Permit (28) CITY OF TIGARD PLUMBING PERMIT
II COMMUNITY DEVELOPMENT1111
Permit#: PLM2016 00073
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/11/2016
Parcel: 2S102AA00903
Jurisdiction: Tigard
Site address: 12090 SW MAIN ST
Project: McDonalds Subdivision: PAYLESS SHOPPING CENTER Lot: 4
Project Description: Repairing 65 ft.of sanitary sewer.
Contractor: APOLLO DRAIN&ROOTER SERVICE Owner: MCDONALD'S CORP 036/0041
2208 NW BIRDSDALE#8 BY DOUBLE K VENTURES INC
GRESHAM, OR 97030 8255 SW HUNZIKER ST#101
TIGARD, OR 97223
PHONE: 503-239-8801 PHONE.
FAX: 503-669-9568
FEES
Quantity Description Date Amount
65 If Sanitary Sewer 02/11/2016 $62.54
Specifics: 1 12%State Surcharge- 02/11/2016 $8.70
Plumbing
10 ea Minimum Fee Adjustment- 02/11/2016 $9.96
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:6r.4....r.;#,.......e. _ Permittee Signature:
S)C--e-___ 4"e"'"'"'-gr7i.::-%
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.
Feb. 10. 2016 10: 37AM No. 1869 P. 1
Plumbing Permit Application
Site Utilities RECEIVED roR 0111Cr l SE ONLY
City of Tigard II 1 2016 �Receiv`d v� it, / ' ? Permit No.;/v AACr''.�}�7
il
,1 l _. 13125 SW Hall blvd.,Tigard,OR 97 Plan Review
• Phone; 503.718,2439 Fax; 50t.1.4160. Date/By Other Permit No.:
Inspection Line: 503.639.4175 OF TIGARD
11(;A RD Date Ready/By: )oris: 61 See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method Su lemen(al lntormatiou
❑New construction ❑Demolition For special Information use checkllst:
Description I Qty. I Ea. I Total
®Addition/alteration/replacement ❑Other; New 1-2-family dwellings(includes 100 ft.for each utility connection)
i ,.s CMJ;- ) tls) r4r(fi e.19:0j' - -. SFR(I)bath 312.70
El1-and 2-family dwelling El Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
4:3 - ;.i,i11 •'�_�4,,,`,i 0 Ut1'lit;i.t:1 ft iii5)a�f-Fa`rit.in40 C VUtO ` • r 1 Site utilities:
Job Site address;12090 SW Main St Catch basin or area drain 18.76
-w -w Drywall,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97223 Footing drain(no.linear ft.: ) Page 2
Suite/bldg-/apt,no.: Project name: plc awald t
J Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:65) 1 Page 2 62.,y
Storm sewer(no.linear ft.; ) Page 2
Water service(no.linear ft.:,____) Page 2
Subdivision: f Lot no.: Fixture or item!
Tax map/parcel no.: Backflow preventer 31.27 i
0=41,
�`i' _ ,�"` '��r Ycgi�r ` Clothes ersher 12.51
-4 4^t- � Clothes washer 25.02
L1'IK Technologies CIPP trenchless sewer repair 65FT long Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
ir1 i �::S+`Q1RmyQRd:.. ? � - Y..... !.j�,,Atv, oii x:j 4.,1h ,; Expansion tank 12.51
'
Name: Fixture/sewer cap 25.02
Y..,.• - Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax;( ) lee maker 12.51
® AITUCANT, r ❑`•C;QL`]Tit>:C ' wii Intercepror/grease trap 25.02
Business name:Apollo Drain&Rooter Service Inc Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Kara Oltean
Roof drain(commercial) 12.51
Address;2208 NW Birdsdale Ave Ste 8 Sink/basin/lavatory 25.02
City/State/ZIP:Gresham,OR 97030 Solar units(potable water) 62.54 _-
Phone;(503)389-1326 Fax::(503)669-9568 Tub/shower/shower pan 12.51
E-mail office«apollodtaincom Urinal 25.02
a �,y r s k ,,f ,e,1r Watrr closet 25.02
7. - ", ....::..,.,.-:•-•;-,,:•.....,..,,-.2,-,,.
.', :: ,W - +,(, x; .;:.a. x.::3,•• Water hearer 37.52
Business name:Apollo Drain&Rooter Service insWater piping/DWV 56.29 1
Address:2208 NW Birdsdale Ave Ste 8 Other: 25,02
City/State/ZIP;Gresham,OR 97030 Subtotal
Phone:(503)389-1326 Fax:(503)669-9568 Minimum permit fee: 572.50 '7,2 50
Plan review (25%of permit fee)
CCD Lie.;49418 Plumbing Lic.no.:26-533PB
,r-� � State surcharge(12%of permit fee) "fid
Authorized signaturestC
/ LA _ //�1 TOTAL PERMIT FEE ei-
Print name: f G. _, 4`}-LP�.0-- Date: 2 j lO/f� This permit application expires it permit is not obtained within 180 days
L after it has been accepted es complete.
*tee methodology set by Tri-County Building Industry Service Board.
I:\Building\rer ae\1'LMU-PermirAOp-doe 10/01/09 440-4616T(1047-(COM/WWB)
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