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/e1/5i *v,- 14ft cr- RECEIVED IICity ofTigard JA 1 10 2022 _ n FINANCE DEPARTMENT Systems Development Charge (SDC) Kxemp �T s A lipY1 jU ti TIGARD ton • `1; REQUEST FOR ACCESSORY DWELLING UNIT (ADU) SDC EXEMPTION (Allowed under TMC 3.24.100.F) Note:Refer to TMC 3.24.180 and the Systems Development Charge(SDC)Exemptions for AccessoryDwelling Units Guideline for eligibility requirements before completing application.City Transportation and Park SDCs exemption only. REQUIRED DOCUMENTS PROPERTY INFORMATION ❑ Recorded Deed with the legal Name of property owner(s): Blue Palouse Properties description of the Property ❑ Proof of Ownership/ Authorized Representative Address of ADU : 10851 SW Annand Hill Ct Tax map and tax lot numbers: 2s 110 ad 12400 Land Use Approval Case Number: MLP 2020-00002 ADU 2020-0021,0022,0023 Type of Unit Total Units Square footage of each unit Attached ADU 1 992 Detached ADU APPLICANT INFORMATION Name(s), as appears on title of property: Blue Palouse Properties Mailing address: 333 S State St Suite V452 City/State: or Zip: 97034 Phone: 503-936-3212 Email: robm@bluepalouse.com Applicant's representative (if not property owner): Phone: Email: robm@bluepalouse.com THE PROPERTY OWNER ACKNOWLEDGES AND AGREES TO THE FOLLOWING: 1. I understand that acceptance of this application and required documents by the City does not constitute an approval of an exemption. Exemptions are not granted until after all required documentation is received, the property owner(s) sign, notarize and record with Washington County the restrictive covenants agreement. 2. I understand that if at any time during a period of 10 years from the time my final inspection is approved the Page I 1 Rev. 10/21 accessory dwelling unit for which an exemption is granted is rented or listed as a short-term rental(AirBnb, VRBO,etc.),the owner of the property at that time will be required to pay to the City the amount of the exempted system development charges,plus interest. I also understand that an advertisement of the accessory dwelling unit as a short-term rental is sufficient evidence for the city to assess the amount of the exempted SDCs. I understand that this restriction will bind the property even through transfers of ownership. 3. I understand that the City may verify any of the information contained in this application at any time. 4. I understand that the City, its agents,successors and assigns will rely on the information contained in this application and the information represented herein;if any information should change prior to obtaining a certificate of occupancy,I will notify the Cite. I certify that to the best of my knowledge,all the information provided in this application is true and accurate as of the date rovided opposite my signatures below. Rob Matthews 11/23/21 Irr crty owner signature Print Name Date Property owner signature Print Name Date APPLICANTS It is the responsibility of the applicant to ensure that the application for the SDC exemption is submitted and approved before the payment of all SDCs are due to the City. SDCs are calculated and due and payable pursuant to Tigard Municipal Code 3.24.080. In accordance with TMC 3.24.080.B,the City may not issue a building permit or allow connection to the City's systems until either all SDCs have been paid in full or an exemption has been granted.It is the applicant's sole responsibility to ensure an exemption application is submitted to the City in a timely manner in order to meet the timelines in TMC 3.24.080. Electronic submittal of this application and required documentation is preferred and can be sent to SDC( tigard- or.gov Hardcopy applications and required documentation can be mailed to: City of Tigard—SDC Administrator, 13125 SW Hall Blvd.,Tigard,OR 97223. Questions can be directed to Christine Moody,at christine@tigard-or.gov or 503-718-2415. '1-111 I Date Received: 11/23/21 Approved by: Christine Baker 1/6/22 Dat`: 11/23/21 Amount of SDCs t $11,719.00 $Exempt Park 7,591.00 'Transportation $4,128.00 Page 12 Rev.10/21 / t DocuSign Envelope ID:2AC214F8-94F6-4AB5-A9FC-05939EF972CA �f Washington County,Oregon 2021-127151 12/10/2021 01:56:00 PM D•1RUL Cnt=1 5tn=10 A DUYCK $35,00$5.00$11.00$60,00-Total=$111.00 RETURN TO: IIIIIl1I!IIIiI1I1IIIIIlIIIIIIIIIJII IIIII111111111 Cityof Tigard 02832399202101271510070078 Finance and Information Services I,Joe Nelson,Director of Assessment and Taxation Contracts&Purchasing end Ex-Ofnclo County Clerk for Washington County, Oregon,do hereby certify that the within instrument of 13125 SW Hall Blvd. writing was received and recorded In the book of itr" Tigard,OR 97223 records of said county. �'r•� Joe Nelson,Director of Assessment and Taxation,Ex- `+' ,,,,'-� Officio County Clerk SPACE ABOVE FOR RECORDER'S USE CITY OF TIGARD COMPLIANCE AGREEMENT,DECLARATION OF RESTRICTIVE COVENANTS AND EQUITABLE SERVITUDE SDC EXEMPTION FOR ACCESSORY DWELLING UNIT TI-IIS COMPLIANCE AGREEMENT, DECLARATION OF RESTRICTIVE COVENANTS AND EQUITABLE SERVITUDE (the "Agreement") is made and entered into this 1st day of December 2021, by and between Blue Palouse Properties (the"Grantor") and the City of Tigard (the"City"). PURPOSE The City desires to exempt the construction of an accessory dwelling unit ("ADU") located at 10851 SW Annand Hill Ct., Tigard, Oregon, and approved through case File No. ADU2020-00023. (the "Project"), from payment of City of Tigard parks and transportation system development charges ("SDCs") pursuant to Tigard Municipal Code. The legal property description of said Project is set forth in Exhibit A,which also is attached hereto and incorporated herein by reference. The SDCs exempted for eligible Project units are shown on Exhibit B. Grantor desires to receive the exemption,to satisfy the conditions thereof, and to execute and record this Agreement for the purpose,in part,of creating restrictive covenants and an equitable servitude that shall run with the Project land and bind any and all subsequent owners of the Project for the term of this Agreement. AGREEMENT SECTION 1. REPRESENTATIONS,COVENANTS AND WARRANTIES OF THE GRANTOR CONCERNING USE OF THE ACCESSORY DWELLING UNIT. Grantor hereby represents, covenants, warrants,and agrees that Grantor will not use the ADU on the Property as a short-term rental,as defined in Tigard Municipal Code 3.24 (as amended July 9,2019), for a period of 10 years(the"Exemption Period") from the date of fmal approval of final inspection of the building permit ("Exemption Date"). For the purposes of this Agreement, posting a listing of the ADU on the Property on a short-term rental website is prima facie evidence that the property owner has violated this requirement. SECTION 2. COVENANTS TO RUN WITH THE LAND; EQUITABLE SERVITUDE. The Grantor represents,covenants,warrants and agrees that: a. The City is granting the exemption to the Grantor as an inducement to the Grantor to construct and operate the Project in accordance with the terms of this Agreement. In consideration of the receipt of the exemption, the Grantor has entered into this Agreement with the City and has agreed to restrict the use of the Project during the Exemption Period as set forth in this Agreement. SDC EXEMPTION FOR ACCESSORY DWELLING UNIT Page 1 of 7 DocuSign Envelope ID:2A6214F8-94F6-4AS5-A9FC-05939EF972CA b. The representations,covenants,and restrictions granted by Grantor therein with respect to the Project shall be deemed restrictive covenants running with the Project land and also shall be deemed an equitable servitude running with the Project land in favor of and enforceable by City.These restrictive covenants and equitable servitude shall pass to and be binding upon the Grantor's successors in tide including any purchaser,grantee, or lessee of any portion of the Project, shall pass to and be binding upon the respective heirs, executors, administrators, devisees, successors,and assigns of the Grantor or any purchaser,grantee, or lcsscc of any portion of the Project and shall pass to and be binding upon any other person or entity having any right,title, or interest in the Project. Each and every contract,deed,or other instrument hereafter executed covering or conveying the Project or any portion thereof or interest therein shall contain an express provision making such conveyance subject to the covenants,restrictions,and charges contained herein;provided,however,that any such contract, deed, or instrument shall conclusively be held to have been executed, delivered, and accepted subject to such covenants,restrictions and charges regardless of whether or not such covenants, restrictions and charges are set forth or incorporated by reference in such contract,deed,or instrument. SECTION 3. BURDEN AND BENEFIT. The parties hereby declare their understanding and intent that the burdens of the covenants,restrictions,and charges set forth herein touch and concern the Project land and that the Grantor's legal interest in the Project may be rendered less valuable thereby. The parties further declare their understanding and intent that the benefits of such covenants,restrictions,and charges touch and concern the Project land by enhancing and increasing the enjoyment and use of the owners and tenants of the development,the intended beneficiaries of such covenants, restrictions, and charges and by furthering the public purposes for which the exemption is granted. SECTION 4. COMPLIANCE. The Parties hereby agree that Grantor,if requested by the City, will provide certification,in a format approved by the City in its sole discretion,that the Grantor is fulfilling its obligations under this Agreement. SECTION 5. TERM OF AGREEMENT. The parties agree that this Agreement and the restrictive covenants and equitable servitude created hereunder become effective upon execution of this Agreement and will remain in full force and effect for a 10-year Exemption Period. Notwithstanding any other provision of this Agreement,this Agreement will terminate and be of no further force and effect in the event of a completed foreclosure by the primary financing lender or by a lender to whom the City has subordinated this Agreement,or their successors or assigns,or in the event of a delivery by the Grantor of a deed for the Project to the primary financing lender in lieu of foreclosure,or to a lender to whom the City has subordinated this Agreement,or their successors or assigns. SECTION b. TERMINATION. The City may terminate this Agreement,without further liability,upon 30 days'notice and opportunity to cure. Notwithstanding termination,City may pursue any remedy provided for in Section 7. If the Grantor fails to perform or breaches any of the terms of this Agreement;or immediately and without notice and opportunity to cure if the City loses the authority to grant the exemption,as determined by its counsel or otherwise as lacking the authority to administer the exemption, or fails to receive or loses necessary funding, appropriations, limitations, or other expenditure or position authority sufficient to carry out the terms of this Agreement. SECTION 7. REMEDIES. If the Grantor defaults in the performance or observance of any covenant, agreement,or obligation set forth in this Agreement and if such default remains uncured for a period of 30 days after the notice thereof shall have been given by the City to the Grantor,then the City,at its option,may take any one or more of the following steps: a. Terminate the exemption of the Project or a portion thereof,in which case the SDC's exempted herein shall be immediately due and payable to City in the amounts shown on Exhibit B,along with interest accruing from the Exemption Date at the rate shown on the City's Master Fees and Charges Schedule for"SDC Financing" SDC EXEMPTION FOR ACCESSORY DWELLING UNIT Page 2 of 7 DocuSign Envelope ID:'2AC214F8-94F6-4AB5-A9FC-05939EF972CA calculated semi-annually.City may,in addition to an action to collect SDC's due,withhold issuance of building or development permits until paid in full; b. Take such other action under this Agreement,at law,or in equity as may appear necessary or desirable to the City to enforce the covenants,agreements,warranties,and obligations of the Grantor hereunder. No waiver or delay in enforcing the provisions hereof as to any breach or violation shall impair,damage,or waive the right of any person entitled to enforce the same to obtain relief against or recover for the continuation or repetition of such breach or violation or any similar breach or violation thereof at any later time or times. SECTION 8. RECORDING AND FILING. The Grantor shall cause this Agreement and all amendments and supplements hereto to be recorded and filed in the real property records of Washington County and in such other places as the City may reasonably request. The Grantor shall pay all fees and charges incurred in connection with any recording.The Grantor shall provide either the original recorded document or a certified copy of the recorded document within ten days of the date of this Agreement. SECTION 9. GOVERNING LAW;VENUE. This Agreement shall be governed by the laws of the State of Oregon. The courts of the State of Oregon,or to the degree necessary,the U.S.District Court for the District of Oregon,shall have exclusive jurisdiction over any action brought by or against the City under this Agreement. The Grantor hereby consents to such exclusive jurisdiction and waives any and all objections it might have thereto. SECTION 10. AUTHORITY. Grantor hereby represents,warrants,and certifies that: a. It possesses legal authority to apply for and accept the terms and conditions of the exemption and to carry out the proposed Project; b. Its governing body,if any,has duly authorized the filing of the application,including all understandings and assurances contained therein; c. The person identified as the official representative of the Grantor in the application is duly authorized to act in connection therewith and to provide such additional information as may be required. The Grantor's official representative has sufficient authority to make all certifications on its behalf; d. This Agreement does not and will not violate any provision of any applicable law,rule,regulation,or order of any court, regulatory commission, board, or administrative agency applicable to the Grantor or any provision of the Grantor's organic laws or documents; e. This Agreement has been duly executed by an official representative of Grantor,delivered by Grantor, and will constitute the legal,valid,and binding obligations of the Grantor, enforceable in accordance with their terms. SECTION 11. AMENDMENTS. This Agreement may be amended only by a written instrument executed by the parties hereto or by their successors and duly recorded in the real property records of Washington County. SECTION 12. SEVERABILITY. If any provision of this Agreement shall be invalid, illegal, or unenforceable,the validity,legality,and enforceability of the remaining portions hereof shall not in any way be affected or impaired thereby. SECTION 13. CONSTRUCTION. The parties to this Agreement acknowledge that each party and its counsel have participated in the drafting and revision of this Agreement Accordingly,the parties agree that any rule of construction to the effect that ambiguities are to be resolved against the drafting party shall not apply in the SDC EXEMPTION FOR ACCESSORY DWELLING UNIT Page 3 of 7 DocuSign Envelope ID:2AC214F8-94F6-4AB5-A9FC-05939EF972CA interpretation of this Agreement or any amendment,modification,supplement,or restatement of the foregoing or of any exhibit to this Agreement. SECTION 14. NO LIMITATIONS ON ACTIONS OF CITY IN EXERCISE OF ITS GOVERNMENTAL POWERS.Nothing in this Agreement is intended,nor shall it be construed, to in any way limit the actions of the City in the exercise of its governmental powers.It is the express intention of the parties hereto that the City shall retain the full right and ability to exercise its governmental powers with respect to the Grantor,the Project,the land,and the transactions contemplated by this Agreement to the same extent as if it were not a party to this Agreement or the transactions contemplated thereby,and in no event shall the City have any liability in contract arising under this Agreement by virtue of any exercise of its governmental powers. IN WITNESS WHEREOF,the parties have caused this Agreement to be executed by their duly authorized representatives as of the day and year first above written. GRANTOR(s): FULL N:11i By : Signature Name:LeO 3QM k}tki s STATE OF at`ei tlAt ) County of ) The foregoing instrument was acknowledged before me thistLday of`✓etN ikb-e ,9°`31,by 1U/CMA4— Notary Public for the State of 10 ___.... My commission expires: `/ id0D-C � OFFICIAL STAMP TONI A RICCARDI "�`-'" NOTARY PUBLIC-OREGON I►, COMMISSION NO.1012794 MY COMMISSION EXPIRES MAY 31,2025 SDC EXEMPTION FOR ACCESSORY DWELLING UNIT Page 4 of 7 ' t DocuSign Envelope ID:2AC214F6-94F6-4AB5-A9FC-05939EF972CA CITY: CITY OF TIGARD,an Oregon municipal corporation i--DowSigned by: Sh L ith" By cup seiso4cos. Steve Rymer,City Manager II SDC EXEMPTION FOR ACCESSORY DWELLING UNIT Page 5 of 7 DocuSIgn Envelope ID:2AC214F8-94F6-4AB5-A9FC-05939EF972CA ' EXHIBIT A LEGAL DESCRIPTION OF THE PROJECT A tract of land situated in the Northeast quarter of Section 10,Township 2 South,Range 1 West of the Willamette Meridian,in the City of Tigard,County of Washington and State of Oregon,described as follows: Beginning at a point on the North line of the Southeast quarter of the Northeast quarter of said Section,North 89°34'10"West 990.18 feet,more or less,from the East line of said section and running thence South 0°51"50'West parallel with said East line of section, 124.71 feet,more or less,to the North line of a 50.0 foot deeded roadway; thence South 68°30'East on said roadway Northerly line 106.95 feet,more or less,to the West line of that tract of land described in Book 1092,Page 594,Deed Records of said county;thence North 0°51'50"East on said West line 163.17 feet,more or less,to the North line of the Southeast quarter of the Northeast quarter of said section;thence North 89°34'10"West on said line 100.09 feet,more or less to the point of beginning. SDC EXEMPTION FOR ACCESSORY DWELLING UNIT Page 6 of 7 'DocuSign Envelope ID:2AC214F8-94F6-4AB5-A9FC-05939EF972CA EXHIBIT B SCHEDULE OF SDCs EXEMPTED System Exemption Amount City Transportation $4,128.00 Parks $7,591.00 Water NOT ELIGIBLE Sanitary Sewer NOT ELIGIBLE Stormwater NOT ELIGIBLE County Transportation Development Tax NOT ELIGIBLE Total Exemption $11,719.00 This SDC exemption is granted to the units located at the property address(es)listed below: 10851 Armand Hill Ct.,Tigard,OR 97223 SDC EXEMPTION FOR ACCESSORY DWELLING UNIT Page 7 of 7 Washington County,Oregon 2019-087839 RECORDING REQUESTED BY: D-DW Stn=8 J CHOATE 12/04/2019 01:34:35 PM SiLawyers Title $15.00$11.00$5.00 S60.00$336.00 $427.00 ofama,,u.c I,Richard Hobernicht,Director of Assessment and Taxation and Ex- Officio County Clerk for Washington County,Oregon,do hereby certify that the within instrument of writing was received and 12550 SE 93rd Ave,Ste 420 recorded in the book of records of said county. Clackamas,OR 97015 Richard Hobernicht,Director of Assessment and Taxation.Ex-Officio GRANTOR'S NAME: — Joseph M Van Lom Trust dated 12/21/2006 GRANTEE'S NAME: Blue Palouse Properties LLC,an Oregon limited liability company AFTER RECORDING RETURN TO: Order No.: 161901394-SB Robert Matthews Blue Palouse Properties LLC,an Oregon limited liability company 333 South State Street Ste V452 Lake Oswego,OR 97034 SEND TAX STATEMENTS TO: Blue Palouse Properties LLC,an Oregon limited liability company 333 South State Street Ste V452 Lake Oswego,OR 97034 APN: R1014397 Map: 2S110AD08805 No Sttus Address,Tigard,OR 97224 --- SPACE ABOVE THIS LINE FOR RECORDER'S USE STATUTORY WARRANTY DEED Joseph M Van Lom and Cynthia S Van Lam, Trustees of the Joseph M Van Lom Trust dated 12/21/2008, A Grantor, conveys and warrants to Blue Palouse Properties LLC, an Oregon limited liability company, ' Grantee, the following described real property, free and clear of encumbrances except as specifically set forth below,situated in the County of Washington,State of Oregon: A tract of land situated in the Northeast quarter of Section 10,Township 2 South, Range 1 West of the Willamette Meridian, in the City of Tigard, County of Washington and State of Oregon,described as follows: Beginning at a point on the North line of the Southeast quarter of the Northeast quarter of said Section, North 89°34'10"West 990.18 feet, more or less, from the East line of said section and running thence South 0°51°50'West parallel with said East line of section, 124.71 feet, more or less, to the North line of a 50.0 foot deeded roadway;thence South 68°30'East on said roadway Northerly line 106.95 feet, more or less, to the West line of that tract of land described in Book 1092, Page 594, Deed Records of said county;thence North 0°51'50"East on said West line 163.17 feet,more or less,to the North line of the Southeast quarter of the Northeast quarter of said section;thence North 89°34'10"West on said line 100.09 feet, more or less,to the point of beginning. THE TRUE AND ACTUAL CONSIDERATION FOR THIS CONVEYANCE IS THREE HUNDRED THIRTY-SIX THOUSAND AND NO/100 DOLLARS($336,000.00). (See ORS 93.030). Subject to: SEE EXHIBIT"A"ATTACHED HERETO AND MADE A PART HEREOF BEFORE SIGNING OR ACCEPTING THIS INSTRUMENT, THE PERSON TRANSFERRING FEE TITLE SHOULD INQUIRE ABOUT THE PERSON'S RIGHTS, IF ANY, UNDER ORS 195.300, 195.301 AND 195.305 TO 195.336 AND SECTIONS 5 TO 11, CHAPTER 424, OREGON LAWS 2007, SECTIONS 2 TO 9 AND 17, CHAPTER 855, OREGON LAWS 2009, AND SECTIONS 2 TO 7, CHAPTER 8, OREGON LAWS 2010. THIS Deed(Statutory Warranty) OR01293.dac/Updated; 04.26.19 Page 1 OR-t.T-FXEB-01060.474579-161901394 ...... .......... .........". .,............ ... ....x..e.v+.m vxr.r.xa ...rew:rnell 31(1ilftOMIONO.arrr , ..., .. r n..as rrf aflAN ..4.t.,1 44s ars.A aiitr44. tlrlH319111434 1 YAaai... ttr rrr. STATUTORY WARRANTY DEED (continued) INSTRUMENT DOES NOT ALLOW USE OF THE PROPERTY DESCRIBED IN THIS INSTRUMENT IN VIOLATION OF APPLICABLE LAND USE LAWS AND REGULATIONS. BEFORE SIGNING OR ACCEPTING THIS INSTRUMENT, THE PERSON ACQUIRING FEE TITLE TO THE PROPERTY SHOULD CHECK WITH THE APPROPRIATE CITY OR COUNTY PLANNING DEPARTMENT TO VERIFY THAT THE UNIT OF LAND BEING TRANSFERRED IS A LAWFULLY ESTABLISHED LOT OR PARCEL,AS DEFINED IN ORS 92.010 OR 215.010, TO VERIFY THE APPROVED USES OF THE LOT OR PARCEL, TO DETERMINE ANY LIMITS ON LAWSUITS AGAINST FARMING OR FOREST PRACTICES, AS DEFINED IN ORS 30.930, AND TO INQUIRE ABOUT THE RIGHTS OF NEIGHBORING PROPERTY OWNERS, IF ANY, UNDER ORS 195.300, 195.301 AND 195.305 TO 195.336 AND SECTIONS 5 TO 11, CHAPTER 424, OREGON LAWS 2007,SECTIONS 2 TO 9 AND 17,CHAPTER 855, OREGON LAWS 2009,AND SECTIONS 2 TO 7,CHAPTER 8,OREGON LAWS 2010. IN WITNESS WHEREOF, the undersignedp�' have executed this document on the date(s)set forth below. Dated: '//lJ I I J. .7 Joseph anlom Trust d ed 12/21/2006 BY: ' V lr 041 Jos h Van Lom rut Cyn`hla S Van Lom Trustee State of Cf j.,. County of (if This instrument was acknowledged before me on 11A - `7t by Cynthia S Van Lom, as Trustee for Jos h Panlom Trust dated 12/21/2006 and Joseph M Van Lom,as Trustee for Joseph M Vanlom Trust dated 12/21 0 . Notary Publi -State of Oregon My Commission Expires: Nt`L.._. c= ` = '! OFFICIAL STAMP DEBORA J OLSON �;.. NOTARY PUBLIC-OREGON �E COMMISSION NO. 947119 atY COMMISSION EXPIRES FEBRUARY 03,2020 Deed(Statutory Warranty) ORD1293.dec/Updated: 04.26.19 Pane 2 QR-LT-FXE9.01060.474579.161901394 EXHIBIT "A" Exceptions Subject to: Covenants, conditions, restrictions and sewer easements but omitting any covenants or restrictions, if any, including but not limited to those based upon race,color, religion, sex,sexual orientation,familial status, marital status, disability, handicap, national origin, ancestry, source of income,gender,gender identity, gender expression, medical condition or genetic information,as set forth in applicable state or federal laws,except to the extent that said covenant or restriction is permitted by applicable law,as set forth in the document Recording Date: August 29, 1978 Recording No: 78 38656 Deed(statutory Warranty) CRD1293.doe Updated. 04.26.19 Page 3 OR-LT-FXEB-01060.474579-164901394 CITY OF TIGARD BUILDING PERMIT ' COMMUNITY DEVELOPMENT Permit#: BUP2021-00280 Date Issued: 2/10/2022 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S110AD12400 Jurisdiction: Tigard Site address: 10851 SW ANNAND HILL CT Project: Annand Hill Partition.Lot 3(2 of 2)ADUs Subdivision: ANNAND HILL CT PARTITION Lot: 3 Project Description: A new multi-family dwelling on the upper level.Trade permits to be obtained separately. NO FINAL INSP UNTIL WATER METER UPSIZED. Contractor: BLUE PALOUSE PROPERTIES Owner: BLUE PALOUSE PROPERTIES LLC 333 S STATE ST, SUITE V452 333 S STATE ST STE V452 LAKE OSWEGO, OR 97034 LAKE OSWEGO, OR 97034 PHONE: 503-936-3212 PHONE: FAX: Specifics: FEES Description Date Amount Type of Use: MF Class of Work: NEW Type of Const: VB Building Permit-New Construction 02/07/2022 $915.06 Plan Review 11/25/2021 $751.34 Occupancy Grp: R-2 Occupancy Load: 4 12%State Surcharge-Building 02/07/2022 $109.81 Dwelling Units: 1 Stories: 3 Height: 35 ft Wash Co Trans Dev Tax- 02/07/2022 $5,756.00 Condominium/Townhouse Bedrooms: 2 Bathrooms: 2 Plan Review-Fire Life Safety 02/07/2022 $366.02 Value: $111,714 Metro CET 02/07/2022 $134.06 Tig-Tual School CET-Residential 02/07/2022 $1,300.02 DC Provision Review,SF-Ping 02/07/2022 $110.00 Floor Areas: Plan Review 02/07/2022 $-156.55 Total Area: 922 Accessory Struct: 0 Basement: 0 Carport: 0 Covered Porch: 0 Deck: 25 Garage: 0 Mezzanine: 0 Total $9,285.76 Required: Required Items and Reports(Conditions) 1 Special Inspection(see plans) Fire Sprinkler: Yes Parapet: No 2 "Trade permits to be obtained Fire Alarm: Yes Protected Corridors: No separately" Smoke Detectors: Yes Manual Pull Stations: No Accessible Parking: 0 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: Edgaroto-Ma-lol on.ada- Permittee Signature: Se.& 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. v Buildine Permit Application E.esid ntial RECEP\/El ,tll�.►ll i i' I' Received �17� ipi ' '',.'City of Tigard / ,27 ZC� Perim Nn.:, 0CT 21 2021 D.,tc/Ify: o ./ -_ �., ---B +1° ,At'00 1,1 ., " 1 i 17_! 5W Hall Blvd.,Tigard,OR 97223 P �7W�OZ/ 0027 Ian Reviaw a Phone: 503.718.2439 Fax: 503.598.1960 - Other Parini CITY OF• IGARD Date/3 : '• - �._. lit it Inspection Line: 503.639 4175 BUILDING I�,�+ tt�``�+ Date N,eadyBy r 61 ea Pa 2.for i� ',1 Internet: www.tigard-or.gov BUILDING DI SIISIO ,,: tifiediMe:hu.• wi _A�upMenturnE lntormaticn r ;tt t,�#1.ti I p s a ,� ,� ta£€��,}= rn, 3 p 2 a'°'£'t �• o- € r n sx,x i t „- -p7-1•--- -;- �- �-:, �- jl o f r a 1 d i r : E ik t T t 1 r : t N r �t t't4 t .:-„ii01 i Fire .i ..:-0 , Y:. 7 1. Val. >=.,+5 „,t.:;.EL.S 1. ,<, r. i ~„ ,,..., :. i i,. .,f� v,� R� t tll�I �G SI gi[ New construction ❑Demolition P4,-ni:fees*are based on the value af`the wcrl: perfon];ed. -- [relicste the value'rounded It;tke u,.aresl C.olla.l of 1 0 Addition'alterattonreplaceinent ❑Other: octal Jinent,materials,labor,overhex d,and r the g'g('f ',( tt f ' . t t E t zh a t 4lei f1 cr.. ndicatcd on this application. i t r s ss t,s0 t 1I, ,..'4't �eY.,:..,�,. � ?.-.,:'2�".t,,, -�3•'. �,t„„s.. ...,,��>�.& x:,�.,:,'z�9.:,�.>.:3.$ ��'E��u-f:. ��������� USi '-and 2-family dwelling 0 Commercial/industrial �o t:inn: _---_`-$ - ❑Accessory building ❑Multi-family Number of bedrooms: ❑Master builder ❑Other: Number of bathrooms: 2 „ri 5,:s 4 1 r s _ 1 ii t . 'MA 'r1,7r it _Total number o1 floors: I Job site address: lO O S I jct) }i N JNJDD ivu- crNewv dwelling area: squareset City/State/ZIP: r,4.lLQ q7 Z z¢ rp Gat age caort area: square,'set ,I, Suite/bldg.iapt.no.: YY Project name,A � Cowered porch area: square Prci } Cross street'directions to job site: C�� /2, �J -- Deck area: s square 'set I'�:�3u/zt� ��tiQ y Z _ _ -•--• r Other strucr.ire area: squa-. 't1 - :.. Subdivision: Lot no.: 3 Perini:fees*are based on th value a1 the work i rfonred. P 1 Z S (f O A-P (Z4-DD Indicate the value(rounded to the ni ar=}sl dolls}of all f Tar ma /yatcel nv equipment,materials,labor.overlie(d,and the profit for the I) ltl i '} a` g a�I .ft t r e,si i ,z i °r wcri ndtcate:d on t i_s al:iplie.ati r,V 2, l Vpf UFrU Valva:ion: - - $ - - --- — -- �y A:,& fr7i // ,7 -r. af_e/k ni,yr b'xist.ngbuildingarea: squareIset New building area: square feet I I. � _' ;., ` ` ; 1. Number olEtones: . ' � t --- - - --. - - Name: 5 � 1-/ aas , op 77es Type of construction: Address:333 s 57 - sr; SC/11 .i/ 4 --- Dccupancygroups: --- City/State/TIP: /_7>X c eG9 Qyz -l-_--___ Existing: Phone ( 7 936 52f a Fax ( ) --- -- - ,t Iz cH r,5,2 s4' -a r"'a€r laP41 a«as,a, a 14 77. F v a New: ` ���' M �[,->:m:a� ,.uy..::,..s.W.. .,.,: y.?�-ill }tb it tii a{� 1 ga 1�?.x'�, Ir ,I -� ` 1:L. ,Lehi(.&_ 4i h `: Business name_J �. A noti/Er s.�j 4 -- -- Strucar al plan review fee(n d.pot it): Contact name: -_-- -.--.•---___ .. Address: -' -FI S plan review fee if spill•cable): - —City/State/ZIP. Total Fees due upon applcation. : ---------•------- ---------... I' Phone:( 1 Fax::( ) Amour t re eiv ed - - y�Tyy ram i P� r E-mail a Rv ••3. 6 1 � ! ' 1� i I.. t( ) s ` t 9 s)p it t t t a , r V n tr it t rf'a" tk €tel Commercial and residential nrescrip Live installation of .,4 ,r kt+ e A ''al i bi�' x4. _..4.-a,�a?-+..'h._ g. 1 eti.r l rF�Iiti.t�i t.aa rrt ., i roof top mounted Photo'Voltaic >oiar Panel System. Business name: /2i i'C pAis?f� Pi2a e 77 Subrtrt two(2)sets of mof plan wit t connection details and fire depart vent access,al on g w th the 2010 Oregon Address: 33 3 S• 577E $r: sv1 v*.c'Z.,- Solar Installation Specialty Cod checklist -_-- City/State/ZIP: 6, re- OS'(e/ -. Permit Fee(includes plan rev ew• - $180.00 ------- _ and administrative fees): _ Phone:( .1 936 Fax ( —) - _ - ___ i State surcharge(12%�o of penult foe): --� 521.60 _f�'7 ' 7 --- ------ _-_-- — - — . CCB lie.: Total fee due upon ayp,cation: 201.6f1 Authorized signature: This permit application expire;Ifs pt:rinit is not obitniated - - -- within 18C days after it has been accepted as complete. I Print name: I G Date: (, .7,0.2,( *Fee;un:thodology set by Tri-County Building industry Sewce.Board. I:\Building\Pcrmits'BUP-RESPermitApp.doc 02/24/2011 440••461.3T(I Ii02/CGMAVEB) r. !I Mechanical Permit ApplicatioRECElVE I „.„,: t)rrit I t '4vI r City of Tigard OCTReceived Permit No.: t 2 1 2021 Date/By: q.I- C+[LL[IE.�e!�'tElS� 11 / :I 13125 SW Hall Blvd.,Tigard,OR 9;223 Plan Review Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: 1.1 t_A R t-t Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Juris. M See Page 2 for Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Suppiemental Information a xa1if Sx�iT tla�_.,�tt P1 3I ,_,._—_, Y.t.� B€:i a a>:K::" {4S -. wasi, 00 0:WAttitit ;.. . A11, 00:041.y�- Mechanical permit fees"are based• the value of the work 0 New construction 0 Addition/alteration/replacement performed.Indicate the value(o .nded to the nearest dollar)of all 1)emolition 0 Other: mechanical materials,equipm/.t,lanor,overhead,and profit. _— - ,,. . V. ue:$ .,. .-..._ _, , ., W - ._ .. _- I<l cs=w.1#0 ;<..,,,i:<a (x e:.: .-c.,«. ..,nss30 .0#i..:<;0a.+ 0 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For sp 'al information use checklist. 0 Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total iiiktitl igk �y Heating cooli, i t l'"�ip.axtxnl xR:. { sz . a& � +.,. ,„r ,,..W,....- . .,,,..� , _-.�._.wW. �...... .,..,d Air cpttditi.,.m!`-- _ 46.'75 Job site address: /Ogy-'I $CJ /0�,CM /7//L,L Fi}[itace d0,00U BTU(ducts/vents) — — 46.75 I City/State/ZIP: 7're,, D oil- „lima 100,000-1 BTU(ducts/vents) 54.91 -_ i ------ tic. P!ui I 61.06 Suite/bldg./apt.no.: Project name: -" — -- .11 ,0 I tea work - -.-_--- )-_ 23.32 - Cross street/directions to job site: G / /3U�" 4 =,4�s� �� Q_jil1� Iydioni:;hot w ter system 3.32 --- L Residential boiler(radiator or hydronic) 23,32 '1 Umit heaters(fuel-type,not electric), r in-wall,in-duct,suspended,etc. 46.75 Flue/vent for any of above 23.32 Other: _ 23.32 'j Subdivision: Lot no... Other fuel appliances: — - -- Tax map/parcel no.: !j I ►D f 7-D (24.4 O Water heater - , 23.32 ` .- 7 kin'Pill)' Ol-- \V )Rif` Gas fireplace/insert 33.39 f'�l ) /'QQ - -2572- r -y -' °'" blue vent for water healer or gas _ l!_.11.—.2- -L )I - V,6�. - - fireplace - I 23.32 Log lighter(gas) 23.32 - - _Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 1 r Other 23.32 0 1"ItOPt RT'i OWNER !d TENANT A, ---- �__.._._. _-_.._. ___.(_-__--._ _ .t. ,.-. , .._ __;. ___-._ j Jsi Environmental exhaust and ventilation: \atne:: , f(Jf iaitLOC/'.SL�f9/1D/at r- 7-: Range hood/other kitchen ` - equipment 33.39 Address: 73 3 5- 57 SU re- �¢ -- Clothes dryer exhaust ( 33.39 Single-dact exhaust(bathrooms, n City Statc,'LIP: �LC eV d. toilet compartments,utility rooms) �J 23.32 Phone: $ 3l 93 J Z l z Fax i /, p, --. ( Atuc�7�awls oceans 23.:�2 q as) . r" 1 i.(' EIt lA tj54 1h` j U CON 11' 1 PERSON Other: 23.32 / Business name: 5140/6 fr!�� Fuel piping: - $14.15 for first four;54.03 for each additional Contact name: Furnace,etc. 1 Address: Gas heat pump Wall/suspended/unit heater _ City/State/ZIP: Water heater L Fireplace Phone:( ) Fax::( ) -- -- - — - Range _L_ E-mail: Barbecue s € t / xx ) hdr si $ ,,i , .. . r (gas) Business name: � r f .— - Oih ;z<- tx77�� ma�yY' � - - ilL Address: „_,x�.li.t.-�e...i.t. �. ,. .:. ZO(70 S. /zo --------- --- Subtotal City/State/ZIP: to, -„ 4 eIpi- /2,' ?m Minimum permit fee($90.00) --- Plan review(25%of permit fee) Phone:( ' ) Fax:( ) _ _ _ State surcharge(12%of permit fee) _ CCB lie.: #106 • 03 -- TOTAL PERMIT FEE This permit application expires if a permit is not obtained within IRO days after it has been accepted as complete. Authorized signature: " Fcc iwthodology set by Tri•County Building industry Service Board [ Print name: fj((ti f- i 00/ Date: le._Z 'V i r:Building'Permits 4 ME,C_PormitApp_0401 I3.doc 440-4617T(I I'02;COM/WEB) Electrital Permit Application . 1 11 , , , , ,, ,, , , ,, , „: RECEIVEI 1H H ' ' ' I' - I - - -4- \ I ' ' 1 H'1' I ' , ;1 ,, 1 . 1 Ilk( l'I'll I: 1 h,.; t 1 , ;,! , 'Ill; ;II ,1 . 1 : 11 1: Cit'Y of Tigard Received I-P-°`"Y: Perlin t_tategalb 00„3 n . . ---." 13125 SW Hall Blvd..Tigard,OR 97223 OCT 2 1 2021 i pm liaview ',... . g Phone: 503.718.2439 Fax: 503.598.1960 ' Catei&v: Related Permit 4. ' I I, :,.. Inspeetion Line: 503.6.39.4175 CITY OF TIGARD Reacb7bate/By: Anis: I.I!See Page II for .'il -'4`P 1'.It, Triton et: www.tigard-or.goa, BU1LD!NG nivisnr\t_INotificd/Mothod: :'Implements I Information ----- ------------- - . -- ---- . .----..s.---____--- IPE OP WORK -777- 1 ----77'VI taf.4641)-iiiiIiii-; :',:"1 I ew construction -TeN • . • 0 Addition/alteration/replacement Plcate chi di all that apply(submit 2 sos it plias wilt:nits els:eke:it: 0 S,rViCl.or feeder 400 amps or more 0 Ituildirg over.hree stories. 0 Demolition - 0 Other: whre:he available fault current 0 tarsus ant'b:iityarda CATEGORY OF CONSTRUCTION eseeods lona°slips af 150:tin or OF!eating build.ngs less to ground,or exceeds 14.000 0 tow ler,MC-ute agricultural 1-am',2-farnily dwelling 0 Cornniercial/industrial El ,Nccessory building carp f re all other installations. t dices. 0 Multi-family 0 Master builder 0 Other: 0 F ue pc mo , isudiatipn.4150 KVA co vs,ots,opoitmATiorc AND LocAlloN 0 Emerginey system. lager separately derived ,. „,,........_ 0,4&Mimi of vmotor load of stem Job#: Job site address: z0,59.5-1 Aviowa gik .01-ip ot more __ City/State/Z1P: 77& )s at ?_Vdz_____ os,.c r nom rcsai:ntial il nit.. 0 II ea Ith.ccre fac.i lit.es. Orerice vpaary. itsationa I vehicle parks Suite/bldg./apt.#: Project name: 0 Razarcous locations. 0!.upply volcagc for mere than J I OSVViCt,or feeder( lamps or more. (00 wits ricra r zil. Cross street/directions to job site: eh-A/m-602y 4. 4-0441,60,ara. 7-77'. ' . FE'S IICIAlVill 5, --I ------ IZt-f713 01:---'-- -------""."-'''TIL --7i7V1*-1Z1---E7 New res d hal single-or multi-fame) dwelling unit. Subdivision: 1-Lot#: 3 Intlud et 'ftacheol garage. 1,001- .ft.or less 168.54 .1 a): map/parcel#: S„,5 110A-0 12+00 1 4 Ea. WI 500 sq.ft or portion 33.92 1 -.---- -- , nviiTijoitioiii or woRN .,nitcd cnergy,residential : 75.00 2 /4-0 U- 2- ( t)refit- 1-eVV-1-1Li(with above so.11.) mited t clergy.multi-family . 75.00 1 residential(with above so.ft) .4. - - , ---- I ' ' .i „.,.,.1p,;IT 11.... .1-11S11311t!EJ11Ig. L 0 S te Tinge 2 • 0 raorami,. OWNER 1 _ Services or feeders installation,alteration,and/or relocation _ .i. li Name: Bt-UE- 04-425e- /47277eS ___ 20:1am 3:or less _....._, 100.70 1 2 I 4 11 Address: 333 S. $m-76.- sr .5u I re-- 1/4s--z. 201 impt to 400 araps 133.56 2 city/staterzip: 6,4vtr a e:)716 401 am?!to 600 arms 601 mix to 1,009 amps 200.34 3C1.04 2 I 2 i Phone:(03) f-3,e 3'z/Z. Fax:( ) chef 1,0110 amps or volts . 552.26 • I --1 * Temporary services or feeders installation,alteration,and/or 1 Email: 24g at&_.igt-Ve-toilAte:VeCer Coge relocation _ Fi ..._ _______ _____ Owner installation:This installation is being made on property that I ' n which is not 203 mat or less : 59.3.5 intended for sale,lease,rent,or exchange,according to ORS 447,44 ,670,acid 701. 201 torn to 400 imps 12035. 21 Owner signature: I.te: 401 anon iii 599 amps 168.54 2__I ---- - --..., . _Blanch eirculta:Lnew,alteration,or e ctensiLon._p_uancl______J u APPLICANT -- 7-- 0 CON"A.C1 PERSON -- - - - .4- --A.Tire.bqranch circuits with- Business name: 314-A4A- above service 3r feeder fee, 7.42 ,, - - -------- _etch braach circuit Contact name: It.Tet iorl:ranch circuits witt-out --------------- seivicii or feeder fee.tint Address: brancl circuit 56.1:3 :-.... _ City/State/ZIP: Each 86(11 inanch circuit 1 7.42 2 Miscellaneous(service or feeder not included!. Phone:( ) Fax: •( ) fad.matioractunrd or roodular ' 67.8.4 - dwelling service end/or feeder Reconnect only 67.84 i - !::1.11411117*4' '''El: . Fuinrior rrigationirele 67.84 2 Business name: A/&-y 7- 1....Evez_ ea-tie-41_ a....e..- Sign or online lighting 67.84 2 , Signalin et it(s)or limited-energy 1 Address: 5-13'7'7 S-- ja,t() : 'idIP _awl,alteration.01'extension. .. Each additional inspection over allowable in an_Lof the above 'i City/State/ZIP: Veplictv(A_ 0 . 0 , , __ Additional inspection(1 hr min) 66 25/hr _L_ :...-_-•_ Phone:( ) Fax:( ) Investigwien i 1 hr min) i 10.00/hr Industrial plant it hr mitt) •i) 78.18/hr ' Email: . - Iespc.itiots for which no fee is : 'I CCB Lic.: t 4:r(y 5 Ele:Mica!Lic.: Cil.-4,( Suprv.Lic.: „sue.iie.a.alisted41•5 hr nti,x4m _ i _ . ,______,..„,_,___, : - .1..L..................11-- • ..• ......,_ _.........___;......,,,„,_. Suprv.Electrician signature,re ired: &banal: , -'i Print name: Date: El 91an Review Re,quired(25%of perm it tee): - : c..7 ) f/t___ ,. .. State surcharge(12%of permit fee): Authorized signature TOTAL PERMIT FEE: -ibis pet ant application expires If a Istria is not obtained velthin ISO Print name: Z_ 4(gIV‘er-oriAr -_ Date: /0-ZZ. • / days after it has been accepted as complete. * Numb,f of inspections allowed pet Ninth. 1,`BuildingPaniii:ELC_PcnnitApp RIR_ERE ilnc Rev 06/I 7/2015 44(14/.1.5T(1 I.05'COM/WEB 0 Z.A, .E 57-&-Ve-il) 1 / g forni) Electrical Permit Application—City of Tigard ive • Page 2—Supplemental Information Limited Energy Permit Fees: u " Renewable Energy Permit Fees:: RESIDENTIAL,WOP(ON1E:Yf � ! ILA SG11E19U1:E Fee for all residential systems combined: $75.00 Renewa)le electrical energy systems: 5 kva or less 100.70 2 Check Type of Work Involved: ---- - - - ------ --- 5.01 to 1:,kva 133.56 • Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: [1 B• urglar Alarm 25.01to:+0kva 301.04 t 50.01 to 00 kva 552.26 2 Garage I)oor Opener* _-- — -- g >10(1 Icia(tee in accordance 2 with OAR 91F-309-0040) 552. 6 n H• eating,Ventilation and Air Conditioning Solar generation systems in excess of 25 l:va: System* Each additional kva over 25 1 7.42 3 Vacuum Systems* _100 kva_no additional charge 0.0 3 Each additional inspection over allowebis in any or the above: ❑ O• ther: Each additional inspection is -- 60.251 hr charged rt on hourly(1 hr min) __— Inspectio is for which no fee is --- k +'4 90.00i hi specificity listed(iz hr min) lt?f1kERCIWO tr0,87. _ fiIT Subtotal 1 Enter o t Pane 1). Fee for each commercial system: $75.00 — Numblx of inspections allowed per permit. (SEE OAR 918-309-0000) I Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ H• VAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ L• andscape Irrigation Control* ❑ Medical ❑ N• urse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ O• ther: _ Total number of commercial systems: *No licenses are required. Licenses are required for all other installations i t\Building\Pa oiid.ELC_Pc'ntitApp_ELR_ERE.dor 12cv 06l17/2015 Plurnbin2 Permit ApplicatiolREcEIVE 1 I1 , 1-c►It ,)Filet 1 si O 'I. 4 Building Fixtures 4. j , ' OCT 21 2021 Received /� _ r ':1 City of Tigard Datas": --- Permit r1 ) 4 13125 SW Hall Blvd.,Tigard,OR 97223 Dan Review g : Phone: 503.718.2439 Fax: 503.598 TY OF 1 IGARD Other Pcrmi+No.. j Inspection Line: 503 639.4175 U LDING DIVISION 1--- Date xead B run. EI Sea Page 2tar Il + '1 Iil Internet www tigard or gov I Notified/Method Sgemental Information .f�{r.j} '"e r�t a r rr. 'lrrt t� °I "� � � .�xrs ��d i t �tt � t 'a �( x st �,t11771137 }�z"'S'� ....�.'•: e ' 1.-t.. :. ,,.4 �,.. t 7L Y� ". -7,.f3...,.: ., ... .t .tl. t ins. f 4:.. ," i" C'�- ;A�� '�i,i._SF.,j,. s.,€ su.i KNew ccor•struction ❑Demolition - For special informorionpwerhecklist. --- Desccrintion ltv i Brt. I Tctat ❑AdditiorialterationIreplacement 0 Other: New 1.-2-fa¢aly dwellings(inched 150 ft.t)r each utility connection' :riil�r ,: ( x ry t • -rx SFR(1)hart, - ---- 31;:7t1 - :;ice i ,i1 W: 1.46 , - �-,l I'.,., a, f , . J L -'--- ❑ 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath ( J 437.7� 1 SFR(3)bath ! 5003 ❑Accessory building 0 Multi-family -- Each additional batl/schen - 25.02 ❑Master builder 0 Other: Fire sprinkle, ) ) ag •• ac r. as x R - t xas ao r�u a 0 i t--�'-' ( St..ft. ,•, I. >: 11#4 st T;,a . ,,.,, v.. . - Site utilities: - - - Job site address: e OS c r sw I D 1u, Catch bail. .(area drain 18.7C. )--1,/ -+- Drywell each line,or trench drain - 1 E:7t; • City/State/ZIP: (mot) DYE-- f?4 - — -- Fno, g drain(no.lincrr fl.: j - -- -1'3E.'- Suite/bldg.iapt.no.: Project name: M.uf'actvnd harne rtilities 50 0.. --- Cross street/directions to job site: e/f7V `7) y rughtg t1 M'ic- . anhole_.-__ -' 18 7t. - ' Rain drain connector . 1 F.7ii - Sanitary sewe-(no.linear ft.:_) ! Paw . ----- - Storm sewer(no.linear ft.:_) Page 2 — _ Water service(no.linear ft.: ) Page 2 Subdivision: Lot no.: Fixture or item_ ___•- ____,_ Tax map/parcel no.: ss Backflow pre enter - 31.27 - ) r -�� 1 u ae' at n; (w t Hackv ester va•vc 1?..5' ti.,; .,. • Clothes Washt.r � 2 V{�P - S Dishwasher I 25.02 —_ - -- Drinking fountain I 25.02 Ejectors/sump -_J 25.0. /iti krf t �'° .,e t 407: "6 #''.1 g MAR' Expansion tack 12 51 Name: A/ �/�0066- P/lp rj Fixture/sewer cap --- 25.0 Floor drain/floor sink'hub 75 02 Address: ;3. S. 57 -sT s //, V1 Z ---- , -----... Garbage rLsposal -L 2- 0:: ---- CityiState'ZIP: t,14 4-- atd,7 I I I` ,oA -- Hose bib 25.0:: - Phone (03) Q3 .S L f 7 Fax ( ) Ice makes' - 1--1- --- 11'I�k'' t; .w .'''pit ,sy 9<d `'}i;� r 1 i ' I. • �a'"" Interceptor/'muse trap - --- 25 02 Business name: Ltd - -- Medical gas(.ahte:$ ) ---� Page:: — Primer 1 12.51 Contact name: t-- -- - Roof drain( mmercial) - -12 51 Address: -- - Sink/basin'lasatory -__ 225 02__---_._ City/State/ZIP: Solar units(potable water) 62.54. -_^— Phone:( ) Fax: :( ) Tub/showcrisliower pan `, 12..51 -_— Urinal 25 p E-mail -- -1 --- E a 1 i i ii�tp . 'F�rk ttl x .. s 'i dt 11 1 Ex i'i lit TIN Water closet ey 1 0.. — ,gnitati iatrat .r_s.�.,lit ,.. , , r-arena. ! f k,,F. a 1x,sa,In Water heater I 37.52 Business name: f7L Split puff. 'A1& _ Water piping/DWV.. Other: -- --- 5629 -- -25.02 Address: 13 $ 3tD - --- - ---- City/State/ZIP: Po(.ri„, r, ca. -_-Subtotal Phone:(ST) 9 C -7.. 5730-- Fax:( ) - Minimum permit fee: $72.51i ----- Plan review (25%ofperi.it`ee) CC.B Lic.: -' r 7Plumbing Lic.no.: 70 o State surcharge(12%of pettmt fx j Authorized signature: TOTAL P11R.MIT FEE Print name: CagifjP,r, C4/ Date: This permit application expires if a permit is not obtained*thin ISO days `v r after It has been accepted as complete. 'Fee methodology set by Tri-County Euil3,ng Indusuy Son ice Board. I:t.Buiki ink?\Pcrmit•OPLMU-PcrmiLApp.dic I0/01.09 440_4/,1[,Ti I(012 COu/WEB) . .0 itOr' ' ' Plumbme Permit Application City of Tigard �, Page 2 - Supplemental Information ‘© GU) Fee Schedule: .A. Residential F- >r Suppression , e m, E . tall ti h .... r . trti t T '33ia Bta r $ Rf i j.r i# ,• lf Footing drain-1"100' 50.03 0 to 2,000 $121.90 -T Footing drain-each additional 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer-1st 100' 62.54 7,201 and greater $327.54 Sewer-each additional 100' 37.52 Water Service- 1st 100' 62.54 Medical Gas Systems: Water Service-each additional 100' 37.52 '# _., s,.t''.#. i i l oFF rd! °`i y i ' IlL€a _,1: Storm&Rain Drain- I st 100' 62.54 $1.00 to$5,000.00 __ Minimum fee$72 50 _ Storm&Rain Drain-each additional 100' 37.52 $5,001,00 to$10,000.0C $"2.50 for the first$5.000.00 anti$i.52 for t � t� _��'`r , each additional$100.00 fraction thereof,to .: ti" '; z • and including$10,000.00. __ Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first.$11),0)0.00 and$1.54 for which no fee is specifically indicated 90.00/hr each additional$100.00 or friction thereof,to (minimum charge-1/2 hour) ar.d including$25,000.00. _ Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the firs:$15,0)0.00 and$1.45 for hours(minimum charge-2 hours) each additional$100.00 of fraction thereof,to Reinspection Fees 90.00/hr and including$50,000.00. _ Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the tnsc$30,0)0.00 and$1.20 for each additional$100.00 co fraction thereof. �nhinimum charge- 1/2 hour) -- --` - Subtotal: U. INOMMINISMSOMONNE.01111110MM.00.9.41M.IMWM.IM. Commer 'al Fixture Work: Are you cape ,adding or replacing fixtures? If"yes", please indicate k performed by fixture. Failure to accurately report ii res could result in increased sewer fees". 1 't ,, F Ta' ;;' t * ' ` 1t ' Vat t 7 �r , i/l4. d e, g..;, , # *Rt ' Plan review is required for any of the following. l 3 o,t it j ,:j�fs � ' t y' Please check all that apply. Y; r... tAF ,. ` .:: . . ��.£. ❑ Any new commercial building with water service 2"and 'f. Baptistry'Font \ greater,except systems designed and stamped by licensed `) Bath: -Tub/Shower engineer. -Jacuzzi/Whiripool ❑ New exterior plumbing site utilities for any complex structure Car Wash: -Each Stall as defined in OAR918-780-0040. -Drive Thru ❑ Medical gas and vacuum systems for health care facilities. Cuspidor/Water Aspirator ' Dishwasher. -Commercial \ 0 Any multipurpose fire sprinkler system. ❑ Any complex structure as defined in OF.R918-780-0040. -Domestic fi �D s Fountain \ Submit 2 sets of plans with any of the above. Eye Wash Floor Drain/sink: -2" i i 3; s $0 x xx r, iWI)` 1 . 4" 0 Isometric or riser diagram is required for new buildings -Car Wash Drain �� that meet the qualifications above. Garbage -Domestic non-food t Disposal: -Domestic food related lt' -Commercial food related 't -Industrial food related T. Ice MachJRefrig.Drains Comments regarding fixture work: Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower: -Gang r -Stall Sink: -Lav/Bar non-food related _ -- --- -Bradley '1 -Com/Serv/Util food related -Service *Note: If the fix are work under this permit results in an Swimming Pool Filter increase of sewer i Us,a sewer permit will be issued and 1 Washer-Clothes fees assessed for the sewer increase must be paid before the Water Extractor _ Water Closet-Toilet plumbing permit can be issued. .1] Urinal Other Fixtures: l:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 tj City of Tigard 1114 a COMMUNITY DEVELOPMENT DEPARTMENT T 1 G A R D Building Permit Review — Residential 0. Building Permit #: e&jPolo.t .6t2gro Site Address: l 0 v 1 giAJ\ A i ,t &k Project Name: AAfr14 ( 411( -. air - T'I ) 14 Lot #: _3 Planning Review fJC4,.i ft (- ��11Wes" erJN Pc. /c4Jc.f. Proposal: a , (� Cj e -t-- ) I Verify address/suite# active in Accela. ❑ In River Terrace: 0 No E Yes, River Terrace Review Addendum Site Plan Elements: PErosion Control VIA copies of site plan on 8-1/2"x 11"or 11 x 17"paper CRetained trees with drip line and tree protection measures C$Drawn to scale(standard architect or engineer scale) OFootprint of new structure(including decks)and FFE North arrow RiUtility locations&easements(required for new and additions) gSite address,project or subdivision name and lot number Sidewalk/driveway approach L .Applicant information(name and phone number) EPLot dimensions and building setback dimensions SIStreet tree size,type and location I STI irrrra untage of h„il_ z t.'I rni hed ` Street names ^a^ Pc nn citP t erential) p,,ot area,building coverage area,percentage of coverage and >1,000 sf of impervious area created or replaced? ( Yes ❑No impervious area (applicable if R-7,R-12,R-25&R-40) If yes,is a storm water quality facility shown? ❑Yes 7No ID Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995): Required: ❑ Yes,applicant was notified ,l) No Received: ❑ Yes ❑ No Q Water Meter Fixture Unit Worksheet—Additions,Remodels and ADUs Required: yg Yes,applicant was notified ❑ No Received Yes ❑ No LA SDC Exemption forADU applied for: ❑ Yes igt)No Received: ❑ Yes No 29 Public Facilities Improvement (PFI) Permit: Required: ❑ Yes,applicant was notified Cit9No Applied For: nn❑ Yes ❑ No,stop intake P Land Use Case#: Apo ZO* 2,3 a Zoning: VLF~ (Z. IA Required Setbacks: Front: 15` Rear: I I Side: Street Side: GD ' Garage: 2513f LP Building Height: /��, Max. Height: '3 + Actual Height: '2.Cj.51 C9 Landscape Area: -l�o % Ligl Lot Coverage Max: eO % Entrance (X Set back no more than 8'from street-facing wall [� Parallel to street or offset 45 degrees or less Windows :+r Minimum 12%of area of all street-facing facades Garage ❑ Garag is behind widest street-facing wall ❑ Yes ❑ I�rr,one of the following is met: ❑ Door exten o more than 5'from wall and there is a cover rch extending beyond garage. ❑ Door extends no mo n 5' from wall and there is sq ft.window above garage on 2"d floor. ❑ Garage door width is ❑ 12'or less 50% ess of facade ❑ 60%or less and includes 7 of following: ❑ Covered porch ❑ Recessed e e all offset ❑ 1'Roof eave ❑ Roof offset ❑ Fire shingles ❑ iding ❑ Roof pitch able,hip,or gambrel roof ❑ Dormer ❑ Accent ❑ Window trim ❑ Window recess Window projection ❑ Balcony ,ii Urban Forestry Plan ®' Sensitive Lands: ❑ Yes . No Type: 2" Conditions met prior to issuance ofbuildinng 'ermit Notes: pa(Zs(( t✓L 1/.� GU C9000 Z_ CAI Approved By Planning: kettA g Date: Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved 1:\Building\Forms\BldgPermitRvw_RES_122419.docx Building Permit Submittal Original Submittal Date: /9/2//ze Site Plans: # c3 Building Plans: # a Building Permit#: l.l7 Enter building permit#above. Workflow Routing: 2"-Planning 'Engineering iiirPermit Coordinator l Building Workflow Sign-off: CO-Sign-off for Planning(include notes from planning review) Route Application Documents: Engineering: (1) copy of permit application, (1) site plan, (1) building plan and original plan review routing form. Building: original permit application, site plans,building plans, engineer and beam calculations and st details,if applicable,etc. Notes:it (if S Gldv,.Zrrtlf/A/l,4 L; / ,STal1 �J cc�•► /04,4i By Permit Technician: Date: D 27' ,202/ ze7. Engineering Review Slope at building pad: zm�j eConditions "Met"prior to issuance of building permit aEasements (encroachments) per engineering conditions of approval and plat KWater Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes l/No Assess Water Quantity Fee in-lieu: ❑ Yes lNo LIDA Facility on lot: ❑ Yes 0/Final Plat Recorded: [1NOT Approved by Engineering: Date: 1//3/2/ Z Notes: e74 4 itlr/ C'Approved by Engineering: Date: /1/14f Revisions g Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Permit Coordinator Review Conditions "Met"prior to issuance of building permit ❑ Approved, NOT Released: 5(no,.,r L4Oick. Date: 11 f 417024 Notes: Revisions (after Building Submittal only) Revision Notice 1: Date Sent to Applicant: Revision Notice 2: Date Sent to Applicant: SDC Exemption: 2(Received J Does not apply —Pppiw SDC Fees Entered: Wash Co Trans Dev Tax: . Yes ❑ N/A Tigard Trans SDC: ,r Yes El N/A 1 y Parks SDC: „Zr Yes CI N/A ? i h N LIDA ❑ Yes N/A- NA run1u`„ OK to Issue Permit Approved byPermit Coordinator: Date: Uj 61, 20ZI PP v � �, I:\Building\Fonns\BldgPermitRvw_RES_122419.docx