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Permit CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00054 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/19/2008 PARCEL: 1 S 135DD -05200 SITE ADDRESS: 11708 SW WARNER AVE ZONING: C - SUBDIVISION: HOFFARBER TRACTS NO.2 LOT: 035 JURISDICTION: TIG PROJECT: MIRAGE MINI STORAGE Project Description: interior plumbing for mini storage. Other fixtures are sump and hose bib. 4/23/08 ADDED 100 ft. of water service. CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: S1 FLOOR DRAINS; TRAPS: STORIES: 3 WATER HEATERS: 1 CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: 1 OTHER FIXTURES: 2 TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: 1 WATER LINE: 100 ft DISHWASHERS: RAIN DRAIN: 300 ft Owner: FEES MIRAGE STORAGE LLC 9055 SW BEAVERTON - HILLSDALE HW Description Date Amount PORTLAND, OR 97225 [PLUMB] Permit Fee 2/14/2008 $230.80 [TAX] 12% State Surch 2/14/2008 $27.70 Phone : [PLUMB] Addl Permit 4/23/2008 $55.00 [TAX] 12% State Surch 4/23/2008 $6.60 Contractor: Total $320.10 ASSURED PLUMBING SERVICES LLC PO BOX 835 WILSONVILLE, OR 97070 REQUIRED ITEMS AND REPORTS Contact # : PRI 503- 682 -3590 FAX 503 -682 -3590 Reg #: LIC 176122 PLM PB 102 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 Signature1/1 dior 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 c B FOR OFFIe ONLY � Building Fixtures y ¢� r � 4- ! 9 1 1 - 3u i Lae • - ^• - � r✓ � �ST� •^_ -R '� [�. F,.. � `'i [ �R F �- Ti'k= ='• :'PT .:. i.p 1M �4 %1Sa al. •�. �N -� ' 'yi e seNfl as 71 City of Tigard �1 �O ' eceived a 13125 SW H al l Blvd., Tigard, OR 97223 \ - 1 '� `,) .� n a Y / ! v� ow� 1 :, Phone: 503.639.4171 Fax: 503.598.1960 p;12' C `� ;C ' gy,5 ° `v Other Permit No. : Inspection Line: 503.639.4175 t 0� bl5ate Read /B Kr is: See Page A''SI ^ Ready /By: e 2 for S - .G. Internet: www.tigard - or.gov c; • cr \ � \ '�� " Notified/Method: Supplemental Information TYPE OF WORK f�s• FEE!-SCHEDULE Demolition 0 New construction 0 For special information use checklist. Descri • tion Qt . Ea. Total CATEGORY U Addition/alteration/replacement 0 Other: New 1- 2-family dwellings (includes 100 ft. for each utility connection) OF 1 1 bath 249.20 dwelling El 1- and 2-family N Commercial/industrial FErJ bath 350.03. SFR (3) bath 399.00 El Accessory building 0 Multi-family Each additional bath/kitchen 45.00 El Master builder 0 Other: KIB SITE INFORMATION I LOCATION Job site address: r-2 . • ..- Catch basin or area drain 16.60 Drywell, leach line, or • •1 Footing drain (no. 1Mear ft.: ) Page 2 Suite/bldg./apt. no.: Project name: � ' i1li� _' ( 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 ft.: ) Page 2 Water service (no. linear ft.: / Page 2 • Subdivision: Lot no.: Fixture or item Tax map/parcel Absorption valve 16.60 DESCIUMON OF 1 ' Backflow preventer Page 2 Ailw■I I JA. ! . AN xo 111 Backwater valve 16.60 d wqr— Se rvi C.12._ Clothes washer 16.60 Dishwasher 16.60 ❑ PROPERTY: OWNER I . ❑ TENANT Drinking fountain 661 Ejectors /sump 16.60 Name: Expansion tank 16.60 Address: Fixture /sewer cap 16.60 City /State /ZIP: Floor drain/floor sink/hub 16.60 Phone: ( ) Fax: ( ) Garbage disposal 16.60 Hose bib 16.60 - • ❑ •APPLICANT . ' ❑ CONTACT PERSON' . Ice maker 16.60 Business name: Interceptor /grease trap 16.60 Contact name: Medical gas (value: $ ) Page 2 Address: Primer 16.60 City /State /ZIP: Roof drain (commercial) 16.60 Sink/basin/lavatory 16.60 Phone: ( ) Fax:: ( ) Tub /shower /shower pan 16.60 E -mail: Urinal ..1 CONTRACTOR Water closet 16.60 Business name: . , n /m,y)br �0 v €) Water heater 16.60 Address: f Other: City /State /ZIP: Subtotal Minimum permit fee: $72.50 d. Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 , SS: CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) State surcharge (12% of permit fee) , . Authorized signature: TOTAL PERMIT FEE Print name: Date: This permit application expires if a permit is not obtained withYfi 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. I:\ Building \Permits\PLMF- PermitApp.doc 12/27/06 440- 4616T(10 /02 /COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: 'Site :Utilities Qty. Fee(ea) Total S care Foota ! e: 'Permit Fee: Footing drain - 1" 100' 55.00 :0 to 2,000 $115.00 Footing drain -each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer - 1st 100' 55.00 7,201 and greater $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 Valuation: , Permit Fee: Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each ;Fixture Or Item ,.Qty. Fee (ea) - Total additional $100.00 or fraction thereof, to and including $10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to (minimum permit fee $36.25) 27.55 and including $25,000.00. Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for Inspection of existing plumbing or each additional $100.00 or fraction thereof, to and including $50,000.00. specially requested inspections - per hour 72.50 Subtotal: $50 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. Fixture Work: Plan Review for Plumbin , Installations Are you capping, adding or replacing fixtures? If "yes", Plan review is required for any of the following. please indicate work performed by fixture. Failure to Please check all that apply. accurately report fixtures could result in increased sewer fees *. ❑ Any new commercial building with water service 2" and Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed Fixture Type: , ° Replace ; engineer. Previous . Capped Added Existing ❑ New exterior plum.oing site utilities for any complex structure Baptistry/Font as defined in OAR918- 780 -0040. Bath - Tub /Shower ❑ Medical gas and vzcuum systems for health care facilities. - Jacuzzi/Whirlpool ❑ Any multipurpose :ire sprinkler system. Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040. -Drive Thru Cuspidor/Water Aspirator Submit 2 set; of plans with any of the above. Dishwasher - Commercial Drinking Fountain -Domestic Isometric or Riser Diagram, Eye Wash ❑ Isometric or riser diagram is required for new buildings Floor Drain/sink - 2" that meet the qualifications above. -3" Car Wash Drain Garbage - Domestic Comments regarding fixture work: Disposal - Commercial' - Industrial Ice. Mach. /Refrig. Drains Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar/Lavatory - Bradley *Note: If the fixture' work under this permit results in an - Commercial increase of sewer EDUs, a sewer permit will be issued and - Service fees assessed for the sewer increase must be paid before the • Swimming Pool Filter plumbing permit can be issued. Washer - Clothes Water Extractor Water Closet - Toilet Urinal Other Fixtures: i:\ Building \Permits\PLM - PermitApp.doc 12/27/06 ( ' % %B D d . ;_,,n CITY OF I® D PLUMBING PERMIT COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00054 ieAR6" 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/19/2008 PARCEL: 1S135DD-05200 SITE ADDRESS: 11708 SW WARNER AVE ZONING: C -G SUBDIVISION: HOFFARBER TRACTS NO.2 LOT: 035 JURISDICTION: TIG PROJECT: MIRAGE MINI STORAGE Project Description: interior plumbing for mini storage. Other fixtures are sump and hose bib. 4/23/08 ADDED 100 ft. of water service. 10/23/08, ADDED (1) double -check valve. 10/24/08, ADDED additional (1) CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: S1 FLOOR DRAINS; TRAPS: STORIES: 3 WATER HEATERS: 1 CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: 1 OTHER FIXTURES: ,$'si TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: 1 WATER LINE: 100 ft DISHWASHERS: RAIN DRAIN: 300 ft Owner: FEES MIRAGE STORAGE LLC Description Date Amount 9055 SW BEAVERTON - HILLSDALE HW PORTLAND, OR 97225 [PLUMB] Permit Fee 2/14/2008 $230.80 [TAX] 12% State Surch 2/14/2008 $27.70 Phone : [PLUMB] Addl Permit 4/23/2008 $55.00 [TAX] 12% State Surch 4/23/2008 $6.60 [PLUMB] Addl Permit 10/23/200€ $46.40 Contractor: [TAX] 12% State Surch 10/23/200€ $5.57 ASSURED PLUMBING SERVICES LLC (additional fees not shown here) WI PO BOX IL REQUIRED MIS AND Rl 44 4 WILSONVILLE, OR 97070 Contact # : PRI 503- 682 -3590 FAX 503- 682 -3590 Reg #: LIC 176122 PLM PB 102 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 Ci2 Permittee Signature: 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. q eg ge Y OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00054 7, 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/19/2008 PARCEL: 1 S135DD -05200 SITE ADDRESS: 11708 SW WARNER AVE ZONING: C -G SUBDIVISION: HOFFARBER TRACTS NO.2 LOT: 035 JURISDICTION: TIG PROJECT: MIRAGE MINI STORAGE Project Description: interior plumbing for mini storage. Other fixtures are sump and hose bib. 4/23/08 ADDED 100 ft. of water service. 10/23/08, ADDED (1) double -check valve. CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: S1 FLOOR DRAINS; TRAPS: STORIES: 3 WATER HEATERS: 1 CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: 1 OTHER FIXTURES: 3 TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: 1 WATER LINE: 100 ft DISHWASHERS: RAIN DRAIN: 300 ft Owner: FEES MIRAGE STORAGE LLC 9055 SW BEAVERTON - HILLSDALE HW Description Date Amount PORTLAND, OR 97225 [PLUMB] Permit Fee 2/14/2008 $230.80 [TAX] 12% State Surch 2/14/2008 $27.70 Phone : [PLUMB] Addl Permit 4/23/2008 $55.00 [TAX] 12% State Surch 4/23/2008 $6.60 [PLUMB] Addl Permit 10/23/200€ $46.40 Contractor: [TAX] 12% State Surch 10/23/200€ $5.57 ASSURED PLUMBING SERVICES LLC Total $372.07 PO BOX 835 WILSONVILLE, OR 97070 REQUIRED ITEMS AND REPORTS Contact # : PRI 503- 682 -3590 FAX 503- 682 -3590 Reg #: LIC 176122 PLM PB 102 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 .' _ • .uestions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued = y: . �� /LAA/4., Permittee • . natur • • i� _ _ s�'% � „ i 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. • RETURN RECORDED DOCUMENT TO: RECEIVED HALL RECORDS DEPARTMENT CITY OF TIGARD 13125 SW HALL BLVD. JUL 2 9 2008 TIGARD, OR 97223 CITY OF TIGARD INDIVIDUAL orrORPORAIE) BUILDING DIVISION File No. Space above reserved for Washington County Recording Information RIGHT -OF -WAY AGREEMENT/ ENCROACHMENT (REVOCABLE PERMIT) THIS AGREEMENT is entered into on fr. '�i, 2008, between the CITY OF TIGARD (the "City ") and Kn I ( ( "Property Owner "). RECITALS A. Property Owner owns the property located at 11708 Warner Avenue, Tigard, Oregon 97223, Taxlot 1S135DD05200, more partic arty described as Lo+ 3 s av- 'Tr c c No L f , in the City of Tigard, Washington County, Oreg e "underlying property "). B. Applicant has constructed or is constructing private utility lines (including fire flow and water lines) and fixtures within the City's right -of -way along the western edge of Property Owner's property (the "encroachment "). See attached exhibit A C. The City believes that the encroachment may be maintained in place without significantly interfering with the use of the right -of -way, and is willing to allow the encroachment to remain, subject to removal only if needed to allow the City to use the right -of -way. D. The City therefore agrees to permit the encroachment to remain in place, subject to the City's right to revoke that permission. 'PERMS OF AGREEMENT Property Owner, on behalf of Property Owner and all future owners of the underlying property, agrees: 1. To forego any and all claims that Property Owner might have at any time against the City arising from work performed in the right -of -way due to the encroachment in the right -of -way, including, but not limited to, damage to or removal of the encroachment; 2. To reimburse the City for all repair or installation expense that exceeds the expense that would have been incurred if there had not been an encroachment; v. 3. The City may determine, in its sole discretion, the materials, means, and methods to be used in performing work within the right -of -way. Expenses for work within the right - of-way are deemed reasonable when based upon competitive bids obtained by the City or upon the written opinion of costs by an independent registered engineer selected by the City; and 4. On demand of the City, to remove the encroachment, or such part of it as needed to allow the City to exercise full use of its right -of -way. If Property Owner does not remove the encroachment as directed by the City, the City may remove the encroachment at Property Owner's expense; and 5. To reimburse the City for the total repair expense if the repair work is necessitated by damage caused by the encroachment. The cause of damage shall be established by the written opinion of an independent registered engineer selected by the City. In the event that the City determines that continued occupation of the right -of -way by the encroachment is inconsistent with the City's right to use the right -of -way, the City may revoke this agreement. Any such revocation shall be communicated to Property Owner or successor in interest at least 30 days in advance, unless an emergency situation does not allow the full notice period. It is covenanted and agreed between the parties hereto that all the covenants and agreements above expressed shall be held to run with and bind the property described herein, and shall extend to and include their heirs, assigns, devisees, lessees, and holders of any kind of and under Property Owner. This paragraph does not limit the City's unilateral right to terminate this agreement as provided above. • This agreement allows the encroachment as built to remain, but does not allow any expansion of the encroachment within the right -of -way. If the City undertakes any work that requires removal of the encroachment, the City will allow the encroachment to be reconstructed without expansion, if consistent with continued operation of the City's facilities in or use of the right -of -way. All rights and privileges granted herein by the City shall terminate upon the non - conformance to the plot plan or discontinuance of such use. WITNESS oi • this 2 of ' 1 .' 08. 1 Property 0' n • :igna • Property Owner's Signature Property A.•4 es Mailing Address (if different) C" 41°. a � • •' - pff2 0 O ft- 171,7 STATE OF OREGON) ) ss. County of Washington) a ALI This instrument was acknowledged before me onA 'ri1 \ , 2008 by: .4'11iis'TL +ek; . OFFICIAL SEAL SHIRLEY LL TT "C NOTARY PUBUC • ORES Notary's Signa e Ts' COMMISSION NO. 416777 M1( COISBION EXPIRES APRIL 25, 2011 N My Commission Expires: In accordance with Section 15.16 of the City of Tigard Municipal Co City of Tigard 13125 S.W. Hall Blvd. City Maer Tigard, OR 97223 STATE OF OREGON) ) ss. County of Washington) A �t, This instrument was acknowledged before me on M'Y 2 i t (date) b L ��f C� PZ0S5IZ G•IT'� II• A1' �GE� (name of person(s)). ? OFFICIAL SEAL J BEN TSON f / NOT ARY PUBUC f Notary'si.'gnature COMMISSION NO. 413772 �, /�,,, a-7 �( �f 1 MY COMMISSION EXPIRES APR. 27, 2011 0 My Commission Expires /17 �'t • r x n ® PLUMBING PERMIT COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00054 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/19/2008 PARCEL: 1 S135DD -05200 SITE ADDRESS: 11708 SW WARNER AVE ZONING: C - SUBDIVISION: HOFFARBER TRACTS NO.2 LOT: 035 JURISDICTION: TIG PROJECT: MIRAGE MINI STORAGE Project Description: interior plumbing for mini storage. Other fixtures are sump and hose bib. CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: S1 FLOOR DRAINS; TRAPS: STORIES: 3 WATER HEATERS: 1 CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: 1 OTHER FIXTURES: 2 TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: 1 WATER LINE: ft DISHWASHERS: RAIN DRAIN: 300 ft Owner: FEES MIRAGE STORAGE LLC 9055 SW BEAVERTON - HILLSDALE HW Description Date Amount PORTLAND, OR 97225 [PLUMB] Permit Fee 2/14/2008 $230.80 [TAX] 12% State Surch 2/14/2008 $27.70 Phone : Total $258.50 Contractor: ASSURED PLUMBING SERVICES LLC PO BOX 835 WILSONVILLE, OR 97070 REQUIRED ITEMS AND REPORTS Contact # : PRI 503- 682 -3590 FAX 503- 682 -3590 Reg #: LIC 176122 PLM PB 102 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: Permiftee Signature: / —� 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 ,1,00 -01 ,D /9 4D - a . m.L , Building Fixtures e - FOR o F ID E " US )-oN p e � � a ' 1 . City of Tigard Received ■ /t Q ` at-‘ Permit No.. AM �(J - Cd , e Y' - a 13125 SW Hall Blvd., Tigard, OR 97223 Date/By: 6 t/�{ Pl an e R iew V p C Phone: 503.639.4171 Fax: 503.598.1960 Other Permit No.: SG(�" - /Tiript T i G \ R D ' Inspection Line: 503.639.4175 Date Ready /By: Juris: in See Page 2 for ...,,, , 'i - ,-, - r< Internet: www.tigard - or.gov Notified/Method: Supplemental Information 'TYPE OF WORK ' 'FEE* SCHEDULE 0. New construction ❑ Demolition For special information use checklist Description 1 Qty. 1 Ea. 1 Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION, . SFR (I) bath 249.20 ❑ 1- and 2- family dwelling ® Commercial /industrial 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. ft.) Page 2 . ' JOB SITE ,INFORMATION . AND LOCATION Site utilities Job site address: // 70 0 56,i 6,4,M W qvENitc Catch basin or area drain 16.60 City /State /ZIP: TT 0,e-g& OA/ Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: Project name: /' va c9 Shv4 *( 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 � k 'i'CP c 503 -G3g - pt 7 d Sanitary sewer (no. linear ft.: _) Page 2 Storm sewer (no. linear ft.: _) 3c7/164 Page 2 ,6/ ej �g r , t ,_ ,,,I y 1r I Lot no.: Water service (no. linear ft.: ) Page 2 Subdivision: `y'vl Fixture or item Tax map /parcel no.: 6 Absorption valve 16.60 DESCRIPTION OF -WORK Backflow preventer 1 Page 2 Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 PROPERTY OWNER' ❑TENANT Ejector sump i 16.60 r / (0,&) Name: H k Effect .9 fie. Expansio 16.60 Address: Fixture /sewer cap 16.60 City /State /ZIP: Floor drain/floor sink/hub 16.60 Fax: ( ) Garbage disposal 16.60 Phone: ( ) Hose bib 16.60 44 de ❑ APPLICANT ❑ CONTACT PERSON Ice maker 16.60 Business name: Interceptor /grease trap 16.60 Contact name: Medical gas (value: $ ) Page 2 Address: Primer 16.60 City /State /ZIP: Roof drain (commercial) 16.60 Phone: ( ) Fax: : ( ) Sink/bas i lavatory / 16.60 /4 . Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 / CONTRACTOR Wat er closet 1 16.60 �6 • l� ) Business name: A_ ss 0L f) 0 b,)-1 �/i+ 14 L e . / i 6 Water heater / 16.60 /6 , O Address: Po- 6 vx D S tom, Other: Y 6t/ V 1 / / 0� 7 0 2 Subtotal City/State/ZIP: / f Minimum permit fee: $72.50 gio Phone: (5o3 ) .4 ?:2_ X 570 Fax: ( 5 _6 2_ 75 -- yV Residential backflow minimum permit fee: $36.25 CCB Lio.:: / 7F j / Z w Plumbing Lic- no.: p/j /0 Z _ Plan review (25 %ofpermit fee) ..--&-"' " I State surc (12% of permit fee) /. 7 Authorized signature: a TOTAL PERMIT FEE Z -g, s Print name: apex 5-0/2001/,5k7 Date:, _ p/' 0s This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. I:\Building\Permits\PLMF- PermitApp -doc 12/27/06 440- 4616T(10 /02 /COM/WES) Plumbing Permit Application - City of Tigard • Page 2 - Supplemental Information Fee Schedule:. Residential Fire Suppression Systems: • Site Utilities Qty. ,Fee (ea) Total S • uare Foota e: Permit Fee: Footing drain - 1 100' 55.00 0 to 2,000 $ 1 15.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer - 1st 100' 55.00 7,201 and _• reater $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 Valuation: ' Permit Fee: , ' Storm &Rain Drain - 1st 100' 55.00 y 4" / $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each Fixture or Item Qty.. 'Fee (ea) Total additional $100.00 or fraction thereof, to and including $10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to (minimum permit fee $36.25) 27.55 • • and including $25,000.00. Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for Inspection of existing plumbing or each additional $100.00 or fraction thereof, to • and including $50,000.00. specially requested inspections - per hour 72.50 Subtotal: $50 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. Fixture Work: Plan.Review. for Plumbin Installations '• - Are you capping, adding or replacing fixtures? If "yes ", Plan review is required : or any of the following: please indicate work performed by fixture. Failure to Please check all that apply. accurately report fixtures could result in increased sewer fees * . ❑ Any new commercial building with water service 2" and Quantity_ (Fixture) Work Pei formed greater, except systems designed and stamped by licensed Fixture Type: - Replace . ` engineer. g Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure Baptistry/Font as defined in OAR918- 780 -0040. Bath - Tub /Shower ❑ Medical gas and vz.cuum systems for health care facilities. - Jacuzzi/Whirlpool ❑ Any multipurpose :fire sprinkler system. Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040. -Drive Thru Cuspidor/Water Aspirator Submit 2 set; of plans with any of the above. Dishwasher - Commercial - Domestic Drinking Fountain Isometric or Riser Dia! rain Eye Wash ❑ Isometric or riser diagram is required for new buildings Floor Drain/sink - 2" that meet the qualifications above. -3" -4" Car Wash Drain Garbage -Domestic Comments regard ing fixture work: Disposal - Commercial - Industrial. • Ice Mach. /Refrig. Drains Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang ' -Stall Sink - Bar/Lavatory • - Bradley *Note: If the fixture work under this permit results in an - Commercial increase of sewer EDUs, a sewer permit will be issued and - Service fees assessed for the sewer increase must be paid before the - Swimming Pool Filter plumbing permit can be issued. .Washer - Clothes Water Extractor • Water Closet - Toilet / Urinal Other Fixtures: • i.\Building\Permits\PLM- PermitApp.doc 12/27/06 Accumulative Sewer Tally Parcel # 1S135DD -05200 Tcna;it Narm;: MIRAGE STORAGE This SWR# a 0 0 , 2 - o / , Site Address: 11708 SW WARNER AVENUE This PLM# PLM2008 -00054 Fixture Value Previous Previous Credits Capped Fixture Fixture New New # value capped off value added added total total count off #s count # value #s values Baptistry /Font 4 0 0 0 0 0 Bath - Tub /Shower 4 0 0 0 0 0 - Jacuzzi /Whirlpool 4 0 0 0 0 0 Car Wash - Each Stall 6 0 0 0 0 0 - Drive through 16 0 0 0 0 0 Cuspidor /Water Aspirator 1 0 0 0 0 0 Dishwasher - Commercial 4 0 0 0 0 0 - Domestic 2 0 0 0 0 0 Drinking Fountain 1 0 0 0 0 0 Eye Wash 1 0 0 0 0 0 Itloor Drain /Sink - 2 inch 2 0 0 0 0 0 - 3 inch 5 0 0 0 0 0 - 4 inch 6 0 0 0 0 0 - Car Wash Drn 6 0 0 0 0 0 Garbage Disposal - Domestic (to 3/4 I II)) 16 0 0 0 0 0 - Commercial (to 51.1P) 32 0 0 0 0 0 - Industrial (over 5 1 -1P) 42 0 0 0 0 0 Ice Machine /Refrigerator Drain 1 0 0 0 0 0 Oil Sep (Gas Station) 6 0 0 0 0 0 Rcc. Vehicle Dump station 16 0 0 0 0 0 Shower - Gang (per head) 1 0 0 0 0 0 - Stall 2 0 0 0 0 0 Sink - Bar /Lavatory 2 0 0 1 2 1 2 - Bradley 5 0 0 0 0 0 - Commercial 3 0 0 0 0 0 - Service 3 0 0 0 0 0 Swimming Pool Filter 1 0 0 0 0 0 Washer - Clothes 6 0 0 0 0 0 Water Extractor 6 0 0 0 0 0 Water Closet - "Toilet 6 0 0 1 6 1 6 Urinal 6 0 0 0 0 0 Previous EDU Count 0 0 Capped EDU Credit 0 TOTALS 0 0 0 0 2 8 2 8 Current Fixture Value 8 divided by 16 = 0.5 Current EDU 1 EDU = S 2,800 Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU Change 8 divided by 16 = 0.5 over (under) $ 1,400.00 Enter EDU Change Here 0.5 Notcs. Authorized Name /Signature: Brandon "Taggart Date: 2/14/2008 Building Division Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher which must be submitted to the City of Tigard Building Division tri redeem credits towards future system development charges. I \Building \ Forms \Scwcr'1'allyShcccxls 02 /02/07 CITY OF TIGARD , BUILDING DIVISION PERMIT #: I ?f IV1:.tcf0 s- M.l 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: - 2,19j 20m Phone: (503) 639-4171 . 39 -4171 + Inspection Requests (24 Hrs.): (503) 639 -4175 .�' "�'_I INSPECTION WORKSHEET FOR DATE: 10/24/2008 TIME: 7:01AM PAGE: d SITE ADDRESS: 11708 SW WARNER AVE CLASS OF WORK: SUBDIVISION: HOFF ARBER TRACTS NO.2 LOT #: 035 TYPE OF USE: PROJECT NAME: miRAGE IAN! Si ORAr3F. DESCRIPTION: intorior plumhfing for rnirei storage. Other fi;d.ure ; are sump and hose bib. 4/23/08. ADDED 100 ft. of water service. 10123/08, ADDED (1) double- checkvaivtr. OWNER: MIRAGE STORAGE LLC, PHONE #: CONTRACTOR: ASSURED PLUMBING SERVICES LIG PHONE #: !, Inspection Request Scheduled For: Date: 10/24/2000 Pour Time: Code # Inspection Description Confirm # Contact # Message 339 Plumbing final 071162-01 503..6130.9690 N Corrections /Comments /Instructions: D D A,L \ ¢. C1/4.c c LC v \ Q - re r -- --e-A- wt 1 -) 4-- w -(..i SC/L1 j c- Cast g L' i� Pet....) A PASS ❑ PARTIAL APPROVAL ❑ CANCEL NO ACCESS n FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: GI\'v _& ; ) \ 1 \ a- Date: ii> \'L_ '` c tl Phone #: (503) 718- CITY OF TIGARD cr • BUILDING DIVISION • PERMIT #: Pt M20013.00064 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/1917006 Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 10/23/2008 TIME: 7:00AM PAGE: 13 SITE ADDRESS: '11708 Slur WARNER AVE CLASS OF WORK: SUBDIVISION: I TRACT`; NO.2 LOT #: 0 TYPE OF USE: PROJECT NAME: MIRAGE MINI gfORAGE. DESCRIPTION: interior plumbing for mini storage. Other fixtures are sump and hose bib. 1123108 ADDED 100 ft. of water seMce. OWNER: MIRAGE STORAGE Lie, PHONE #: CONTRACTOR: ASSURED PLUMBING SERVICES I_..LC PHONE #: 503-682-3590 Inspection • Request Scheduled For: Date 1(!/! ?00t3 Pour Time: Code # Inspection Description Confirm # Contact .# Message . 399 Numbing final 077097 -01 503-680 -9690 Y Corrections /Comments/ Instructions: A , 1 1 © 6 t � C I^ c K . Se„' c t- 4-c �... �a- �. <4-r' � � ✓�, r; e . T � � P 1 � �AL, � , Pei te• - • 1 `'C PA V i A C.> r vl i� frt cT h � Q T ", Inc, l. l.J (10 (JC 2 -D o L D ! 1 l-. i-./ 11 et() PASS PARTIAL APPROVAL ❑ CANCEL 1 NO ACCESS FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: '� Date: 1.O \? .? \ iii Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: 1 1 m2000-00054 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: x1912001:I Phone: (503) 639 - 4171 Inspection Requests (24 Hrs.): (503) 639-4175 4 INSPECTION WORKSHEET FOR DATE: 10/2212000 TIME: 7:t AM PAGE: - 31 SITE ADDRESS: 11708 SW WARNER AVE CLASS OF WORK: SUBDIVISION: HOFFARBER TRACTS NO ..2 LOT #: 1 136 TYPE OF USE: PROJECT NAME: P1IRAGE MINI STORAGE DESCRIPTION: interior plumbing for mini st.urarf o. Other fixtures are sump and hose bib 4/23808 ADDED 100 ft. of water service. OWNER: MIRAGE STORAGE LI_C, PHONE #: CONTRACTOR: ASSURED PLUMBING, SERVICES LLC PHONE #: 603 602 - 3590 Inspection Request Scheduled For: Date: 10/22/2000 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumping final 076995.01 603 - 680.9690 N Corrections /Comments /Instructions: • 1 p v , t e ea,„,4,(A,c4,, Votive. ( A J -k✓ Se rv�`�e E C rCA >%g PST) A ) O d. C V a. �l`�. cv / 1/�Z.Z I" .- l/lJcq ' �� z ✓ v � C Q� J 4-A Al Do,.A L ►c C �vva w-k- k):-i e,„ Imo 1 P S u A i C o L A — A . ( : T 1 0 - \ , 34 r it • . ✓ �o �.i �; k a t, c%,-k' C - L � e.'( .6 L,i t I r L (Z VOi \ E l-1cm re_ ;cl..A• \ Occ UG.\ t.) C Z. 1:9 rer Oo.A Lk C �. U kx_ ; Vv � ���;, -� Sk r--4-y Twi :�•�%�f -n) �-- DtaL O 4 t✓ L c• c. U wliv e, W c..:,V ✓ Se.7v e, PV-CA.) E Cn r -re ►'T g p ,/ � A---r (5 {-� b ot, X03 %Laz SPA Co y o j Ve,.t L, c,J 0t ,'v Ci R ,rtv r. e-eA n PASS PARTIAL APPROVAL ❑ CANCEL n NO ACCESS FAIL I I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: \ Date: 10 12 -2-, 1.O 'd'', Phone #: (503) 718- 10/n9/2008 16 09 FAX 5035510986 TVWD Engine ring rZ 001 /O01 Thalatln valley Water District .. 4. t 2 P. O. Bu.{' 745 Bravenr :n, Urtrgo i 97(175 Phone: (503) 64' -' 511 ra . (503) 649 -1733 w'.tiwl.hwd..org Gregory E. DiLorcio _ Grnrrui 1funuger Fax Note 7671 • Poac Date /O r �; _ O ii Ades,. 1 .lt� T I ra cJ.Z z �Frvm 4 Bernice Bagnnll rGolDetrt � C 09 September 2008 66pm yw i? { hiefh'lranrial � P �ii er Phone # Pnone b 6L( 15 -0 Faxtr 505 786 207.G' iFa" V 09 6 Debra Erickson AAI Manager Ihiman 4875 SW Griffith Dr. Suite 300 Reruarcc' Beaverton, Oregon 97005 Dub: rishback Manager, (lrerarinns & FivId So.vMc RE: Mirage Storage E - 7188 Todd Hcidgerken ,Waaagr.,; rnnrnruni {r Upon inspection of the Mirage Storage project we found the public water system d;: Lrlergovernmenrol Relations portion of the project to be within Tualatin Valley Water District standards. The owner /developer's one -year warranty on the water line and accompanying appurtenances begins as of this date. Final acceptance of this project will be in effect as Mark Knudson, RE, soon as the electronic drawings to this project are submitted. AU backflow assemblies Chief F.nginear need to be tested by certified tester and reports submitted to TVWD office. Please submit a drawing showing property lines, street right of ways, and lot numbers, via Brenda Lennox email to the attention of Ryan Smith at ryan@tvwd.org or alternatively deliver a 3 -5" .41anager Cusrome>' & Support.SanJi.o. IBM 1.44 MB disc in AUTOCAD.DWG or DXF format to TVWD Engineering Department. It is the responsibility of the engineering firm to forward copies of this notification to the owner /developer. If there are any further questions contact Tualatin Valley Water District engineering department at (503) 642-1511. 4/0 11 % .-- Herb Ohler Senior Construction Inspector Tualatin Valley Water District WATER - not to he taken for gamed c. /OQ%posr •:unewnarree.vd&Ifiber Case Activity Listing n Q,_, 10 /8 /2008 ��l ' CCEL/ Case #: PLM2008 -00054 9:40:33AM Assigned Done Updated Activity Description Date 1 Date 2 Date 3 Hold Disp To By By Notes PLMI010 Application received 2/14/2008 None RECD BTT 2/14/2008 BLD PLM1020 Permit created 2/14/2008 None DONE BTT 2/14/2008 BLD PLM1030 Check for parcel tags 2/14/2008 None DONE BTT 2/14/2008 BLD PLM1260 PLM signature on 2/14/2008 None DONE BTT 2/14/2008 application BLD PLM 1270 Ready to issue permit 2/14/2008 None REDY BTT 2/14/2008 must pay sewer fees prior to issuance: BLD PLMI280 Issue permit 2/19/2008 None DONE BB 2/19/2008 BB PLM2305 Plumbing underslab 3/7/2008 3/10/2008 3/10/2008 None PASS JW 4/2/2008 066376 - 01 — 503 830 - 7874 — VM - JW Y Interior rain drains storage units completed this inspection. PLM233 Water service N 4 /22/2008 None APRV % add water service to permit before �T w• �` JW calling for future interior plumbing ,v " _ V inspections. PLM 1290 Reprint permit 4/23/2008 None DONE BTT 4/23/2008 BLD ` PLM2320 Plumbing rough -in 8/18/2008 8/19/2008 8/19/2008 None PASS JW 8/19/2008 074340 - 01 — 503 - 680 - 9690 — VM STI N 4`� Page 1 of 1 CaseActivi ..rpt . . . __. CITY OF TIGARD I BUILDING DIVISION PERMIT #: PLM2008-00054 2J1912.001.3 13125 SW Hall Blvd., Tigard, OR 97223 . DATE ISSUED: I Phone: (503) 639-4171 V.It Inspection Requests (24 Hrs.): (503) 639-4175 ,,,.., . -...... a INSPECTION WORKSHEET FOR DATE: TIME: 7:00AM PAGE: 8/19/2008 14 SITE ADDRESS: CLASS OF WORK: 11708 SW WARNER AVE SUBDIVISION: LOT #: TYPE OF USE: HOFFARBER TRACTS NO.2 035 PROJECT NAME: MIRAGE MINI STORAGE DESCRIPTION: interior plumbing for mini storage. Other fixtures are sump and hose bib. 4/23/08 ADDED 100 ft. of water service. OWNER: PHONE #: MIRAGE STORAGE LLC, CONTRACTOR: PHONE #: ASSURED PLUMBING SERVICES LLC 503-682-3590 Inspection Request Scheduled For: Date: Pour Time: 8/19/2008 Code # Inspection Description Confirm # Contact # Message 320 Plumbing rough-in 074340-01 503-680-9690 N Corrections/Comments/Instructions: i g PASS 0 PARTIAL APPROVAL 0 CANCEL I I NO ACCESS fl FAIL 0 CALL FOR INSPECTION EI ADDITIONAL FEES ASSESSED Inspector': CrtANKA-1`,A`N,--t-- Date: 7\ \0\ \.0%) • Phone #: (503) 718- I CITY OF TIGARD • BUILDING DIVISION PERMIT #: - P- i_M20437-00 -160 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/'i5/2001 Phone: (503) 639 - 4171 °�''���i,6�� Inspection Requests (24 Hrs.): (503) 639 -4175 -« p =__L INSPECTION WORKSHEET FOR DATE: 7J25/2008 TIME: 7:00AM PAGE: 30 SITE ADDRESS: 117013 SW WARNER AVE CLASS OF WORK: SUBDIVISION: tFIOFf AfiBi::C -Z TRACTS NO.2 LOT #: 035 TYPE OF USE: PROJECT NAME: MIRAGE MINI STORAGE DESCRIPTION: Site utilities for n'W mini storage. Other work (3) trench drains, cF00 of looting drain, (1) manhole and (1) rein drain connector. Water service to be under s<eporate permit. OWNER: MIRAGE. STORAGE LLC, PHONE #: CONTRACTOR: PACIFIC UNDERGROUND INSTALLATIONS PHONE #: 503 Inspection Request Scheduled For: Date: 2/25/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 3,0S Plumbing underslab 005551 - 01 5413 - 13343.78/4 N Corrections /Comments /Instructions: ` to V r O �Li�t 1 SCIV u✓1.<, CS� ✓a V�",''r� v1c.���J �a� �� ‘.1, AO IQ, L 0AJl. • e b,D �a �-� �✓�-� c 1 w ��;L Pe,ri" `:1 , 1 c-d W air./ �p,✓v%i c e . 1'0 ��� (��, 47 R,) ✓ 0 -I ✓ r- c��o2.�Io� �QJ..:� P Lim 20 c 00 0 5 c / PASS n PARTIAL APPROVAL ❑ CANCEL 1 1 NO ACCESS FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: w}k .: \f\s\,. Date: 2.;\r rr Ci Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION A ° PERMIT #: PLM200B•0O0'-.�4 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: f19/200? Phone: (503) 639 - 4171.. k Inspection Requests (24 Hrs.): (503) 639 - 4175' 'i INSPECTION WORKSHEET FOR DATE: 3/10/2008 TIME: 7:O0AM PAGE: 48 SITE ADDRESS: 11706 .SW WARNER AVE CLASS OF WORK: SUBDIVISION: HOFFARBriR TRACTS Nt:r.2 LOT #: 03'.i TYPE OF USE: PROJECT NAME: MIRAGE MINI STORAGE DESCRIPTION: interior plumbing for mini storage.. Other fixtures are sump and hose bib. OWNER: MIRAGE STORAGE LLC, PHONE #: CONTRACTOR: ASSURED PLUMBING SERVICES LLC PHONE #: 503-682-3590 Inspection Request Scheduled For: Date: 3110/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 305 Numbing underslah 0€6376 -01 503- 830 -7874 1` • Corrections /Comments / Instructions: APASS n PARTIAL APPROVAL ❑ CANCEL I NO ACCESS ❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: \ Date: 3 ( (a ( /D) Phone #: (503) 718-