Permit (16) CITY OF TIGARD MASTER PERMIT
11 2.*
COMMUNITY DEVELOPMENT Permit#: MST2023-00255
TIGA.RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/20/2023
Parcel: 2S108DC16300
Jurisdiction: Tigard
Site address: 15144 SW DEEPBROOK LN
Subdivision: RIVER TERRACE CROSSING Lot: 28
Project: River Terrace Crossing, Lot 28
Project Description: New detached dwelling. NO FINAL INSPECTION UNTIL DEFERRED SDC FEES HAVE BEEN
PAID.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 5 First: 1040 sf Basement: 1015
sf Left: 3 Parking Spaces: 0
Height: 22 Bathrooms: 4 Second: 1663 sf Garage: 590
g sf Front: 12 Smoke
Dwelling Units: 1 Third: 0 sf Right: 3 Detectors: Yes
Total: 3718 sf Value: $606,672.00 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: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
FootingDrain: 0 Ice Maker: 1 Bckflw Prevntr: 1
Hose Bib: 2 Backwater Value: 1
Drywell-Trench Drain: 0 Other Fixtures: 1
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: 1
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'I 500 sf: 7 201-400 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 3718
Owner: Contractor:
PACIFIC LIFESTYLE HOMES INC PACIFIC LIFESTYLE HOMES Required Items and Reports(Conditions)
11815 NE 99TH ST#1200 11815 NE 99TH ST#1200 1 Ersn Cntrl 503-639-4175
VANCOUVER,WA 98686 VANCOUVER,WA 98682 2 Geo Tech Required
PHONE: PHONE: 360-213-0813
FAX: 360-574-6401
Total Fees: $29,916.98
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
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Issued By: / Permittee Signature: -----N: —
03.639.4175 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.
Building Permit Application
Residential RECEIVE
City of Tigard RD t/By: t, its., a-3 ms rOoa3-003155"
Date/By: ertnit No.:
- " 13125 SW Hall Blvd.,Tigard,OR 97223 J U N 8 2023 plan Review I- J
Phone: 503.718.2439 Fax: 503.598.1960 DateBy: l( 1s7/j'2, cd-Permit Sw 033-ool5r
TIGARD
Inspection Line: 503.639.4175 Date Ready/Bykris: ® See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method:.41 $' •A v --rze. Supplemental Information
BUILDING DIVISION t
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
®New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
0 Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
•
CATEGORY OF CONSTRUCTION work indicated on this application. // �
® 1-and 2-family dwelling ❑Commercial/industrial Valuation: i$3110',1100:00., `Q/ ��
❑Accessory building ❑Multi-family Number of bedrooms: 5
❑Master builder ❑Other: Number of bathrooms: l{
JOB SITE INFORMATION AND LOCATION Total number of floors: 2 and a finished basement 4 V
Job site address: 15144 SW Deepbrook LN New dwelling area: 3718 square feet 1(jl, 3
City/State/ZIP: Tigard,OR 97224 Garage/carport area: 590 square feet I09 0
Suite/bldg./apt.no.: Project name:River Terrace Crossing Covered�p/orc/h aarea: 47 square feet I d(1 S
Cross street/directions to job site: C end PJu�c �raeV. 159 square feet
Cn�rr5aj - 159 square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision:River Terrace Crossing I Lot no.:28 Permit fees*are based on the value of the work performed.
Tax map/parcel no.:25108DCO2700 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.
New SFR Valuation: $
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name:Pacific Lifestyle Homes Type of construction:
Address:11815 NE 99th Street,Suite 1200 Occupancy groups:
City/State/ZIP:Vancouver,WA 98682 Existing:
Phone:(360)213-0809 Fax:( ) New:
® APPLICANT E* CONTACT PERSON BUILDING PERMIT FEES*
Business name:Pacific Lifestyle Homes (Please rejerrofee schedule)
Structural plan review fee(or deposit):
Contact name:Permit Coordinator-Kellie Franklin
FLS plan review fee(if applicable):
Address: 11815 NE 99th Street,Suite 1200
Total fees due upon application:
City/State/ZIP:Vancouver,WA 98682
Amount received:
Phone:(360)213-0809 Fax::( )
E-mail:permits@buildplh.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES"
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVollaic Solar Panel System.
Business name:Same Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:Same Solar Installation Specialty Code checklist.
CiTy/State/ZIP:Same Permit Fee-(includes plan review $180.00
and administrative fees):
Phone:( ) Fax:( )
State surcharge(12%of permit fee): $21.60
CCB lic.:173524 / Total fee due upon application: $201.60
Authorized signature: A:211.zi, This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Kellie Franklin Date:6/6/2023 *Fee methodology set by Tri-County Building Industry
Service Board_
'Mudding\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
1
i Mechanical Permit Application FOR OFFICE USE.O\I.Y
City of Tigard Received
• 13125 SW Hal]Blvd.,Tigard,OR 97 Plate/By. VA'l� f`'
Phone: 503.718.2439 Fax: 503.598.E C i U' .t Plan Review
Date/By: other Permit.
-I-I(r.1 1-:[l Inspection Line: 503 639 4175 Date Ready/By: Jan: g See Page 2 for
Internet: www.tigard-or.gov 1 U N 8 2023 Notified/Method: Supplemental Information
TYPE OF WO IV OF TIGARD COMMERCIAL FEE" SCHEDULE —IJSE CHECKLIST
I '1ip /iSiON Mechanical permit fees"are based on the value of the work
El New construction ❑Addition/alter�i{'Y1,IC performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
• ® 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family 0 Master builder ❑Other: Description I Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
• Air conditioning 46.75
Job site address: 15144 SW Deepbrook LN 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 61.06
Suite/bldg./apt.no.: Project name:River Terrace Crossing Duct work 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 Lot no.:28
Other: 23.32
Other fuel appliances:
Tax map/parcel no.:2S10RDCO2700 Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
New SFR fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
ElPROPERTY OWNER 0 TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: Pacific Lifestyle Homes Range hood/other kitchen
equipment 1 33.39 33.39
Address: 11815 NE 99th Street,Suite 1200 Clothes dryer exhaust 33.39 333,
City/State/ZIP:Vancouver,WA 98682 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 6 23.32 139.92
h P one:(360)213-0809 Fax:( ) Attidcrawlspace fans 23.32
® APPLICANT ® CONTACT PERSON Other: 23.32
Fuel piping:
Business name:Pacific Lifestyle Homes
$14.15 for first four;54.03 for ea additional
Contact name:Permit Coordinator-Kellie Franklin Furnace,etc.
Address: 11815 NE 99th Street,Suite 1200 Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Vancouver,WA 98682 Water heater
Phone:(360)213-0809 Fax::( )
Fireplace
Range 1
E-mail:permits@buildplh.com Barbecue
CONTRACTOR Clothes dryer(gas) _
Business name:Wolcott HVAC Other:
MECHANICAL PERMIT FEES*
Address:1075 West Historic Columbia River HWY Subtotal
City/State/ZIP:Troutdale,OR 97060 Minimum permit fee($90.00)
Phone:(503)667-1781 Fax:( ) Plan review(25%of permit fee)
State surcharge(12%of permit fee)
CCB lic.:141eRt `1 t ,1.n TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within ISO
tz j days after it has been accepted g as complete.
Authorized signature: X. Fee methodology set by Tri-County Building Industry Service Board
Print name: Kellie Franklin Date:6/6/2023
I:\Building\Pennits\MEC_PormilApp_040113.doe 440-46177(11/0M/COM/WEB)
r
do
Electrical Permit Application FOR OFFICE I SI.O'vI.Y
City of TigardReceived
Plan L�w '
• 13125 SW Hall Blvd.,Tigard,OR 9 CEIVE Da :
Plan Review
III I Phone: 503.718.2439 Fax: 503.59 1 Date/B : Related Permit✓♦.
Inspection Line: 503.639.4175 �� Ready Date/By: rwms. H See Page 2 for
TIGARD Internet: www.tigard-orgov JUN 8 2023 Notified/MeNotified/Method: Supplemental Information
TYPE OF WORK �t- PLAN REVIEW
El New construction ❑Addition/alterataktrtV pta RnTI tGARD Please check all that apply(submit 72 sets of plans w/items checked):
VISION
❑Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
El 1-and 2-family dwelling El Commercial/industrial ❑Accessory building less to ground or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑ Multi-family ❑Master builder ❑Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
0 Addition of new motor load of system.
Job#: Job site address:15144 SW Dee brook LN tl0HP
p OOHP or more. ❑"A" "E' "1 2" "1-3"
Cit /State/ZIP:TI ard, OR 97224 ❑Six or more residential units. occupancy.
y 9 ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name:River Terrace Crossing ❑Hazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDI ILE
Description I Qty. I Each I Total I .
New residential single-or multi-family dwelling unit.
Subdivision:River Terrace Crossing Lot#:28 Includes attached garage.
Tax map/parcel#:2S108DCO2700 1,000 sq.ft.or less 4 168.544
Ea.add'l 500 sq.ft.or portion 1 33.92 1
DESCRIPTION OF WORK Limited energy,residential
New SFR (with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
® PROPERTY OWNER ❑ TENANT Renewable Energy 0 See Page 2
Services or feeders installation,alteration,and/or relocation
Namc:Pacific Lifestyle Homes 200 amps or less 100.70 2
Address:11815 NE 99th Street, Suite 1200 201 ampsto400 amps 1 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Vancouver,WA 98682 601 amps to 1,000 amps 301.04 2
Phone:( 360).213-0809 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email:permits@buildplh.com relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 i
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
® APPLICANT ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:Pacific Lifestyle Homes above service or feeder fee, 7.42 2
each branch circuit
Contact name:Kellie Franklin B.Fee for branch circuits without '
iceAddress: 11815 NE 99th Street, Suite 1200 rat feeder fee,first brannchh circuit
56.18 2
b
City/State/ZIP:Vancouver, WA 98682 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(360 )213-0809 Fax: :( ) Each manufactured or modular 67.84 2
Email: ermltS build Ih.eom dwelling,service and/or feeder
p p Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Garner Electric Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ❑ See Page 2 2
Address:2890 SE Brookwood Ave. panel,alteration,or extension.
City/State/ZIP:Hillsboro,OR 97123 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr _
Phone:(503)648-4552 Fax:(503)642-7925 Investigation(1 hr min) 90.00/hr _
Email: permits@garnerelectric.com Industrial plant(I hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: 121159 Electrical Lic: 34-305C Suprv.Lie.: 3707-S specifically listed(ir hr min)
/I/ ELECTRICAL PERMIT FEES
/V6•G Suprv.Electrician signature,required: yL Subtotal:
Print name: Charles Garner Date:6/6/2023 ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee)
Authorized signature: , �y TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Brittany Burian Date:6/6/2023 days after it has been accepted as complete.
Number of inspections allowed per permit.
L1 Building 1 Permits 1ELC_PermitApp_ELR_ERE.doc Rev 06/I7/2015 440.4615T(11/05/COM/WEB
• ' l Iumbing Permit Application
Building Fixtures FOR OFFICE USE ON
City of TigardV(�\, ReceiDa[ ved
I'c'nn Ao l S /O D-�--�a
���� ..•
PJ 'Du°�'S�7-
lig • 13125 SW Hall Blvd.,Tigard,OR 9 2 s,, .
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.:
Inspection Line: 503.639.4175 I u AI • Date Read/B Juds: See Page 2 for
TIGARD JY 8 Y Y 6
Internet: www.tigard-or.gov Notified/Method Supplemental Information
TYPE OF WORK.. OF TIGARD FEE* SCHEDULE
®New construction I.?DfA1t0'bf)Ott`. e^ • 7M i 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(I)bath 312.70
LEII-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
El Accessory buildingSFR(3)bath I 500.32 500.32
❑Multi-family
Each additional bath/kitchen 2 25.02 50.04
❑Master builder ❑Other:
•
Fire sprinkler(4308 sq.ft.) Page 2
• JOB SITE INFORMATION AND LOCATION Site utilities:
•
Job site address: 15144 SW Deepbrook LN Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97224 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) I Page 2
• Suite/bldg./apt.no.: I Project name:River Terrace Crossing Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
• Rain drain connector 6 18.76 131.32
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 Lot no.:28 Fixture or item:
Tax map/parcel no.:2S108DCO2700 Backflow preventer I 31.27
•
DESCRIPTION OF WORK Backwater valve 1 12.51
Clothes washer I . 25.02
New SFR
Dishwasher I 25.02
•
Drinking fountain ((�� 25.02
Ejectors/sump ' IJd 25.02
• ID PROPERTY OWNER I ❑ TENANT Expansion tank 1P1 12.51
Name:Pacific Lifestyle Homes Fixture/sewer cap 25.02
• Floor drain/floor sink/hub 25.02
Address: 11815 NE 99th Street,Suite 1200
Garbage disposal 1 25.02
City/State/ZIP:•
Vancouver,WA 98682 Hose bib 2 25.02
Phone:(360)213-0809 Fax:( ) Ice maker 12.51
_t APPLICANT 2 CONTACT PERSON Interceptor/grease trap 25.02
Business name:Pacific Lifestyle Homes Medical gas(value:$_) Page 2
Primer 12.51
Contact name:Permit Coordinator-Kellie Franklin
Roof drain(commercial) 12.51
Address: 11815 NE 99ts Street,Suite 1200 Sink/basin/lavatory 8 25.02 '
City/State/ZIP:Vancouver,WA 98682 Solar units(potable water) 62.54
Phone:(360)213-0809 Fax::( ) Tub/shower/shower pan 4 12.51
• E-mail:permits@buildplh.com Urinal 25.02
Water closet 4 25.02
• CONTRACTOR
- Waterheater 1 3752
Business name:Wolcott Plumbing Water piping/DWV 5629
Address:1075 West Historic Columbia River HWY Other: 25.02
•
•
City/State/ZIP:Troutdale,OR 97060 Subtotal
Phone:(503)667-1781 Fax:( ) Minimum permit fee: $72.50
Zb w���A^ Plan review (25%of permit fee)
CCB Lie.: 112220 Plumbing Lic.no.: Ufa
f4Q/ZleLf.. State surcharge permitfee)
Authorized signature: p�� ,� TOTAL
PERMIT FEE
Print name:Kellie Franklin Date:6/68023 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.
11Building\Pem,its\PLMU-PerrnitApp,doc 10/01/09 440.4616T(10/02/COM/WBB)
City of Tigard
" COMMUNITY DEVELOPMENT DEPARTMENT
Building Permit Review - Residential
TIGAR t:.
I R I , .�. ate■
Building Permit #: M 4r - 00 2. 5
Site Address: 15144 SW Deepbrook Ave i Verified in Accela
Project Name: RT Crossinq Lot/Unit #: 28
Proposal: New SFR Zone: RES-C
Housing Type: ❑SFR(la Single Detached ❑ Duplex 0 Triplex❑ ADU) 0 Rowhouse ❑Cottage Cluster❑CYU ❑Quad 0 Other
Required Site Plan Elements:
I?J 3 copies of site plan on max 11x17"
la Drawn to standard scale ❑ R_t ;,. J 1. d.:,. I:... / L.--
O North arrow ✓a Street and site trees shown / labeled 7 6M 40 srenC) wl l c Meet#(
❑ Site address, project name, lot #
l�Street names (N/A for SFR)
m Applicant name and phone # applicable)
❑ Lot and setback dimensions ❑ Vision clearance triangle
❑ C,.: L:,,y 1, .1., , a,, f l y ❑ Utility locations &easements
O Footprint of new structure and FFE 0 Property corner elevations
❑ Sidewalk/driveway dimensioned
O Lot area and lot coverage percentage m Erosion control
Required Plan Elements:
(For SFR: calcs needed o reet-facing) Summary table with calculations for:
❑ Drawn to standard scale ❑ Total facade area
❑ Building height dimensioned 'ndow and door area
❑ Facade dimensioned
❑ Windows and doors dimensioned
0 Garage doors dimensioned
RequTr n Elements:
(Not required for SFR) ❑ Summary table that includes
O Each story dimensioned or area
❑ Each story floor area calculated ❑ Floor area per s
Planning Review
The following standards have been met:
Setbacks 0 Front: 12/8 Rear: 15/10 Side: 3 Min/Max Street Side: 8 / Garage: 20
Height 0 Max. Height: NA Proposed Height: 21.5'
Yes ❑ N/A Landscape
❑ Ye ■ N/A Screening (Quad only)
❑ Yes ■ A % Window Coverage
❑ Yes ❑ N/' Garage (SFR Only) Parking (Other Res)
El Yes ❑ N/A -• rance (SFR, Rowhouse, Quad only)
❑ Yes ❑ N/A Othe .uilding design standards (Rowhouse only)
❑ Yes ❑ N/A Accessory tructure Standards
❑ Yes ❑ No Qualifying pr- -xisting unit exempt from standards (Cottage unit only)
Additional standards for Cou and Units, Cottage Clusters, Rowhouses,and Quads:
❑ Yes 0 N/A Unit Count:
❑ Yes ❑ N/A Lot Width and Size
❑ Yes ❑ N/A Pathway
Additional standards for Courtyard Units an• Cottage Clusters only:
❑ Yes ❑ N/A Unit Area:
❑ Yes ❑ N/A Floor Area (per story)
❑ Yes ❑ N/A Courtyard
❑ Yes 0 N/A Fence
❑ Yes ❑ No ON/A Clean Water Services - Service Provider Letter (lot platted prior to 9/10/1995)
0 Yes ❑ No ❑N/A Public Facilities Improvement (PFI) Permit:
Required: ❑ Yes ❑ No
Applied For: 0 Yes ❑ No, stop intake
0 Sensitive Lands: ❑ Yes 0 No
a Main Land Use Case #s: PDR2016-00016 , PDR2018-00005 ZConditions met
0 Applicant notified of land use expiration date: 3/2 / 6 _
Approved By Planning: ate: fg /
Notes Optional facade standards do not apply In
Revision 1: ❑ Approved ❑ Not Approved Date:
Revision 2: ❑ Approved ❑ Not Approved Date:
Building Permit Submittal
Original Submittal Date: (otg(?-3
Site Plans #: 2j
Building Plans #: j
Building Permit #: , Building permit # entered on page 1
Workflow Routing: QQ Planning rikEngineering ..Permit Coordinator IP\Building
Workflow Sign-off: A Sign-off for Planning (include notes from planning review)
Route Documents: ticl Engineering: (1) copy of permit application, (1) site plan, (1) building plan
and original plan review routing form.
A Building: original permit application, site plans, building plans, engineer and
beam calculations and trust details, if applicable, etc.
Permit Technician: , Date: 6 f 3/47-'
Notes:
Engineering Review
❑ P�1 Permit:
Slope at building pad: 'S/m
/✓f,�J-G-Conditions met prior to issuance of permit
¢4-Easements (encroachments) per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes 1-fao
Assess Water Quantity Fee in-lieu: ❑ Yes 121No
LIDA Facility on lot: ❑ Yes 4ZI-No Add Fee: ❑ Yes ❑ No
[h'1nal Plat Recorded
O NOT Approved: , Date:
Notes:
Approved By Engineering: Date: `/2 '4'2.-_
Revision 1: ❑ Approved ❑ t Approved Date:
Revision 2: 0 Approved ❑ Not Approved _ Date:
P rmit Coordinator Review
Conditions met prior to permit issuance
❑ Approved, NOT Released: Date notified applicant:
❑ ENG Revisions Required: Date notified applicant:
14 4 SDC Exemption: ❑ Applied for ❑ Received does not apply
�
`4 SDC Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A
��CC" Tigard Trans SDC: Yes ❑ N/A 3 Deferred
Parks SDC: Yes DI N/A Deferred
LIDA ❑ Yes ((/A i....
10K to Issue/Approved by Permit Coordinator: (A
VM MDate:Revision 1: ❑ Approved ❑ Not Approved Date:
Revision 2: ❑ Approved ❑ Not Approved Date:
DocuSign Envelope ID:08ABE211-D9F2-4DA5-97BD-855C88A1A009
RECEIVED
City of Tigard JUN 8 2023
IN - '. Deferral Until Occupancy Request CITY OF D
BUILDING DIGA V SRON
-1 I,,A R I) Washington County Transportation Development Tax(1'D'1),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).
River Terrace Crossing Lot 28
Date: 6/6/2023 Site Address: 15144 SW DEEPBROOK LN
Project River Terrace Crossing
��Use Case or ^
Name; destyle Homes) Bung Permit#: �v�� ( 7i�TjZ DU`�S
(Pacific L' 1 J
Tax Lot r'.54 Total Parks
#: 2S 1, Pc, ((.0. Amounts: $11,830.00
TDT Total TSDC
Amount: NIA 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 Packs-Neighborhood River Terrace.
This constitutes my request to defer payment of the TDT,TSDC,and Parks SDCs,as provided above,
until occupancy.
Payment of the TDT,TSDC,and Parks SDCs may be deferred until issuance of tlw occupancy permit. In
requesting this option,I understand that any deferred'EDT,TSDC,and Parks SDCs must be paid prior to final
inspection or issuance of an occupancy permit.
TDT may only be deferred If the TOT 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.
o.cuspn.a by:
[Fuss �itAnuta. 6/6/2023
Property Owner: nFa7FCs5710A9Fa Date:
r:
(— °2
Developer: �,- Date:
Permit Coordinator: /A - Date: lX' \