Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2015-00165
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/21/2015
TIGARD Parcel: 2S111DB07500
Jurisdiction: Tigard
Site address: 15515 SW ALDERBROOK DR
Project: Eischen Subdivision: SUMMERFIELD NO.7 Lot: 369
Project Description: Plumbing fixtures for master bath,hall bath and kitchen remodel
Contractor: ASSURED PLUMBING INC Owner: EISCHEN ENTERPRISES LLC
PO BOX 230816 15755 SW OAKHILL LN
PORTLAND, OR 97281 TIGARD, OR 97224
PHONE: 503-985-9093 PHONE.
FAX: 971-249-3145
FEES
Quantity Description Date Amount
1 ea Dishwasher 05/21/2015 $25.02
Specifics: 1 ea Ice Maker 05/21/2015 $12.51
1 ea Sink 05/21/2015 $25.02
Type of Use: SF 2 ea Lavatories 05/21/2015 $50.04
Class of Work: ALT 2 ea Tub/Shower/Shower Pan 05/21/2015 $25.02
Type of Const: 2 ea Water Closet 05/21/2015 $50.04
Occupancy Grp: 1 12%State Surcharge- 05/21/2015 $22.52
Stories: Plumbing
Total $210.17
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: > Permittee Signature: f
f
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures �,�,/ / /�
City of Tigard Date/By: �1.2� /.S / PermitNo..."-Z /agI$ /G J
pateBy: <
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
I Phone: 503.718.2439 Fax: 503.598.1960 pate/By. Other Permit No.:
1 I t i n l:L) Inspection Line: 503.639.4175 Date ReadyBy: Juris: 0 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: 77E_Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑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(I)bath 312.70
O 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:15515 SW Alderbrook Drive Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97224
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.: Fixture or item: _
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
Clothes washer 25.02
Master bath remodel,hall bath remodel,kitchen remodel Dishwasher 1 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name:Stanley Eischen Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:15665 SW Oak hill Garbage disposal 25.02
City/State/ZIP:Tigard,OR 97224 Hose bib 25.02
Phone:( ) I Fax:( ) Ice maker 1 12.51
❑ APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 gas
Business name:TL Remodel&Construction Inc Medical (value:$ ) Page 2
Primer 12.51
Contact name:Tim Labunsky
Roof drain(commercial) 12.51
Address:PO Box 1996 Sink/basin/lavatory 3 25.02
City/State/ZIP:Lake Oswego,OR 97035 Solar units(potable water) 62.54
Phone:(503)984-2783 Fax::( ) Tub/shower/shower pan 2 12.51
E-mail:TLRemodel @yahoo.com
Urinal 25.02
Water closet 2 25.02
CONTRACTOR
Water heater 37.52
Business name:Assured Plumbing Inc Water piping//DWV 56.29
Address: PO BOX 230816 Other: 25.02
City/State/ZIP:Portland,OR 97281 Subtotal
Phone:(503)985-9093 Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.:199423 Plumbing Lic.no.:PB1055
State surcharge(12%of permit fee)
Authorized signature: d TOTAL PERMIT FEE a/e,/ 7
Print name:Miguel Doran Date:14/19/15 This permit application expires if a permit is not obtained within 180 days
g after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1-Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)