Permit (3)IV
ti '
Building Permit ApplicationRECEIVE®
Residential FOR OFFICE USE ONLY
City of Tigard JUN 8 2023 Received b j8116 3 pp MS'12p23 BQtiS b
DateBy: permit No.:
III • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review y�p
■ Phone: 503.718.2439 Fax: 503.598.19 Other Permit: n`q
InspectionLine. 503.639.4175 �ITYOFTIGAFD DateBy: 23 S�VhWV3'�15�
TIGARDBUILDING DIVISION Date ReadyBy: » Jwis: ® See Page 2for
Internet. www.tigard-or.goV `�' Notified/Method: ti��7i{�9.2• Ar Supplemental Information
ril,/,u tt et 1Ja o .
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
•Ncw construction ❑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 ❑Other equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work ind sated on this application. e?A
1-and 2-family dwelling ❑Commercial/industrial Valuation: $ 51' 'i A
ElAccessory building El Multi-family Number of bedrooms: 4
❑Master builder ❑other: Number of bathrooms: 3
JOB SITE INFORMATION AND LOCATION Total number of floors: 2 331,g---
Jobsiteaddress: 15426 SW EVERGLADE AVE New dwelling area: 2872 square feed\\l
City/State/ZIP: Tigard / OR / 97224 Garage/carport area: 440 square feet 11,56
Suite/bldg./apt.no.: Project name:River Terrace Crossing Lot 177 Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: Pat square feet
1.1fl ®10Dirl reairutv,V004tiai s e z kl ® 3 yqg €
Subdivision: Crossing At Bull Mountain Lot no.: 177 Permit fees*are based on the value of the work performed.
Tax map/parcel no.: 2S108DC TL#177 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
NI 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:
El APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
Business name: ICHIJO USA CO., LTD. (Please refer to fee schedule)
Structural plan review fee(or deposit):
Contact name: Naoki Yamaoka
Address:
3800 SW Cedar Hills Blvd. Ste. 131 FLS plan revew fee(if applicable);
City/State/ZIP: Beaverton/OR/97005 Total fees due upon application:
Phone:(503)430-7413 —I 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 Specially 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 lic.: 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: 06/08/2023 *Fee methodology set by Tn-County Building Industry
Service Board.
1:1Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
1
•
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.Q0.
$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.
1:1Building\Permits\MEC_PermitApp_040113.doe 2
A
'Electrical Permit Applicat CEIVED FOR OFFICE USE ONLY
Cit ofTi and Received
Jg Date/B : ' u �) i
13125 SW Hall Blvd.,Tigard,OR 9722�I IN p 2023 Plan Review
I ' Phone: 503.718.2439 Fax: 503.598 191816111 0 Date/B : Related Permit H:
•
i,,RU Inspection Line: 503.639.4175 TV�t T/�It r]1� Ready Date/By: funs. H See Page 2 for
Internet wunv_tigard-orgov pp��C���I L1 1 OF 1fI�GARD�I Notified/Method: Supplemental Information
TYPE OFr:#8k IiNG DIVia"lll Y PLAN REVIEW
III New construction D Addition/alteration/replacement Please check all that apply(submit 2 sets of plans es/items checked)
El Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition El Other:
where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
. 1-and 2-family dwelling 0 Commerciallindustrial IDAccessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
' ❑Multi-family ❑Master builder ['Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system larger separately derived
- ❑Addition of new motor load of system.
Job#: Job site address:15426 SW EVERGLADE AVE l00HP or more. ❑ A't"E't"t-z",'l-3",
City/State/ZIP: 0 Six or more residential units. occupancy.
ty Tigard / O R / 97224 ❑Heal Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: River Terrace Crossing Lot 177 ❑Hazardous locations. 0 Supply voltage for more than600voltsnominal.
El Service or feeder 600 amps or more.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I N:nch I `l otal
New residential single-or multi-family dwelling unit.
Subdivision: Crossing At Bull Mountain Lot#: 177 Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: 2S108DC TL#177 Ea.add'1500 sq.ft.or portion 33.92 1
FWORK Limited energy,residential
(with above sq.ft.) 75.00 2
Single Family Detached Dwelling Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2
111 PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: ICHIJ O USA CO., LTD. 200 amps or less 10070 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
APPLICANT ID CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: ICHIJO USA CO., LTD. above service or feeder fee, 742 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 Eachadd'lbranchcircuit 7.42 , 2
Miscellaneous(service or feeder not included)
Phone:(503) 430-7413 Fax: :(503)430-7621 Each manufactured or modular 67.84 2
Email: nao@ichijousa.com dwelling,service and/or feeder
Reconnect only 67.84 2
CONTRACTOR 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 0 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(I hrmin) 90,00/hr
Email: OFFICE@WESTSIDEELECTRIC.COM Industrial plant(I hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: 13306 Electrical Lic.: 26-135C Suprv.Lie.: 5698S specifically listed(%hr min)
� ELECTRICAL PERMIT FEES.p
Suprv.Electrician signature,required: l .4 CI .1.1. se.14.— Subtotal:
Print name: BRENT WALL 5698-S Date: 06/08/2023 0 Plan Review Required(25%of permit fee):
State surcharge of fee):
Authorized signature: TOTAL
PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Naoki Yamaoka Date: 06/08/2023 days after it has been accepted as complete.
w Number of inspections allowed per permit.
I:IBuildinglPerroits\ELC_PermitApp_ELR_ERE.doe Rev 06/17/2015 440-4615T(11/05/COM/WEB
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 s steins combined: $75.00 Description
Renewable
tetr Each Total
y Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 00.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to25 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
n Garage Door Opener* >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ 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:
❑ Other: Each additional inspection is 66.25/hr
charged at an hourly(1 hr min)
Inspections for which no fee is 90,00/hr
specifically listed('/hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 allowed
Subtotal(Enter on Page 1):
y * Number of inspections allowe per permit.
(SEE OAR 918-309-0000)
•
• Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
n 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
FtBuilding\Permits\ELC_PermilApp_ELR_ERE.doc Rev 06/17/2015
Plumbing Permit ApplicatirtiE
���U��
Building Fixtures FOR OFFICI. ISE ONLI
City Of Tigard Received ,'�1
City
gUN Q 2023 DateBy: Permit No.: Ia/,�`1I//4/�_Q Q(1 I
�: ■ 13125 SW Hall Blvd.,Tigard,OR 97224 " S IAL V J v JYJ
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Other Pe rind No.:
p CITY OF TIGARD Date/By:
i l t i 1 k 1 Inspection Line: 503.639.4175 Date Ready/By: Jana: ® See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
•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 312.70I,
•1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 1 500.32
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: 15426 SW EVERGLADE 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.: Project name: River Terrace Crossing Lot177 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: Crossing At Bull Mountain I Lot no.: 177 Fixture or item:
Tax map/parcel no.: 2S108DC TL#177 Backflowpreventer 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 0 TENANT Expansion tank 12.51
Name: ICHIJO USA CO., LTD. Fixture/sewer cap 25.02
FAddress: 3800 SW Cedar Hills Blvd. Ste. 131 Garbage
gdispoorsinkhub 25.02
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
1111 APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: ICHIJO USA CO., LTD. Medical gas(value:$ ) Page2
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 Solar units(potable water) 62.54
Phone:(503)430-7413 Fax: :(503)430-7621 Tub/shower/shower pan 4 12.51
E-mail: nao@ichijousa.com Urinal 25.02
Water closet 3 25.02
CONTRACTOR
----- Water heater 1 37.52
Business name: Pipe It Plumbing LLC. Waterpiping/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 Lic.no.: P B297 Plan review (25%0 of permit fee)
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name: Naoki a m a o ka Date: 06/08/2023 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.
1\Building 1Permitsati.MU-PermitApp.doc 10/O1/09 4404616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard •
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site-Jtilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Fooling drain-I"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-1st 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
Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to
P 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
Baptistry/Font ❑ Any new commercial building with water service 2"and
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
as defined in OAR918-780-0040.
-Drive Thru
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial El Any multipurpose fire sprinkler system.
Domestic 0 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,Riser Diagram .. ..
4' ❑ 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
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar 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:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
II m
Building Division
One & Two-Family Dwelling
TIGARD Fees Checklist
PERMIT INFORMATION: Application Date - FEE VERSION eJ l Y Z0Z2-
Permit#: 13--f j 3 ,—�bZ Plan #: (. l 2 L Floors:
Valuation: l Covered Porch: v_�_ Basement ..---- -
Bedxooms: L' Deck: _ 1' Floor 1 -L6
C�
WC (toilets) 3 Deck Cover: 2 d Floor I I Ll
Lavatories 5 Patio Cover -------_ 3`d Floor
Tub/shower Accessory Struct. ,---- R-3 Total 2$ —7
�s /
Laundry Tray Water Heater Lerozoo Garage Li(f O
Exhaust Vents / Gas Flue Vents Total for Elec. 2 1
Backflow Prey. Jam--' Furnace Heat Pump / AC # for Electrical J
BBQ Gas Fireplace #Fuel Lines ''
FEES: Description: Fee Appli . Fee Entered:
DC Prov Revw: Planning
Info Proc/Arch: Lg$2.00 (over 11x17) a 2-
Info Proc/Arch: Sm$.50 (up to 11x17)
Metro CET: Residential Use
School CET: District:�%
Tigard CET: Admin �,-
Tigard CET: ODHCS Z
Tigard CET: AH
Electrical Permit: Permit Fee: %..//:"
Limited Energy:
12% State Surcharge
Mech. Permit: Permit Fee:
12% State Surcharge
Plumbing Permit: Permit Fee:
12% State Surcharge
Erosion Control: w/Permit-Ping
I:\Building\Fonns\ResPlanCheckFees_Dec2022_AA.doc 12/21/22
Page 1
City of Tigard
" COMMUNITY DEVELOPMENT DEPARTMENT
•
Building Permit Review - Residential
TIGARD .t " �p�
Building Permit #: MS l j�1/S•W 1/5Io
Site Address: 15426 SW Everglade Ave 0 Verified in Accela
Project Name: RT Crossing Lot/Unit#: 177
Proposal: New SFR Zone: RES-B
Housing Type: 0 SFR(0 Single Detached ❑ Duplex❑Triplex❑ADU)❑ Rowhouse❑Cottage Cluster El CYU ❑Quad ❑Other
Required Site Plan Elements:
0 3 copies of site plan on max 11x17"
O Drawn to standard scale ❑ R_L..:....J L. , J.:,, I:•.. / L.c L_ction
O North arrow 0 Street and site trees shown / labeled
O Site address, project name, lot # "—FT "` •' 'urity
Gl Street names (N/A for SFR)
O Applicant name and phone # iiiim6smilipeookmestisosiemelkommeionsel4if applicable)
O Lot and setback dimensions 0 Vision clearance triangle
❑ C : h,,� L L Q 0 Utility locations &easements
O Footprint of new structure and FFE 0 Property corner elevations
O Sidewalk/driveway dimensioned .,f
O Lot area and lot coverage percentage 0 Erosion control
Require' Plan Elements:
(For SFR: calcs neede 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
El Garage doors dimensioned
Requir n Elements:
(Not required for SFR) 0 Summary table that includes
❑ 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: 22.5'
is Yes ❑ N/A Landscape
❑ Y• • N/A Screening (Quad only)
❑ Yes ■ A % Window Coverage
❑ Yes ❑ N/• Garage (SFR Only) Parking (Other Res)
❑ Yes 0 N/A • rance (SFR, Rowhouse, Quad only)
El 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)
fl Yes ❑ No ❑N/A Public Facilities Improvement (PFI) Permit:
Required: ❑ Yes ❑ No
Applied For: 0 Yes 0 No, stop intake
O Sensitive Lands: ❑ Yes fl No
o Main Land Use Case #s: PDR2016-00016 , PDR2018-00005 ❑ Conditions met
o Applicant notified of land use expiration da • 3/ 2/26
Approved By Planning: Date: 6/5/23 /8/
Notes Optional facade s an ar s o no a y I ,
Revision 1: ❑ Approved ❑ Not App ed Date:
Revision 2: ❑ Approved ❑ Not App oved Date:
Building Permit Submittal
Original Submittal Date: 0 3
Site Plans #:
Building Plans #:
Building Permit #: uilding permit # entered on page 1 /
Workflow Routing: Planning Engineering I�Permit Coordinator H Building
Workflow Sign-off: "Sign-off for Planning (include notes from planning review)
Route Documents: B"Engineering: (1) copy of permit application, (1) site plan, (1) building plan
aryl original plan review routing form.
Building: original permit application, site plans, building plans, engineer and
L� �� �,be�am calculations and trust details, if applicable, etc.
Permit Technician: -Pvrv1 Vuv PL4"- - Date: (D)Da
IiblL3
Notes:
Engineering Review
❑ PFI Permit:
I%'Slope at building pad: P�
-Conditions met prior to issuance of permit
pEasements (encroachments) per engineering conditions of approval and plat
Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes LIVo
Assess Water Quantity Fee in-lieu: 0 Yes CO-No
� LIDA Facility on lot: ❑ Yes �No Add Fee: ❑ Yes ❑ No
f�Final Plat Recorded
❑ NOT Approved: Date:
Notes:
Approved By Engineering: Date: .67/- 4S
Revision 1: ❑ Approved of Approved Date:
Revision 2: 0 Approved ❑ Not Approved Date:
Permit Coordinator Review
..2 Conditions met prior to permit issuance
❑ Approved, NOT Released: Date notified applicant:
❑ ENG Revisions Required: Date notified applicant:
SDC Exemption: 0 Applied for ❑ Received /Does not apply
SDC Fees Entered: Wash Co Trans Dev Tax: /1 Yes ❑ N/A
Tigard Trans SDC: /Yes ❑ N/A /Z Deferred
Parks SDC: )Yes ❑ N/A ,1S Deferred
LIDA El Yes 9/N/A
/ G,
/OK to Issue/Approved by Permit Coordinator: Date: (O([✓/207i
Revision 1: ❑ Approved ❑ Not Approved Date:
Revision 2: 0 Approved 0 Not Approved Date:
RECEIVFn
City of Tigard JINN li L;
Deferral Until Occupancy Request BUILDS° ' IF alv
1 G ry Washington County Transportation Development Tax (III},Transportation and Parks System
e 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: 6/2/2023 Site Address: 15426 SW EVERGLADE AVE
Project River Terrace Crossing Land Use Case or MST2023-00256
Name: lchijo Building Permit#:
Tax Lot 2S108DC32200 Total Parks F J $11,830.00
#: Lot 177 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$i3 796.00 for TSDC-River Terrace,if applicable..
*The total Parks SDC amount shown above is the sum of$ 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 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: �'�l'/�"�''y Date: 6/2/2023
r
Developer: ~ Date:
6/15/2023
Permit Coordinator: Date: