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Permit 20z. —c�c� zzt DocuSign Envelope ID:4FA2D51B-BF9D-4708-B815-34DC29CC240E Washington County,Oregon 2022-048997 08/01/2022 09:17:20 AM D-IRUL Cnt=1 Stn=31 RECORDSI $35.00$5.00$11.00$60,00-Total-$111.00 RETURN TO: A CCity of ommunity Development t< '-J 1 7022 111111111111111111111 11011111111 13125 SW Hall Blvd. fIY r�i 02892350202200489970070070 Tigard,OR 97223 I,Joe Nelson,Director of A ment and Taxation mc. l Ill f'!P,!t; r:! end Ex-OMIcio County Clerk for Washington County. Oregon,do hereby certify that the within Instrument of _' writing was received and recorded In the book of rerecordsa saideltl county. Joe Nelson,Director of Assessment and Taxation, ,gq,pbi' Exo-Ofncic 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 THIS COMPLIANCE AGREEMENT, DECLARATION OF RESTRICTIVE COVENANTS AND EQUITABLE SERVITUDE(the"Agreement )is made and entered into this_27th_day of July 2022_,by and between Tma Mooney(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 16027 SW 92nd Avenue, Tigard, Oregon, and approved through case File No. ADU 2022-00012. (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 final 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:4FA2D51B-BF9D-47D8-B815-34DC29CC240E 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 title 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 lessee 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 6. 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 Pmject 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" 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; SDC EXEMPTION FOR ACCESSORY DWELLING UNIT Page 2 of 7 DocuSign Envelope ID:4FA2D51B-BF9D-47D8-B815-34DC29CC240E 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 NAME: �j .I By:/ el`-(A. 7l -Siiggnnaturey�j Name: L l;?a Platte oo11 ey STATE OF ORe&A) ) e, ) ss: County of VVAS14I NC"-TOM ) The foregoing instrument was acknowledged before me this 51day of Z-i4 I , 202 2- ,by lidisk . Caw 141\11,161iitk QE11Tot) Notary Public for the State of (DREGONN My commission expires: 2////2 y . OFFICIAL SEAL �� Natas Green 4 NOTARY PUBLIC-OREGON ~•� \ COMMISSION NO.996573 'MY COMMISSION EXPIRES FEBRUARY 11,2024 SDC EXEMPTION FOR ACCESSORY DWELLING ANIT Page 4 a 7 DocuSign Envelope ID:4FA2D51B-BF9D-4708-8815-34DC29CC240E CITY: CITY OF TIGARD,an Oregon municipal corporation DewSlgned by: c i.,or By: me:we, ,OW... Steve Rymer,City Manager SDC EXEMPTION FOR ACCESSORY DWELLING UNIT Page 5 of 7 • DocuSign Envelope ID.4FA2D51B-BF9D-47D8-8815-34DC29CC240E EXHIBIT B SCHEDULE OF SDCs EXEMPTED System Exemption Amount City Transportation $4,788.00 Parks $8,237.00 Water NOT ELIGIBLE Sanitary Sewer NOT ELIGIBLE Stormwater NOT ELIGIBLE County Transportation Development Tax NOT FT.IGIBLE Total Exemption $ 13,02r 00 This SDC exemption is granted to the units located at the property address(es)listed below: 16027 SW 92nd Avenue,Tigard,OR 97224 SDC EXEMPTION FOR ACCESSORY DWELLING UNIT Page 7 of 7 CITY OF TIGARD MASTER PERMIT ° COMMUNITY DEVELOPMENT Permna: MST2022-00221 Date Issued: 12/08/2022 T I G AR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S114AB00100 Jurisdiction: Tigard Site address: 16027 SW 92ND AVE Subdivision: None Lot: None Project: Mooney Project Description: Convert garage to ADU. No water meter upsize required. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 1 First: 326 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 11.5 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 20 Smoke Yes Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Total: 326 sf Value: $49,183.62 Rear: 15 PLUMBING Sinks: 1 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 1 Urinals: 0 Lavatories: 1 Dishwashers; 0 Floor Drains: 0 Sewer Lines: 100 SF Rain Drains: 0 Storm Sewer: 100 Tubs/Showers: 1 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 1 Backwater Value: 0 Other Fixtures: 0 Drywall-Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 0 Electricity Heat Pump: Y Hoods: 1 Other Units: 0 Fum<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Fum>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add'l 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0 Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0 601-1000 amp: 0 601+amp-1000v: 0 1000+amp/voit: 0 ELECTRICAL•RESTRICTED ENERGY SF Residential Audio&Stereo: N HVAC: N Security Alarm: N Vaccuurn System: N Garage Opener. N All Y Other: N Other Description: Ecompasing: BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ALT SF VB R-3 326 Owner: Contractor: MOONEY,TINA M DG RING CONSTRUCTION Required Items and Reports(Conditions) 16025 SW 92ND AVE 15720 SW KINGFISHER LANE TIGARD,OR 97224 BEAVERTON,OR 97007 PHONE: PHONE: 971-226-9336 FAX: Total Fees: $12,687.40 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. ATTENTIO Oregon law requires ou to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR g5911111Afiln thrns h 0S911n1-nngf1 V r ram, fain a nnnu of tha n,lce nr diranf n,iaelinna to ill IN(:by Tallinn cnm 7399 1 A7 nr 1 AM 21199 TLI4 Issued By: P Permittee Signature: / l / - lra7f 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. • Building Permit Application Checklist 9 One- and Two-Family Dwelling FOR OFFICE I;SE ONL\ City of Tigard ReceivedDate By Permit No.: IN ■ 13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits: C Phone: 503.718.2439 Fax: 503.598.1960 24-Hour Inspection Line: 503.639.4175 El Electrical ❑ Plumbing 0 Mechanical IIGARD Internet: www.tigard-or.gov ❑ Ot1ei: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ 0 II 2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 0 Ili 3 Verification of approved plat/lot. 0 ❑ 4 Fire district approval required. Name of district: 0 ❑ 5 Septic system permit or authorization for remodel. Existing system capacity . 0 ❑ 6 Sewer permit. 0 Cl 7 Water district approval. 0 0 8 Soils report. Must carry original applicable stamp and signature on file or with application. 0 ❑ Al 9 Erosion control 0 plan ['permit required. Include drainage-way protection,silt fence design and location of catch- 0 0 basin protection,etc. 10 3i Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state ❑ ❑ building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. 11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if N] 0 0 there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements and driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction indicator;lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and surface drainage. \_ 12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size 0 ♦I I and location. 13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, NED ❑ 0 furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc. 14 Cross section(s)and details. Show all framing-member sizes and spacing such as floor beams,headers,joists,sub- VI 0 0 floor,wall construction,roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs,fireplace construction,thermal insulation,etc. 15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. V 0 0 Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full-size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- ❑ ❑ prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing ❑ 0 locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered 0 ❑ N systems,see item 22,"Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists 0 0 ,\:\r21 over 10 feet long and/or any beam/joist carrying a non-uniform load. 20 Manufactured floor/roof truss design details. 0 0 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required 0 0 for four or more appliances. 22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or 0 0 architect licensed in Ore on and shall be shown to be licable to the ro'ect under review. 23 Three(3)site plans are required for Item 11 above. Site plans mus a 8-1/2"x 11' or 11"x 17". ❑ 0 24 Two(2)sets each are required for Items 16, 19,20 and 22 above. ❑ 0 'Cl 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. ❑ NEI ❑ 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑ ❑ ill 27 "Drawn to scale"indicates standard architect or engineer scale. \� 0 O 28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard `© El Street Tree List. 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, 0 ❑ and protection measures must be drawn to scale and must include the project arborist's signature of approval. 30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, 0 0 including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. 1:1Building\Permits\BIJP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Submittal Requirements: • (2) sets of plans, drawn to scale. • (2) sets of equipment cut sheets. • (2) copies of site plan for ground and roof top equipment location and screening per Tigard development code. Commercial & Multi-Family Fee Schedule: Total Valuation: Permit Fee: $0.00 to$500.00 Minimum fee$69.06 $500.01 to$5,000.00 $69.06 for the first$500.00 and $3.07 for each additional$100.00 or fraction thereof,to and including $5,000.00. $5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and $2.81 for each additional$100.00 or fraction thereof,to and including $10,000.00. $10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and $2.54 for each additional$100.00 or fraction thereof, to and including $50,000.00, $50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and $2.49 for each additional$100.00 or fraction thereof,to and including $100,000.00. $100,000.01 and up $2,608.71 for the first$100,000.00 and $2.92 for each additional$100.00 or fraction thereof. 1:1Building\Permits\MEC_PermitApp_082520.doc 2 Plumbing Permit Apnlicatit C I ►d "n Building Fixtures FOR OFFICE 1'SF O.N'1.1 City of Tigard .JUL 1 02Z Received Permit No.: • 13125 SW HaII Blvd.,Tigard,OR 972,3 , Da n Rev W OF tIGARL) Plan Review Phone: 503.718.2439 Fax: 503.598. Other Permit No.: , Date/By: T I G A R D Inspection Line: 503.639.4175 m i l l...DING DIVISION' Date Ready/By: J°ris_ ® See Page 2 for Internet: www.tigard-or.gov Notified/Method-. Supplemental Information TYPE OF WORK FEE° SCHEDULE ❑New construction El Demolition For special information use checklist Description I Qty. Ea. I Total ,Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 1(QQ)DDD---ftftft'�'�',.��M1for'ach utility connection)_ CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 ❑ 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 "'El,1Sccessory building ❑Multi-family Each additional bath/kitchen 25.02 ❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCAT[ N i/I Site utilities: Job site address: fjZ,;• Catch basin or area drain 18.76 City/State./ZIP: Drywall,leach line,or trench drain 18.76 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: I'Project name:ise/4-7.��i ' Manufactured home utilities 50.03 Cross streetidirecti to job site: /� Jn Manholes 18.76 /)/ /1-/O��f 4 �_/ij T.--; Rain drain connector ' 18.76 2 (,/ P(/L �/ _�o Sanitary sewer(no.linear ft.:_) k Page 2 Storm sewer(no.linear ft.:_) Page 2 Water service(no.linear ft.: ) l Page 2 Subdivision: I Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 t Z ) o Clothes washer 25.02 !�/ ,�`//27/-16:7727,a> Dishwasher 25.02 '\ / Drinking fountain 25.02 \ ✓7 Ejectors/sump 25.02 PROPERTY�✓✓ OWNER ////ff/J // ❑ 'TENANT Expansion tank 12.51 Name: / ; 4' ,/ /7 2,, t-!' /� Fixture/sewer cap 25.02 I F' Floor drain/floor sink/hub 25.02 Address: qq Garbage disposal 25.02 City/S to/ZIP: /4 Q� q ' Hose bib 25.02 Phone:( ) Fax:( ) Ice maker 12.51 PPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 t Business name: / //� QU/ ay-- ci l fi -3 Medical gas(value:$ ) Page 2 Contact name: . ! `' 1 / Primer 12.51 �l pP1 Roof drain(commercial) 12.51 Address: / -1 �/�/ / A J ��� -_,4 Sink/basin/lavatory 25.02 City/State/ZIP: / r V v�Y Solar units(potable water) 62.54 Phone: S / Fax::( ) Tub/shower/shower pan 12.51 E-mail: e4.-^ ' P-Von (.t,- <') .n/L��•n, 4� ,Urinal 25.02 t '/ 1X - r/1 'y V/Y 1 CONT CT Water closet Tot ` ' 25.02 1 A Water heater 37.52 Business name: o,c.,I r'I ' L{ 1 i') Water piping DW V 56.29 Address: /'„ ft � G' Other: 25.02 City/State/ZIP:I )-\qI\c 'aabj Subtotal v- `-{�� Minimum permit fee: $72.50 Phon Fax:( ) CCB Lie ' [ (p C Plumbing Lic.no.: Plan review (25%of permit fee) d- State surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE Print name:,-/Y'f Date:-7 I I aa- This permit application expires if a permit is not obtained within ISO days FFFFFF------��^^^��� after it has been accepted as complete. "Fee methodology set by Tri-County Building Industry Service Board. I?BuildingtPermitstPI.MU-PernotApp.doc 10/01/09 440-4616T(10/02/COM/WEB) • ,I • , Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee: Footing drain- I' 100' 50.03 0 to 2,000 $121.90 Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 $233 20 Sewer-1st 100' I 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 Valuation: Permit Fee: Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum tee$72.50 Stone&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for OtherInS ectionsor Fees Qty. Fee(ea) Total each additional S 100.00 or fraction thereof,to p and including$10,000.00. Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to (minimum charge-1/2 hour) and including$25,000.00. Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for hours(minimum charge-2 hours) each additional$100.00 or 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 first$50,000.00 and$1.20 for (minimum charge-1/2 hour) each additional$100.00 or fraction thereof. Subtotal: Commercial Fixture Work: Are you capping,adding or replacing fixtures? If"yes", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees*. Plan Review for Plumbing Installations Quantity by Fixture Type Plan review is required for any of the following. Fixture Type for Replace/ Please check all that apply. Work Performed: Capped Added Relocate ❑ Any new commercial building with water service 2"and Baptistry/Font greater,except systems designed and stamped by licensed Bath: -Tub/Shower engineer. -Jacuzzi/Whirlpool Car Wash: -Each Stall 0 New exterior plumbing site utilities for any complex structure as defined in OAR918-780-0040. -Drive Thru Cuspidor/Water Aspirator ElMedical gas and vacuum systems for health care facilities. Dishwasher: Commercial El Any multipurpose fire sprinkler system. Domestic ❑ Any complex structure as defined in OAR918-780-0040. Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: -2" 3" Isometric or Riser Diagram 0 Isometric or riser diagram is required for new buildings -Car Wash Drain Garbage Domestic non-food that meet the qualifications above. Disposal: -Domestic food related -Commercial food related -Industrial food related Ice Mach./Refrig.Drains Comments regarding fixture work: Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower: -Gang -Stall Sink: -Lav/Bar non-food related -Bradley -Com/Serv/Util food related -Service *Note: If the fixture work under this permit results in an Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and Washer-Clothes fees assessed for the sewer increase must be paid before the Water Extractor Water Closet-Toilet plumbing permit can be issued. Urinal Other Fixtures: 1:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 of Tigard COMMUNITYCity DEVELOPMENT DEPARTMENT 11111 ?1GARD Building Permit Review — Residential Building Permit #: M 2) 6� Site Address: \ (0OIZ't 5u J C{ ok "`V Project Name: Mpp ��� Lot #: Planning Review A n�-t SS' ` G 4r Proposal: ` ��� c /1 p (pc, G� VI -e-- Verify address/suite#active in Accela. El In River Terrace: El No ❑ Yes,River Terrace Review Addendum `Sit 'Plan Elements: ❑F in:rCuutrt>l lj opies of site plan on 8-1/2"x 11" or 11 x 17"paper ❑R p line and tree protection measures ra (standard architect or engineer scale) iFeettiiitt,f-rrew-gtxucture(including decks)and FFE '}LV ort arrow ❑Utility locations&easements(required for new and additions) Site address,project or subdivision name and lot number dewalk/driveway approach Applicant information(name and phone number) ❑Lticaicnrsf-wells.,Iseptic systems of dimensions and building setback dimensions ❑S . . ,type and location krotage of buildings to be demolished et names xisting structures on site ( elevatioii2'contours if more than 4'differential) ow �`g coverage area,percentage of coverage and >1,111 sf of impervious area created or replaced? ❑Yes KNo impervious area (applicable if R-7,R-12,R-25&R-40) (114t% If yes,is a storm water quality facility shown? ❑Yes,No "2: t rilter ervices'aStarvice Provider Letter(lot platted prior to 9/10/1995): Required: Yes,applicant was notified ❑ No Received: ❑ YesJNo -Triffiter Meter Fixture Ur orksheet—Additions,Remodels and ADUs Required: T.., Yes,applicant was notified ❑ 1:.,..;), Received: ❑ Yes No ❑ DC Exemption for ADU applied for: Yes ❑ No Received: ❑ Yes CI No Public Facilities Improvement (PFI) Permit: Required: ❑ Yes,applicant was notified t No Applied For: ❑ Yes ❑ No,stop intake \iFtLand Use Case#: ArDl) -ti- 00012, i Zoning: C--Lk•S Required Setbacks: Front: Rear: I S Side: 5, Street Side: -1.0 Garage: 2-D Building Height: Max. Height: 2 5 Actual Height: 11'S ❑ Landscape Area: NPr % ❑ Lot Coverage Max: nil Entrance ❑ Set back no more than 8'from street-facing wall ❑ Parallel to street or offset 45 degrees or less / Windows ❑ Minimu 12%of area of all street-facing facades Garage ❑ Garage 's behind widest street-facing wall ❑ Yes ❑ No,one of the following is met: ❑ Door exten o more than 5'from wall and there is a co orch extending beyond garage. \ ❑ Door extends no more ' om wall ere is a 12 sq ft.window above garage on 2nd floor. ❑ Garage door width is ❑ 12'or le ss of facade ❑ 60%or less and includes 7 of following: N. ❑ Covered porch cessed entrance ❑ Wa o ❑ 1'Roof eave ❑ Roof offset ❑ Fire s ' ❑ Lap Siding ❑ Roof pitch ❑ Gable,hip,or gambrel roof ❑ Dormer ❑ ccent siding ❑ Window trim ❑ Window recess ❑ Window projection ❑ Balcony ❑ Visual Clearance ❑ Urban Forestry Plan ❑ Sensitive Lands: ❑ Yes ❑ No Type: ❑ Conditions met prior to issuance of building pe 't • Notes: ❑ Approved By Planning: Date: c'/ '0 f�Z Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved I:\Building\Forms\131dgPennitRvw RES I22419.docx Building Permit Submittal / Original Submittal Date: ! / /L— Site Plans: # Building Plans: # Building Permit#: O E er building permit#above. Workflow Routing: 1 Planning _ngineering 1nit Coordinator Building Workflow Sign-off: —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 riginal plan review routing form. Building: original permit application,site plans,building plans,engineer and beam calculations an trust det 's,if applicable,etc. Notes: By Permit Technician: Date: 7//4/)__.) Engineering Review 2.--,,Slope at building pad: Z% RI Conditions "Met"prior to issuance of building permit n/'" 0'Easements (encroachments)per engineering conditions of approval and plat vl fa. I.Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes Z No Assess Water Quantity Fee in-lieu: ❑ Yes RiNo LIDA Facility on lot: ❑ Yes CI No Add Fee: ❑ Yes ❑ No GVFina1 Plat Recorded: H/c- ❑ NOT Approved by Engineering: Date: Notes: Z'Approved by Engineering: 704,1„,f 8 y, Date: 7 l(q t 2ftZ2 Revisions (after Building 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: Date: Notes: Revisions (after Building Submittal only) Revision Notice 1: Date Sent to Applicant: Revision Notice 2: Date Sent to Applicant: ,,/y� ❑ DC Exemption: ❑ Received ❑ Does not apply (y3\\c�Y " W`\` " SDC Fees Entered: Wash Co Trans Dev Tax: Yes El N/A �\ 111 Tigard Trans SDC: Yes ❑ N/A Parks SDC: Yes ❑ N/A LIDA ❑ Yes I . N/A OK to Issue Permit Approved by Permit Coordinator: 1c)IIt`\CN'c(\,, Date: ' 2 - Z 1:1Bu ilding\Fomis\BldgPennitRvw_RE S_1208021.docx r1-‘- T2oZz_ ZzI Water Meter Fixture Unit Worksheet for Additions/Renwdels/ADUs Please complete the following information: Customer Name: 7-1 t/1ij 114 Q E,:Li�� Service Address: Street/Suite#: (&0 7 5i f °I.a nalAir City: —it ��j State: DP- v$Zip: ( ( - Phone Number: .5 '(�j ' (W7 j6Email: Dorvilt12251 LfQ lip0.(}{Jnee) ***** 16025 SW 92nd Ave **** Please fill in the number of each fixture you currently have. Please fill in the number of fixtures you propose to add. Multiply the quantity by the point value to arrive at the current Multiply the quantity by the point value to arrive at total. the proposed total. Fixture Unit Current Point Current Proposed Point Proposed Quantity Value Total Addition Value Total Bar sink x I = x l = Bidet x 1 = x I = Clothes washer r x 4 =— T x 4 = Dishwasher x 1.5 = 1,5 x 1.5 = lg 2 Outside Water Spigot x 2.5 = x 2.5 = Water Spigot,each add'I x 1 = x 1 = Kitchen sink _ x 1.5 = I. Cj I x 1.5 = 1,S' Laundry sink x 1.5 = x 1.5 = Lavatory(bathroom sink) -----"t— X 1 = _ / X 1 = J Water closet,1.6 GPF(toilet) _ x 2.5 = ` x 2.5 = :2, S— Bathtub/whirlpool x 4 =✓ x 4 — Shower stall _ r _ x 2 = t. j x 2 f Bath/shower combo 1 x 4 = x 4 = Current Points: _ Proposed Increase: (17 Current Points+Proposed Increase= 0) =New Total Points =Required Meter Size 5(' N Meter Sizes: Ito 30 points=5/8" 30.5 to 37 points='/," 37.5 and over points= 1" New Meter Size Needed for New Total Points: Cost: $ (see page I) Current Meter Size per Utility Billing: Cost: $ (see page 1) New Meter Size Cost minus Current Meter Size Cost= S (This is Your Cost to Increase Meter Size Due to Additional Fixture Units) ************************************************************************************* FOR OFFICE USE ONLY Meter is 5/8 inch and does not need to be upsized. Current Meter Size Confirmed with UB J Bentley 07/18/22 Signature of UB Representative Date 1;/Building/Forms/WaterMeters_070121 Add.docx Page 2 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT N . Water Meter Fixture Unit Worksheet TIGARD For Additions /Remodels /ADUs 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439• www.ticard-or.gov LOCATION: City of Tigard—City Hall WATER METER SALES: Utility Billing By Email Only. Please contact 13125 SW Hall Blvd. ubonlinepay@tigard-or.gov Tigard,OR 97223 to discuss sending documents and payment METER: SIZE: FEE: _ Pricing effective 07/01/2021 5/8" $9,495.00 Fee includes: 3/4" $13,554.00 water system development charge, 1" $24,886.00 - water meter, and 1-1/2" $73,689.00 meter installation fee. 2" $119,333.00 _ DETERMINING METER SIZE FOR RESIDENTIAL CUSTOMERS City of Tigard Water Service Area uses the American Water Works Association Manual and the Oregon Plumbing Specialty Code to determine the size of meter needed to adequately serve buildings. Due to the variety of home sizes built in the Tigard area, we count the fixture units of all homes to determine the appropriate meter size. Use the worksheet on Page 2 to calculate the current number of fixture units compared to the proposed increased number of fixture units,which will determine whether an increased meter size will be required. Submit this signed worksheet with your building or plumbing permit application submittal. DOCUMENTATION Once you are ready to purchase the new meter, please provide the following items to the Utility Billing counter: • Completed water meter fixture unit worksheet for additions, remodels, ADUs, etc.(on back page). • Copy of building or plumbing permit application date-stamped by building division. • Copy of issued building or plumbing permit. Your fixture count will be verified and your request will be processed upon receipt of these documents. No exceptions: INSTALLATION TIME Once the upgraded meter size has been purchased, most meters are installed within 10-14 business days. 1:/Building/Forms/WaterMeters 070121_Add.d0CX Page 1 Clean Water Services SENSITIVE AREA PRE-SCREENING SITE ASSESSMENT Clean Water Services File Number 22-001314 1. Jurisdiction:Washington County RECEIVED 2. Property Information(example: 15234AB01400) 3. Owner Information Tax lot ID(s): Name:Tina Mooney Pi 1 P, 7077 2S114AB00100 Company: nuy, Address:same as above CAT TI ,,: OR Site Address: 16025 SW 92nd Ave City,State,Zip: City, State,zip:Tigard OR 97224 Phone/fax:503-869-8740 Nearest cross street: Durham Email: dorothvoz29@vahoo.com 4. Development Activity(check all that apply) 4 Applicant Information 0 Addition to single family residence(rooms, deck,garage) Name:Karen Linder ❑ Lot line adjustment ❑ Minor land partition Company: Karen Linder Interior Designs ❑ Residential condominium ❑ Commercial condominium Address:11870 SW Wildwood St 0 Residential subdivision ❑ Commercial subdivision City,State,Zip:Portland, Or 97224 ❑ Single lot commercial ❑ Multi lot commercial Phone/fax: 503-515-4745 Other Email: karen-designs@comcast.net 6. Will the project involve any off-site work? ['Yes • No 0 Unknown Location and description of off-site work: 7. Additional comments or information that may be needed to understand your project: Turning a garage into a ADU This application does NOT replace Grading and Erosion Control Permits,Connection Permits,Building Permits,Site Development Permits,DEQ 1200-C Permit or other permits as issued by the Department of Environmental Quality, Department of State Lands and/or Department of the Army COE. All required permits and approvals must be obtained and completed under applicable local,state,and federal law. By signing this form, the Owner or Owner's authorized agent or representative, acknowledges and agrees that employees of Clean Water Services have authority to enter the project site at all reasonable times for the purpose of inspecting project site conditions and gathering information related to the project site. I certify that I am familiar with the information contained in this document,and to the best of my knowledge and belief,this information is true, complete,and accurate. Print/type name Karen Linder Print/type titleKaren Linder Interior Designs Signature Date 4/29/22 FOR DISTRICT USE ONLY 0 Sensitive areas potentially exist on site or within 200'of the site.THE APPLICANT MUST PERFORM A SITE ASSESSMENT PRIOR TO ISSUANCE OF A SERVICE PROVIDER LETTER. If Sensitive Areas exist on the site or within 200 feet on adjacent properties,a Natural Resources Assessment Report may also be required. • Based on review of the submitted materials and best available information sensitive areas do not appear to exist on site or within 200'of the site.This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas if they are subsequently discovered.This document will serve as your Service Provider Letter as required by Resolution and Order 19-5,Section 3.02.1,as amended by Resolution and Order 19-22.All required permits and approvals must be obtained and completed under applicable local,State and federal law. ❑ Based on review of the submitted materials and best available information the above referenced project will not significantly impact the existing or potentially sensitive area(s)found near the site.This Sensitive Area Pre-Screening Site Assessment does NOT eliminate the need to evaluate and protect additional water quality sensitive areas if they are subsequently discovered:This document will serve as your Service Provider Letter as required by Resolution and Order 19-5,Section 3.02.1,as amended by Resolution and Order 19-22.All required permits and approvals must be obtained and completed under applicable local,state and federal law. ❑ THIS SERVICE PROVIDER LETTER IS NOT VALID UNLESS CWS APPROVED SITE PLAN(S)ARE ATTACHED. ❑ The proposed activity does not meet the definition of development or the lot was platted after 9/9/95 ORS 92.040(2).NO SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. Reviewed by G� C?/1-10140-• Date 5/2/2022 Once complete,email to:SPLReview@cleanwaterservices.org • Fax: (503)681-4439 OR mail to: SPL Review,Clean Water Services,2550 SW Hillsboro Highway,Hillsboro,Oregon 97123 Revised 2rz020 Main Office • 2550 SW Hillsboro Highway • Hillsboro, Oregon 97123 • p: 503.681.3600 f: 503.681.3603 • cleanwaterservices.org