Permit CITY OF TIGARD PLUMBING PERMIT
°� COMMUNITY DEVELOPMENT Permit #: PLM2011 -00275
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/01/2011
Parcel: 2S104CD07600
Jurisdiction: Tigard
Site address: 13564 SW BRIM PL
Project: ESSIEH Subdivision: HILLSHIRE ESTATES Lot: 76
Project Description: Replacing 100 ft. of water service and installing a backflow preventer. Electrical permit may be required if house
grounding is affected.
Contractor: PRO DRAIN & ROOTER SERVICE, INC Owner: ESSIEH, MATTHEW S & EMMANUELLA E
3300 NW 185TH AVE #213 13564 SW BRIM CT
PORTLAND, OR 97229 TIGARD, OR 97223
PHONE: 503 - 533 -0430 PHONE:
FAX: 503 - 533 -9376
FEES
Quantity Description Date Amount
100 If Water Service 09/01/2011 $62.54
Specifics: 1 ea Backflow Preventer 09/01/2011 $31.27
1 12% State Surcharge - 09/01/2011 $11.26
Type of Use: SF Plumbing
Class of Work: ALT.
Type of Const:
Occupancy Grp:
Stories:
Total $105.07
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:
Ca 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.
Aug 31 11 02:13p Pro Drain & Rooter Srvc. 503 533 -9376 p.1
Plumbing Permit Application �+T�
Site Utilities RECEIVED FOR OFFICE USE ONLY
City Cit of Tigard RECEIVED aJ Received Permit No . A
`J g .
• 13125 S W Hall Blvd., Tigard, OR 972k I r y 1 2011 Date /By: I 1I� _id /
.11 Phone: 503.718.2439 Fax: 503.598. Plan Review Other Permit No.:
Date/By:
Inspection Line: 503.639 y
T 1 GA RD ]Internet ww4v.ti� ardor, ov CITY OF TIGARD Date Read /B y run El See Page 2 far
e R Notified/Method: �8 , Supplemental information
TYPE OF EliiiiiisDING DIVISION 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 (1) bath 312.70
® 1- and 2-family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
❑ Accessory building ❑ Multi - family SFR (3) bath 50032
Each additional bath/kitchen 25.02
El Master builder ❑ Other:
Fire sprinkler ( _ sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 13564 SW Brim Place Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City /State/ZIP: Portland, OR 97223
Footing drain (no. linear ft.: ) Page 2
Suite/bldg./apt. no.: 1 Project name: J s 5 r "�(s 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.: irL)) _ I Page 2 62.54
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.:
Backflow preventer I 31.27 31.27
DESCRIPTION OF WORK
Backwater valve 12.51
Clothes washer 25.02
Install water service and connect to irrigation system. Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
El PROPERTY OWNER J 0 TENANT Expansion tank 12.52
Name: r� 5S lc f M )_ tl 1- . � C Q 0)� F drain/floor aN 2 .02
Address: t/1 I ( �f tTY1°W v wrl Floordrain /floorsink/hub 25.02
Garbage disposal 25.02
City /State/ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
® APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: ProDrain and Rooter Service Medical gas (value: $ ) Page 2
Printer 12.51
Contact name: Lisa Bolke
Roof drain (commercial) 12.51
Address: 3300 NW 185th, #213 Sink basin +lavatory 25 "02
City /State/ZIP: Portland, OR 97229 Solar units (potable water) 62.54
Phone: (503) 533 -0430 Fax: : (503) 296 -2419 Tublshower/shower pan 12.51
E -mail: plumbing* prod rainpdx.com Urinal 25.02
CONTRACTOR Water closet 25 "02
Water heater 37.52
Business name: ProDrain and Rooter Service
Water pipingJDR'V 56.29 f '
Address: 3300 NW 185th, #213 Other: 25.02
City /State/ZiP: Portland, OR 97229 Subtotal ; -aryl`
Phone: (503) 533 -0430 Fax: (503) 296 -2419 Minimum permit fee: 572.50
Plan review (25% of permit fee)
CCB Lie.: 108504 Plumbing Lie. no.: 26 -776PB
State surcharge (12% of permit fee) 11.26
Authorized signature: `‹` { l i TOTAL PERMIT FEE
application expires Thi permit applises a permit is not within I
after it has if ems n obtained name: Lisa K. Bolke Date: 8/31/2011 i e accepted s if e m id s complete pin t l VS• J
*Fee methodology set by Tri- Counly Building Industry Service Bo