Permit 1•
CITY TIGARD PLUMBING PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00084
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/1/2007
PARCEL: 1 S125DC - 05800
SITE ADDRESS: 07438 SW RED CEDAR WAY ZONING: R -4.5
SUBDIVISION: WEIGELA TERRACE LOT: 010 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 3/1/2007 $36.25
[TAX] 8% State Surcha 3/1/2007 $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 # : PR! 503- 691 -6105
Reg #: LIC 5019
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. S.ecialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit = - - ..or" is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law --quires you • fe low rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952- 0001 -0010 through •AR 952- 0001 -0 0. You may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.234.
i
Issued By: J � 0 = Permittee Signa ure: t j A • A
.
Call 503.639.4175 by 7:00 a.m. for an inspection that busin:ss d. .
This permit card shall be kept in a conspicuous place on the job site until c • pl : ion of the project.
Approved plans are required on the job site at the time of each i • ection.
Plumbing Permit OFFICE, 1 SE ()1_,) ()1_,) City of Tigard V E FOR
x�«i vea .S� �y� r7�J� � �J_ ,/,/
B�. ✓ / - / 7 /' Permit N 1 ►" '24 / OU U y
• 13125 SW Hall Blvd., Tigard, OR 9722 i; 0 1 2007
Phone: 503.639.4171 Fax: 503.598.1 . i R Date/By. Other Permit NO.:
r 1 C. A h D Inspection Line: 503.639.4175 CITY OF T y.. Fur
IGARD mate Ready/Bs: See Page 2 for
Internet: www.tigard - or.gov r3 iItDii& moot; Notified/Method I ® Supplemental Information
TYPE OF WORK FEE` SCHEDULE
New construction ❑ Demolition For spedal information use checklist -
Description I Qty. I Ea. I Total
❑ Addition /alteration/replacement ❑ Other: New 1 -2- family dwellings (includes 100 R for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 24920
3711. 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
❑ �� Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 714 35‘ Rv„, y) bvi Catch basin or area drain J 16.60
City / State/ZIP: Drywell, leach line, or trench drain 16.60
Suite/bldg /apt. no.: l Project name: Footing drain (no. linear R: ) 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.: lion valve 16.60
_ � (� DESCRIPTION OF WORK o Ban flow preventer Page 2
_��1 r • l_ 1 J Jl(Z.l (crg t-e,,- valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
❑ RRO OWNER ❑ TENANT E) /imp 16.60
Name: '�/ � Expansion tank 16.60
Address: Fixture/sewer cap 16.60
City/State/ZIP: Floor drain/floor sink/hub 16.60
Phone5O ) )(0 C) 17_ 5) e t Q Fax: ( ) Garbage disposal 16.60
❑ APPLICANT l ❑ 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
Phone: ( ) I Fax: : ( ) Sink/basin/lavatory 16.60
E-mail: Tub/shower /shower pan 16.60
Urinal 16.60
CONTRACTOR Water closet 16.60
Business ram : LY` Ilk "kVOS VO i h Water heater 16.60
Address: t Cp S V ti- ki 0v2 Other:
Subtotal
City/State/ZIP:
2"91..14%\-- - yam' f 1 en QCp 7.-- Minimum permit fee: $72.50
Phone oO ) Col I _ , i ( IDS Fax: ( ) Residential bankflow minimum permit fee: $36.25
CCB Lic. Plumbing Lic. no.: Plan review (25% of permit fee)
Al Authoriz signer State surcharge (8% of permit fee)
4intli TOTAL PERMIT FEE
Print n: e: 1 0 tV) t VIA VI ` L Date:' ' • 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.
1: U &dldmg\Peimiu\PLM- PermitApp.doc .. rr.. 440-4616T(1on2/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 - l a 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
Sewer - 1st 100' 55.00 3,601 to 7,200 $220.00
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 $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,00 1.00 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 S 10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first S 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
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 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: 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
OaandtY by (Fixture) Work Performed gceter, except systems designed and stamped by licensed
Fixture Type: Replace engineer.
Previous Capped Added Fs6tlaa ❑ 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 I or Riser Diagram
Drinking Fountain g
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
-Commercial
fees assessed for the sewer increase must be paid before the
- Service plumbing permit can be issued.
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal •
Other Fixtures:
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