Permit City of Tigard
Deferral Until Occupancy Request
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: 15444 SW Peace Ave
Project River Terrace Crossing Land Use Case or
Name: (Ichijo) Building Permit#: MST2022-00452
Tax Lot 2S108DC05500 Total Parks
##: Lot 61 Amount*: $11,830.00
TDT N/A Total TSDC
Amount: Amount*:
$12,004.00
m
*The total TSDC amount shown above is the sum of$7 760.00 for TSDC-Improvement,$44800 for TSDC-
Reimbursement,and$3,796 00__—for TSDC-River Terrace,if applicable..
*The total Parks SDC amount shown above is the sum of$6,812-00 for Parks-Improvement,$–JJHU 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: �Ak$ Date: 11/16/2022
Developer: Date: 11/16/2022
Permit Coordinator: Date: 11/14/2022
CITY OF TIGARD MASTER PERMIT
n Permit#: MST2022-00452
COMMUNITY DEVELOPMENT Per
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/29/2022
Parcel: 2S108DC05500
Jurisdiction: Tigard
Site address: 15444 SW PEACE AVE
Subdivision: RIVER TERRACE CROSSING Lot: 61
Project: River Terrace Crossing, Lot 61
Project Description: New detached dwelling. NO FINAL INSPECTION UNTIL DEFERRED SDC FEES HAVE BEEN
PAID.
BUILDING
Floor Areas Required Setbacks Required
Stones: 2 Bedrooms: 4 First: 1258 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 27 Bathrooms: 3 Second: 1614 sf Garage: 440 sf Front: 12 Smoke
DwellingUnits: 1 Yes
Third: 0 sf Right: 3 Detectors:
Total: 2872 sf Value: $463,522.00 Rear: 10
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Drains: 0 Storm Sewer: 100
Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Bekflw Prevntr: 0
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 5 Clothes Dryers: 1
Natural Gas Heat Pump: Y Hoods: 1 Other Units: 0
Fum<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 3
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'I 500 sf: 5 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-60D amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio R Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
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 2872
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 Ersn Cntrl 503-639-4175
131 BEAVERTON,OR 97005 2 (2)layers of 2x fire blocking
BEAVERTON,OR 97005 at area indicated
PHONE: 503-430-7413 PHONE: (503)430-7413
FAX:
Total Fees: $25,738.33
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specially 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. ATT TION: Oregon law
JJrreeeqquire.you follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
MM n Oc9.n - 10 th nh AR oc9J1n1-nnO ! rib nht.i , ,of the.ndoc nr dirw.t,,,, tinnc to Al INC hw',scion c04 717 10R7 nr 1 non 749 94dd
5Y dpp ; �e.t
Issued By: Permittee Signature:
Call 503.639.4175 y 7:00 a.m.for the next available inspection data.
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.
a
t
Building Permit Application Checklist `
One- and Two-Family Dwelling FOR OFFICE USE OyLv
City of Tigard
Received Permit No.:
Date/By:
r 13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits:
■ Phone: 503.718.2439 Fax: 503.598.1960 0 Electrical ❑ Plumbing ❑ Mechanical
T I G A R D 24-Hour Inspection Line: 503.639 4175 ❑ Other:
Internet: www.tigard-or.gov
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW 1es No 11.E
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑❑ 00 0
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 0 0
0
3 Verification of approved plat/lot. 0 0 0
4 Fire district approval required. Name of district: . ❑ 0 0
5 Septic system permit or authorization for remodel. Existing system capacity 0 0 0
6 Sewer permit. 0 0 0
7 Water district approval. 0 0 0
8 Soils report. Must carry original applicable stamp and signature on file or with application.
9 Erosion control 0 plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- ❑ 0 0
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state • 0 0
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 II ❑ ❑
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. ■ ❑ 0
12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size
and location. 0 0
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater,
•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- • 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,roofmg,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. • 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. ■ 0 0
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 El 0 0
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ 0 0
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 j 0 0
over 10 feet long and/or any beam/joist carrying a non-uniform load. 0 0
20 Manufactured floor/roof truss design details. MI
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required II ❑ ❑
for four or more appliances. 0 ❑
22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or
II architect licensed in Ore:on and shall be shown to be applicable to the .ro'ect under review.
JURISDICTIONAL SPECIFICS
23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". • 00 ❑❑
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. I.
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. U 0 0
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. : 0 0
27 "Drawn to scale"indicates standard architect or engineer scale.
0
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard li ❑ ❑
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, Q ❑ ❑
and protection measures must be drawn to scale and must include the project arborist's signature of approval. 0 0
30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions,
III
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.
l\Building\Permits\B P-RESPennitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi-Family Fee Schedule:
Total Valuation: Permit Fee:
$0.00 to S500.00 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
Electrical Permit Application E.III FOR OFFICE USE ONLY
t��a er Received
City of Tigard {�� Date/By:
permit 5:
t� a 13125 SW Hall Blvd.,Tigard,OR 9722 Val Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 t 1 V U LL Date/By: Related Permit#:
T I G A RD Inspection Line: 503.639.4175 ND D Ready Date/By: lurir. 1 See Page 2 for
Internet: www.tigard-or.gov Gal OF {l\Yv r Notified/Method. Supplemental Information
TYPE OF W'OIY tU[JINGB"SICIN PLAN REVIEW
•New Construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
['Demolition ❑other: 0 Service or feeder 400 amps or more ❑Building over three stories.
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
I-and 2-family dwelling ❑Commercial/industrial ['Accessory building less to ground,or exceeds 14,000 ❑commercial-use agricultural •
•
❑ Multi-family D Master builder El Other:
Other: all other installations. Installation
re s for all
0 of 150 KVA or
JOB SITE'INFORMATION AND LOCATION 0 Emergency system. larger separately derived
O Addition of new motor load of system.
Job#: Job site address: 15444 SW PEACE AVE 100HPormore. ❑"A'.'E", 'l-2","l-3
City/State/ZIP: Tigard / OR / 97224 ❑Six or more residential units. occupancy.
❑Health-care facilities. D Recreational vehicle parks.
Suite/bldg./apt.#: Project name: River Terrace Crossing Lot 61 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 I Total I "
New residential single-or multi-family dwelling unit.
Subdivision: River Terrace Crossing Lot#: 61 Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: 2S108DC05500 Ea.add'1500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
(with above sq.ft.)
Single Family Detached Dwelling Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: ICHIJO USA CO., LTD. 200 amps or less 100.70 2
Address: 3800 SW Cedar Hills Blvd. Ste. 131 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: Beaverton/OR/97005 601 amps to 1,000 amps 301.04 2
Phone:(503 )430-7413 Fax:(503) 430-7621 Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: info@ichijousa.com relocation
Owner installation: This installation is being made on property that i own which is not 200 amps or less 59.36 1
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
1. APPLICANT 0 CONTACT, PERSON Branch circuits—new,alteration,or extension, r er panel
------- A.Fee for branch circuits with
Business name: ICHIJO USA CO., LTD. above service or feeder fee, 7.42 2
each branch circuit
Contact name: Naoki Yamaoka B.Fee for branch circuits without
service or feeder fee,first Address: 3800 SW Cedar Hills Blvd. Ste 131 branch circuit 56.18 2
City/State/ZIP: Beaverton / OR / 97005 Each add'I branch circuit 7.42 2
Phone: (503) 430 7413 Fax: :(503)430-7621 Miscellaneous(service or feeder not included)
Each manufactured or modular 6784 2
dwelling,service and/or feeder
Email: nao@ichijousa.com Reconnect only 67.84 2
- - Pump or irrigation circle 67.84 2
Business name: WEST SIDE ELECTRIC COMPANY Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy El See Page 2 2
Address: 1834 SE 8TH AVE panel,alteration,or extension.
City/State/ZIP: PORTLAND, OR 97214 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503 )231-1548 Fax:( ) Investigation(1 hr min) 90.00/hr
Email: OFFICE@WESTSIDEELECTRIC.COM Industrial plant(Ihrmin) 78.18/hr
Inspections for which no fee is 90.001 hr
CCB Lie.: 13306 Electrical Lie.: 26-135C Suprv.Lie.: 5698S specifically listed(it hr min)
.p y ELECTRICAL PERMIT.FEES
Suprv.Electrician signature,required: u t I rit Subtotal:
Print name: BRENT WALL 5698-S Date: 11/7/2022 ❑Plan Review Required(25%of permit fee):
State surchargefee):
Authorized signature: TOTAL
OTT ALL PERMIT
FEE:
This permit application expires if a permit is not obtained within 180
Print name: Naoki Yamaoka Date: 11/7/2022 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\BuildingtPmnits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615TO 1/05/COM'WEB
Plumbing Permit Application
• ' Building Fixtures FOR OFFICE USE ONLY
Cityof Tigard E L.eceived
.t g �,�,� �� Permit No.:
• 13125 SW Hall Blvd.,Tigard,OR 9722 Date/By:
Nov8 202 Plae/By: w
Phone: 503.718.2439 Fax: 503.598.1960 L 7 Other Permit No.:
Date By:
T I G A RD Inspection Line: 503.639.4175 Date Ready/By: Juris: 0 See Page 2 for
Internet, www.ligard-or.gov CITV OF TIGARU Notified/Method: Supplemental Information
TYPE OF WORK BUILDING D VISION FEE* SCHEDULE
III New construction 0 Demolition For special information use checklist
Description I Qty. I Ea. I Total
El Addition/alteration/replacement ❑Other: New 1-2-fa mily dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
•1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
ElAccessory building 0 Multi-family SFR(3)bath 1 500.32
Each additional bath/kitchen 25.02
0 Master builder ❑Other. _ Fire sprinkler( sq.ft.) Page 2
JOB SITE.INFORMATION AND LOCATION Site utilities:
Job site address: 15444 SW PEACE AVE 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.: ) Page 2
Suite/bldg./apt.no.: I Project name: River Terrace Crossing Lot 61 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.: 61 Fixture or item:
Tax map/parcel no.: 2S108DC05500 Backflow 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 25.02
• PROPERTY OWNER El TENANT Expansion tank 12.51
Name: ICHIJO USA CO., LTD. Fixture/sewer cap 25.02
FlooAddress: 3800 SW Cedar Hills Blvd. Ste. 131 Garbage
gedispoorsinkhub 25.02
Gage 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 ' ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: ICHIJO USA CO., LTD. Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: Naoki Yamaoka Roof drain(commercial) 12.51
Address: 3800 SW Cedar Hills Blvd. Ste. 131 Sink/basin/lavatory 6 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 4 12.51
P-mail: nao@ichijousa.com Urinal 25.02
CONTRACTOR "1 ""1. Water closet 3 25.02
Water heater 1 37.52
Business name: Pipe It Plumbing LLC. Water piping/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
174351 g Pg297 Plan review (25%of permit fee)
CCB Lic.: Plumbing Lic.no.:
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name: Naoki a m a o k a Date: 11/7/202 2 This permit application expires if a permit is not obtained within 180 days
after it has been accepted ac complete.
°Fee methodology set by Tri-County Building Industry Service Board.
I:1Building5Pennits\PLMU-ParmitApp.doc I0/01/09 440-4616T(l0/02/COM/WEB)
City of Tigard
74 ,ii er
COMMUNITY DEVELOPMENT DEPARTMENT
Building Permit Review - Residential
TIGARD
Building Permit #: /'S1)�20/`� --00 52—
Site Address: 1 -- ' �L-1 5N ac-Q eVerified in Accela
Project Name: ( e (b'r j\ Lot/Unit #: CO I
Proposal (include housing type): C5C { -- Zone: d9e.� C,
Required Site Plan Elements:
3 copies of site plan on max 11x17" /
0 Drawn to standard scale ' �\5P etained trees, drip line/tree protection "l�—
North arrow ') reet an $rNfs/ labeled
Site address, project name, lot # -•'A able calculating tree canopy at maturity t1yl
Street names (1 - . FR)
Applicant name and phone # ---❑ Cum tydrd rectangle dimensioned (if applicable)
Lot and setback dimensions El Vision clearance triangle
Existing structures &square footage El Utility locations & easements
Footprint of new structure and FFE ❑ Property corner elevations
Sidewalk/driveway dimensioned O'tiDR (- 1,000 sf disturbance)
Lot area and lot coverage percentage 41 Erosion control
Required Elevation Plan Elements:
(For SFR: calcs needed only on street-facing) Garage doors dimensioned
flaSuawn to standard scale
mmary table with calculations for:
uilding height dimensioned 'Total facade area
la Facade dimensioned ®Total window and door area
`L&Windows and doors dimensioned ,Total garage area
R q ' d Floor an Elements: ❑ Summary table that includes
O Eac ry dimensioned ❑ Total floor area
❑ Eac sto floor area calculated ❑ Floor area per story
Planning Review
The following standards have been met:
Setbacks {Front: j7.-1(Rear: lO Side: JMin/Max Street Side /5 / X Garage: .0
Height I�Max. Height: osed Height: 4 /
Yes ❑ N/A Landscape -1,(2/�$12)
---�sreepi «�ua nnl
Yes ❑ N/A % Window Coverage '7 II --Tr-,
. Yes ❑ N/A Garage (SFR Only) C Tbe3 7,,
4Yes ❑ N/A Entrance (SFR, Rowhouse, Quad only)
des' s (Rowhouse only)
❑ Yes ❑ N/A ructure Stan ar s
❑ o Qualifying pre-existing unit exe t from standar s it only)
ditional standards for Courtyard Un' , Cottage Clusters, Rowhouses, and Quads:
❑ Y N/A Unit Count:
❑ Yes A Lot Width and Siz
❑ Yes El N/ Pathway
Additional stan rds f ourtyard Units and Cottage Clusters only:
❑ Yes ❑ N/A Unit
❑ Yes ❑ N/A F r Area r story)
❑ Yes ❑ N/ Courtyard
❑ Yes 0 A Fence
❑ Yes ❑ No`11/A Clean Water Services - Service Provider Letter (lot platted prior to 9/10/1995)
Elides ❑ No ❑N/A Public Facilities Improvement (PFI) Permit: `,�-
Required: ❑ Yes ❑ No ii(`�� Y l' 4 ,v )
Applied For: ❑ Yes ❑ No, stop intake }��' " , TeVI
t.Sensitive Lands: ❑ es 6tNo p,� `' `
Land Use Case #: 2� l LQ"t.�(:\k !�` 0 onditions met prior permit issuance J
Approved By Planning: 3. oil l(G i 1'of S e Date: ALL g(22..,
Notes
Revision 1: ❑ Approved 0 Not Approved Date:
Revision 2: ❑ Approved ❑ Not Approved Date:
Building Permit Submittal
Original Submittal Date: 1t /( Riz 2
Site Plans #:
Building Plans #:
Building Permit #: wilding permit # entered on page 1
Workflow Routing: )2ilanning p-Engineering .a-Permit Coordinator gilding
Workflow Sign-off: '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: 1 i 1OR r20 —
Notes:
Engineering Review
Slope at building pad: 7� Wo
y//9 "Conditions met prior to issuance of permit
f/Easements (encroachments) per engineering conditions of approval and plat
*Water Quality/Quantity Facility: ,
Assess Water Quality Fee in-lieu: ❑ Yes LYNo
Assess Water Quantity Fee in-lieu: ❑ Yes Allo
LIDA Facility on lot: ❑ Yes IiVo Add Fee: ❑ Yes ❑ No
Final Plat Recorded
O NOT Approved: Date:
Notes:Approved By Engineering: Date: /049/2L
Revision 1: 0 Approved Not Approved Date:
Revision 2: 0 Approved ❑ Not Approved Date:
Permit Coordinator Review
'Conditions met prior to permit issuance
❑ Approved, NOT Released:. Date notified applicant:
❑ ENG Revisions Required: Date notified applicant:
\JASDC Exemption: ❑ Applied for ❑ Received 0 Does not apply
L'SDC Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A
`1 Tigard Trans SDC: Yes ❑ N/A Deferred
Parks SDC: Yes ❑ N/A 4 Deferred
LIDA 0 Yes t 741lt/A
ZOOK to Issue/Approved by Permit Coordinator: -t4 C6k OX 6 Date: I` J yam,
f Revision 1: ❑ Approved 0 Not Approved Date:
Revision 2: 17 Approved 0 Not Approved Date: