Permit CITY OF TIGARD PLUMBING PERMIT
a : COMMUNITY DEVELOPMENT Permit#: PLM2013 00364
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/17/2013
Parcel: 2S104CC05700
Jurisdiction: Tigard
Site address: 14306 SW MISTLETOE DR
Project: NELSON Subdivision: HILLSHIRE WOODS Lot: 1
Project Description: 50 ft.of water service.
Contractor: 3 MOUNTAINS PLUMBING Owner: NELSON, MARK B&
524 N TILLAMOOK ST NANCY PEIFFER
PORTLAND,OR 97227 14306 SW MISTLETOE DR
TIGARD,OR 97223
PHONE: 503-670-1342 PHONE:
FAX: 503-828-0515
FEES
Quantity Description Date Amount
. 50 If Water Service 10/17/2013 $62.54
Specifics: 1 12%State Surcharge- 10/17/2013 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 10/17/2013 $9.96
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
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: AMP Permittee Signature: i
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.
From:Bill Kerriggan Fax:(503)765-5512 H `' �T ���� Fax: +1 (503)598-1960
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City of Tigard OCT 16 2013 Received :Permit No. /
/ -60 DateB : L J L/ _' • G
III + 13125 SW Hall Blvd.,Tigard,OR 97223 plan Review
Phone: 503.718.2439 Fax: 503.598 OtherPermitNo.:LH Y OF IGARD Date Ready/By:I G,∎R I Inspection Line: 503.639.4175 Date Ready/By: orris Iil See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVJSIONN0tified/Mcthod: Supplemental Information
TYPE OF WORK YJ 11 V FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist
Description I Qty. I Ea [ 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
2(1-and 2-family dwelling ❑Concrcial/industrial SFR(2)bath 437.78
tm
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
J1141 SITE INFORMATION AND LOCATION Site utilities:
11 tit)(// Catch basin or area drain 18.76
Job site address:i`'-;CL .SGJ /tq,stcE7e£ -.1- �
Drywell,leach line,or trench drain 18.76
City/State/ZIP: B ' U2 q7,7a3 Footing drain(no.linear ft.:_J Page 2
Suite/bldg./apt.no.: l Project name: il/,L5Oi\J Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary scwcr(no.linear fl.:__) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:.J I Page 2 192. S'/
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
Clothes washer 25.02
i' viz4Nt3 /4E0 is r'Ee SEztftC6 Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0/PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Fixture/sewer cap 25 02
Name: /danit) n.IELSon) Floor drain/floor sink/hub 25.02
Address: f580(, 604 la's re -r c Garbage disposal 25.02
City/State/Z1P:--R,e.-r`Ario OR q7?a3 Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
0 APPLICANT L CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$_) Page 2
3 i�eu�r�rr.ls �[untPirtLr Primer 12.51
Contact name: 2Ed li2CEr Roof drain(commercial) 12.51
Address: sc94 ,v T,,-.+Mue>L !J'r Sink/basin/lavatory 25.02
City/State/ZIP: Re•,rC jr, tom' 9 7,0' Solar units(potable water) 62.54
Tub/shower/shower pan 12.51
Phone:(,So3)L"10• l.g`I-z �'c"( )
/1 �/ Urinal 25.02
E-mail: IgoRn�3�un ns-piumbtr.c$.(orn (IV !// S+4-(1) Water closct 25.02
CONTRACTOR
Water heater 37.52
Business name: 2 b.4. l-rA-,.as R0,4131 N4i Water piping/DWV 56.29
Address: S.3cl 1,j T..r-el4oDt6 ST Other. 25.02
City/State/ZIP: 17ett-rutr.l7 be 973,2"1 Subtotal (i2.SI
Minimum permit fee: $72.50 7�,Sj
Phone:(SOT) (y'70 /3y.? � �! Plan review (25%of permit fee)
CCB Lie.: x6,9 e/c Plumbing Lie.no.: �gy�• q
�J ,sv�'" let State surcharge(12%of permit fee) g 7r;
Authorized signature: � e�__ TOTAL PERMIT FEE J.}p
Print name: �^-` Date: This permit application expires if a permit is not obtained within 180 days
LhUe_Enl C reEk_nr /D//(,/20/3 after it has been accepted as complete.
•Fee methodology set by Tri-County Building Industry Service Board
I.\BuildingTermiin'PLMU-PermitApp doe 10/01/09 440-4616T(10/02/COM/WEB)
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
14306 SW MISTLETOE DR, TIGARD, OR, 97223
Residential - Plumbing
399 Plumbing final
2013-10-22 09:31:00
PLM2013-00364
PASS - No C of O
Violation Summary:
Inspector Contractor