Permit CITY OF TIGARD PLUMBING PERMIT
2'. COMMUNITY DEVELOPMENT Permit#: PLM2020-00069
Date Issued: 02/18/2020
T.'GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: IS134BC00500
Jurisdiction: Tigard
Site address: 12388 SW SCHOLLS FERRY RD
Project: McDonald's Subdivision: 1993-057 PARTITION PLAT Lot: 1
Project Description: (1)new catch basin.
Contractor: OWEN CONSTRUCTION INC Owner: MCDONALDS CORPORATION (36-0105)
PO BOX 21150 PO BOX 182571
KEIZER, OR 97307 COLUMBUS, OH 43218
PHONE:
PHONE: 503-390-6936
FAX:
FEES
Quantity Description Date Amount
1 ea Catch Basin or Area Drain 02/18/2020 $18.76
Specifics: 1 12%State Surcharge- 02/18/2020 $8.70
Plumbing
54 ea Minimum Fee Adjustment- 02/18/2020 $53.74
Type of Use: COM 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: -7 Permittee Signature: -7i___ .!/e.
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.
mbing Permit Application
Utilities
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11'hme9 ways Itgar c+ \ohiicdMlethod r7� 1 Supplemental Information
"PAT_ OF WORK FEB 1.8 2020 FEE* SCHEDULE
❑New constructiolt LitlYr9liofTIGARD _ For specialinformationutechec/disr. _
—Description i QtY. 11 La i T+na1
gAdditioru'atreratiomreplacernent [B C sEllNG DIVISION New I-2-family dwellings{includes 100Ifor each ur3in connection)
CATEGORY OF CONSTRUCTION 1 SFR tit bath 312 70
0 I-and 2dami 1c dwell rig �C ommercrallindusinal SF'R(2)bath 437.78
SFR(3)bath 5.1)0 32
❑Accessor..building ❑Multi-61mih
Fitch additional bath/kitchen 25 02
❑Master budder 1 ❑Other
lire sprinkler sq fl.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address v� y,1 , � O.S J Catch trim or area drain k.lb J�
f- v
1Jr}wclh leach line.or trench drain 18 76
City/State/ZIP: Footing drain inc linear tt _i Page 2
Suitefildg./apt-no.: Project name: (7 //],1�4�le� i
/ ,VGvvr+id S. Manuhiciured home utilities 50 03
Cross streeVdirections to job site: I I Manholes 18 76
i
I Ram dram connector 18.76
-�� Senaary sewer(in.linear tie.�) Pace 2
1 Storm sewer{no linear ft.• 3 Page 2
I Water ser<1ce Ino linear It _) Page 2
Subdivision: Lot no: Fixture or item:
Tax map parcel nu_: Backflow pres-enter 31 27
Backwater valve 12-51
DESCRIPTION OE WORK
j'h1SC(Ct—t_ bI �t) 21 VFW- 1 Clothes washer 25 2
Dishwasher 2502
Drinking fountain { 25.02
Ejectors/sump 1 25.02
LPROPERTY OWNER ❑ 'TENANT Expansion tank 1251
Name: ....p irLAT� Flxturclscwvrtap _5.02
Floor dnuninoor sink/hub 25.02
Address:
Garbage disposal 1 ? IL'
City%State;ZIP: i Hose bib
_2502
Phone:I 'I Fax 1 I 1 Ice maker 1 12.51
VAPPLICANT 0 CONTACT PERSON In iereeptor grease trap I 25.02
1 Slcd tat Is Ivalue S I Page 2
Business name.
KtA•S �� Pnmer I 12 51
+Y(rnitn Hamer e
Kim(drain icommcrciaU 12 Sl
Address. "Ann Slnkbasrolas:Mimi 2.502
(u}•`State./IP ,errcrt-1.0 t 1 Solar units t notable water) C.:it
Phone ) cs-- AS ( ha'. . t 1 1 I cabshower shower pan :.^_51
1:-mail IAaylta •60144, Ennui +U:
CONTRACTOR
0,:net hearer 55 i'
Business name /✓/F. 6,...r,f,jlc't G %,7 >. ' «`c- Water piping peaA 5629
Address. 1�?" 2✓/50 Other .._ _;IL
�.
(us`State-71P f?�ry‘f-��,-- 63,<'. 2.7,j' 7 Subtotal MEI
Phone I,SC7j I ' - t��/Z ' I Fax_1 i Minimum nerntu fie 'I 72 51' MEM
Plan rc ne++ r r' fee
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( 13 I_lc /6s 5-16' / 1 Plumbing Lic.no..A'c,( y(rf Slate surcharge 1 I on print feel _�Q
Authorized sign sure: TOT?' PI-RV11} I kl o� y / I
' This permit expires if a permit is not obtained nit in 1Stl days
!'run name /� Uate.,t/-�y'- ZC',7
=` /' after t haa Mien a+ eyed as complete.
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