Permit •
CITY OF TIGARD PLUMBING PERMIT
li g COMMUNITY DEVELOPMENT Permit #: PLM2012 -00337
T I G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/20/2012
Parcel: 2S104CD04800
Jurisdiction: Tigard
Site address: 13923 SW MISTLETOE DR
Project: Rothstein Subdivision: HILLSHIRE ESTATES Lot: 48
Project Description: (1) water heater
Contractor: UNITED PLUMBING Owner: ROTHSTEIN, MICHAEL
PO BOX 971 ROTHSTEIN, ROMAINE
FAIRVIEW, OR 97024 ROTHSTEIN, LORRAINE M
13923 SW MISTLETOE DR
TIGARD, OR 97223
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PHONE: 503 - 752 -8446 PHONE: 503-690-8985
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FAX: 503 -491 -8671
FEES •
Quantity Description -Date Amount
1 ea Water Heater 11/20/2012 $37.52
Specifics: 1 12% State Surcharge - 11/20/2012 $8.70
Plumbing
Type of Use: SF 35 ea Minimum Fee Adjustment - 11/20/2012 $34.98
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
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Stories:
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Total $81.20
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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 0(1.800.332.2344.
Issued By: Permittee Signature: 014, A p t. , D
Call 503.639.4175 by 7:00 a.m. for the next available inspection date. ILL
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.
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NOV -16 -2012 09:51 From: f To:5035981960 Pa9e:2'2
Plumbing Permit Application RECEIVE,
Building Fixtures NOV 16 2012 Raetved FOR OFFICE (ISE ONLY
City of Tigard DatclB : 11,1_0 a-- ST- Permit No.:.fUK e100, .0
13125 SW Hall Blvd., Tigard, OR 97223 'ry RC TIG RD Plan Review
ti ' . Phone; 503.718.2439 Fax: 503.598.1 1 T lA 1lal�fW �� : Other Permit No 414421) 1.1.600/0 T I G A I: D Inspection Line: 503.639.4175 �L G LJ1 V � J 1 Date Rerdy r� ® See Page 2 for
Internet www.tigard -or.gov Notified/Method %AO Supplemental Information
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❑ New construction I ❑ Forspeeial information Me checklist
Description I Qty. 1 Ea. I Total
$4ddititm/alteratk)n/replacernen I ❑ Other: New 1- 2- family dwellings (includes 100 ft for each utility connection)
'�: = :. : . 7 am Y:4'SS ,..±5:974 - _ - - =
�, ....,c � f ��.�.. �.. ... . -..... , .�v:�. , .;, ; l'"1...... : s :• SFR (I) bath 312.70
... :A ti:'; ? K ;: � ' ".: ;- fk (ioR]'xitOF SI`,11. [gi : 4:: `' ' ::, • .
l- and 2- family dwelling •y I ❑'Commercial/iindustrial SFR (2) bath 437.78
❑ Accessory building I ❑ Multi- family SFR (3) bath 500.32
Each additional bath/kitchen 25.02
❑ Master builder I ❑ Other: Fire sprinkler ( sq. ft.) Page 2
q._-...s 'r - ` ^ =.J O ''' l N ITE ° IIV F�RMA • j ON; ;, 1; : ' T1ON �' '' '` _: w ° . � 7 - °- S it e • ut ilitie s : - -
Job site address: - : I 3 CU S 5 w Imo. c S"i a - 1 - Q e- Catch basin or area drain 18.76
City/State/ZIP: Tic; v_u 612 9 719 a 7 + Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: ) Page 2
Suite/bldg./ apt no.: 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.: _J Page 2
Water service (no. linear ft.: _ j Page 2
Subdivision: 1 Lot no.: Fixture or item: -
Tax map/parcel no.: Backflow preventer 3127
f,.- ; „ s -•,,• a.�a,,, <: - - - .ter. Backwater valve 12.51
;.b ON " WO"atK" f r_
. `:`. _ . . .. � ... ,-.-7. . :: : Clothes washer 25.02
(A ) A- - re-vr 6 -J t i -eA Dishwasher 25.02
I Drinking fountain 25.02
I Ejectors/sump 25.02
- j �. �, , ... _ ,..° _ , ; = .. ' . r . -t... . , ^' s; R: Expansion tank 12.51
'�•` s��� PB OPEttT1G,� OVI!l!7ER� �.. •�� ®. E'EN r ': -
Name: I Fixture/sewer cap 25.02
Address:
Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City /State/ZIP: I Hose bib 25.02
Phone: ( ) I Fax: ( ) Ice maker 12.51
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. , :, 14-. ANr ., 2 'D 0*600 x . _ Interceptor/grease trap 25. 02
_ ::."x. .`: ,._, ,.. .. :.fi :' :.:'a.' ` .,w:..._ ...:.. .:... .-�� -�. _ �:.
Business name: ()� t •t1 I h Medical gas (value: T > Page 2
tl eM twC. Amer 12.51
Contact name: 'TA S 0,,,‘ I `
Roof drain (commercial) 12.51
Address: a 0 Q Qdc qr 1 FoLA f ki t L' L ✓ / Sink/basin/lavatory 25.02
City/State/ZIP: I O C 7 a. it,- Solar units (potable water) 62.54
( col ) S 1 S � q 3 I �3 e6 -.z ( Tub /showcr/showa pan 12.51
Phone: Fax:: ( ) <•( °(Ll
E- mail: Urinal 25.02
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- W a te r c 25
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t z e` s: CONT14GOR4 �7y Water heater 37.52
Business name: C,� t T I T I v l'‘. 6"„_, Water piping/DWV 56.29
Address: I Other. - 25.02
City /State/ZIP: I Subtotal
Phone: ( ) Fax: ( ) 11'114 Minimum permit fee: $72.50 7,2,5
CCB Lic.: le, 5 / !if- ti" Plumbing Lic. no.: fl. 13 �� Plan review (25 of permit fee)
i State surcharge (I 2% of permit &e) , t7
1
Authorized signature: of a7y t I TOTAL PERMIT FEE VI, Q
b 1 Date: f a This permit application expires if a permit is not obtained within 180 lays
Print name:
04'$ h �Ca / / after it has hems accepted as complete.
r Fee methodology set by Tri- County Building Industry Service Board.
I :WuiIdiog\Permar■%.MU .Pami1Appdce loam 440.4616T(IWO2ICOM/WEB)