Permit p CITY OF TIGARD PLUMBING PERMIT
III 6' ' COMMUNITY DEVELOPMENT Permit#: PLM2015-00018
T IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/21/2015
Parcel: 25111 CC23000
Jurisdiction: Tigard
Site address: 10420 SW GREENLEAF TER
Project: Eischen Subdivision: SUMMERFIELD NO.5 Lot: 288
Project Description: Remodel,(1)dishwasher,(1)ice maker,(2)lays,(1)kitchen sink,(2)tub/showers,(2)toilets&relocate(1)water
heater.
Contractor: ASSURED PLUMBING INC Owner: STANLEY EISCHEN
PO BOX 230816 10445 SW GREENLEAF TER
PORTLAND,OR 97281 TIGARD,OR 97224
PHONE: 503-985-9093 PHONE: 503-440-2095
FAX: 971-249-3145
FEES
Quantity Description Date Amount
1 ea Dishwasher 01/21/2015 $25.02
Specifics: 1 ea Ice Maker 01/21/2015 $12.51
1 ea Sink 01/21/2015 $25.02
Type of Use: SF 2 ea Lavatories 01/21/2015 $50.04
Class of Work: ALT 2 ea Tub/Shower/Shower Pan 01/21/2015 $25.02
Type of Const: 2 ea Water Closet 01/21/2015 $50.04
Occupancy Grp: 1 ea Water Heater 01/21/2015 $37.52
Stories: 1 12%State Surcharge- 01/21/2015 $27.02
Plumbing
Total $252.19
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 q ions to Ol t, y calli 3.232.1987 or 1.800.332.2344.
Issue By: k // /�//�///�/ n Permittee Signature:
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.
Plumbin Permit A li EIVEI�
Building Fixtures
City of Tigard �teisy: / i /5 Permit No.: u/*l . ly
14 • 13125 SW Hall Blvd.,Tigard,0131/11h22 1 2 015 Plan Review
s Phone: 503.718.2439 Fax: 503.598.1960 I, Y, Date/By: Other Permit No.:
I �e ,�R l) Inspection Line: 503.639.41'5`ITY U 1 r GARO Date Ready/By: Juris: El See Page 2 for
Internet: www.tigard-or.gov j]l1j j][j�f c I Notified/Method: Supplemental Information
TYPI,"Ola1M�& (J 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 SFR(2)bath 437.78
® Y g ❑Commercial/industrial
❑Accessory building ❑Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler(_sq.ft.) Page 2
JOB SITE INFORMATION AM) LOCATION Site utilities:
Job site address:10420 SW Greenleaf Terrace Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97224 Drywell,leach line,or trench drain 1 8.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: INV4i10 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
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Master bath remodel,hall bath remodel,kitchen remodel,move water heater 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:( ) Fax:( ) Ice maker 1 12.51
❑ APPLICANT ® CONTACT PERSON Interceptor/grease trap 25.02
Business name:TL Remodel&Construction Inc Medical gas(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
CONTRACTOR Water closet 2 25.02
Water heater I 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 223.i 1
Phone:(503)985-9093 Fax:( ) Minimum permit fee: $72.50
CCB Lie.:199423 Plumbing Lic.no.:PB1055 Plan review (25%of permit fee)
State surcharge(12%of permit fee) ;'7-c 7�
Authorized signature: TOTAL PERMIT FEE 2y a•l`!1
Print name:Miguel Dorantes Date:1/19/15 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.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-46161(10/02/COM/WEB)
A
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10420 SW GREENLEAF TER, TIGARD, OR,
97224
Record Type: Record ID:
Residential - Plumbing PLM2015-00018
Inspection Type: Inspector:
399 Plumbing final George Heimos
Result:
FA I L
Comments:
1 . Dishwasher hose to be securely anchored to underside of cabinet top. 807.4
2. Recall inspection when corrections have been completed. Re-inspection required.
103.5.6.1
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10420 SW GREENLEAF TER, TIGARD, OR,
97224
Record Type: Record ID:
Residential - Plumbing PLM2015-00018
Inspection Type: Inspector:
399 Plumbing final David Young
Result:
FA I L
Comments:
Stop Work Order posted on site. No inspections prior to correction for stop work order.
Violation Summary:
Inspector Contractor