Permit City of Tigard
Deferral Until Occupancy Request
T I G A RD 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: 11/2/2022 Site Address: 15474 SW Peace Ave
Project River Terrace Crossing Land Use Case or
Name: (Iehijo) Building Permit#: MST2022-00437
Tax Lot 2S108DC05700 Total Parks $11,830.00
#: Lot 63 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 1'DT 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: / 2/ 'Va Date: 11/8/2022
U�'eruuz Developer: Date: 11/04/2022
Permit Coordinator: `,tMet vU Date: 11/2/2022
Agnes Lindor
From: Agnes Lindor
Sent: Wednesday, November 2, 2022 11:23 AM
To: Naoki Yamaoka
Cc: Boris Piatski; Hope Pollard;Jenny McGinnis
Subject: RT Crossing Lot 110, 62, 112, 63
Attachments: MST2022-00436 Lot 112.pdf; MST2022-00437 Lot 63.pdf; MST2022-00434 Lot 110.pdf;
MST2022-00435 Lot 62.pdf
Hi Naoki-
Please see attached deferrals that need to be signed by both the property owner and developer. This permits have been
approved but cannot be released until these conditions are met:
07. Prior to commencing site improvements,the Applicant must submit a preliminary intersection sight distance
certification for the intersections between SW Everglade Ave and SW Hawk Ridge Rd and between SW Missouri Ave and
SW Hawk Ridge Rd. The certification shall be prepared and stamped by a registered professional engineer,and in
accordance with County Standards, as well as a detailed list of improvements necessary to obtain adequate intersection
sight distance.
10. Prior to final plat approval, the Applicant must submit a final intersection sight distance certification for the
intersections between SW Everglade Ave and SW Hawk Ridge Rd and between SW Missouri Ave and SW Hawk Ridge Rd
indicating that intersection sight distances are still adequate. The certification shall be prepared and stamped by a
registered professional engineer, and in accordance with County Standards.
If you have questions related to these COAs, please contact Boris copied on this email. I believe that Boris did reach out
to Pacific Community Design about this and they are working on it. Thanks,
Agnes Lindor I Senior Planner
City of Tigard I Community Development
13125 SW Hall Boulevard
Tigard, Oregon 97223
Phone: 503.718.2429
Email:AgnesL@tigard-or.gov
1
CITY OF TIGARD MASTER PERMIT
r 4
COMMUNITY DEVELOPMENT Permit#: MST2022-00437
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/21/2022
Parcel: 2S108DC05700
Jurisdiction: Tigard
Site address: 15474 SW PEACE AVE
Subdivision: RIVER TERRACE CROSSING Lot: 63
Project: River Terrace Crossing, Lot 63
Project Description: New detached dwelling. NO FINAL INSPECTION UNTIL DEFERRED SDC FEES HAVE BEEN
PAID.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 1258 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 23 Bathrooms: 3 Second: 1614 sf Garage: 440
Units: 1 9 sf Front: 12 Smoke Yes
Dwelling Third: 0 sf Right: 3 Detectors:
Total: 2872 sf Value: $461,528.80 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
FootingDrain: 0 Ice Maker: 1 Bckflw Prevntr: 0
Hose Bib: 2 Backwater Value: 1
Drywall-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
Furn<100K: 0 Vents: 0 Woodstoves: 0
Gas Outlets: 3
Furn>=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,500 sf: 5 201-400 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
Other: N Other Description: Ecompasing: Y
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 (2)layers of 2x fire blocking
131 BEAVERTON,OR 97005 at sides-no eave vents
BEAVERTON,OR 97005 2 Ersn Cntrl 503-639-4175
PHONE: 503-430-7621 PHONE: (503)430-7413
FAX:
Total Fees: $25,740.36
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 you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
oc9An111Mn thrni inh(1CR o9-nni_nnon Vni i mp,i nhtm' d hp nine nr rii rant ni metinne in Cul IM(`.hst Tallinn 5n7 919 10A7 nr 1 An ; 9 Odd
Issued By Permittee Signature:
503.639.4175 by 7:00 a.m.for the next available Inspection dat .
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.
Rk.,.
Building Permit Application 'Checklist
One- and Two-Family Dwelling FOR OFFICE USE ONLY
City of Tigard Received permit No.:
't 13125 SW Hall Blvd.,Tigard,OR 97223 Dated t
a : Phone: 503.718.2439 Fax: 503.598.1960 Associated permits:
TIGAAD 24-Hour Inspection Line: 503.639.4175 0 Electrical ❑ Plumbing ElMechanical
Internet: www.tigard-or.gov 0 Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW l es No NI
I Land use actions completed. See jurisdiction criteria for concurrent reviews. 0 ❑ •
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ❑ 0 0
3 Verification of approved plat/lot. ❑ ❑ ❑
4 Fire district approval required. Name of district: . ❑ ❑ ❑
5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ ❑
6 Sewer permit. 0 ❑ ❑
7 Water district approval. ❑ ❑ ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ 0 0
9 Erosion control ❑plan ❑permit required. Include drainage-way protection,silt fence design and location of catch- ❑ ❑ ❑
basin protection,etc.
10 3 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 III ❑ ❑
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 El ❑ ❑
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, • 0 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- • 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. • ❑ ❑
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- • 0 0
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 • ❑ ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑
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 • ❑ ❑
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. IN ❑ ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required II ❑ ❑
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 ❑
architect licensed in Ore•on and shall be shown to be at tlicable 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". ❑ ❑
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. • ❑ 0
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. • 0 0
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. • ❑ ❑
27 "Drawn to scale"indicates standard architect or engineer scale. • ❑ ❑
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard III ❑ ❑
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, D! ❑ ❑
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, ❑ ❑ •
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.
I:1Building\Permits'BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
' Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Received
DateBy: Permit No.: l,lsnv LL��7h17}-2
• Bone SW Ha18.243l Blvd.' Fgax:r 'OR 503. 9722NtUtlVE , Plan Review ,J ®VtTO W l f
�' Phone: 503.718.2439 Fax: 503.598.19 (Nher Pemtit:
DateBy:
T 1 G A R D Inspection Line: 503.639.4175 Date Ready/By: Jeffs: RI See Page 2 for
Internet: www.tigard-or.gov NOV qnr Notified/Method: Supplemental Information
TYPE OF WOIIKiIY O(- iIGAHLI COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
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:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
• I-and 2-family dwelling ❑ Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family 0 Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION �� F.. Heating/cooling:
( " �" ' Air conditioning 46.75
Job site address: 15474 SW PEACE AVE Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: Tigard / OR / 97224 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 1 61.06
Suite/bldg./apt.no.: Project name: River Terrace Crossing Lot 63 Ductwork 1 23.32
Cross street/directions to job site: Hydronic 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 Crossing Lotno.: 63 Other: 23.32
Other fuel appliances:
Tax map/parcel no.: 2 S108 DC05700 Water heater 1 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
' Flue vent for water heater or gas
Single Family Detached Dwelling fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Il PROPERTY OWNER ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: ICHIJO USA CO., LTD. Rangehood/otherkitchen
equipment 1 33.39
Address: 3800 SW Cedar Hills Blvd. Ste. 131 Clothes dryer exhaust 1 33.39
City/State/ZIP: Beaverton/OR/97005 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 5 23.32
Phone:(503) Fax:(503) 430-7621Attic/crawlspace fans 23.32
mi 430-7413 p
APPLICANT 0 CONTACT PERSON Other: 23.32
Fuel piping:
Business name: ICHIJO USA CO., LTD. _ $14.15 for first four;$4.03 for each additional
Contact name: Naoki Yamaoka Furnace,etc.
heatump
Address: 3800 SW Cedar Hills Blvd Ste. 131 Cmsp
Wal]/sussuspendeded unit heater
City/State/ZIP: Beaverton / OR / 97005 Water heater 1
Phone:(503)430-7413 Fax: :(503)430-7621 Fireplace
Range 1
E-mail: nao@ichijousa.com ichijousa.com Barbecue 1
CONTRACTOR Clothes dryer(gas)
Business name: Supreme Heating and Cooling LLC Other:
MECHANICAL PERMIT FEES*
Address: 13009 NE 91ST Circle Subtotal
City/State/ZIP: Vancouver, WA 98682 Minimum permit fee($90.00)
Phone:(503)333-3213 Fax:( ) Plan review(25°�/eofpermitfee)
State surcharge(I2/o of permit fee) I
CCB lic.: 221270 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within ISO
days after it has been accepted as complete.
Authorized signature: //11 " Fee methodology set by Tri-County Building Industry Service Board
Print name: Naoki Yamaoka Date: 11/1/2022
F\Building\Permits1MEC_PermstApp 040113.doc 440-46171'(11/02/COM/WEB)
r ,
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
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.
Note: All new commercial buildings require 2 sets of plans.
I:1BuildinglPermits NEC_PermitApp_040113.doc 2
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined: S75.00 Description I Qty. I Each reel
Renewable Renn ewwable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
(� Wind generation systems in excess of 25 kva:
I I 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
with OAR 918-309-0040) 552.26 2
❑ 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:
n Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90 00/hr
specifically listed(1/2hr min)
v ^� ELECTRICAL PERMIT FEES
COMMERCIAL WORK ONLY: tit, L_
Fee for each commercial system: $75.00 Subtotal(Enter on Page I):
y * 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
L\Building\Permits'ELC_PemutApp_ELR ERE.doc Rev 06/17/2015
' ',Plumbing Permit Application
Building Fixtures FOR OFFICE USE ONLY
City ofTi and RECEIVFIte/ t6a al43
- `1 Tigard PermitNo.: M�
III • 13125 SW Hall Blvd.,Tigard,OR 97223 f ' 7
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.:
Inspection Line: 503.639.4175 )�'
TIGARD '- •' Date Ready/By: Ions: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK lJl I I Ur- l IUHtSU FEE* SCHEDULE
R(in IlUU\,l( nnii I(1R!
•New construction ❑Demolition For special information use checklist.
Description I 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(1)bath 312.70
•1-and 2-family dwelling IDCommercial/industrial SFR(2)bath 437.78
buildingSFR(3)bath 1 500.32
❑Accessory 0 Multi-family
Each additional bath/kitchen 25.02
❑ Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 15474 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.:_) Paget
Suite/bldg./apt.no.: I Project name: River Terrace Crossing Lot 63 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.: 63 Fixture or item:
Tax map/parcel no.: 2S 108 D C05700 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
I. PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: ICHIJO USA CO., LTD. Fixture/sewer cap 25.02
Floor Address: 3800 SW Cedar Hills Blvd. Ste. 131 Garbage
rsinkhub 25.02
Garbage 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:$ ) Page 2
Contact name: Naoki Yamaoka Primer 12.51
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 Solarunits(potablewater) 62.54
•
Phone:(503)430-7413 Fax: :(503)430-7621 Tub/shower/shower pan 4 12.51
Urinal 25.02
E-mail: nao@ichijousa.com
- Water closet 3 25.02
CONTRACTOR
Water heater 1 37.52
Business name: Pipe It Plumbing LLC. WaterpipinglDWV 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
Plan review (25%of permit fee)
CCBLic.: 174351 Plumbing Lic.no.: PB297
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Naoki o k i a m a o ka 11/1/2022 This permit application expires if a permit is not obtained within 180 days
Print name: Date: after it has been accepted as complete.
Fee methodology set by Tri-County Building Industry Service Board.
I/Building\Pennus\PL.MU-PemtilApp.doc 10/01/09 440-4616T(10/02/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 j $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' 62.54 7,201 and greater $327.54
•
Sewer-each additional 100' 37.52
•
Water Service-Iet 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 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
Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
ll 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 ❑ New exterior plumbing site utilities for any complex structure
Drive Th u as defined in OAR918-780-0040.
CICuspidor/Water Aspirator Medical gas and vacuum systems for health care facilities.
Dishwasher: -Commercialrator El Any multipurpose fire sprinkler system.
Domestic El 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 RiserDiagram
❑ 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 Comments regarding fixture work:
Ice Mach./Refrig.Drains g g
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -IavBar 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:
I:1Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
City of Tigard
INl:
" COMMUNITY DEVELOPMENT DEPARTMENT
Building Permit Review - Residential
TIGARD
0.
Building Permit #: MSV'2022--CD1-1:17
Site Address: 1 54111 5 W QC4Ce Av XyVerified in Accela
Project Name: ILiJt( L�'' CArK6( l Lot/Unit #: (p�
Proposal (include housing type): cr-VOI 1 S'TY1 Zone: P-rs-C
Required Site Plan Elements: U
' copies of site plan on max 11x17"
Drawn to standard scale 1❑-Retaii ed-trees, drip line/tree protection
North arrow
.Street and site trees shown / labeled
Site address, project name, lot # btE c Tculating tree canopy at maturity
.Street names (N/A for SFR)
,KApplicant name and phone # rd rectangle dimensioned (if applicable)
g Lot and setback dimensions Vision clearance triangle
❑ Existing structures &square footage )Utility locations &easements
,✓I Footprint of new structure and FFE Property corner elevations
XI Sidewalk/driveway dimensioned Pf LIDA (>1,000 sf disturbance)
,PJ Lot area and lot coverage percentage /Erosion control
Required Elevation Plan Elements:
(For SFR: calcs needed only on street-facing) Garage doors dimensioned
,uf Drawn to standard scale Summary table with calculations for:
y- EfBuilding height dimensioned Total facade area
,I2'Fagade dimensioned ZrTotal window and door area
Windows and doors dimensioned gfotal garage area
Required Floor Plan Elements: ummary table that includes
,24ach story dimensioned Jotal floor area
rkKEach story floor area calculated Floor area per story
Planning Review
The following standards have been met:
Setbacks -Front: la" Rear: t72 Side: 3 Min/Max Street Side: /5 / - Garage: Zo
Height 'Max. Height: N4 Proposed Height: 23�
P'Yes 0 N/A Landscape
❑ Yes PI/N/A Screening (Quad only)
,"Yes ❑ N/A % Window Coverage 15,2 %,
g'Yes ❑ N/A Garage (SFR Only)
Parking (Other Res)
yJ Yes ❑ N/A Entrance (SFR, Rowhouse, Quad only)
❑ Yes la N/A Other building design standards (Rowhouse only)
❑ Yes jZ'N/A Accessory Structure Standards
❑ Yes Qf No Qualifying pre-existing unit exempt from standards (Cottage unit only)
Additional standar for Courtyard Units, Cottage Clusters, Rowhouses, and Quads:
0 0 N/A Count:
❑ Yes N/ Lot Width and Size
❑ Yes ❑ A Pathway
Addi ' nal andards for Courtyard Units and Cottage Clusters only:
❑ s ❑ N/A nit Area:
Yes 0 N/A F r Area (per story)
❑ Yes ❑ N/A Cou and
❑ Yes 0 N/A Fence
L.
❑ Yes ❑ NoV/A Clean Water Services - Service Provider Letter (lot platted prior to 9/10/1995)
❑ Yes ❑ No pig/A Public Facilities Improvement (PFI) Permit:
Required: ❑ Yes ❑ No
Applied For: ❑ Yes ❑JVo, stop intake
Z.-Sensitive Lands: ❑ Yes kr No pn
,e-Land Use Case #: C /9--2071b'&001(0 r 1 DV-7J - OcoOS /Conditions met prior permit issuance
Approved By Planning:
Date: If l I it
Notes Date:
Revision 1: 0 Approved 0 Not Approved
Revision 2: 0 Approved 0 Not Approved Date:
Building Permit Submittal
Original Submittal Date: 11 / 17Z
Site Plans #:
Building Plans #:
Building Permit #: ,ilding permit # entered on 1
Workflow Routing: annin Engineering Permit Coordinator ❑ Building
Workflow Sign-off: in-off for Planning (include notes from planning review)
Route Documents: ngineering: (1) copy of permit application, (1) site plan, (1) building plan
and original plan review routing form.
rni Building: original permit application, site plans, building plans, engineer and
beam calculations and trust details, if applicable, etc.
Permit Technician: i
Date: ///01/02-
En9ineering Review /
� 9 h ' a ��
/g Yd'Conditionslopet metbuilding priorpad:to issuance of permit
cements (encroachments) per engineering conditions of approval and plat
ater Quality/Quantity Facility: 1
Assess Water Quality Fee in-lieu: ❑ Yes t,_y/,�(vo
Assess Water Quantity Fee in-lieu: ❑ Yes I�'No
LIDA Facility on lot: ❑ Yes 144.io Add Fee: ❑ Yes 0 No
'Final Plat Recorded
❑ NOT Approved: Date:
Notes:
Approved By Engineering: Date: /l/2i/Z2
Revision 1: ❑ Approved ❑ D of Approved Date:
Revision 2: ❑ Approved ❑ Not Approved Date:
Permit Coordinator Review
gonditions met prior to permit issuance
Approved, NOT Released: A1- Date notified applicant: 11 f Z 2A2-Z
❑ ENG Revisions Required: Date notified applicant:
/SDC Exemption: 0 Applied for ❑ Received 7 Does not apply
SDC Fees Entered: Wash Co Trans Dev Tax: KlYes El N/A
Tigard Trans SDC: J2'Yes 0 N/A /Deferred
Parks SDC: /Yes ❑�, N/A /Deferred
LIDA ❑ Yes /N/A
/OK to Issue/Approved by Permit Coordinator: � Date: II[117I2.0ZZ/
Revision 1: 0 Approved El Not Approved Date:
Revision 2: 0 Approved ❑ Not Approved Date: