16704 SW JORDAN WAY -J
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CITYOF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2.000-00219
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 06/16/2000
SITE ADDRESS: 16704 SW JORDAN WY PARCEL: 2S116AD-25200
SUBDIVISION: BEDFOP.O GLEN ZONING-
BLOCK: LOT: 018 JURISDICTION: KIN
CLASS OF WORK: AL' GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH. BACKFLOW PREVNTPS: 1
OCCUPANCY GRP: PS FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
_F_I_XTURE`; LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS. GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB SHOWERS SEWER LINE: ft
WATr-': CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks. Install a backflow prevention device; __—
FEES
Owned_ ------ _==)
-- �—�� Type By Date Amount Receipt
WALTERS, RYAN & JENNIFER PRMT GEO 06/16/2000 $25.00 0003061
16704 SW JORDAN WAY 5PCT GEO 06/16/200( $2.00 0003061
KING CITY, OR 97224 _ —
Total $27.00
Phone 1: 503-639-7600
Contractor:
OWNER
REQUIRED INSPECTIONS
RP/Backflow Preventer
Phone 1: Final Inspection
Reg #:
EXPIREkb
0 R I G" 'N A L
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 Cep,r-r. Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-0080
You may ot,ain copies of these rules or direct questions to OLINC by calling (503) 246-1987
Issued BPermittee Signature�c:� � ! f
� Call (503) 639-4175 by 7:00 P.M. for an Inspection needed the next bust ess day
CITY OF TIGARD Plumbing Permit Application Plan Check
13125 SW HALL BLVD. Commercial and Residential Recd
TIGARD, OR 97223 Date Recd
(503) 639-4171 �r Date to P E
Print or T` r �`�+� Date to DST
Incomplete or illegible applications will not be ac6epted Permit:(reef#oce-00,71
Reiateu SWR#_
6 el ( Called__ -
Name of elopme�t/Proje FIXTURES (individual) QT PRICE AMT
Job 2 �/���� r Sink ----- .�_ 11.50
Address Street Address Suite Lavatory 11.50
ill lint Sul-j'yewn lut _ Tub or Tub/Shower Comb. 11.50
Bldg# City/State Zip Shower Only 11 50
TT, r,.f- 04 47124 _ - --
Name n - Water Closet 11.50
Y t 1. it Lei' WL(I C r L Urinal 11 50
Owner MaiingAddress Suite Dishwasher _ 11.E0
I J1.(1,,OYtfGl�1 Garbage Disposal - -- - 11 50
City/State Zip Phone - -
i, c C✓Q Q'7 l_2`{ h1)P-74' � Loura. ray 11.50
Aa �Nirde Washing Machine/Laundry Tray 11.50
4 M:f Floor Drain/Floor Sink 2" 11.50
OccupantM ingAddressSuite 3" 11.50
04 iv 4" 11.50
City/State ZipPhone Water Heater O conversion O like kind 11.50
r l rC' 01zz 47714
34-74rw Gas piping requires a separate mechanical permit
Notine MFG Home New Water Service 32.00
Contractor Malling Address Suite MFG Home New San/Storm Sewer 32.00
Hose Bits 11.50
r'rior to permit City/State Zip Phone Roof Drains 11.50
lssuanc^ a copy Drinking Fountain 11.50
of all licenses are Oregon Const.Cont.Board I u,# Exp.Dale -
Other Fixtures(Specify) 15.00
required If
expired in COT Plumbing Llc.# Exp.Date
database
Name - - -
Architect _ Sewer-1st 100' - 38.00
or Mailing Address Suite Sewer-each additional 100' 32.00
Engineer City/State Zip Phone Water Service-1st 100' _ 38.00
g Water Service-each additional 201' 32.00
Describe work to Le done: Storm&Rein Drain-1st 106' -- 38.00
New O Repair O Replace with like kind. Yes O Nn Storm&Rain Drain-each additional 100 32.00
Residential Commercial O _ ---
A
ddJ�lonal description of work: - Commercial Beck Flow Prevention Device 32.00
d F, ��� Residential Backflow Prevention Device' L 1900.
�/�- _ Catch Basin 11.50
Are you capping,moving or repiacirg any fixtures? Insp.of Existing Plumbing or Specially Requested 50.00
Yes O No O Inspectionsper/hr
If yes,see back of form to indicate work p^rformed by Rain Drain,single family dwelling 4500
fixture:. FAILURE TO ACCURATELY REPORTFIXTURE Grease Traps 11 517
WORK COULD RESULT IN INCREASED SEWER FEES. QUANTITY TOTAL
I hereby acknowledge that I have read this application,that the information Isornetur.or riser diagram is required d Quantity Total ins--9
given Is correct,that I am the owner or autht rized agent of the owner,and -- -- •SUBTGTAL
that plans submitted are in compliance with Oregon Slate Laws.
Slgnfrture of
on nnerl eM Date --
f=t � L d (�� �•. (_k, Q008°/, SURCHARGE
CEt Po n Name Phone -
"PLAN REVIEW 25%OF SUBTOTAL
- -- - -- RegWrso;nly It nidure qty total s>9
1 BATIt HOUSE 5178.00 TOTAL
2 BATH HOUSE$250.00
3 BATH HOUSE$285.00 --- -`
(I his fee Includes all plumbing fi>.cures In the dwelling and the first 'Minimum permit fee Is$5e+8%surcharge,except Residential Backflow Prevention
100 feel of sanittry sewer stone sewer and water service) Device,which Is$25+8%surcharge
•ATI New Commercial Buildings require plans in isometric or riser diagram and
plan review
I lost vds4,lum app doc 11!1 a199
P�L-KA E_CQWMPLETE:
—
_ Type n _t;�y by Work Pe f--____--
ormed
..noveu
Sink -- -----"-'–___.-- ew— Replaced R
_ emoved/Capped
Lai,story ------__ _ __– – -- - --- ---_r
Tub or Tub/Shower Combination
Shower Onl ---__------ - - - -_--- –
Water Closet
Urinal ----- ------__–__ _ _ ------- -- –
Dishwasher ---- _
Garbage DisNosal �_--- - ----- -- --- ----------
Laundry Room Tray
– ---
Washing_Machine - – –
Floor Drain/Floor Sink 2"
411
Water Heater --- _ ------
Other Fixtures (Specify) -----
---------------
COMMENTS REGARDING ABOVE: –
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