Permit 1: a CITY OF TIGARD ti PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00387
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/7/2008
PARCEL: 2 S 102AA - 00903
SITE ADDRESS: 12090 SW MAIN ST ZONING: CBD
SUBDIVISION: RITE AID SHOPPING CENTER LOT: 004 JURISDICTION: TIG
PROJECT: MCDONALDS
Project Description: Interior plumbing. Floor sinks: (2) 2 "and (1) 3 ". Adding 2" floor drains and replacing existing floor
drain with 3" floor sink. 10/7/2008 ADDED (1) lavatory.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: A2 FLOOR DRAINS; 3 TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
MCDONALDS CORP 036/0041
PO BOX 66207 Description Date Amount
AMF O'HARE [PLUMB] Permit Fee 10/7/2008 $72.50
CHICAGO, IL 60666 [TAX] 12% State Surch 10/7/2008 $8.70
Phone : Total $81.20
Contractor:
HENDRICKSON PLUMBING LLC
212 HABERMAN RD
WOODLAND, WA 98674 REQUIRED ITEMS AND REPORTS
Contact # : PR! 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: L /. - Permittee Signature: U V
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.
Oct 01 0847:0pCDJar Flend'ricks i CV. 360- 225 -0917 p.1
f_-
:•� _ ``'APlumbinz Permit Application � �� �v . 137
Building Fixtures
g FOR OFFICE l'SI: ONI.1'
• City of Tigard Received
Datc/B �� Permit No.: '
IN .' ■
13125 SW Hall Blvd., Tigard, OR 97223 OQ� y' � "7 � / /i 1,
Phone: 503.639.4171 Fax: 503.59: c t Pl an Review
O •
• �► CR_ DabdB :
Other Permit No.. I
Inspection Line: 503.639 ii
T I G A R D % - 11 or. I to Readv /B funs; ® age for I
Internet: www.tigardgov k ' o t ified/Method:
0. ^ �c \ %' Ma Suppleme
TYPE OF WORK `7 FEE" SCHEDULE
❑ New construction II ❑ Demob► 9
Description For s dal in ormtn'ion use checklist ,
• ® Addition/alteration/replacement ❑ Other- O1�' Q Ea. Total
New l- 2- family dwellings (includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath I 249.20
❑ 1- and 2- family dwelling ® Commercialiindustrial SFR (2) bath 350.00
❑ Accessory building ❑ Mulli- family SFR (3) bath 399.00
•
Each additional bath/kitchen 45.00
❑ Master builder ❑Other.
Fire sprinkler ( , sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION
Site utilities
Job site address: 12090 SW Main Street Catch basin or area drain 16.60
City /State/ZIP: Tigard, Oregon 97223 Drywell. leach line, or trench drain ME 16.60
Suite bldg. /apt no.: I Project name: McDonalds Footing drain (no. linear IL: _j Page 2
Cross street/directions to job site: Manufactured home utilities 1 10.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _ ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: I Lot no.:
Tax mall!parcel no.: Fixture or item
-- Absorption valve 16.60
DESCRIPTION OF WORK
Backflow preventer Page 2
Install Two 2 inch floor sinks replace floor drain with floor sink
Backwater valve 16.60
Clothes washer 16.60
-
Dishwasher 16.60
El PROPERTY OWNER 1 TENANT Drinking fountain 16.60
Name: Double "K" Ventures, Inc Ejectors/sump 16.60
Expansion tank 16.60
Address: 8255 SW Hunziker Street Suite 203
Fixture/sewer cap 16.60
City/State/ZIP: Tigard, Oregon 97223 Floor drain/floor sink/hub 3 16.60 49.80
Phone: ( ) Fax: ( ) Garbage disposal 16.60
® APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Business name: Hendrickson Plumbing, LLC Ice maker 16.60
Interceptor /grease trap 16.60
Contact name: Jami Hendrickson Medical gas (value: $ ) Page 2
Address: 212 Haberman Road Primer 16.60 r
CityiState!Z1P: Woodland, WA 98674 Roof drain (commercial) 16.60
- Phone: (360) 2255087 Far:: (360) 2250917 Sink/basin/lavatory 16.60 (p. Co
E -mail: Tub/shower /shower pan 16.60 '
Urinal 16.60 r 7
CONTRACTOR Water closet 16.60
Business name: Hendrickson Plumbing, LLC Water heater 16.60
Address: 212 Haberman Road Oth
i if 1St _ ;
; '.IP: Woodland, WA 98674 Subtotal 49,80
1' ,..u1�: (360)22:55087 Minimum permit fee: 572.50
Fax: (360) 2250917 Residential backtlow minimum permit fee: 536.25 i :x•50
CCB l..ic.: 163351 Plumbing Lic. no.: PB213 Plan review (25% of permit fee)
.i
Authorized signature: State surcharge (12% of permit fee) 9. Al
TOTAL PERMIT FEE 81.20 I
Print name: Jami Hendrickson i Date: 10 -01 -2008 This permit application expires if a permit is not obtained witir4n
180 days after it has been accepted as complct:.
"Fee methodology set by Tri- County Building Industry Service Board.
1 : 1 . 11 uildisvPUm @sV'LAW- PermilApp.doc 1217,0E 440.46 16T( IO;OZCOM/wEa)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM200/3- 003E37
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/7/2008
Phone: (503) 639 -4171 Avol
Inspection Requests (24 Hrs.): (503) 639- 4175il
INSPECTION WORKSHEET FOR DATE: 10/20/2008 TIME: 7:Ot1AM PAGE: 14
SITE ADDRESS: 12090 SW MAIN 7 f CLASS OF WORK:
SUBDIVISION: RITE AID SHOPPING CENTER LOT # 004 TYPE OF USE:
PROJECT NAME: MCDONALDS
DESCRIPTION: Interior plumbing. Floor sinks: (2) 2 "and (1) 3 ". Adding 2" floor drains and replacing existing floor
drain with 3" floor sink. 10/7/2008 ADDED (1) lavatory.
OWNER: MCDONALDS CORP 036/0041, PHONE #:
CONTRACTOR: HENDRICKSON PLUMBING LLC PHONE #: 360 -225 -5087
Inspection Request Scheduled For: Date: 0/20/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 076908 -01 360-798-0268 N
Corrections /Comments /Instructions:
Ca.. -c. cb+ "\ - 9 1 ' ..j
4 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: `\ \) \—a- Date: t t7 ;1> 1 O Phone #: (503) 718-
CITY OF TIGARD -
BUILDING DIVISION PERMIT #: PLM2008- 00387
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/7/20013
Phone: (503) 639 -4171 1 111
Inspection Requests (24 Hrs.): (503) 639 -4175 .1111411
' ��
INSPECTION WORKSHEET FOR DATE: 10/10/2008 TIME: 7:00AM PAGE: 4
SITE ADDRESS: CLASS OF WORK:
12090 SW MAIN ST
SUBDIVISION: RITE AID SHOPPING CENTER LOT #: 004 TYPE OF USE:
PROJECT NAME:
MCDONALDS
DESCRIPTION: Interior plumbing. Floor sinks: (2) 2 "and (1) 3 ". Adding 2" floor drains and replacing existing floor
drain with 3" floor sink. 10/7/2008 ADDED (1) lavatory.
OWNER: MCDONALDS CORP 036/0041, PHONE #:
CONTRACTOR: HENDRICKSON PLUMBING LLC PHONE #: 360. 225.5087 -
Inspection Request Scheduled For: Date: 10/1012008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 076561 -01 360.798 -0268 N
Corrections /Comments /Instructions:
Cgt PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 0 t.-^- Date: 101 1 I Og Phone #: (503) 718-
CITY OF TIGARD
1
V
BUILDING DIVISION PERMIT #: PLM2008-00387
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/7/2008
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
° ∎I 1
INSPECTION WORKSHEET FOR DATE: .1011012008 TIME: 7 :00AM PAGE: 5
SITE ADDRESS: 1 2090 SW MAIN ST CLASS OF WORK:
SUBDIVISION: RITE AID SHOPPING CENTER LOT # : 004 TYPE OF USE:
PROJECT NAME: MCDONALDS
DESCRIPTION: Interior plumbing. Floor sinks: (2) 2 "and (1) 3 ". Adding 2" floor drains and replacing existing floor
drain with 3" floor sink. 10/7/2008 ADDED (1) lavatory.
OWNER: MCDONALDS CORP 036/0041, PHONE #:
CONTRACTOR: HENDRICKSON PLUMBING LLC PHONE #: 360 -225 -5087
Inspection Request Scheduled For: Date: 10/10/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
305 Plumbing underslab 076560 -01 360 - 798.0268 N
Corrections /Comments /Instructions:
Ik PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Crb ‘'Vvt.--) \ N _ Date: 1 0 1 1 I 61' Phone #: (503) 718-