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Permit (180) Cf 111 Q ? o CITY OF TIGARD PLUMBING PERMIT ° COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00395 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/17/2008 PARCEL: 2S115BA -00100 SITE ADDRESS: 16200 SW PACIFIC HWY ZONING: C -G SUBDIVISION: TIGARD TOWNE SQUARE LOT: JURISDICTION: TIG PROJECT: MCDONALDS Project Description: Interior plumbing. Floor sinks: (2) 2 ", (1) 3 ". CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: M 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 IBJ SCHRODER BANK & TRUST CO BY ALBERTSONS INC #565 Description Date Amount ATTN: CORPORATE ACCTG DEPT [PLUMB] Permit Fee 10/15/200€ $72.50 BOISE, ID 83726 [TAX] 12% State Surch 10/15/200€ $8.70 Phone : 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 By: i . �,: _` /'` Permittee Signature: e e Q// 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 d7� p `�"'3i3mi i il Stn AAA/ 360- 225-0917 p.1 • Plumbing Permit Application Gt) (di 'Building Fixtures roll (lr•rlc 1: i •sl: ONLY City of Tigard v 0 % Received la III 13125 SW Hall Blvd., Tigard, a'` 223 Date/13 : %.141/ Permit No.: /• C Phone: 503.639.4171 Fax: 503.598 � �� Date�eview ' Other Permit No_ Inspection Line: 503.639.4175 . T I G A R 04� �Sle1 Date Ready /By: ]uric: 10 See Page 2 for >8r /�� Internet: www.tigard- or.gov w Notified/Method: ']2& I Supplemental Information TYPE OF woRLO l V FEE' SCHEDULE _ New construction ofiLion For spedal information use checklist. Description I Qty. ! Ea. ! Total _ ® Addition/alteration/replacement ❑Colter: New 1- 2- family dwellings (includes 100 ft for each utility connection) • CATEGORY OF CONSTRUCTION SFR (1) bath 249.20 ❑ 1- and 2- family dwelling ® Commercial/industrial SFR (2) bath 350.00 ❑ Accessory building D Multi- family SFR (3) bath 399.00 Each additional bathlkitchrn 45.00 ❑Master builder ❑ Other: Fire sprinkler ( sq. ft.) [ I Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: 16200 SW Pacific Hwy Catch basin or area drain I 16.60 City /State/ZIP: Tigard, Oregon 97224 Drywell, leach line, or trench dram 16.60 Suite/bldg. /apt. no.: I Project name: McDonald's Footing drain (no. linear ft.: ) Page 2 Cross street/directions to job site: Manufactured home utilities 114.00 Manholes 16.60 Rain drain connector 16.60 ' Sanitary sewer (no_ linear ft.: _) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: I Lot no.: Water service (no. linear ft: ) Page 2 - Tax map/parcel no.: Fixture or item Absorption valve 16.60 DESCRIPTION OF WORK Badc(low preventer Page 2 install 2 floor sinks Backwater valve 16.60 replace one floor drain with a floor sink Clothes washer 16.60 install one hand sink Dishwasher 16.60 ❑ PROPERTY OWNER 0 TENANT Drinking fountain 16.60 • Name: Ejectors/sump 16.60 ' Expansion tank 16.60 Address: Fixture/sewer cap 16.60 City /State/ZIP: Floor drain/floor sink/hub 3 16.60 49.50 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 City/State/ZIP: Woodland, WA 98674 Roof drain (commercial) 16.60 Phone: (360) 225 -5087 I Fax: : (360) 225 -0917 Sink/basin / lavatory 1 16.60 16.60 E -mail: hp@cni.net Tub /shower/shower pan 16.60 Urinal 16.60 CONTRACTOR Water closet 16.60 Business name: Hendrickson Plumbing Water heater 16.60 Address: 212 Haberman Road Other: City /State /ZIP: Woodland, WA 98674 Subtotal 66.40 Phone: (360) 225 -5087 Minimum permit fee: 572.50 Fax: (360) 225 -0917 Residential backflow minimum permit fee: 536.25 72.50 CCB Lie.: I63351 Plumbing Lic. no.: P11213 Plan review (25% of permit fee) Authorized signature: State surcharge (12% nf permit fee) 8.70 TOTAL PERMIT FEE 81.20 Print name: Jami Hendrickson Date: 10/07/2008 This permit application expires if permit is not obtained within 180 days after it has beta accepted as complete. *Fee methodology set by Tli- County Building Industry Service Board. 1 : 1 auildingTermits lPLMF- PamitApp.doe 12/27/06 440-4016T(I0/O2/C M,WEB) CITY OF TIGARD ` BUILDING DIVISION PERMIT #: PI.M20O8 - Q 395 13125 SW Hall Blvd., Tigard, OR 97223 � DATE ISSUED: 10/1 // OM Phone: (503) 639 -4171 / a� t.r�� l1� Inspection Requests (24 Hrs.): (503) 639 -4175 �: _.. INSPECTION WORKSHEET FOR DATE: 11/14/2008 07:00AM PAGE: 4 SITE ADDRESS: 16200 SW PACIFIC HWY CLASS OF WORK: SUBDIVISION: TIGARD TOWNE SQUARE LOT #: TYPE OF USE: PROJECT NAME: MCDONALDS DESCRIPTION: Interior plumbing. Floor sinks: (2) 2 ", (1) 3 ". OWNER: IBJ SCHRODER BANK & TRUST CO, PHONE #: CONTRACTOR: HENDRICKSON PLUMBING LLC PHONE #: 360-225 Inspection Request Scheduled For: Date: 11/14/2000 Pour Time: Code # ,Inspection Description Confirm # A Contact # Me- .. • - 399 Plumbing final 078102 -01 360 - 708.0268 Corrections/Comments/Instructions: ) i j-fIcS - S — ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED �� voci Inspector: Dat e: � Phone #: (503) 718 -24 CITY OF TIGARD i . BUILDING DIVISION PERMIT #: PI .M2008-00395 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/17/20(18 Phone: (503) 639 -4171 /T��i�� ,. it Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 11/12/2008 TIME: 7 :00AM PAGE: 33 SITE ADDRESS: 16200 SW PACIFIC HWY CLASS OF WORK: SUBDIVISION: TIGARD `IOWNE SQUARE LOT #: TYPE OF USE: PROJECT NAME: MCDONALDS DESCRIPTION: Interior plumbing. Floor sinks: (2) 2 ", (1) 3 ". OWNER: IBJ SCHRODER BANK & TRUST CO, PHONE #: CONTRACTOR: HENDRICKSON PLUMBING LLC PHONE #: 360-225-5087 Inspection Request Scheduled For: Date: 11/12/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 077913.01 360-798-0268 N Corrections/Comments/Instructions: 0 9 V - D — fit.A_; 1 71 VA.Vj.tc C e....110 4 r 1 "- C4 Ni\-(ss N vvi V l01 V;, Sa f ‘ / \ _it- ciL. . ❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS F AIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED 1 l a Z 1 l -?-� Inspector: Date: l �'I Phone #: (503) 718 CITY OF TIGARD A ' BUILDING DIVISION PERMIT #: PLM2000 -00385 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 10/1712008 Phone: (503) 639 -4171 t al • Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 10/29/2008 TIME: 7 :00AM PAGE: 6 SITE ADDRESS: 16200 SW PACIFIC HWY CLASS OF WORK: SUBDIVISION: TIGARD TOWNE SQUARE LOT #: TYPE OF USE: PROJECT NAME: MCDONALDS DESCRIPTION: Interior plumbing. Floor sinks: (2) 2 ", (1) 3 ". OWNER: IBJ SCHRODER BANK & TRUST CO, PHONE #: CONTRACTOR: HENDRICKSON PLUMBING LLC PHONE #: 360-225-5087 Inspection Request Scheduled For: Date 10/2912008 Pour Time: Code # Inspection Description Confirm # Contact # Message 305 Plumbing underslab 077331 -01 360.798 -0268 Y Corrections /Comments /Instructions: • PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: l' U ►^- Date: / 01101, [Oh Phone #: (503) 718- CITY OF TIGARD 4 . r , .. BUILDING DIVISION PERMIT #: PLM2008 -00395 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1n/17/2008 Phone: (503) 639 -4171 U l i\ Inspection Requests (24 Hrs.): (503) 639 -4175 _ - ' '__ INSPECTION WORKSHEET FOR DATE: 10/29/2008 TIME: 7 :00AM PAGE: 6 SITE ADDRESS: 16x00 SW PACIFIC HWY CLASS OF WORK: SUBDIVISION: TIGARD TO1NNE SQUARE LOT #: TYPE OF USE: PROJECT NAME: MCDONALDS DESCRIPTION: Interior plumbing. Floor sinks: (2) 2 ", (1) 3 ". OWNER: IB,J SCHRODER BANK & TRUST CO, PHONE #: CONTRACTOR: HENDRICKSON PLUMBING LLC PHONE #: 360 - 22.5.5087 Inspection Request Scheduled For: Date: 10/29/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 320 Plumbing rough -in 077332 -01 360-798-0268 N Corrections /Comments /Instructions: 1 1 K PASS ❑ PARTIAL APPROVAL III CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: ( 14 n — Date: I 0125A 10 ?\ Phone #: (503) 718-