Permit City of Tigard
Deferral Until Occupancy Request
Washington County Transportation Development Tax (IDT),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: 11114/2022 Site Address: 15149 SW Deepbrook Ln
Project River Terrace Crossing Land Use Case or
Name: (Ichijo) Building Permit#: MST2022-00462
Tax Lot 2S108DC03400 Total Parks $11,830.00
#: Lot 37 Amount*:
TDT NIA Total TSDC
Amount: Amount*: $12,004.00
*The total TSDC amount shown above is the sum of$7.760.00 for TSDC-Improvement,$448.00 for TSDC-
Reimbursement, and$moa nn 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&0 for Parks-
Reimbursement,and either$ NIA 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: . a Date: 11/16/2022
Developer: Date: 11/16/2022
Permit Coordinator: A~/A (iAMP.0 b Dais: 1111412022
1
+ Building Permit Application /1004:71r 41r)
' Residential �C�CI` f�
C EP V Date/By:
/,�t57� —/ice r /6/)
City of Tigard Da"ive PermitNo. fv` /�YVII� �y
i 13125 SW Hall Blvd.,Tigard,OR 97223 f
111111 a_ NOVlrtnr' Plan Review tr ) Other Peanit Kzon_60 ZGq
Phone: 503.718.2439 Fax: 503.598.1960 ,�V � � fey DateBy: l w
C1C;ARD Inspection Line: 503.639.4175 T f� Date Ready/By Juris: l See Page 2 for
Internet: wwwtigard-orgov ::i T✓OF l .A [. Notified/Method: Supplemental Information
t
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING �•New construction D 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 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application. !o
1-and 2-family dwelling ElCommercial/industrial
Valuation: $ 71(e3 93)
❑Accessory building El Multi-familyNumber of bedrooms: 4
❑Master builder ElOther:
Number of bathrooms: 3
JOB SITE INFORMATION AND LOCATION Total number of floors: 2 T12>)
Job site address: 15149 SW D E E P B R OO K LN New dwelling area: 2872 square feet ot%
City/State/ZIP: Tigard / OR / 97224 Garage/carport area: 440 square feet t DS
Suite/bldg./apt.no.: Project name:River Terrace Crossing Lot 37 Covered porch area: 64 square feet
Cross street/directions to job site: Deck area: B *quare feet
Otl er struc ve rea: ati9 ivare feet
RE W„,WA:COMMERCIAL-USE CHECKLIST
Subdivision: River Terrace Crossing Lot no.: 37 Permit fees*are based on the value of the work performed.
Tax map/parcel no.: 2S108DC03400 Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Single Family Detached Dwelling Valuation: $
Existing building area: square feet
Request the Transportation and Parks SDCs to be deferred to occupancy New building area: square feet
1111 PROPERTY OWNER ❑ TENANT Number of stories:
Name: ICHIJO USA CO., LTD. Type of construction:
Address: 3800 SW Cedar Hills Blvd. Ste. 131 Occupancy groups:
City/State/ZIP: Beaverton/OR/97005 Existing:
Phone:(503)430-7413 Fax:(503)430-7621 New:
II APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business name: ICHIJO USA CO., LTD. (Please refer rn fee schedule)
Contact name:
Naoki Yamaoka Structural plan review fee(or deposit):
FLS plan review fee(if applicable):
Address: 3800 SW Cedar Hills Blvd. Ste. 131
Total fees due upon application:
City/State/ZIP: Beaverton/OR/97005
Phone:(503)430-7413 Fax: :(503)430-7621 Amount received:
E-mail: nao@ichijousa.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: ICHIJO USA CO., LTD. Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: 3800 SW Cedar Hills Blvd. Ste. 131 Solar Installation Specialty Code checklist.
City/State/ZIP: Beaverton/OR/97005 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:(503)430-7413 Fax:(503)430-7621 State surcharge(12%of permit fee): $21.60
CCB lie.: 215360 Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Naoki Yamaoka Date: 11/10/2022 *Fee methodology set by Tri-County Building Industry
Service Board.
C\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(I1/02/COM/WEB)
r—
i ,r "1., i
Building Permit Application Checklist ,
One- and Two-Family Dwelling FOR OFFICE USE ONLY
Received
City of Tigard Date/By:
No.:
a 13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits:
C- - Phone: 503.718.2439 Fax: 503.598.1960
24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical
TICARll Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes NO NI.\
I Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ D
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 0 0
3 Verification of approved plat/lot. 0 0 0
4 Fire district approval required. Name of district: . 0 0 0
5 Septic system permit or authorization for remodel. Existing system capacity CI 0
6 Sewer permit. 0 0 0
7 Water district approval. ❑ 0 0
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ 0
9 Erosion control ❑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 El 0 ❑
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 I♦ 0 ❑
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, • 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. I ❑ ❑
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- • ❑ ❑
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 U ❑ ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ 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 II ❑ ❑
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. U ❑ 0
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required El ❑ 0
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 U ❑ 0
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". • ❑ ❑
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. U ❑ 0
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. I ❑ 0
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. III ❑ ❑
27 "Drawn to scale"indicates standard architect or engineer scale. • 0 0
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard U 0 El
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, II ❑ ❑
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, 0 0 •
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:\Building\Permits\BUP-RESPennitApp.doc 02/24/2011 440-4613T(I I/02/COM/WEB)
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: Description FEE SCHEDULE Each
Total
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
5 kva or less 100.70 2
Check Type of Work Involved:
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:
❑ 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)
n 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(.hr min)
COMMERCIAL WORK ONLY: 4F ELECTRICAL PERMIT FEES
Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 • Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:U3uilding\Permits\ELC_PernntApp_ELR ERE.doe Rev 06/17/2015
MN
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-l''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 $233.20
Sewer-let 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: 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
Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
Other Inspections 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
each additional$100.00 or fraction thereof
(minimum charge-1/2 hour)
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 ❑ New exterior plumbing site utilities for any complex structure
Car Wash. -Each Stall as defined in OAR918-780-0040.
-Drive Thru ❑ Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator ❑ Any multipurpose fire sprinkler system.
Dishwasher: -Commercial
❑ Any complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2"
3„ Isometric or Riser Diagram
❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -LavBar 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 plumbing permit can be issued.
Water Closet-Toilet
Urinal
Other Fixtures:
I:\Building\Permits\PLMF-PermitApp.doc 08/04/2011 2
City of Tigard
" COMMUNITY DEVELOPMENT DEPARTMENT
s .
Building Permit Review - Residential
TIGARD
Building Permit #: V SI; C7rf4fct
Site Address: !c-)4 < �w `Dt '$R L) ❑ Verified in Accela
Project Name: 21t15T._ 'VICRI2ACC cQ `&SKL-1 Lot/Unit #: S7
Proposal (include housing type): kl)r;"L AIN-FM tn1ceNT1Al- cr— Zone: C
Req ' ed Site Plan Elements:
3 co pits of site plan on max 11x17"
I}rawn to standard scale , , �r � prutc on
h arrow LW-Street eett and site trees shown / labeled
ite address, project name, lot # {] Tv` etrhatii,g tree--c-anopyat-maturity
eet names (N/A for SFR)
icant name and phone #
Ircr and setback dimensions Q V r�lea u, e� h ianyl
q'E�cisting structures & square footage .,0'U ' ocations & easements
���Fc�tprint of new structure and FFE roper rner elevations
alk/driveway dimensioned -L 4,QOO-sf-clistur-bance)
'WC° area and lot coverage percentage Erosion control
Required levation Plan Elements:
(For SF calcs needed only on street-facing) Garage doors dimensioned
zwn to standard scale Su ary table with calculations for:
4Xf>ding height dimensioned e Tgtal facade area
F ade dimensionedf al window and door area
Windows and doors dimensioned otal garage area
Requir loor Plan Elements: Gli.rtcrnary table that includes
story dimensioned floor area
ach story floor area calculated Floor area per story
Planning Review
The following standards have been met:
Setbacks ❑ Front: 't Rear: /0 Side: Min/Max Street Side: -t / /fij" Garage: 00
di
Hei t I: Max. Height: 3� Proposed Height: Zr.a
Yes ❑ Landscape
El Y N/A Screening (Quad only)
Y N/A % Window Coverage
tW-Yes ❑ N/A Garage (SFR Only)
Parking (Other Res)
Yes ❑ N/A Entrance (SFR, Rowhouse, Quad only)
❑ Yes ❑ N/A Other building design standards (Rowhouse only)
❑ Yes ❑ N/A 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:
El Yes ❑ N/A Floor Area (per story)
❑ Yes Q N/A Courtyard
❑ Yes 0 N/A Fence
❑ Yes ❑ No 1;1N/ Clean Water Services - Service Provider Letter (lot platted prior to 9/10/1995)
❑ Yes ❑ Noj/A Public Facilities Improvement (PFI) Permit:
Required: ❑ Yes ❑ No
hApplied For: 0 Yes ❑ NN stop intake�� 6/
ive Lands: ❑ Yes S'No
and Use Case #: ?-01- / ❑ Conditions met prior permit issuance
d��� O /ZZ
Approved By Planning: --- .L✓ Date: ii/�
Notes v
Revision 1: 0 Approved ❑ Not Approved Date:
Revision 2: 0 Approved 0 Not Approved Date:
Building Permit Submittal
Original Submittal Date: 11/1� 2022
Site Plans #: 3
Building Plans #: 3
Building Permit #: wilding permit # entered on page 1
Workflow Routing: 51/Kanning 1Geigineering .8'15-ermit Coordinator Ja'Building
Workflow Sign-off: ign-off for Planning (include notes from planning review)
Route Documents: gEEngineering: (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: ii ( Ib I ZaV2-
Notes: 7
En ineering Review
i
Slope at building pad: fr-Ye %
/4-f onditions met prior to issuance of permit
Easements (encroachments) per engineering conditions of approval and plat
Id'tNater Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: 0 Yes lklo
Assess Water Quantity Fee in-lieu: ❑ Yes ®'No
LIDA Facility on lot: 0 Yes &o Add Fee: 0 Yes ❑ No
Final Plat Recorded
❑ NOT Approved: Date:
Notes: /,
Approved By Engineering: Date: /1//0--2
Revision 1: ❑ Approved ❑ of Approved Date:
Revision 2: ❑ Approved ❑ Not Approved Date:
Permit Coordinator Review
ri Conditions met prior to permit issuance
❑ Approved, NOT Released: Date notified applicant:
❑ ENG Revisions Required: Date notified applicant:
OISIDC Exemption: ❑ Applied for ❑ Received ❑ Does not apply
lySDC Fees Entered: Wash Co Trans Dev Tax: Yes 0 N/A
ll Tigard Trans SDC: Yes ❑ N/A lil Deferred
Parks SDC: Yes ❑ N/A ❑ Deferred
LIDA ❑ Yes y N/A
d4OK to Issue/Approved by Permit Coordinator: Pb`\ Date: t - 7/- .,2"2
Revision 1: ❑ Approved ❑ Not Approved Date: J
Revision 2: 0 Approved 0 Not Approved Date: