Permit 41
111 CITY OF TIGARD PLUMBING PERMIT
2 COMMUNITY DEVELOPMENT Permit#: PLM2021-00314
Date Issued: 8/9/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1 S 136CB04600
Jurisdiction: Tigard
Site address: 10855 SW 83RD AVE
Project: Zinter Subdivision: STEVE&HUGHIE'S PLACE Lot: 18
Project Description: Installation of irrigation backflow
Contractor: OWNER Owner: ZINTER, DEAN K AND DONNA F
10855 SW 83RD
TIGARD, OR 97223
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 08/09/2021 $31.27
Specifics: 1 12%State Surcharge- 08/09/2021 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 08/09/2021 $41.23
Class of Work: OTR Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
Issued By: /f 41 't(1‘lVA‘\ Permittee Signature: S .
Q y�� �r
'�K Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit ApplicatiJ EC IVED
Building Fixtures JUL 15 2021
City of Tigard CITY OF TIGARD DateBReceivedy: 7/ZZ/(�7
i t Permit NpL.r.i 2,0^7, 00 5)if
• 13125 SW Hall Blvd.,Tigard,OR �iNG DIVISION Plan Review N
Phone: 503.718.2439 Fax: 503.5§$' Date/By: Other Permit No.:
Inspection Line: 503.639.4175 Date Ready/By:- /1 lulls: ® See Page 2 for
TIGARD Internet: www.ti rd-or, ov 7�L 2�Z�
ga g Notified/Method: Supplemental Information
TYPE OF WORK VI til-- .,, A. FEE* SCHEDULE
0 New construction ❑Demolition For special information use checklist.
Description I Qty. I 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
® 1-and 2-family dwelling 0 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: 10855 SW 83rd Ave Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: Tigard,Oregon 97223
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: sprinkler system backflow preventer Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
SW 83rd Ave&Pfaffle street 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: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27 37.12
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Installation of a irrigation back flow preventer Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: Dean Zinter Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:10855 SW 83rd Ave
Garbage disposal 25.02
City/State/ZIP: Tigard,Oregon 97223 Hose bib 25.02
Phone:( ) 503-708-2411 Fax:( ) Ice maker 12.51
® APPLICANT is CONTACT PERSON Interceptor/grease trap 25.02
Business name: owner Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: Dean Zinter
Roof drain(commercial) 12.51
Address: 10555 SW 83rd Ave, Sink/basin/lavatory 25.02
City/State/ZIP: Tigard,Oregon 97223 Solar units(potable water) 62.54
Phone:( ) 503-708-2411 Fax::( ) Tub/shower/shower pan 12.51
E-mail: Showboatsix@comcast.net Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: OWNER Water piping/DWV 56.29
Address: 10855 SW 83rd Ave Other: 25.02
City/State/ZIP: Tigard,Oregon 97223 Subtotal
Phone:( ) 503-708-2411 Fax:( ) Minimum permit fee: $72.50 7• ..-Sc)
CCB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee)
State surcharge(12%of permit fee) O r 71)
Authorized signature: TOTAL PERMIT FEE h, 3d
a Print name: Dean Zinter PQ.a.ot //77e Date:, 07/15/2021 This permit application expires if a permit is not obtained within 180 days
(/.9 after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:ABuildingVPermits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Ij
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- 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
Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
Other Inspections or Fees 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 ❑ Any new commercial building with water service 2"and
greater,except systems designed and stamped by licensed
Bath: -Tub/Shower
-Jacuzzi/Whirlpool engineer.
IDCar Wash: Each Stall New exterior plumbing site utilities for any complex structure
Drive Thr 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:
I:ABuilding\Permits\PLMF PermitApp.doc 08/04/2011 2
Property Owner Statement
RECEIVEDGARD
p Y JUL 15 2021
Regarding Construction Responsibilities cITYOGT:21
Oregon Law requires residential construction permit applicants who are not licensed vVi k� DIVISION
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.325 (2))
This statement is required for residential building, electrical, mechanical, and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement. This statement will be filed with the permit.
Please check the appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
Dean Zinter 2CLLtLt Property Owner
Name CCB# Expiration Date
I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
VI will be performing work on property I own, a residence that I reside in, or a residence that I will
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
Dean Zinter
Print Name of Permit Applicant
Z7ea4plut ti 07/15/2021
Signature of Permit Applicant Date
Permit#: Pt--1"1 .749 2-4 ` l'O3 P/ •
S Nam,—
Address: I D S S W ?3 AVE: •
Issued by: Date: Ea,-
This Copy for Permit Offices
Information Notice to Owners About
` '" ° !� Construction Responsibilities
-i, . (ORS 701.325 (3))
Homeowners acting as their own general contractors to construct a new home
or make a substantial improvement to an existing structure, can prevent many problems
by being aware of the following responsibilities:
• Homeowners who use labor provided by workers not licensed by the Construction Contractors
Board, may be considered an employer, and the workers who provide the labor may be considered
employees. As an employer, you must comply with the following:
• Oregon's Withholding Tax Law: Employers must withhold income taxes from employee wages
at the time employees are paid. You will be liable for the tax payments even if you don't actually
withhold the tax from your employees. For more information, call the Department of Revenue at
503-378-4988.
• Unemployment Insurance Tax: Employers are required to pay a tax for unemployment insurance
purposes on the wages of all employees. For more information, call the Oregon Employment
Department at 503-947-1488.
• Oregon's Business Identification Number (BIN): is a combined number for both Oregon
Withholding and Unemployment Insurance Tax. To file for a BIN, go online to the Oregon Business
Registry. For questions, call 503-945-8091.
• Workers Compensation Insurance: Employers are subject to the Oregon Workers Compensation
Law, and must obtain Workers Compensation Insurance for their employees. If you fail to obtain
Workers Compensation Insurance, you could be subject to penalties and be liable for all claim costs
if one of your workers is injured on the job. For more information, call the Workers Compensation
Division at the Department of Consumer and Business Services at 800-452-0288.
• Tax Withholding: Employers must withhold Social Security Tax and Federal Income Tax from
employee wages. You may be liable for the tax payment, even if you didn't actually withhold the tax.
For a Federal EIN number, go online to www.irs.gov.
Other Responsibilities of Homeowners:
• Code Compliance:As the permit holder for a construction project, the homeowner is responsible
for notifying building officials at the appropriate times, so that the required inspections can be
performed. Homeowners are also responsible for resolving any failure to meet code requirements
that may be found through inspections.
• Property Damage and Liability Insurance: Homeowners acting as their own contractors should
contact their insurance agent to ensure adequate insurance coverage for accidents and omissions,
such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be
redone. Liability Insurance must be sufficient to cover injuries to persons on the job site who are not
otherwise covered as employees by Workers Compensation Insurance.
• Expertise: Homeowners should make sure they have the skills to act as their own general
contractor, and the expertise required to coordinate the work of both rough-in and finish trades.
CONSTRUCTION CONTRACTORS BOARD
PO Box 14140, Salem, OR 97309-5052
Telephone. 503-378-4621 —Fax: 503-373-2007
Website Address: www.oregon.gov/ccb
f/property_owner adopted 9-2016 This Copy for Permit