r.
I v CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00001
TIGARD DATE ISSUED: 1/2/2007
13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1S125DC-05600
SITE ADDRESS: 07498 SW RED CEDAR WAY ZONING: R - 4.5
SUBDIVISION: WEIGELA TERRACE LOT: 008 JURISDICTION: TIG
Project Description: Residential backflow prevention device 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 Description Date Amount
19200 SW 46TH
TUALATIN, OR 97062 [PLUMB] Permit Fee 1/2/2007 $36.25
[TAX] 8% State Surchart 1/2/2007 $2.90
Phone : 503- 692 -3390 Total $39.15
Contractor:
TERRASOL 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 OR. Specialty Codes and all other applicable
laws. All work will be done in accordance with approved plans. This permit will expire if work is not - - - • ; I days of issuance, or if
work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow ru - ad• -i -d by th- • - gon Utility Notification
Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. Yo ay obtain copies of se rules or direct questions
to OUNC by calling 503.246.6699 or 1.800.332.2344.
Iss d By: "V Permi ftee Signet re: _ f
Call 503.639.4175 by 7:00 a.m. for an inspection that business d - .
This permit card shall be kept in a conspicuous place on the job site until completr • I of e project.
Approved plans are required on the job site at the time of each inspection.
H
Plumbing Permit Application
74 City of Tigard B - /. 0, Permit No.: u7 Ow' ewoo /
a 13125 SW Hall Blvd., Tigard, OR 97223
e Phone: 503.639.4171 Fax 503.598.1960 Date/By. ew Other Permit No.:
TI G n Ic p Inspection Line: 503.639 Date Ready/BY rt , El See Page 2 for
Internet: www.tigard- or.gov Notified/Method: /M ,_ Supplemental Information
dlq
TYPE OF WORK FEE* SCHEDULE
ew construction ❑Demolition For speckl information use checklist
Description I Qty. 1 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 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:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 9 % LA) Q 641.1401411/L. ��, / Catch basin or area drain 16.60
City /State/ZIP: .%` 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: I Lot no.: Water service (no. linear ft.: Page 2
Fixture or item
Tax map/parcel no.: �bserptien- 16.60
DESCRIPTION OF WORK Badc flow preveMer Page 2 5j7,
■, ve 16.60
Clothes washer 16.60
u Dishwasher 16.60
PROPERTY 07I16 I 0 TENANT Drinking fountain 16.60
/i.I
1�//�^.�, O Ejectors/sump 16.60
V
Name: S ?�' Expansion tank 16.60
Address: Fixture/sewer cap 16.60
•
City/State/ZIP: p, ) Floor drain /floor sink/hub 16.60
Phon ) 19 - 1 `-- 3 )G 0 Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON 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
Sink/basin/lavatory 16.60
Phone:
( ) • I Fax::( )
Tub/shower /shower pan 16.60
E-mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business nam . li ti - � j � 1�/I�l� (./ ✓ J I FLU Water heater 16.60
Address: a,l 86 .. tc,A t aS O� \.. Other:
Subtotal
City/State/ZIP: I V , - ( 9 � „/
/ _ Minimum permit fee: $72.50 ,pp
Phone: /) tP e l ,- • Fax: ( ) Residential back flow minimum permit fee: $36.25
CCB Lic.: S 0 r cf Plumbing Lic. no.: Plan review (25 % of permit fee) },
State surcharge (8% of permit fee) . rt%
Authoriz ature: TOTAL PERMIT FEE C y . /5
Print name: � � ` VY1 tZ r(L Wl p-f� I Date: f -2. b T his 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 ABuiIdmg\Pe'm its PUN .PamitApp.doc . 4404616TO0/CO/COM/WEB) 7g• 0
Plumbins: Permit Application - City of Tigard T
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee:
Footing drain - 1 ° 100' 55.00 0 to 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
Valuation: Permit Fee:
Storm &Rain Drain - 1st 100' 55.00 $1.00 to $5,00000 Minimum fee $72.50
Storm & Rain Drain - 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
Fixture or Item Qty. Fee (ea) Total 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 Baddlow 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
each additional $100.00 or fraction thereof to
Inspection of existing plumbing or
and including $50,000.00.
specially requested inspections - per hour 72.50
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: Plan Review for Plumbing Installations
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
Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: Replace engineer.
Previous Capped Added Existing ❑ 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.
- Jawm/Whirlpool ❑ My 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
Drinking Fountain Isometric or Riser Diagram
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
- Service plumbing permit can be issued.
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
i:\B Wdma\Pe mlu\Ptat- PamitApp.doc 09/22/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007- 00001
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/2/2007
Phone: (503) 639-4171 _NM.
Inspection Requests (24 Hrs.): (503) 639 -4175 °__
INSPECTION WORKSHEET FOR DATE: 1/17/2007 TIME: 7 :00AM PAGE: 10
SITE ADDRESS: 07498 SW RED CEDAR WAY CLASS OF WORK:
SUBDIVISION: WEIGELA TERRACE LOT #: 008 TYPE OF USE:
PROJECT NAME: WEIGELA TERRACE
DESCRIPTION: Residential bacldlow prevention device for irrigation.
OWNER: GERTZ CONSTRUCTION CO INC, PHONE #: 503 -692 -3390
CONTRACTOR: TERRA -SOL LANDSCAPING PHONE #: 503 691 -6105
Inspection Re est Scheduled For: Date: 1/17/2007 Pour Time:
Cot - nspection Description Confirm # Contact # Message
395 Misc inspection 042214 -01 503 - 691 -6105 N
•r ctions /Comments /Instructions:
", 1 0
r
SS ❑ PAR L APPROVAL ❑ CANCEL El NO ACCESS
111 FAIL III LL FO - I er TION ADDITIONAL FE S ASSESSED
/ /7 457-
Inspector: Date: Phone #: (503) 7