Permit City of Tigard
. ' Deferral Until Occupancy Request
T IGARD Washington County Transportation Development Tax (101),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: 15194 SW Coolwater Lane
Project River Terrace Crossing Land Use Case or
Name: (Ichijo) Building Permit#: MST2022-00455
Tax Lot 2S108DC04300 Total Parks $11,830.00
#: Lot 46 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$3,7g6.00 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 1DT 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'g1A- Date: 11/16/2022
�� .211/16/2022
Developer: Date:
Permit Coordinator: [!/ l�U 0eA Date: 11/14/2022
CITY OF TIGARD MASTER PERMIT
IIII
2 COMMUNITY DEVELOPMENT Permit#: MST2022-00455
T t GA.R.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/29/2022
Parcel: 2S108DC04300
Jurisdiction: Tigard
Site address: 15194 SW COOLWATER LN
Subdivision: RIVER TERRACE CROSSING Lot: 46
Project: River Terrace Crossing, Lot 46
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: 30 Bathrooms: 4 Second: 1470 sf Garage: 440
g sf Front: 8 Smoke
Dwelling Units: 1 Third: 0 sf Right: 3 Detectors: Yes
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
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 BckFlw Prevntr: 0
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
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
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: 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/volC 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo, N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Other, N Y
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 Ersn Cntrl 503-639-4175
131 BEAVERTON,OR 97005 2 Geo Tech Required
BEAVERTON,OR 97005 3 (2)layers of 2x fire blocking
as indicated on plan
PHONE: 503-430-7413 PHONE: (503)430-7413
FAX:
Total Fees: $27,012.07
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: Ore n law requires to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
oc rirH-nrNn thrni inh(1AR QS 1_nn nu mm ain,rnn of the n,Ipc nr rlirprt n„nctinne fn fir my,by Tallinn Fn1 919 1QA 1 Ann T197'444]////n . / •
Issued By: Permittee Signature: Lyi'—a/OLL Gal`
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.
• Plumbing Permit Application
' Building Fixtures s• FOR OFFICE USE ONLY
City of Tigard �� Received Penni[ o. V
4 13125 SW Hall Blvd.,Tigard,OR 97223 `' 2�2� Date/By: d L),'�1�" T`` 5�
Phone: 503.718.2439 Fax: 503.598.1960 P4 tl L L Plan Review Other Permit No.:
Date/By:
Inspection Line: 503.639.4175 I l a O f TIGAR ate Read
Ti G A R D (�++ yBy: rods: ® See Page 2 for
Internet www.tigard-or.gov H ified/Method: Supplemental Information
TYPE OF WORK k31:111�}IN13131VIS1 FEE* SCUEDULE
1.1 New construction 0 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 ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 1 500.32
❑Accessory building ❑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: 15194 SW COO L W AT E R 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.:_) Page 2
S»ite/bldg./apt.no.: I Project name: River Terrace Crossing Lot 46 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 Lot no.: 46 Fixture or item:
Tax map/parcel no.: 2 S 108 D C 043 00 Backflow preventer 31.27
DESCRIPTION OF WORK * Backwater valve 12.51
tt. '<
Clothes washer 1 25.02
Single Family Detached Dwelling Dishwasher 1 25.02
Drinking fountain 25.02
Ejectors/sump 1 25.02
IIIIIPROPERTY OWNER ID TENANT Expansiontank 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
U APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: ICHIJO USA CO., LTD. Medical gas(value:$ ) Paget
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
--- -- - Water closet
CONTRACTOR 25.02
Water heater 1 37.52
Business name: Pipe It Plumbing LLC. Water i in p p g/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 Lie.: 174351 Plumbing Lie.no.: P B297 Plan review (25%of permit fee)
State surcharge(12°/u of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name: N a o kl a m a o ka 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:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
City of Tigard
14 COMMUNITY DEVELOPMENT DEPARTMENT
Building Permit Review - Residential
TIGARD
Building Permit #: MST' ZO2Z o ySs
Site Address: 11-I6)9 LA) ,, oDL- A-1 LA) ❑ Verified in Accela
Project Name: 2)V'C''�.�c- -i2AC ' I Nt Lot/Unit #: ziki
Proposal (include housing type): /461U SMALL fW,-1 -Re Sl own AL u!r Zone: 1.7S
Requ red Site Plan Elements:
3 co i s of site plan on max 11x17"
Dawn to standard scale ' n
pldrth arrow treet and site trees shown / labeled
life-address, project name, lot # ri Table calculating tr e r nop y3*›treet names (N/A for SFR)
Dr Pj,pplicant name and phone #
of and setback dimensions '
rg =*u'et..res'k cquar footage ■'O Uity locations & easements
rint of new structure and FFE Property corner elevations
S' OW
'Property
dimensioned 0 LI K(>1,000 .sf di,;turbancc}
Lot area and lot coverage percentage rosion control
Required Elevation Plan Elements:
(For SF talcs needed only on street-facing) Garage doors dimensioned
wn to standard scale Su 1ary table with calculations for:
of B g height dimensioned lef I al facade area
❑'F ade dimensioned I window and door area
Windows and doors dimensioned B'Total garage area
Requir loor Plan Elements: ❑ SJammary table that includes
ch story dimensioned 'Iota! floor area
Each story floor area calculated ❑ Floor area per story
Planning Review
The following standards have been met: �/�
Setbacks 0 Front: I Rear: /J cc Side: 5 Min/Max Street Side: 7 I /"' Garage: 2-'0
Height Max. Height: 3S Proposed Height: 170t'
❑ Yes Landscape
❑ s )/A Screening (Quad only)
/A % Window Coverage
Yes ❑ N/A Garage (SFR Only)
Parking (Other Res)
1;14-171 Entrance (SFR, Rowhouse, Quad only)
O Yes Other building design standards (Rowhouse only)
O Yes Accessory Structure Standards
O Yes No Qualifying pre-existing unit exempt from standards (Cottage unit only)
Additional standards for Courtyard Units, Cottage Clusters, Rowhouses, and Quads:
O 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
17 Yes N/A Fence
❑ Yes ❑ No �CIN Clean Water Services - Service Provider Letter (lot platted prior to 9/10/1995)
❑ Yes ❑ No BN-/A Public Facilities Improvement (PFI) Permit:
Required: ❑ Yes ❑ No
Applied For: ❑ Yes ❑ No, stop intake
ensitive Lands: ❑ Yes
❑ Land Use Case #: g t a05 ❑ itions met prior permit issuance
Approved By Planning: Date: /1 /9/L2
Notes fi N i21V cro Sus lb f an-
Revision 1: ❑ Approved 0 Not Approved Date:
Revision 2: ❑ Approved ❑ Not Approved Date:
Building Permit Submittal
Original Submittal Date:
Site Plans #:
Building Plans #:
Building Permit #: ❑ Building permit # entered on page 1
Workflow Routing: ❑ Planning ❑ Engineering ❑ Permit Coordinator ❑ Building
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:
Notes:
En ineering Review
Slope at building pad: ZOf
4/f/4 &Conditions met prior to issuance of permit
&Easements (encroachments) per engineering conditions of approval and plat
IP6Vater Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes -1Vo
Assess Water Quantity Fee in-lieu: ❑ Yes o
� LIDA Facility on lot: ❑ Yes No Add Fee: ❑ Yes ❑ No
final Plat Recorded
❑ NOT Approved: Date:
Notes:
Approved By Engineering: / "[ Not Approved Date: /l/IO/ZZ
Revision 1: ❑ Approv Date:
Revision 2: ❑ 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:
SDC Exemption: ❑ Applied for ❑ Received ❑ Does not apply
6igSDC Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A
Tigard Trans SDC: Yes ❑ N/A Deferred
Parks SDC: Yes ❑ N/A Deferred
LIDA ❑ Yes W\J/A
❑ OK to Issue/Approved by Permit Coordinator: Qb\\C r ' . Date: k '" v ✓
Revision 1: ❑ Approved ❑ Not Approved Date:
Revision 2: 0 Approved 0 Not Approved Date: