Permit M
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CITY OF TIGARD PLUMBING PERMIT
.,
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00267
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/12/2008
PARCEL: 2 S 104 D C - 02400
SITE ADDRESS: 13381 SW CLEARVIEW WAY ZONING: R -4.5
SUBDIVISION: BENCHVIEW ESTATES LOT: 024 JURISDICTION: TIG
PROJECT: CINCOTTA
Project Description: Replace kitchen sink, disposal & dishwasher.
CLASS OF WORK: ALT GARBAGE DISPOSALS: 1 MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Owner: FEES
DAN CINCOTTA
13381 CLEARVIEW WAY Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 6/12/2008 $72.50
[TAX] 12% State Surch 6/12/2008 $8.70
Phone : Total $81.20
Contractor:
ROBERTSON PLUMBING INC
PO BOX 1329
BORING, OR 97009 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 658 -5818
FAX 503- 658 -7106
Reg #: LIC 88717
PLM 3 -184PB
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 started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rule : questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issue By: # / Permittee Signature: ' •", .jN"` QV
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 completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures / n ( FOR OFFICE, USE ONLY
• City of Tigar Date/By: CS (� D Permit No.: r L4 I 0 26 7
a 13125 SW Hall Blvd., Tigard, OR 97223
-
Phone: 503.639.4171 Fax: 503.598.1960 Plan Review
Date/By: Other Permit No.:
T I GA RD Inspection Line: 503.639.4175 Date Ready /By. s: ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method: I (� Supplemental Information
. TYPE OF WORK FEE* . SCHEDULE
❑ New construction El Demolition For special information use checklist
Descri•tion Qt . Ea. 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
X 1- and 2- family dwelling El Commercial /industrial SFR (2) bath 350.00
I=1 Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2 • JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 1 1 5 uJ a Tj V ( 4 , L,) (.9( Catch basin or ..1
City /State /ZIP: rot A-0_0 Drywell, leach line, or ■ 16.60
(no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: ✓ 1 Project name: Footing a '
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
Water service (no. linear ft.: ) Page 2
Subdivision: I Lot no.:
Fixture or
Tax map /parcel no.:
Absorption 1
.,
DESCRIPTION, OF WORK .
t ‘t.0 r cc Je t C �+ 4 5 )c I 5r0-5 ,4(_ Backwater valve 16.60 Clothes washer 16.60
Ma i
D i,L) , Lc c ( Jf.D Dishwasher • .1
PROPERTY OWNER ❑ TENANT Drinking fountain 1
• . 16.60
Name: N1 C- i N C C^ TTY Expansion tank 16.60
Address: , 16.60
City/State /ZIP: Floor drain/floor U
Phone: ( ) Fax:( ) '=' bth ❑ APPLICANT ' la CONTACT PERSON Hose Ice maker
Business name: Interceptor/grease 1
Contact name: Medical
Address: Primer 16.60
City /State /ZIP: Roof drain (commercial) 16.60 4j9
Phone: ( ) Fax:: ( ) Sink/basin/lavatory t Tub /shower /shower pan • .
E -mail:
Urinal 16.60 •
CONTRACTOR - ' . ` Water closet 16.60
Business name: �� 1 Rn6 (2-1--(\-1 p EL,,vl'� 6,,` ��) Water heater 16.60
P-
Address: 1 3 y Other:
n j ^ x 1 Subtotal
City/State /ZIP: ` i'.J eD
t ■`/ � � Minimum permit fee: $72.50
Phone: (`Tg ‘ - -, 5Qf6 Fax: ( 6 - - 7 / "� Residential backflow minimum permit fee: $36.25
CCB Lie.: — C Plumbing Lic. no.: ' • - ,i / Plan review (25% of permit fee) MAE
s '. State surcharge (12% of permit fee) i NIZE
Authorized signature: g u TOTAL PERMIT FEE 1 19
Print name: C) kY„ N i_ Rn 1, ...A Date: 71/ / 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:\Building \ Permits \PLMF - PermitApp.doc 12/27/06 440- 4616T(10 /02 /COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
SiteUtilities' ,.Qty• Fee (ea), Total Square Footage:: Permit Fee:
Footing drain - li 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 - I'st 100' 55.00
$1.00 to $5,000.00 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 Backflow 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 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.
- 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 •
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
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
tce Mach. /Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
- Stall
Sink - Bar/Lavatory
- Bradley *Note: If the fixture work under this permit results in an
- Commercial increase of sewer EDUs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes
Water Extractor.
Water Closet - Toilet
Urinal
Other Fixtures:
i.'.Building'Permits\PLM- PermitApp.doc i2 /27/06
- . - -
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2008-00267
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6i12/20013
Phone: (503) 639-4171 aryo till i i
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR •DATE: 7/31/2008 TIME.
- 7:00AM PAGE: 53
SITE ADDRESS: 13381 SW CLEAR VIEW WAY CLASS OF WORK:
SUBDIVISION: LOT #: 024 TYPE OF USE:
PROJECT NAME: BEI4CHVIEW ESTATES
CINCOTTA
DESCRIPTION: Replace kitchen sink, disposal & dishwasher.
OWNER: CINCOTTA, DAN PHONE #:
CONTRACTOR ROBERTSON PLUMBING INC PHONE #: 503-658-5818
Inspection Request Scheduled For: Date: Pour Time:
'7/31/2008
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 073482-01 503-380-2129 N
Corrections/Comments/Instructions:
Car-t
_ ..
.__
PASS I I PARTIAL APPROVAL 0 CANCEL r7 NO ACCESS
fl FAIL n CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: Cr6 \, 1/4,_N-0....- Date: .r-- k i ( 0& Phone #: (503) 718-