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CITY Or TIGARD PLUMBING PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00407
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/22/2008
PARCEL: 1S136DB
SITE ADDRESS: 11201 SW 72ND AVE ZONING: C -
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: MCDONALDS
Project Description: Interior plumbing. Floor sinks: (3) 2 ", (1) 3 ". Replacing floor drain with 3" floor sink and adding 2"
floor sinks. 10/29/08 REVISION: changed (1) floor sink to hand sink.
CLASS OF WORK: GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS; 3 TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
ciukS URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
MIKE KENNEDY
8255 SW HUNZIKER ST 203 Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 10/22/200E $72.50
[TAX] 12% State Surch 10/22/200E $8.70
Phone : 503 -519 -9524 Total $81.20
Contractor:
HENDRICKSON PLUMBING LLC
212 HABERMAN RD
WOODLAND, WA 98674 REQUIRED ITEMS AND REPORTS
Contact # : PRI 360- 225 -5087
FAX 360 - 225 -0917
Reg #: LIC 163351
PLM PB213
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 B % Permittee Signature: w/ � Lei
Cali 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.
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLNi2008.00407
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/22/2008
Phone: (503) 639 -4171 /vm 1. .
Inspection Requests (24 Hrs.): (503) 639 -4175 ' R __J
INSPECTION WORKSHEET FOR DATE: 11/7/2008 TIME: 7:02AM PAGE: 3
SITE ADDRESS: 11201 SW 72ND AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: MCDONALDS
DESCRIPTION: Interior plumbing. Floor sinks: (3) 2 ", (1) 3 ". Replacing floor drain with 3" floor sink and adding 2"
floor sinks. 10/29/08 REVISION: changed (1) floor sink to hand sink.
OWNER: KENNEDY, MIKE PHONE #: 503.519.9524
CONTRACTOR: HENDRICKSON PLUMBING LLC PHONE #: 360 - 225.5087
Inspection Request Scheduled For: Date: 11/7/2008 G 0 Pour Time:
Code # Inspection Description Confirm # Contact # Mes- :ge CI_ y
399 Plumbing final 077835.01 360-798-0268 Y ��ii
Corrections/Comments/Instructions:
/
r
_ , I
0
A v� TL I - L s�AA /07.2
a► PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
. l
Inspector: Date: 1 \ 7 Phone #: (503) 718 - )"/‘-/c)1
CITY OF TIGARD ��. -,-
BUILDING DIVISION PERMIT #: PI_ ?.008 - 00407
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/22/2008
Phone: (503) 639 -4171 v i lic
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE 10/30/2008 TIME: 7:OOAM PAGE: 4
SITE ADDRESS: 11201 SW 72ND AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: MCDONALDS
DESCRIPTION: Interior plumbing. Floor sinks: (3) 2 ", (1) 3 ". Replacing floor drain with 3" tk or sink and adding 2"
floor sinks. 10/29/08 REVISION: changed (1) floor sink to hand sink.
OWNER: KENNEDY, MIKE PHONE #: 503 -6•19 -9524
CONTRACTOR: I- IENDRICKSON PLUMBING LLC PHONE #: 363225 -5087
Inspection Request Scheduled For: Date 10/30/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 07740301 360- 907 -7348 N
Corrections /Comments/ Instructions:
DIA/ r.--- M .... _x.
Aim/ 5lbJ
„.. ........ Th
p /t+vi h
Qi
'PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: v (/4 Date: / . Phone #: (503) 718 - 2 ) f DI
CITY OF TIGARD
BUILDING DIVISION r PERMIT #: I�I_M2008 00 -�fU7
1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/22/2008
Phone: (503) 639 -4171 / urdgpu �'�
Inspection Requests (24 Hrs.): (503) 639 -4175 ° °`'I L
INSPECTION WORKSHEET FOR DATE: 10/30/2008 TIME: 7:00AM PAGE: 5
SITE ADDRESS: 11 SW 72ND AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: MCDONAI DS
DESCRIPTION: Interior plumbing. Floor sinks: (3) 2 ", (1) 3 ". Replacing floor drain with 3" floor sink and adding 2"
floor sinks. 10/29/08 REVISION: changed (1) floor sink to hand sink.
OWNER: KENNEDY, MIKE PHONE #: 503519.9524
CONTRACTOR: HENDRICKSON PLUMBING LLC PHONE #: 360 - 225.5087
Inspection Request Scheduled For: Date: 10/30/2.008 Pour Ti • 0
Code # Inspection Description Confirm # Contact # Mes: : ge
305 Plumbing underslab 077408 -01 360- 907 -7348 Y
C rrections /Comments /Instru •ons:
/±Lfil) lU d- -� ..— - ?) - v Avi Gtr 5
f .
• D a Itlet , <
V PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED o t,,--
� �(/►� 1 v 7bi P hone #: (503) 1
Inspector: Date: � ) 718-
CITY TIGARD PLUMBING PERMIT
I COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00407
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/22/2008
• PARCEL: 1 S 136DB -02600
SITE ADDRESS: 11201 SW 72ND AVE ZONING: C -G
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: MCDONALDS
Project Description: Interior plumbing. Floor sinks: (3) 2 ", (1) 3 ". Replacing floor drain with 3" floor sink and adding 2"
floor sinks.
CLASS OF WORK: GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS; 4 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
MIKE KENNEDY
8255 SW HUNZIKER ST 203 Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 10/22/200E $72.50
[TAX] 12% State Surch 10/221200f $8.70
Phone : 503 -519 -9524 Total $81.20
Contractor:
HENDRICKSON PLUMBING LLC
212 HABERMAN RD
WOODLAND, WA 98674 REQUIRED ITEMS AND REPORTS
Contact # : PR1 360- 225 -5087
FAX 360- 225 -0917
Reg #: LIC 163351
PLM PB213
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 • ` �« Permittee Signature: yke-Cie
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.
r ,f' /do ( sue. - 74 , 1
Plumbing Permit Application
,,,v/ cep -- ,Ai . /
Site Utilities -0 v FOR OFFICE 1 SE (NI.V
City of Tigard 0 ISO � Date/F1 : / Permit No.: r
IN C • 13125 SW Hall Blvd.. Tigard, OR 97223 A ,
Phone: 503.639.4171 Fax: 503.598.1960 �� ' Other Permit No.:
Inspection Line: 503.639.4175 , �
T I G A R D _,�1 O�'� ' 1S W i�? a Ready/By: tu ns El Page 2 for
Internet: www.tigard- or.gov ��) r D� Notified Method: Supplemental Information
TYPE OF WORK B `1 A./ / -v FEE* SCHEDULE
❑ New construction ❑ Demolition For special Information use checklist
Description 1 Qty. 1 Ea. j Total
® Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 R. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 24920
❑ I- and 2- family dwelling �4 C,rtmmercial/iindustrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. R.) Page 2
JOB SITE INFORMATION AND LOCATION .
Site utilities
Job site address: 11201 SW 72 Catch basin or area drain 16.60
City /Statc/ZIP: Tigard, OR 97223 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: McDonalds Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no. linear R.: _) Page 2
I Subdivision: Lot no : Water service (no. linear R.: ) Page 2
Fixture or item
Tax map/parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK Backflow pro/enter Page 2
1 floor drain under ABS Machine will be replaced with a floor sink Backwater valve 16.60
1 new 2 inch floor sink for the dinning room drink station Clothes washer 16.60
2 new 2 inch floor sinks for the coffee bar equipment Dishwasher 16.60
Drinking fountain 16.60
❑ PROPERTY OWNER ® TENANT Ejectors/sump I6.60
Name: Double 'K' Ventrues, Inc.
Expansion tank 16.60
I Address: 8255 SW IIUNZIKER ST. SUITE 2 Fixture/sewer cap 16.60
j City /State/ZIP: Tigard, OR 97223 Floor drain/floor sink/hub 4 16.60 66.40
Phone: ( ) Fax: ( )
Garbage disposal 16.60
® APPLICANT ❑ CONTACT PERSON Hose bib 16.60
-- Ice maker 16.60
Business name: Hendrickson Plumbing, LE..0 Interceptor /grease trap 16.60
Contact name:.1ami Iendrickson Medical gas (value: 5 _ ) Page 2
Address: 212 Haberman Road Primer 16.60
City /State /ZIP: Woodland, WA 98674 I Roof drain (commercial) 16.60
Phone: (360) 2255087 Fax: : (360) 2250917 Sink/basin/lavatory 16.60
Tub/shower/shower pan 16.60
E -mail: hp@cni.net Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: Hendrickson Plumbing, LLC Water heater 16.60
Address: 212 Haberman Roa' Other:
Subtotal
City /State/ZIP: Woodland, ^'A 98674
Minimum permit fee: $72.50
72.50
Phone: (360) 225 -5087 ` Fax: (360) 225-0917 Residential backflow minimum permit fee: $36.25
CCI3 Lic.: P13213 Plumbing Lic. no.: 163351 Plan review (25% of permit fee) 0
State surcharge (12 %of permit 'fee) 8.70
Authorized signature: An n TOTAL PERMIT FEE 81.20
Print name: Jami Ile , , n ( Date: 10/20/2008 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
•Fee methodology set by 'Fri-County Building Industry Service Board.
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