Permit ry0�M CITY OF TIGARD
PLUMBING PERMIT
` COMMUNITY DEVELOPMENT Permit #: PLM2010 -00190
rr, Date Issued: 06/11/2010
AT E G RD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S110DB00500
Jurisdiction: Tigard
Site address: 15336 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Sonic Drive -In Restaurant
Project Description: Backflow installation.
Owner: FEES
MWF TIGARD LLC Quantity Description Date Amount
2123 NW ALOCLEK DR #1203
HILLSBORO, OR 97124 1 ea Backflow Preventer 06/11/2010 $31.27
PHONE: 503 617 -0175 1 12% State Surcharge - 06/11/2010 $8.70
Plumbing
41 ea Minimum Fee Adjustment - 06/11/2010 $41.23
Contractor: Plumbing
NEW GROWTH LANDSCAPE
PO BOX 1571
BEAVERTON, OR 97075
PHONE: 503 - 848 -2404
FAX: 503 - 848 -2408
Type of Use: COM
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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature: /
� '/ ��iit , y �_AI
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.
Plumbing Permit Application
Site Utilities C'II) FOR OFFICE USE ONLY
City of Tigard 0 1 ` R eceived
n
a Date /By: 4111 ICJ g-r-� - Permit No.: LA trtd t I �,., a jo -ovt O
13125 SW Hall Blvd., Tigard, OR 97223 1 L�0 GU
L Plan Review
C Phone: 503.639.4171 Fax: 503.598.1960 \�N Other P JP� W Permit No 1,. _ '
J
TIGARD Inspection Line: 503.639.4175 ,�l�ptZ D ate Ready,By:
Date/By: o
Juris: El See Page 2 for
Internet: www.tigard- or.gov � � 1` II
�1 CS `! C40 ti0ed /Method: 'JjJ Supplemental Information
TYPE OF WORK 1 1 FEE* SCHEDULE
® New construction ❑ De o lition
For special information use checklist.
Description Qty. Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
❑ 1- and 2- family dwelling ® 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
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 15300 SW PACIFIC HWY Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City /State /ZIP: TIGARD, OR 97224
Footing drain (no. linear ft.: _) Page 2
Suite/bldg. /apt. no.: I Project name: TIGARD SONIC DRIVE IN Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain dram connector 18.76
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.: Fixture or item:
Tax map /parcel no.: Backflow preventer 1 31.27 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
BACKFLOW PREVENTION DEVICE
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: MWF TIGARD, LLC Fixture /sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 2123 NW ALOCLEK DRIVE SUITE 1203
Garbage disposal 25.02
City /State /ZIP: HILLSBORO, OR 97124 Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT ® CONTACT PERSON Interceptor /grease trap 25.02
Business name: NEW GROWTH LANDSCAPE LLC Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: MIKE KOLODZIEJCZAK
Roof drain (commercial) 12.51
Address: P.O. BOX 1571 Sink/basin/lavatory 25.02
City /State /ZIP: BEAVERTON, OR 97075 Solar units (potable water) 62.54
Phone: (503) 572 - 2628 F. :: (503) 848 - 2408 Tub /shower /shower pan 12.51
E - mail: TERESAF @NEWGROWTHLS.COM Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: NEW GROWTH LANDSCAPE LLC Water piping/DWV 56.29
Address: P.O. BOX 1571 Other: 25.02
City /State /ZIP: BEAVERTON, OR 97075 Subtotal 31.27
Phone: (503) 848 - 2404 Fax: (503) 848 - 2408 Minimum permit fee: S72.50 72.50
Plan review (25% of pennit fee)
(,.,GLic.: ' /I/ PlumbingLic. o.: State surcharge (12% of pennit fee) 8.70
Authorized signatu • t TOTAL PERMIT FEE 81.20
Print name:
�! ) / / 7 " � Date& /7 / This permit application expires if a permit is not obtained Nithin 180 days
�-- • � te �. after it has been accepted as complete.
L
*Fee methodology set by Tri County Building Industry Service Board.
I: Building Permits PIMU- PermitApp.doc 10 01 09 440- 4616T(10 02 COM WEB)