Permit CITY OF TIGARD PLUMBING PERMIT
IIII $ COMMUNITY DEVELOPMENT Permit#: PLM2014-00167
T f C;q R O 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/21/2014
Parcel: 2S 111 CC 11800
Jurisdiction: Tigard
Site address: 10445 SW HIGHLAND DR
Project: Eischen Subdivision: SUMMERFIELD NO.4 Lot: 169
Project Description: Remodel two bathrooms and one laundry room:(2)lays,(2)tub/showers,(2)water closets,(1)ice maker&(1)
hose bib.
Contractor: ASSURED PLUMBING INC Owner: EISCHEN ENTERPRISES LLC
PO BOX 230816 10445 SW HIGHLAND DR
PORTLAND,OR 97281 TIGARD, OR 97224
PHONE: 503-985-9093 PHONE:
FAX: 971-249-3145
FEES
Quantity Description Date Amount
1 ea Hose Bib 05/21/2014 $25.02
Specifics:, 1 ea Ice Maker 05/21/2014 $12.51
2 ea Lavatories 05/21/2014 $50.04
Type of Use: SF 2 ea Tub/Shower/Shower Pan 05/21/2014 $25.02
Class of Work: ALT 2 ea Water Closet 05/21/2014 $50.04
Type of Const: 1 12%State Surcharge- 05/21/2014 $19.52
Occupancy Grp: Plumbing
Stories:
Total $182.15
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
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: j� n Permittee Signature: evairxr__
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.
I f
Plumbing Permit Application
'Building Fixtures RECEIVE I ,Ilt III I �I I I •I 1,•I ,
City of Tigard DateByd 5 ! Permit No.: PLHx01 cry 4,7
Ili
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
�, /
MAY 21 2014 Date/By:Review Other Permit No.:
Phone: 503.718.2439 Fax: 503.598.1960 DazeBy:
Inspection Line: 503.639.4175 Date Ready/By: Jwis: 0 See Page 2 for
I I t .1 1:I) Internet: www.ti ardor. ov Notified/Method: Supplemental Information
g g CITY OF TIGARD - p
i rss' TYPE OF WORE FEE' SCHEDULE
1D.i1VG DIVISION For special information use checklist
❑New construction ❑Demolition
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
g 1-and 2-family dwelling ❑Commerciallmdustrial _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
. JOS SITE INFORMATION AND LOCATION Site utilities:
Job site address: 10 q L' 5(.,,, N �' Or.
Catch basin or area drain 18.76
ty � Cr� Cori 1 Drywell,leach line,or trench drain 18.76
City/State/ZIP: i3 ` 6 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: 14,k k r),. 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.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
/�
J Clothes washer 25.02
X Z Q A41N rer 4 //' ! \t Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
l'.PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name: l Lj �
1+ Floor drain/floor sink/hub 25.02
Address: 1�O,k (r 1 /°t4- Garbage disposal 25.02
City/State/ZIP: 1 1.3,,,,( c Hose bib i 25.02 a57o0-
Phone:( ) Fax:( ) Ice maker ' 12.51 /,- ,Si
1.0 "-CONTACT PERSON Interceptor/grease trap 25.02
Business name: 7(„ P jaw ,00 Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:7-i t41 L 0.b' K� Roof drain(commercial) 12.51
Address: Po 60A 4/9' Sink/basin/lavatory 2. 25.02 co,04'
City/State/ZIP: Lly,t4. ^ l D'g 9 7035 Solar units(potable water) 62.54
Phone:( ) -Ibci.2.94,3- Fax::( ) Tub/shower/shower pan 2 12.51 625-.4?'
E-mail: Urinal 25.02
Tl" O��` Water closet .2 25.02 �p 4'F
Water heater 37.52
Business name: As 50YL t{J p(l7 wt,s i; 1,t� TrtA C Water piping/DWV 56.29
Address: P D T t7 X 2.30916 Other: 25.02
City/State/ZIP: ?6r} kcuA,& 97 ZQI Subtotal l ,(o V7
Minimum permit fee: $72.50
Phone:(5 63) 9$5 q a 9 3 Fax:(17 i) 2.y y 3i H 5 _ Plan review (25%of permit fee)
CCB Lic.: 1 9 Lit/ 2 3 7/,//,,---- Plumbing Lic.no.: °
105 / ty
State surcharge(12%of permit fee) /.7.S.2,
Authorized signature: PQ 7l TOTAL PERMIT FEE /go/,15--
Date:5 This permit application expires if a permit is not obtained within 180 days•Print name: M L v,.,P,' {� C�h■V trd' #tS J ' after it has been accepted as complete.
J
*Fee methodology set by Tri-County Building Industry Service Board.
I:\BuildingWermits\PLMU-PennitApp.doe 10/01/09 440-4616T(10/02/COM/WEB)