Permit CITY OF TIGARD PLUMBING PERMIT
111
IV COMMUNITY DEVELOPMENT Permit #: PLM2010 00349
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/26/2010
Parcel: 25111 CCO5300
Jurisdiction: Tigard
Site address: 15910 SW CENTURY OAK CIR
Subdivision: SUMMERFIELD NO. 1 Lot: 76
Project: Eischen
Project Description: Kitchen, bathroom and laundry room remodel.
Owner: FEES
EISCHEN, STAN Quantity Description Date Amount
9445 SW BRENTWOOD PLACE
TIGARD, OR 97224 1 ea Ice Maker 10/26/2010 $12.51
PHONE: 503 - 440 -2095 3 ea Sink 10/26/2010 $75.06
2 ea Tub /Shower /Shower Pan 10/26/2010 $25.02
1 12% State Surcharge - 10/26/2010 $13.51
Contractor: Plumbing
M B PLUMBING
7112 NE 65TH PLACE
VANCOUVER, WA 98661
PHONE: 360 - 608 -9521
FAX: 360 - 696 -3330
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $126.10
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 Or-gerr - --
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of t e rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: ` Permittee Signature: 0
Call 503.639.4175 by 7:00 a.m. for an inspection that • usiness 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
Oc � bolt OFFICE: lSl oNl.l
i
Q ` \ Received
City o f Tigard n � , 6 2 Date/By: /1) 76 to Permit No.: P�rlflvld -tcn3
;�
q 13125 SW Hall Blvd., Tigard, OR 97223 u, „` T1V
C � Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 C �G (� e,/By: Other Permit No.:
T I G A K p Inspection Line: 503.639
all 0` �� uate Ready/By: runs: ® See Page 2 for
Internet: www.tigard or.gov ` , 11 ��� � Notified/Metho T Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction 0 Demolition For special information use checklist
Description 1 Qty. 1 Ea. 1 Total
2rAddition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
5'1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
building SFR (3) bath 500.32
❑ Accessory g ❑ 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: 15Q ( 0 S w Cepi ('y OAK (�' 1t CA. ( , Catch basin or area drain 18.76
1 Drywell, leach line, or trench drain 18.76
City/ State/ZIP: j i >� (� Z Z �I J / Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: Project name: £(,,c ` C.`, Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
t hfk4Vh. 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: 1 Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
L 1 Clothes washer 25.02
K e vhe�J J) Z a fir& tao ttiNalel / 1 a 1 4 Dishwasher I 25.02
ftbW7 i fi Drinking fountain 25.02
Ejectors/sump 25.02
a PROPERTY OWNER 1 ❑ TENANT Expansion tank 12.51
Name: Str{►r, E I Stit,e Fixture/sewer cap 25.02
�/ p � Floor drain/floor sink/hub 25.02
Address: q`lt/r S W (`e.hiwc,0d Pickce _
Garbage disposal 25.02
City/ State/ZIP: T! 4 OR Lt L) Hose bib 25.02
Phone: (503, ) y ZO-15 Fax: ( ) Ice maker i 12.51 il. 51
❑ APPLICANT J s ig. CONTACT PERSON Interceptor /grease trap 25.02
Business name: Tt. RQv1,,,,da1 .
Co 1 f�C f. 0� ' Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: /R � t, . I> k " Roof drain (commercial) 12.51
Address: P O+ t30) / � 1 Sink/basin/lavatory a 25.02 75,
City/State/ZIP: W and ' V 07/ Solar units (potable water) 62.54
Phone: 50i ) (48 y . Z 7 K31 V Fax: : cOS ) 63i a t CIO Tub /shower /shower pan 2 12.51 ?S t BZ
?L (Ze.r,eat) Q Ig o o . (OAS Urinal 25.02
E -mail:
Water closet 25.02
CONTRACTOR Water heater 37.52
Business name: M Q Pi 4,„,,b;r, L1,.t Water piping/DWV 56.29
Address: 7 t a /1/F" /1 /t. Other: 25.02
City /State /ZIP: LAO/C0i, '7G ( Subtotal 11 2. 5'1
I g q L� , 1 ( Minimum permit fee: $72.50
6 O f3 52
Phone: (30) Fax: ( ) p
D Plan review (25% of permit fee) ...a-87W' CCB Lic.: 151 z ii S /7 !. 4 Plumbing Lic. no.: S/8 Pg 1
State surc (12% of permit fee) 3 _ S 1
Authorized signature: 7 / //( TOTAL PERMIT FEE j
a ( This permit application expires if a permit is not obtained withm 00 days
Print name: M p (vale a . t - Date: 1b .2Q .16)
•�� ' . � � � after it has been accepted as complete. /� I 0 *Fee methodology set by Tri- County Building Industry Service oats.
I:\ Building 'Permits\PLMU- PennitApp.doc 10/01/09 440- 4616T(I0 /02/COM/WEB)