Permit City of Tigard
c " Deferral Until Occupancy Request
T I G A R D Washington County Transportation Development Tax (TDT),Transportation and Parks System
"' Development Charges (SDCs)
This form is to be signed and submitted prior building permit issuance or,if no building permit is required,then
upon land use approval(TMC 3.24,as amended by Ordinance No.21-09).
Date: 11/14/2022 Site Address: 15109 SW Deepbrook Ln
Project River Terrace Crossing Land Use Case or
Name: (Pacific Lifestyle Homes) Building Permit#: MST2022-00413
Tax Lot 2S108DC03600 Total Parks $11,830.00
#: Lot 39 Amount*:
TDT N/A Total TSDC
Amount: Amount*: $12,004.00
*The total TSDC amount shown above is the sum of$7.760.00 for TSDC-Improvement,$448.00 for TSDC-
Reimbursement,and$-4,716-00 for TSDC-River Terrace,if applicable..
*The total Parks SDC amount shown above is the sum of$6,812.00 for Parks-Improvement,$ 1.887.00 for Parks-
Reimbursement,and either$ N/A for Parks-Neighborhood or$ 3,131.00 for Parks-Neighborhood River Terrace.
This constitutes my request to defer payment of the TDT,TSDC, and Parks SDCs, as provided above, to
prior to final inspection.
Payment of the TDT,TSDC, and Parks SDCs may be deferred until issuance of the occupancy permit. In
requesting this option,I understand that any deferred TDT,TSDC,and Parks SDCs must be paid prior to final
inspection.
TDT may only be deferred if the TDT is greater than the amount for a single-family residence. I further
understand that the amount of TDT due on deferred obligations shall be the amount in effect at the time of
issuance of the building permit.
For a deferral request to be accepted both the Property Owner and the Developer must sign this request.
Property Owner: Date: /64!'
Developer: MAXant/a, Date:
Permit Coordinator: Arallt6Oet V" `" Date: 11/14/2022
CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2022-00413
Date Issued: 11/30/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S108DC03600
Jurisdiction: Tigard
Site address: 15109 SW DEEPBROOK LN
Subdivision: RIVER TERRACE CROSSING Lot: 39
Project: River Terrace Crossing, Lot 39
Project Description: New detached dwelling. NO FINAL UNTIL DEFERRED SDC FEES ARE PAID.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 3 First: 1910 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 15.5 Bathrooms: 2 Second: 0 sf Garage: 454 sf Front: 12 Smoke Yes
Dwelling Units: 1 Third: 0 sf Right: 3 Detectors:
Total: 1910 sf Value: $319,111.48 Rear: 10
PLUMBING
Sinks: 1 Water Closets: 2 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 3 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Drains: 0 Storm Sewer: 100
Tubs/Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Bckflw Prevntr. 1
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 4 Clothes Dryers: 1
Natural Gas Heat Pump: Y Hoods: 0 Other Units: 0
Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 3
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add'I 500 sf: 3 201-400 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/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo. N HVAC: N Security Alarm: N Vaccuum 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:
NEW SF VE R-3 1910
Owner: Contractor:
CND-RIVER TERRACE LLC PACIFIC LIFESTYLE HOMES Required Items and Reports(Conditions)
1111 N POST OAK RD 11815 NE 99TH ST#1200 1 Ersn Cntrl 503-639-4175
HOUSTON,TX 77055 VANCOUVER,WA 98682
PHONE: PHONE: 360-213-0813
FAX: 360-574-6401
Total Fees: $21,426.25
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 you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
oR9-nnLMln+hrn unh rl 0c2.nnl.nnon Vnu n fain a nnnv of the ri ilpc nr direr t nuaetinne In ill INrt by roIlinn Sill 7' 1QR7 nr 1 Rnn'it9 9144.
Issued By: Permittee Signature:
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
Residential RECEIVE ', FOR OFFICE USE ONLY
City of Tigard 'ec/13y: / / . , /J �,1C/ 3
• 13125 SW Hall Blvd.,Tigard,OR 97223 Daie ey` l0 \ t�
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 OCT 0 3 2022 Date/By: t I (5 ZZ j 1 :, U-Z7 S`
T 1 G A R D Inspection Line: 503.639.4175 CITY OF TIGARD D ��Ready/By: J/ runs: ® See Page 2 for
Internet: www.tigard-or.gov N4lilled/Method: L( Supplemental Information
BUILDING DIVISIO
TYPE OF WO' ' L. « + a31' DDATA:1-A I 2-FAMILYDWE
®New construction ❑ Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application. Lt Q
El1-and 2-family dwelling ❑ m Comercial/indust al Valuation: 1C 11 1 l O
El Accessory building 0 Multi-family Number of bedrooms: 3 1 b l
❑Master builder El Other:
Number of bathrooms: 2
JOB SITE INFORMATION AND LOCATION Total number of floors: 1 2
Job site address: 6i 0"1 1 �i t ,�{�
�-�` ` ���}D a k New dwelling area: 1910 square feet
City/State/ZIP:Tigard,OR Garage/carport area: 454 square feet
Suite/bldg./apt.no.: Project name: /C 1VZy- �tl/ar�(befSdi- Covered porch area: 24 square feet
Cross street/directions to job site: '�/ Deck area: square feet
44tFterzt."(9-6 square feet
FP'' REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision:River Terrace Lot no.:39 Permit fees*are based on the value of the work performed.
Tax map/parcel no.:R2205791 Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
E RIPTION OF WORK work indicated on this application.
\, New SFR-3 bedrooms and Valuation: $
L r(i (({' tl ✓) ^/`Lil life /� � ��� (,/xisting building area: square feet
II reci'(�Vr / /'I(2t/ [b 5 GZ Q_14-t!C_ L I New building area: square feet
ElPROPERTY QWNER ❑ TEN Number of stories:
Name:Pacific Lifestyle Homes Type of construction:
Address:11815 NE 99'Street,Suite 1200 Occupancy P y groups:
City/State/ZIP:Vancouver,WA 98682
Existing:
Phone:(360)573-8081 Fax:(360)574 6401
New:
* II APPLICANT i* CONTACT PERSON BUILDING PERMIT FEES*
Business name:Pacific Lifestyle Homes (Please rejerro feeu/1¢¢gte).
Contact name:Permit Coordinator Structural plan review fee(or deposit):
Address:11815 NE 99th Street,Suite 1200 FLS plan review fee(if applicable):
v City/State/ZIP:Vancouver,WA 98682 Total fees due upon application:
Phone:(360)573-8081 ] Fax::(360)574-6401 Amount received:
`v E-mail:permits�buildplh.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
%\- roof-top mounted PhotoVoltaic Solar Panel System.
„ Business name:Same Submit two(2)sets of roof plan with connection details
Address:Same and fire department access,along with the 2010 Oregon
Solar Installation Specialty Code checklist.
City/State/ZIP:Same Permit Fee(includes plan review $180.00
\ and administrative fees):
1,. Phone: ) Fax:( )
State surcharge(12%of permit fee): $21.60
k.o CCB lie.: 173524
Total fee due upon application: $201.60
Authorized sign lure: ,^ /y) r/_ This permit application expires if a permit is not obtained
"� �' I-i ,l - ��(,� (` within 180 days after it has been accepted as complete.
Print name:Summer Dowell Date:9/1 022 *Fee methodology set by Tri-County Building Industry
ll , Service Board.
'sy` I:\Building\Permits\BUP-RESPennitApp.doc 02/24/2011 440-4613T(ll/02/COM/WEB)
Mechanical Permit Application FOR OFFICE USE ONI.v
City of Tigard R EC E IVEuate/By Permit No.:
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
_ Phone: 503.718.2439 Fax: 503.598.1960 Other Permit:
3 2Ogq Date Re
TIGARD Inspection Line: 503.639.4175 OCTlr I U L LL Date Ready/By: lads: RI See Page 2 for
Internet: www.tigard-or.gov 7' f�otified/MethodN : Supplemental Information
CITY OF 1 I(►Au 1L�
TYPE OF WO' '; :- „ COMMERCIAL FEE* SCHEDULE - USE'
? t' Mechanical permit fees*are based on the value of the work
®New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑ Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:S
CATEGORY OF CONSTRUCTION REsm6FnAL EQUIPMENT/SYSTEMS FEES*
® 1-and 2-family dwelling ❑Commercial/industrial ❑ Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑ Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND I.00ATION Heating/cooling:
Air conditioning 1 46.75
Job site address: i S.I p(� 1`�o c /L Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 1 61.06
Suite/bldg./apt.no.: Project name:River Terrace
Duct work 1 23.32
Cross street/directions to job site: Hydmnic hot water system 23.32
Residential boiler(radiator or
hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Subdivision:River Terrace Lot no.:39 Other: 23.32
Other fuel appliances:
Tax map/parcel no.:R2205791 Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 1 33.39
Flue vent for water heater or gas
New SFR fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
0 PROPERTY OWNER ElTENANT Other. 23.32
Environmental exhaust and ventilation:
Name: Pacific Lifestyle Homes Range hood/other kitchen
equipment 1 33.39
Address:11815 NE 99th St.Suite 1200
Clothes dryer exhaust 1 33.39
City/State/ZIP:Vancouver,WA 98682 Single-duct exhaust(bathrooms,
toilet compartments,utility moms) 44 23.32
Phone:(360)573-8081 Fax:( ) Attic/crawlapace fans 23.32
� fYf APPLICANT ® CONTACT PERSON Other: 23.32
Fuel piping:
Business name:Pacific Lifestyle Homes
S14.15 for first four;S4.03 for each additional
Contact name:Permit Coordinator Furnace,etc.
Address:11815 NE 99th Street,Suite 1200 Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Vancouver,WA 98682 Water heater
Phone:(360)573-8081 Fax::(360)574-6401 Fireplace
Range 1
E-mail:permits@buildplh.com Barbecue 1
CONTRACTOR Clothes dryer(gas)
Business name:Wolcott Other:
MECHANICAL PERMIT PE
Address: 1075 W Historic Columbia River Hwy Subtotal
City/State/ZIP:Troutdale,OR 97060 Minimum permit fee(S90.00)
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee)
CCB lic.:41320- // O l/7/G? TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within ISO
��_ (//� p�l� days after it has been accepted as complete.
Authorized signatt.�:-X`1"`-�.i' 'j/A-1" l/-�/ ^� * Fee methodology set by Tti-County Building Industry Service Board
Print name:Summer Dowell Date: /1/2022
I:Building)Permits\MEC_PermitApp_040113.do4 440-4617T(11ro2/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi-Family Fee Schedule:
Totalyat ;tion: P t :.
$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.
Note: All new commercial buildings require 2 sets of plans.
l:\Building\Permits\MEC_PermitApp_040113.doc 2
RECEIVE'_
Electrical Permit Application NOV
fir qq FOR OFFICE USE ONLY
Cityof Tigard 1 O J LOLL Received
g _ Date/B Perm;t d:
• 13125 SW Hall Blvd.,Tigard,OR 97223E CITY OF I iCiAFll-; Plan Re iew
Phone: 503.718.2439 Fax: 503.598.1960 pale By Related Pemut tt:
Inspection Line: 503.639.4175 :1111..n11\ln flAIIS1!
TIGARD 9 Ready DateBy: lures ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
is New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans wi;tems checked):
El Demolition El Other: ElService or feeder 400 amps or more ElBuilding over three stones.
where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
1-and 2-familydwellingless to ground,or exceeds 14,000 ❑Commercial-use agricultural
® 0 Commercial/industrial ❑Accessory building
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ['Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address:15109 SW Deepbrook IOOHP or more. ❑"A","E,"1-z', 1-3 ,
City/State/ZIP:Tigard, OR 97224 El Six or more residential units. occupancy.
❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldgiapt.#: Project name:River Terrace Crossing 0 Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each 1 Total 1
New residential single-or multi-family dwelling unit.
Subdivision: Lot#:39 Includes attached garage.
Tax map/parcel#:R2205791 1,000 sq.ft.or less 1 168.54 4
Ea.add'l500 sq.ft.or portion 3 33.92 1
• DESCRIPTION OF WORK Limited energy,residential 75.00 2
New SFR (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
® PROPERTY OWNER El TENANT Services or feeders installation,alteration,and/or relocation
Name:Pacific Lifestyle Homes 200 amps or less 100.70 2
Address:11815 NE 99th St. Suite 1200 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Vancouver, WA 98682 601 amps to 1,000 amps 301.04 2
Phone:(360-p73-8081 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email:permits@buildplh.com relocation
Owner installation:This installation is being made on property that 1 own which is not 200 amps or less 59.36 I
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
Branch circuits-Dew,alteration,or extension,per panel
la APPLICANT 0 CONTACT PERSON
A.Fee for branch circuits with
Business name:Pacific Lifestyle Homes above service or feeder fee, 742 2
each branch circuit
Contact name:Summer Dowell B.Fee for branch circuits without
service or feeder fee,first
Address:Same as owner branch circuit 56.18 2
City/State/ZIP: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(360 )904-8130 Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: permits@buildph.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Garner Electric Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address:2890 SE Brookwood Ave. panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP:Hillsboro,OR 97123 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)648-4552 Fax:(503)642-7925 Investigation(1 hr min) 90.00/hr
Email:permits@garnerelectric.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 121159 Electrical Lic.: 34-305C Suprv.Lie,: 3707-S specifically listed(Vs hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: Charles Gamer Date:11/9/2022 ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: Se g ds. TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 190
Print name: Brittany Burian Date:11/9/2022 days after it has been accepted as complete.
r Number of inspections allowed per permit.
I:11wIdingiPermits1ELC_PermiiApp_ELR_ERE.doc Rev 06/17/2015 440-4615TOI/05/COM/iEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Deacripaon I QV. I Each I Total I "
Fee for all residential systems combined: 575.00 Renewable electrical energy systems:
5kva or less 100.70 2
Check Type of Work Involved:
5.01 to15kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance
552.26 2
with OAR 918-309-0040)
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66 25/hr
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(Ya hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page 1):
Fee for each commercial system: 575.00 • Number of inspections allowed per permit
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I'1 Building\Permits lELC_PermitApp_ELR_ERE.doe Rev 06/17/2015
Plumbing Permit Application
Building Fixtures FOR OFFICE USE ONLY
City of Tigard E!V E ' Received
MII• 13125 SW Hall Blvd.,Tigard,OR 97223
Plan/By. Permit No.:
Phone: 503.718.2439 Fax: 503.598.1960an Review
OCTJCT 0 3 202Z Date/By: Other Permit No.:
Inspection Line: 503.639.4175
TIGARD Date ReadylBy: raris: ® See Paget for
Internet: www.tigard-or.gov - -si ■
a i Notified/Method: Supplemental Information
TYPE OF WO '»" i at :Air °.i=y 9 lip' �._: t, FEE* SCHEDULE
® New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
Ell-and 2-family dwelling ElCommercial/industrial SFR(2)bath 1 437.78
❑Accessory building El Multi-familySFR(3)bath 500.32
❑Master builder Each additional bath/kitchen 25.02
❑Other. Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
6!b� J p ai
l ' Catch
C 18.76
Job site address: `
City/State/ZIP:Tigard,OR Drywall,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name:River Terrace Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:1) 1 Page 2
Storm sewer(no.linear ft.:1) 1 Page 2
Water service(no.linear ft.: .) 1 Page 2
Subdivision:River Terrace Lot no.:39 Fixture or item:
Tax map/parcel no.:R2205791 Backflow preventer 1 31.27
DESCRIPTION OF WORK Backwater valve I 12.51
New SFR Clothes washer 1 25.02
Dishwasher 1 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
d:/ PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name:Pacific Lifestyle Homes Fixture sewer cap 25.02
Address: 11815 NE 99th St.Suite 1200 Floor drain floor sink/hub 25.02
Garbage disposal 1 25.02
City/State/ZIP:Vancouver,WA 98682 Hose bib 2 25.02
Phone:(360)573-8081 Fax:( ) Ice maker 12.51
r' •.'w-w.ar P+laS.
APPLICANT lc CONTACT PERSON Interceptor/grease trap 25.02
Business name:Pacific Lifestyle Homes Medical gas(value:$_) Page 2
Contact name:Permit Coordinator
Primer 12.51
Roof drain(commercial) 12.51
Address:11815 NE 99th Street,Suite 1200 Sink/basin/lavatory 4 25.02
City/State/ZIP:Vancouver,WA 98682 Solar units(potable water) 62.54
Phone:(360)573-8081 Fax::(360)574-6401 Tub/shower/shower pan 2 12.51
E-mail:permits@buildplh.com Urinal 25.02
CONTRACTOR Water closet 2 25.02
Water heater 1 37.52
Business name:Wolcott
Water piping/DWV 56.29
Address:1075 W Historic Columbia River HWY Other: 25.02
City/State/ZIP:Troutdale,OR 97060 Subtotal
Phone:( ) Fax:( ) `/ -7)" Minimum permit fee: $72.50
CCB Lic.:11220 Plumbiug Lie.no.:0Z4e? e
if4 Plan review (25%of permit fee)
y� State surcharge(12%of permit fee)
Authorized signature: kin./ L,f 9
/(,- TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180 days
Print name:Summer Dowel Date:9 1/22
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:iBuilding\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(I 0/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information .
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-1'100' 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 $23320
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
valuation: u.r a t.Fe ;
Storm&Rain Drain-1st 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$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
Other or Fees 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*.
Quantity by Fixture Type Plan Review for.Plumbing Installations
Fixture Type for Replace/Work Performed: Capped Added Relocate Plan review is required for any of the following.
Please check all that apply.
Baptistry/Font
Bath -Tub/Shower ❑ Any new commercial building with water service 2"and
-Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thm ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink -2" Submit 2 sets of plans with any of the above.
-3"
Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sinkl av -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter *Note: If the fixture work under this permit results in an
Washer-Clothes increase of sewer EDUs,a sewer permit will be issued and
Water Extractor
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Futures:
P:Vob Folders\Oregon\Subdivisions\River Terrace\Lot 391Permits and Inttections\PLB_PetmitApp.doc
RECEIVED
i City of Tigard OCT 08 2022 •
=III
IIICOMMUNITY DEVELOPMENT DEPARTMENT
: CITY OF TIGARD 124rZf.Whce-C" ?q
TIGARD Small Form Residential SIB0191 ritMtal
Building Permit #: _//451 o)j-c A-f/3 Project Name: Five41 P tal Gras_ny
Site Address: OW CIA) feepb✓bo(_ U
Lot #: . - Three
r
New Configuration: Single Detached ❑ Duplex D Triplex ❑ +ADU
ff. fp(-719(,6_000',
Small Form Residential Standards
Setbacks ` Front: 1�-' Rear: to Side: 3 Street Side: - , Garage: �D
Height O Max. Height: ta- Actual Height: lS • S-f
lrc-trovl
Landscape 11 andscape Area: 145 •5 % Lot Coverage Max: 1%v
Entrance et back no more than 8' from street-facing wall
Parallel to street or offset 45 degrees or less
Windows Minimum 12% of area of all street-facing facades
Garage Garage door is behind widest street-facing wall
g'es
❑ No, and one of the following is met:
❑ Door extends no more than 5' from wall and there is a covered porch
extending beyond garage.
❑ Door extends no more than 5' from wall and there is a 12 sq ft.
window above garage on 2nd floor.
Garage door width is:
❑ 12' or less
)450% or less of facade
'❑ 60% or less and includes 7 of following:
❑ Covered porch ❑ Recessed entrance ❑ Wall offset
❑ 1' Roof eave ❑ Roof offset 0 Fire shingles
❑ Lap Siding ❑ Gable, hip, gambrel roof ❑ Dormer
❑ Roof pitch ❑ Accent siding ❑ Window trim
❑ Window recess ❑ Window projection ❑ Balcony
Approved By Planning: Date: 4� 11
I'.BwldinglPorrrslBldgPernntRvw_SPR Supplcmwtal 070722
3q- s_ 25�. 15
o
33 k- 2d
kfa
\3 ,3 / . 1-
tco ,
City of Tigard
C a COMMUNITY DEVELOPMENT DEPARTMENT RECEIVED
TIGARD
Building Permit Review - Residential OCT 032022
V1I r Cr Tlar\Ir1L
Building Permit #: /7.447- 6j - ✓jj� 1,3 BUILDING DIVISION
Site Address: , 7,rcn - l v'
Project Name: f-iVeY -rmy-ota rctS5d'1q Lot #:
Proposal: rkittA) aopecutittn, fir ut ai MOd.e! Noy
(FloSaIe6 office)
Required Submittal Elements
ji3 copies of site plan olished
id-Drawn to standard scale AFootprint of new structure and FFE
North arrow ip line rtr -protection
Site address, project name, lot # 'Street trees shown / labeled
g'Street names Sidewalk / driveway shown and dimensioned
, -Applicant name and phone # )Utility locations & easements (new / additions)
Lot and setback dimensions
re3- of area and lot coverage percentage
'Erosion control Corner elevations (2' contours if > 4' differential)
❑ Vision clearance triangle .6-Ground slope at building pad calculated / shown
Planning Review
Verify address / suite # active in Accela.
,efZone: cS-C
zlaClean Water Services - Service Provider Letter (lot platted prior to 9/10/1995)
Required: ❑ Yes zffle-No
Received: ❑ Yes ❑ No
Ali blic Facilities Improvement (PFI) Permit:
Required: ❑ Yes 211Vo
Applied For: ❑ Yes ❑ No, stop intake
)2rSensitive Lands: ❑ Yes ❑ No
Type:
Housing Supplemental Sheets Completed
❑ Cottage Cluster C&O (1 site, 1 per unit) ❑ Quad
❑ Courtyard Units C&O (1 site, 1 per building) ❑ Rowhouse
❑ Cottage Cluster Type II (1 per unit) Small Form Residential / ADU
❑ CourtyardrUnits Type II (1 per building) CI River Terrace Addendum
ii- Un
Land Use Case #: 1J'e---20(6 - OODl, ❑ Conditions met prior permit issuance
Approved By Planning: Date: _ (6 /3I2,../
Notes 0V_ Fvv ?-ekAttil ,,,k 10‘okr fr% tfY covr /
Revision 1: ❑ Approved 0 Not Approved Date:
Revision 2: El Approved ❑ Not Approved Date:
1:1BuildinglFmmslBldgPermitkvw_Res_08162022.docx
Building Permit Submittal
Original Submittal Date: Co, 7L2
Site Plans #:
Building Plans #: 5'
Building Permit #: Et-Building permit # entered on page 1
Workflow Routing: Planning 9_€ngineering t Permit Coordinatp.x f] Building
Workflow Sign-off: -E3 Sign-off for Planning (include notes from planning review)
Route 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 trust details, if
applicable, etc.
Permit Technician: � � Date: /a,�L2 _
Notes
Engineering Review
Slope at building pad verified Slope: "/,
lVl4 TrConditions met prior to issuance of permit
ITYEasements (encroachments) per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes I -No
Assess Water Quantity Fee in-lieu: ❑ Yes Ik'No
LIDA Facility on lot: ❑ Yes eNo Add Fee: ❑ Yes ❑ No
Enal Plat Recorded
❑ NOT Approved: Date:
Notes
Approved By Engineering: Date: // 740—
Revision 1: ❑ Approved ❑ of Approved Date:
Revision 2: ❑ Approved ❑ Not Approved Date:
Permit Coordinator Review
/0' Conditions met prior to permit issuance
❑ Approved, NOT Released: Date notified applicant:
❑ ENG Revisions Required: Date notified applicant:
7SDC Exemption: ❑ Applied for 0 Received Jzf Does not apply
SDC Fees Entered: Wash Co Trans Dev Tax: yf Yes ❑ N/A
Tigard Trans SDC: yr Yes ❑ N/A 7 Deferred
Parks SDC: VI Yes ❑ N/A ( Deferred
LIDA ❑ Yes N/A
prOK to Issue/Approved by Permit Coordinator: Date: (Ll 1l2 1 2 6 2/1--
Revision 1: ❑ Approved ❑ Not Approved Date:
Revision 2: ❑ Approved ❑ Not Approved Date:
4