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Permit y n CITY OF TIGARD PLUMBING PERMIT 111- COMMUNITY DEVELOPMENT Permit#: PLM2013 00361 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/16/2013 Parcel: 2S102DC06600 Jurisdiction: TIGARD Site address: 13838 SW 90TH AVE Project: Edgewood No.2,Lot 15 Subdivision:GERTZ HOMES AT EDGEWOOD NO.2 Lot: 15 Project Description: Installation of residential backflow preventer for irrigation Contractor: TERRA-SOL LANDSCAPING Owner: GERTZ CONSTRUCTION CO INC 21685 SW HEDGES DR 19200 SW 46TH AVE TUALATIN, OR 97062 TUALATIN,OR 97062 • PHONE: 503-691-6105 PHONE: FAX: FEES Quantity Description Date Amount 1 ea Backflow Preventer 10/16/2013 $31.27 Specifics: 1 12%State Surcharge- 10/16/2013 $8.70 Plumbing Type of Use: SF 41 ea Minimum Fee Adjustment- 10/16/2013 $41.23 Plumbing Class of Work: ALT 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, St- of OR. '.pecialty 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 issuan , oe r if work-is,suspended for more the 180 days. ATTENTION: Oregon law requires you • folio t - rules adopted by the Oregon Uti Notification Center.\hose rules are set forth in OAR 952-001-0010 through OAR 952-00 -0090. Yo may obtain a copy of the rules o direct questions to OUNC by'c- •;503.232.1987 or 1.800.332.2344. • I ued By: 41, . Permittee Signature: k 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 o me • •ject. Approved plans are required on the job site at the time of each inspection. • 1 Plumbing Permit Application . Building Fixtures ) ECFR!FD City of Tigard Received Date/By. /o /� �?> Permit No.: Goa, 3,ao3�j 71 n 13125 SW Hall Blvd.,Tigard,OR 97/PA T 1 6 2013 Plan Review C. Phone: 503.718.2439 Fax: 503.598.1960 y i /� p y Date/By: Other Permit No.:N6raoi 5-00:1:1? Inspection Line: 503.639.4175 CITY OF I IGAtRD Date Ready/By: lures: 61I See Page 2 for f I G A K D Internet: www.tigard-or.gov Notified/Method: Supplemental Information f'1 Jll f1,tp1r1 I�ttnn^s'en• �°-'it,I.sicV0I,M1iiklIVi` FEE* SCHEDULE TYPE OF WORK . !A New construction ❑Demolition For special 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 312.70 0 1-and 2-family dwelling ['Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 ❑Accessory building ❑Multi-family Each additional bath/kitchen 25.02 ❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE•INFORMATION AND,LOCATION Site utilities: Job site address: 13 czc3g 5 /0°- Catch basin or area drain 18.76 City/State/ZIP: 7.,U ro'U Y� Drywell,leach line,or trench drain 18.76 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03 Cross-street/directions to job site: - - Manholes 18:76- - - - Rain drain connector 18.76 Sanitary sewer(no.linear ft.: ) Page 2 Storm sewer(no.linear ft.: ) Page 2 Water service(no.linear ft.: ) Page 2 Subdivision: I Lot no.: Fi a or item: Tax map/parcel no.: ackftow preventer l 31.27 . � ckwater valve. 12.51 DESCRIPTION OF WORK Clothes washer 25.02 scA fd tr 7 t \_ Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 PROPERTY'OWNER I ❑ TENANT Expansion tank 12.51 A Fixture/sewer cap 25.02 Name: • o L _ ariA '1 A s, : Floor drain/floor sink/hub 25.02 Address: --- Garbage disposal 25.02 City/State/ZIP: _ Hose bib 25.02 Phone:( r 1 Fax:( ) Ice maker 12.51 ❑ APPLICANT .0 CONTACT PERSON Interceptor/grease trap 25.02 Business name: Medical gas(value:$ ) Page 2 Primer 12.51 Contact name: Roof drain(commercial) 12.51 Address: Sink/basin/lavatory 25.02 City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax::( ) Tub/shower/shower pan 12.51 E-mail: Urinal 25.02 • Water closet 25.02 ' .CONTRACTOR . •l- Water heater 37.52 Business name: fl',C - .•i1 A k,_ OS _ .1 Water piping/DWV 56.29 Address: t , Other: 25.02 City/State/ZIP:-ELL . /Alt i 111 Z 0,ce--- Subtotal Phone:�05) , ' -F, D Fax:( ) Minimum permit fee: $72.50 --2e2,6-0 CCB Lic.: / O (CIA Plumbing Lic.no.: Plan review (25%of permit fee) State surcharge(12%of permit fee) S:70 Authorize. •a •ture: IY_AkAiA TOTAL PERMIT FEE 8 I .2U to /b This permit application expires if a permit is not obtained within 180 days Print name: I (� rm.' Date: p pP p p after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\PLMU-PermitApp.doc 1001/09 440-4616T(l0/02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities qn: ; .'Fee(ea) Total •Square Footage: , Permit:Fee: • Footing drain-I"100' 50.03 0 to 2,000 $121.90 Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer- 1st 100' 62.54 7,201 and greater $327.54 Sewer-each additional 100' 37.52 Water Service-1st 100' 62.54 Medical Gas Systems: Water Service-each additional 100' 37.52 Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee: . $1.00 to$5,000.00 Minimum fee$72.50 Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for 'Other Inspections or Fees Qty. Fee(ea) ' Total each additional$100.00 or fraction thereof to and including$10,000.00. Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to (minimum charge-1/2 hour) and including$25,000.00. Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to Reinspection Fees 90.00/hr and including$50,000.00. Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for (minimum charge-1/2 hour) each additional$100.00 or fraction thereof. Subtotal: Commercial Fixture Work: Are you capping,adding or replacing fixtures? If"yes", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees*. Plan Review for Plumbing Installations Quantity.by'Fixture Type Plan review is required for any of the following. Fixture Type for Replace/ Please check all that apply. Work Performed: Capped Added Relocate Baptistry/Font CI Any new commercial building with water service 2"and greater,except systems designed and stamped by licensed -Bath:- - -Tub/Shower -- - - - - - - - engineer. -Jacuzzi/Whirlpool Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure Drive tall as defined in OAR918-780-0040. Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system. Domestic ❑ Any complex structure as defined in OAR918-780-0040. Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: -2" 3" 'Isometric or Riser Diagram • ❑ Isometric or riser diagram is required for new buildings -Car Wash Drain Garbage Domestic non-food that meet the qualifications above. Disposal: -Domestic food related -Commercial food related -Industrial food related Ice Mach./Refrig.Drains Comments regarding fixture work: Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower: -Gang -Stall Sink: -Lav/Bar non-food related -Bradley -Com/Serv/Util food related -Service *Note: If the fixture work under this permit results in an Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and Washer-Clothes fees assessed for the sewer increase must be paid before the Water Extractor Water Closet-Toilet plumbing permit can be issued. Urinal Other Fixtures: 1:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2