Permit C ITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00193
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/7/2008
PARCEL: 2S 103BC -03000
SITE ADDRESS: 12210 SW ALBERTA AVE ZONING: R -4.5
SUBDIVISION: CANOGA PARK LOT: 004 JURISDICTION: TIG
PROJECT: BERG
Project Description: Installation of residential backflow for irrigation.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
KATHY BERG
12210 SW ALBERTA Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 5/7/2008 $36.25
[TAX] 12% State Surch 5/7/2008 $4.35
Phone : Total $40.60
Contractor:
WEST HILLS PLUMBING
2925 NE REDWOOD DRIVE
MCMINNVILLE, OR 97128 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 474 -9031
Reg #: LIC 108214
PLM 34 -273PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: L ` `I/ Permittee Signature:
//
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
05/06/2008 14:00 5034749031 WEST HILLS PLBG INC PAGE 01/02
Plumbing Permit Application
Building fixtures
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• , - City ornigi rd i k J) t: t v RAi e .I_ p
+r 13128 SW Hall Blvd„ Tlpard, OR 97223 C Q V .Penul No. IV
Poc8 -0c IV,
r'7 r Phone: 503,143(),417] Pax; 5 03,598.1964
• Plan i�rtvicw
Ina eationTjrre; , 503,639,4175 MAY 2U1 Other Permit No.;
. 1 < 2 bats Rowdy Illy:
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Internet: www.tiEmd'�rr.gnv 13 $mPnxeZ
— ... T Yfl 01? WORK b ll. 5 ": m[ Information
r - r _ _ / ,',, .,. FEE' ,, �O ULC:',' r : . .,,
0 New construction L.., ^al k t I f� i V v B �A xJ For
h ems ti' :igerdttll n]brni�los rtse checklist
dition /altcrntlotllreplacetntaat Other — ( 17,. r Erf. 1 Total
- n y dwellin
es
., �, �...,,.,... New (includes 100 connection/ A6 ', , ., • -•,,- :- ' 1. 'Econy o C4IV'Sl it tLrON .'�.,, , bath . l2 1' m91 (es , tot ca h utility connection/
. $F R. (t) 249,20
1- and 2..- i dwelling �] CommrraialCndustrial SFR (2) both
330,00
0 ActeMery building (] Multi- family Sl'R (3) bath 399,00
Master builder Each additional blttti/Wtclum 45.00
0 ()that:
• . , JOB S lf'OPIWA'fON AND LUCAITON Fire utilities ( a4, fl.) Page 2
I �w. .. Site utFllilea
Job t its addreoy, : - r, r (+V r ' C
_ tlieh basin or a rea drain
/ 1 6,60
City/Statc/71P: ,, , . t • 2- Arywell, leach line or tnnnch drain 16.60
Staitc/bldg, /apt. no.: ,Project name:
sooting drain (no, linear. ft.: _) Pagc 2
Gt Ds!f Strcct/dircctiotls to f ob;ritr ; Manufactured home utilities 1 10.00
07_7,09(11)i Manholes 16,60
Rain drain connector .. 16.60
— Sanitary tome (now ear lin ft,; ) Page 2
Storm sewer (no. linear 11.; ,,,,....) Pare 2
Subdivision: I Lot no.: Watar service (no, linear R,; ) P agp 2
Tax map/parcel nn,; . Flxtnre or item
�g9G1Z1[E1101'� 17th', WO Absorption valve
as kflow preveater mons, 7 5-
ibellrwatcr valve 16.60
Clothes washer 16.60
Dishwasher 16.60
' PRO ' i I'1'/ OWNER'. Q TIs1+1Au"�I - Drinking fountain 14,50
. . 0
Name: I=,let:targyump KO
Expansion tank 16.60
Address: ' rflbctt _ Fixturciscwercap 16.60
City /Stnte/7[[ 7 6 fi✓L� _. �t -, � Floor drain /floor sink/huh 16,$0
Phone: ( ) Fax: ( } — Oar t c disposal 16.60
. : .•!.../ ' Et. ApPUC+ ' : " :'..... ; :' .: ❑" CbAI M` ost bib ._.. .
A PERSCaN' 1 640
Business aortic: Ten maker 16,b0
• .� Interceptor/mast trap 16,40
Comaet name_
..r .— Medical as (value: S ) Page 2
Adeirese: -- �_
Primer t 6.60
Ci ty/5itatcJZT,F; hoof drain (commercial) 16.60
( ) Fax: ; ( ) Sink/haain /lavaf� try 14,60
E -moil: - nrU�hotver /sho'vetpan 14.60
Urinal 16.60
' CONTRACTOR" , Water closet �'
Saeiiac!ts adm - 16,60
t, r �✓� / , ,,, .� / Water heater 16.60
Addre 7 y ` _ r •
Fr a'���I<IA Other:
Ci tylStatc/Z[: 'I. I' . i 2, ' f Subtaeal
Phone t � ) r , ) Minimum permit fte:
« <� -e Fox: (rllyy u p 872,50
,� ` � � —�Q.� f Residcntigt haa:lcflami tn,init pctmit fee: $36.25
CC.B T,ic,; ea r 2 - •
Authorized v ry O - Plumbing Twit, no,: .7 3 j3 Plan review (23% of permit Authorized i .
s r p $ Slate sort Marge (l2°/n 4F Permit fee) ..
' +
�� _ TOTAL PERMIT FEE 0 0
Print name: r
�-- � 4, ' Gralet� This permit app cation exp[r�w Vf n trait is not nom n d within
ISO data otter it bon been accented ns complete.
1 : 1 F 3 tIIIdiMRIPamIksIPLMF•P r, mi pp ° Fee methodology set by Ter;- County Building industry Service coed.
.doc Ia /�as,aa 4d0- 4e1d71 Ctmtll l>
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM200B -00193
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/7/1008
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 `__..
INSPECTION WORKSHEET FOR DATE: 5/12/2008 TIME: • 7:01AM PAGE: 33
SITE ADDRESS: 12210 SW ALBERTA AVE CLASS OF WORK:
SUBDIVISION: CANOGA PARK LOT #: 004 TYPE OF USE:
PROJECT NAME: BERG
DESCRIPTION: Installation of residential bacillo u for irrigation.
OWNER: BERG, KATHY PHONE #:
CONTRACTOR: WEST HILLS PLUMBING PHONE #: 503-314 -0341
Inspection Request Scheduled For: Date: 5/12/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
395 Misc. inspection 069682-01 5503 -519 -1352 N
S A LIv( F to “....) k
Corrections/Comments/Instructions:
•
1 : - -e Ile c-e. "re rel (Q,c Ku. eAvue
PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
I I FAIL I I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: 0 --- Date: (c 1 2 L' T) Phone #: (503) 718-