Permit City of Tigard
a ' 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: 15154 SW Deepbrook Ln
Project River Terrace Crossing Land Use Case or MST2022-00454
Name: (Ichijo) Building Permit#:
Tax Lot 2S108DCO2800 Total Parks $11,830.00
#: Lot 29 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$3,796.00 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: 11/16/2022
7a 13edaiz, 11/16/2022
Developer: Date:
Permit Coordinator: A11116 1vtj.g / Date: 11/14/2022
CITY OF TIGARD MASTER PERMIT
S . COMMUNITY DEVELOPMENT Permit#: MST2022-00454
Date Issued: 12/29/2022
T I[;A R O 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S108DCO2800
Jurisdiction: Tigard
Site address: 15154 SW DEEPBROOK LN
Subdivision: RIVER TERRACE CROSSING Lot: 29
Project: River Terrace Crossing, Lot 29
Project Description: New detached dwelling. NO FINAL INSPECTION UNTIL DEFERRED SDC FEES HAVE BEEN
PAID.
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 3 First: 1088 sf Basement: 518 sf Left: 3 Parking Spaces: 0
Height: 29.8 Bathrooms: 4 Second: 1470 sf Garage: 440 sf Front: 8 Smoke Yes
Dwelling Units: 1 Third: 0 sf Right: 3 Detectors:
Total: 3076 sf Value: $503,178.28 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 4 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 6 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Drains: 0 Storm Sewer: 100
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Bckfiw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Other Fixtures: 1
Drywell-Trench Drain: 0
Other Fixture Units: Ejector/Sump
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 6 Clothes Dryers: 1
Natural Gas Heat Pump: Y Hoods: 1 Other Units: 0
Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 4
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 add1500 sf: 6 201-400 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 VB R-3 3076
Owner: Contractor:
ICHIJO USA CO.,LTD. ICHIJO USA CO LTD Required Items and Reports(Conditions)
3800 SW CEDAR HILLS BLVD,STE 3800 SW CEDAR HILLS BLVD STE 130 1 Geo Tech Required
131 BEAVERTON,OR 97005 2 (2)layers of 2x fire blocking
BEAVERTON,OR 97005 at area indicated
3 Ersn Cntrl 503-639-4175
PHONE: 503-430-7413 PHONE: (503)430-7413
FAX:
Total Fees: $27,432.07
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 ou to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
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Issued By: Permittee Signature:
Call 503.639.4175 y 7:00 a.m.for the next available inspection date.
This permit card shall be kept 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.
r
. ` plumbing Permit Application
Building Fixtures RECEIVE I FOR OFFICE USE ONLY
Cites,of Tigard Received
III - `5 g NOVDant R Permit No.:
� 13125 5W Hall Blvd.,Tigard,OR 97223 FYO Y 9 2022 y' ������_�3.4
Dan Review
' Phone: 503.718.2439 Fax: 503.598.1960 Date/By Other Permit No.:
Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: luris: El See Page 2 for
TIGARD Internet: www.tigard-or.gov Rt11Lni NC Inn sr , Notified/Method. Supplemental Information
-a, ' , jr TYPE OF WORK FEE° SCHEDULE
IMI
New construction 0 Demolition For special information use checklist
Description l Qty. I Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
buildingSFR(3)bath 1 500.32
❑Accessory 0 Multi-family
Each additional bath/kitchen 1 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 15154 SW D E E P B R O O K LN Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP. Tigard / OR / 97224 Footing drain(no.linear ft.:_) Page2
Suite/bldg./apt.no.: I Project name: River Terrace Crossing Lot 29 Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: River Terrace Crossing I Lotno.: 29 Fixture or item:
Tax map/parcel no.: 2 S 10 8 D C 0 2 8 0 0 Backtlow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 1 25.02
Single Family Detached Dwelling Dishwasher 1 25.02
Drinking fountain 25.02
Ejectors/sump 1 25.02
III PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name.
ICHIJO USA CO., LTD. Fixtuersewercap 25.02
FAddress: 3800 SW Cedar Hills Blvd. Ste. 131 Garbage
Gar rb drain/floor sink/hub 25.02
disposal disposal 1 25.02
City/State/ZIP: Beaverton/OR/97005 Hose bib 2 25.02
Phone:(503)430-7413 Fax: (503)430-7621 Ice maker 1 12.51
• APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: ICHIJO USA CO., LTD. Medical gas(value:$ ) Page2
Primer 12.51
Contact name: Naoki Yamaoka
Roof drain(commercial) 12.51
Address: 3800 SW Cedar Hills Blvd. Ste. 131 Sink/basin/lavatory 7 25.02
City/State/ZIP: Beaverton / OR / 97005 Solar units(potable water) 62.54
Phone:(503)430-7413 Fax: :(503)430-7621 Tub/shower/shower pan 3 12.51
E-mail: nao@ichijousa.com
Urinal 25.02
CONTRACTOR Water closet 4 25.02
Water heater 1 37.52
Busincssname: Pipe It Plumbing LLC. Waterpiping/DWV 56.29
Address: PO BOX 1389 Other: 25.02
City/State/ZIP: Boring / OR / 97009 subtotal
Phone:(503) 544-0477 Fax:(503) 912-0045 Minimum permit fee: $72.50
CCB Lic.: 174351 Plumbing Lic.no.: P B297 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name: Naoki amaoka Date: 11/9/2022 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
I:IBuilding\Permils\PL.MU-PermitApp.doc I0/01/09 440-4616r(10/02/COM/WEB)
City of Tigard
11111 p COMMUNITY DEVELOPMENT DEPARTMENT
a
Building Permit Review - Residential
TIGARD
G
Building Permit #: ing72E 2Z—O IL(SLI
Site Address: I'S I S' 1 ) 5 IproO V- W. ❑ Verified in Accela
Project Name: `2i0'c-0-12�C S(i I.‘) Lot/Unit #: ��,
Proposal (include housing type): t%nw SMAIL filers Recia J1AL WI-T Zone: S -L
Requ red Site Plan Elements:
B :i cos of site plan on max 11x17"
erl:›dwn to standard scale . n
Lrth arrowStreet and site trees shown / labeled
l fife address, project name, lot # �g calculating tr e ranch * ma ity
'street names (N/A for SFR)
D(Applicant name and phone # •
of and setback dimensions
I�- tipg ctructurcs &square footage PE'LLtility locations & easements
J~TFy6fprint of new structure and FFE C�'Property corner elevations
��5el'ewalk/driveway dimensioned ,
Lot area and lot coverage percentage rosion control
Required Elevation Plan Elements:
(For SF calcs needed only on street-facing) Garage doors dimensioned
wn to standard scale Summary table with calculations for:
G3 Byrild. g height dimensionede dimensioned
T al facade area
od ' pt�al window and door area
Windows and doors dimensioned otal garage area
Requir loor Plan Elements: CIm
S mary table that includes
at ch story dimensioned p' ot: tl floor area
o
Each story floor area calculated ❑ Floor area per story
Planning Review
The following standards have been met: J�
Setbacks 0 Front: '5 Rear: /5� Side: 5 Min/Max Street Side: Z / 1 Garage:
Height Max. Height: jS Proposed Height: 2-1 - 8"
❑ Yes Landscape
❑ s /A Screening (Quad only)
st 'J/A % Window Coverage
Yes El N/A Garage (SFR Only)
Parking (Other Res)
es ❑ Entrance (SFR, Rowhouse, Quad only)
❑ Yes Other building design standards (Rowhouse only)
❑ Yes Accessory Structure Standards
❑ Yes No Qualifying pre-existing unit exempt from standards (Cottage unit only)
Additional standards for Courtyard Units, Cottage Clusters, Rowhouses, and Quads:
❑ Yes N/A Unit Count:
❑ Yes N/A Lot Width and Size
❑ Yes N/A Pathway
Additional standards for Courtyard Units and Cottage Clusters only:
❑ Yes N/A Unit Area:
❑ Yes N/A Floor Area (per story)
❑ Yes N/A Courtyard
❑ Yes N/A Fence
❑ Yes 0 No fdN A Clean Water Services - Service Provider Letter (lot platted prior to 9/10/1995)
❑ Yes 0 No Ci1�j/A Public Facilities Improvement (PFI) Permit:
Required: ❑ Yes ❑ No
Applied For: 0 Yes ❑ No, stop intake
ensitive Lands: ❑ Yes y� es
�p
❑ Land Use Case #: I V2vlg - Cr 'DOS-- 0 itions met prior permit issuance`
Approved By Planning: Date: ii /4 62
Notes Alfbt IN glVn (WA O''itYO Sus rb r' n,
Revision 1: 0 Approved 0 Not Approved Date:
Revision 2: 0 Approved 0 Not Approved Date:
Building Permit Submittal
Original Submittal Date:
Site Plans #:
Building Plans #:
Building Permit #: -Building permit # entered on page 1
Workflow Routing: ,0-Planning oktligineering rmit Coordinator wilding
Workflow Sign-off: 0-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.
wilding: original permit application, site plans, building plans, engineer and
beam calculations and trust details, if applicable, etc.
Permit Technician: M Date: ///G mrzczez,
Notes:
Engineering Review y
t3'Slope at building pad: 2e2/d
A/74- JO/Conditions met prior to issuance of permit
IP'Easements (encroachments) per engineering conditions of approval and plat
i3'Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: 0 Yes �No
Assess Water Quantity Fee in-lieu: ❑ Yes leNo
LIDA Facility on lot: 0 Yes 1'No Add Fee: ❑ Yes ❑ No
fnal Plat Recorded
0 NOT Approved: Date:
Notes: C^
Approved By Engineering: Date: ///*d,/Z Z_
Revision 1: 0 Approved of Approved Date:
Revision 2: ❑ Approved ❑ Not Approved Date:
Permit Coordinator Review
lit/Conditions met prior to permit issuance
❑ Approved, NOT Released: Date notified applicant:
❑ ENG Revisions Required: Date notified applicant:kEli?SDC Exemption: 0 Applied for 0 Received ❑ Does not apply
'SDC Fees Entered: Wash Co Trans Dev Tax: Yes 0 N/A
Tigard Trans SDC: Yes ❑ N/A Deferred
Parks SDC: Yes ❑ N/A Ella Deferred
LIDA ❑Yes 11/A
OK to Issue/Approved by Permit Coordinator:\ r \\U'V Date: t\ - 2. "? 2--2,
Revision 1: 0 Approved ❑ Not Approved Date:
Revision 2: 0 Approved ❑ Not Approved Date: