Report (2) t
AlS7020/9— OdYyo - Clean Water Services File Number
9..1.,/ Sim o — -f % 19-003763
fI- SS By /9:6 a- CleanWater Services
d��
Sensitive Area Pre-Screening Site Assessment 1 HIV
1. Jurisdiction: Tigard JAN 14 2020
2. Property Information (example 1S234AB01400) 3. Owner Information CITY OF TI( ARD
Tax lot ID(s): Name: Trish Culber BUILDING DIVISION
1S136AA01202 Company:
� � Address: 5000 MacArthur#9914
QR Site Address: 6915 SW Oak a"'� City, State, Zip: Oakland, CA, 94613
City, State,Zip: Tigard, OR, 97223 Phone/Fax:
Nearest Cross Street: SW 71st E-Mail:
4. Development Activity (check all that apply) 5. Applicant Information
Va Addition to Single Family Residence(rooms,deck,garage) Name: Ellen Cusick
❑ Lot Line Adjustment ❑ Minor Land Partition Company: EMC Interior Design
❑ Residential Condominium ❑ Commercial Condominium
Residential Subdivision Address: 4037 N Albino Ave
❑ ❑ Commercial Subdivision
❑ Single Lot Commercial ❑ Multi Lot Commercial City, State,Zip: Portland, OR, 97227
Other Phone/Fax: 503.544.8688
convert(e) garage to ADU. Minor site work for 50 SF E-Mail: ellen@emc-id.com
6. Will the project involve any off-site work? ❑Yes I,$J No ❑Unknown
Location and description of off-site work
7. Additional comments or information that may be needed to understand your project
ADU AND 50 SF OF SITE WORK
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 Ellen Cusick Print/Type Title Principal
Signature ONLINE SUBMITTAL Date 12/11/2019
FOR DISTRICT USE ONLY
❑ 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 19-05, Section 3.02.1. All required permits and approvals must be
obtained and completed under applicable local,State,and federal law.
34 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 it they are subsequently discovered.This document will serve as your Service Provider letter as required by Resolution and Order 19-05,Section
3.02.1. All required permits and approvals must be obtained and completed under applicable local,state and federal law.
14 This Service Provider Letter is not valid unless 1 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 _ �fs Date 1/7/2020
Once complete, email to: SPLReview@cleanwaterservices.org • Fax: (503)6814439
OR mail to: SPL Review, Clean Water Services, 2550 SW Hillsboro Highway, Hillsboro, Oregon 97123
Revised 6/2017
Ms --..2_d/ 9- -- ad9y0
Water Meter Fixture Unit Worksheet for Additions/Remodels/ADUs
Please complete the following information:
Customer Name: C u Sf Cfc_
690-I
Service Address: Street/Suite#: 112(21 12 Ok1L
City:-1-14PrvLi> State: CDX - Zip: 0(1Z29-
Phone Number: Email:
Q.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
v® Quantity Value Total Addition Value Total
. Bar sink x 1 = x 1 =
Bidet x 1 = x 1 =
Clothes washer ( x 4 = ( x 4 = 4
,g Dishwasher 1 x 1.5 = 1•S x 1.5 =
Hose bib x 2.5 = x 2.5 =
` Hose bib, each x I = x 1 =
Kitchen sink 1 x 1.5 = 1 S i x 1.5 = l 'S
pLaundry sink 1 x 1.5 = l ,S -- I x 1.5 = — I• S
Lavatory 'L x 1 = 2 I x 1 = i
- Water closet, 1.6 GPF 2 x 2.5 = S i x 2.5 = 2• S
�l Bathtub/whirlpool x 4 = x 4 =
Shower stall 1 x 2 = 2, 1 x 2 = 2
'1 Bath/shower combo I x 4 = .4 x 4 =
Current Points: 2I S Proposed Increase: ' S
LI
Current Points+ Proposed Increase= ?v �' Q =New Total Points =Required Meter Size 31ei
!(\ Meter Sizes: 1 to 30 points=5/8" 30.5 to 37 points=3/a" 37.5 and over points — 1"
New Meter Size Needed for New Total Points: Cost: $ (see page 1)
Current Meter Size per Utility Billing: Cost: $ (see page 1)
New Meter Size Cost minus Current Meter Size Cost= $
(This is Your Cost to Increase Meter Size Due to Additional Fixture Units)
*************************************************************************************
FOR OFFICE USE ONLY
Current Meter Size Confirmed with UB -T'V�11 5 f'l Iu-U� �`�`� 10-I 1 1 1 1 9
Signature of UB Representative Date
/19.Er77a ua`S/2.6— ArPT / SGLu141.--- i' -- 7Vzup —.£ -- -s1`7'7iehL . "
I:/Building/Forms/WaterMeters_070119_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.tigard-or.gov
LOCATION: City of Tigard—City Hall WATER METER SALES:
Utility Billing By Appointment Only: 503-718-2460
13125 SW Hall Blvd. Monday —Thursday, 9 a.m. to Noon
Tigard, OR 97223
METER: SIZE: FEE: Pricing effective 7/1/2019
5/8" $9,406.00 Fee includes:
3/4" $13,425.00 water system development charge,
1" $24,645.00 water meter, and
1-1/2" $72,969.00 meter installation fee.
2" $118,163.00
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,please contact Public Works for installation. Their
number is 503-718-2591. Most meters are installed within 10-14 business days.
1:/Building/Forms/WaterMeters_070119 Add.dOCX Page 1
Julie Drinkwater
From: Dianna Ornelas
Sent: Wednesday, March 04, 2020 4:05 PM
To: Ellen Cusick
Cc: #Building Permit Technicians
Subject: RE: SDC ADU Exempt Approved for 6921 SW Oak St.Want to pay permit tomorrow, 3/3.
MST2019-00440
Importance: High
Hello Ellen,
We require information in writing from the Tualatin Valley Water District representative via email, letter, signature on
city water meter fixture worksheet, etc. indicating that a water meter upsize is not required for the scope of work of the
current project. We will accept your word that you `spoke' with Michele at TVWD at this time, but on the next ADU we
will require it in writing from TVWD as it becomes part of the building permit public record.
Thank you.
Dianna L. Ornelas(Howse)
Building Division Services Supervisor
City of Tigard I Community Development
13125 SW Hall Blvd I Tigard, OR 97223
503-718-2430 Direct 1503-718-2439 Permits
From: Ellen Cusick<ellen@emc-id.com>
Sent: Wednesday, March 4, 2020 3:50 PM
To:Julie Drinkwater<JulieD@tigard-or.gov>
Cc:#Building Permit Technicians<TigardBuildingPermits@tigard-or.gov>
Subject: Re: SDC ADU Exempt Approved for 6921 SW Oak St. Want to pay permit tomorrow, 3/3. MST2019-00440
Warning!This message was sent from outside your organization and we are unable to verify the sender.
Julie,
I have talked with Michele at Tualatin Valley Water district and we are not required to upgrade the meter for this
project, HOWEVER,the client may build another ADU in the future, so we will be upgrading the meter to a 3/4" line at
this time. Am I good to pay for the permit and send the GC to pick it up now that you have this information?
Thanks,
Ellen
Ellen Cusick, NCIDQ ASID IIDA
503.544.8688
ellen(p�emc-id.com
On Mar 3, 2020, at 1:34 PM,Julie Drinkwater<JulieD@tigard-or.gov>wrote:
1
. Hello Ellen
The permit for the Lawson project is ready to be issued. The revised balance due, after SDC exemptions,
is $7,336.41. Attached please find the invoice for your review.
You can pay the fees online, or when you pick up the permit, Monday-Thursday, 8:00 am to 4:00 pm.
We are closed on Fridays.
To pay the fees online, you can go to our website: https://aca.accela.com/TIGARD/Default.aspx. From
there, click on the Building tab, enter the permit number in the Record Number field, and click Search.
Thank you
Julie Drinkwater
Permit Technician
City of"Tigard Building Department
13125 SW Hall Blvd
Tigard, OR 97223
503-718-2804
From: Dianna Ornelas
Sent: Monday, March 02, 2020 11:21 AM
To: Ellen Cusick<ellen@emc-id.com>
Cc:#Building Permit Technicians<TigardBuildingPermits@tigard-or.gov>
Subject: RE: SDC ADU Exempt Approved for 6921 SW Oak St. Want to pay permit tomorrow, 3/3.
MST2019-00440
Hello Ellen,
This is in the que for processing and we will contact you today or tomorrow with revised fees.
Thank you.
Dianna L. Ornelas(Howse)
Building Division Services Supervisor
City of Tigard I Community Development
13125 SW Hall Blvd I Tigard, OR 97223
503-718-2430 Direct 1503-718-2439 Permits
From: Mai Quach< maiq@tigard-or.gov>
Sent: Monday, March 2, 2020 9:16 AM
To: #Building Permit Technicians<TigardBuildingPermits@tigard-or.gov>; Albert Shields<albert@tigard-
or.gov>; Edgardo Maldonado <edgardom@tigard-or.gov>
Subject:SDC ADU Exempt Approved for 6921 SW Oak St. Want to pay permit tomorrow, 3/3. MST2019-
00440
Hi all,
2
SDC exemption application for ADU located at 6921 SW Oak St. under File NO. ADU2019-00013 is
approved. Applicant wants to come by to pay for permit tomorrow, 3/2. Can someone contact Ellen
Cusick to let her know if she can come in to pay for permit tomorrow? Her contact email and phone
number is in below email she sent to me.
Attached is a copy of the approved SDC ADU exemption application and recorded deed restriction. Let
me know if you have additional questions.
Thanks.
Mai
Mai Quach
Finance & Information Services
(503) 718-2496
From: Ellen Cusick< ellen@emc-id.com>
Sent: Friday, February 28, 2020 12:40 PM
To: Mai Quach <maig@tigard-or.gov>
Subject: 6915-21 SDC Waiver Document
Hi Mai!
Attached is a scan of the recorded document. I will bring the certified copy by on Tuesday morning. Do
you think the permit will be ready to paid & picked up by then?
Thanks so much for all your help on this!
E
Ellen Cusick, NCIDQ ASID IIDA
503.544.8688
ellen@emc-id.com
DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If
requested, e-mail may be disclosed to another party unless exempt from disclosure under Oregon Public
Records Law. E-mails are retained by the City of Tigard in compliance with the Oregon Administrative
Rules "City General Records Retention Schedule."
<Invoice.pdf>
3
/t7rr420/ 9 — ao / d
Dianna Ornelas 6 9' . / Sc„..) eek_ S r--
From: Ellen Cusick <ellen@emc-id.com>
Sent: Wednesday, March 4, 2020 4:16 PM
To: Dianna Ornelas
Cc: #Building Permit Technicians
Subject: Re: SDC ADU Exempt Approved for 6921 SW Oak St. Want to pay permit tomorrow, 3/3.
MST2019-00440
Attachments: residential_water_meter_sizing_worksheet_6921 SWOak.pdf
Importance: High
Warning! This message was sent from outside your organization and we are unable to verify the sender.
Here is the water fixture count sheet that I sent to Michelle. Let me know if you have any questions or comments.
According to Michelle the meter size requirements are thus:
5/8" meter: 0-39 fixture units
3/4" meter:40-54 fixture units
1" meter: 55-150 fixture units
E
Ellen Cusick, NCIDQ ASID IIDA
503.544.8688
ellen@emc-id.com
On Mar 4, 2020, at 4:05 PM, Dianna Ornelas<Dianna@tigard-or.gov>wrote:
Hello Ellen,
We require information in writing from the Tualatin Valley Water District representative via email,
letter, signature on city water meter fixture worksheet, etc. indicating that a water meter upsize is not
required for the scope of work of the current project. We will accept your word that you 'spoke' with
Michele at TVWD at this time, but on the next ADU we will require it in writing from TVWD as it
becomes part of the building permit public record.
Thank you.
Dianna L. Ornelas(Howse)
Building Division Services Supervisor
City of Tigard I Community Development
13125 SW Hall Blvd I Tigard, OR 97223
503-718-2430 Direct 1503-718-2439 Permits
From: Ellen Cusick<ellen@emc-id.com>
Sent:Wednesday, March 4, 2020 3:50 PM
To:Julie Drinkwater<JulieD@tigard-or.gov>
Cc:#Building Permit Technicians<TigardBuildingPermits@tigard-or.gov>
1
Subject: Re: SDC ADU Exempt Approved for 6921 SW Oak St.Want to pay permit tomorrow, 3/3.
MST2019-00440
Julie,
I have talked with Michele at Tualatin Valley Water district and we are not required to upgrade the
meter for this project, HOWEVER, the client may build another ADU in the future, so we will be
upgrading the meter to a 3/4" line at this time. Am I good to pay for the permit and send the GC to pick
it up now that you have this information?
Thanks,
Ellen
Ellen Cusick, NCIDQ ASID IIDA
503.544.8688
ellenaemc-id.com
On Mar 3, 2020, at 1:34 PM,Julie Drinkwater<JulieDPtigard-or.gov> wrote:
Hello Ellen
The permit for the Lawson project is ready to be issued.The revised balance due, after
SDC exemptions, is$7,336.41. Attached please find the invoice for your review.
You can pay the fees online, or when you pick up the permit, Monday-Thursday, 8:00
am to 4:00 pm. We are closed on Fridays.
To pay the fees online, you can go to our
website: https://aca.accela.com/TIGARD/Default.aspx. From there, click on the Building
tab, enter the permit number in the Record Number field, and click Search.
Thank you
Julie Drinkwater
Permit Technician
City of Tigard I Building Department
13125 SW Hall Blvd
Tigard, OR 97223
503-718-2804
From: Dianna Ornelas
Sent: Monday, March 02, 2020 11:21 AM
To: Ellen Cusick<ellen@emc-id.com>
Cc:#Building Permit Technicians<TigardBuildingPermits@tiard-or.gov>
Subject: RE: SDC ADU Exempt Approved for 6921 SW Oak St. Want to pay permit
tomorrow, 3/3. MST2019-00440
Hello Ellen,
2
This is in the que for processing and we will contact you today or tomorrow with revised
fees.
Thank you.
Dianna L. Ornelas(Howse)
Building Division Services Supervisor
City of Tigard I Community Development
13125 SW Hall Blvd I Tigard, OR 97223
503-718-2430 Direct 1503-718-2439 Permits
From: Mai Quach< maiq@tigard-or.gov>
Sent: Monday, March 2, 2020 9:16 AM
To:#Building Permit Technicians <TigardBuildingPermits@tigard-or.gov>; Albert Shields
<albert@tigard-or.gov>; Edgardo Maldonado <edgardom@tigard-or.gov>
Subject: SDC ADU Exempt Approved for 6921 SW Oak St. Want to pay permit tomorrow,
3/3. MST2019-00440
Hi all,
SDC exemption application for ADU located at 6921 SW Oak St. under File NO.
ADU2019-00013 is approved. Applicant wants to come by to pay for permit tomorrow,
3/2. Can someone contact Ellen Cusick to let her know if she can come in to pay for
permit tomorrow? Her contact email and phone number is in below email she sent to
me.
Attached is a copy of the approved SDC ADU exemption application and recorded deed
restriction. Let me know if you have additional questions.
Thanks.
Mai
Mai Quach
Finance & Information Services
(503) 718-2496
From: Ellen Cusick< ellen@emc-id.com>
Sent: Friday, February 28, 2020 12:40 PM
To: Mai Quach <maiq@tigard-or.gov>
Subject: 6915-21 SDC Waiver Document
Hi Mai!
Attached is a scan of the recorded document. I will bring the certified copy by on
Tuesday morning. Do you think the permit will be ready to paid & picked up by then?
Thanks so much for all your help on this!
E
3
Ellen Cusick, NCIDQ ASID IIDA
503.544.8688
eIlen@emc-id.com
DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public
record laws. If requested, e-mail may be disclosed to another party unless exempt from
disclosure under Oregon Public Records Law. E-mails are retained by the City of Tigard
in compliance with the Oregon Administrative Rules"City General Records Retention
Schedule."
<Invoice.pdf>
4