HomeMy WebLinkAboutPermit (6) rl CITY OF TIGARD MASTER PERMIT
"1 2 COMMUNITY DEVELOPMENT Permit#: MST2023-00276
Date Issued: 08/03/2023
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S108DC29900
Jurisdiction: Tigard
Site address: 15611 SW MISSOURI AVE
Subdivision: CROSSING AT BULL MOUNTAIN Lot: 154
Project: River Terrace Crossing, Lot 154
Project Description: New detached dwelling with 56 sq.ft. patio cover. 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: 22 Bathrooms: 3 Second: 1614 sf Garage: 440 sf Front: 8 Smoke Yes
Dwelling Units: 1 Third: 0 sf Right: 3 Detectors:
Total: 2872 sf Value: $461,579.60 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
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Other Fixtures: 0
Drywell-Trench Drain: 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 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 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 area indicated
BEAVERTON,OR 97005 2 Ersn Cntrl 503-639-4175
PHONE: PHONE: (503)430-7413
FAX:
Total Fees: $25,713.93
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. ATTENT Oregon law re • you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
o59-nn1-nnt n lbni in o59-nn1-noon ii f, •nbthin o rel.,,,n11hm rota,tie rlirarl nneolinna In ni intr. 4 by Tallinn 5(11 9/9�11057 nrr�I Ann 1z9 9'Sdd
Issued By: "' e Permittee Signature: j'f/v" t. Q. ,.._
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 pro] t.
Approved plans are required on the lob site at the time of each Inspection.
Electrical Permit Application FOR OFFICE USE ONLY
E"" ' ri,7GGA „i Received
City of Tigard vr 6 `10 DDate/By: Perm t n:r S I)6, )? �v -d
13125 SW Hall Blvd.,Tigard,OR 97213 ' Plan Review Related Permit#
s Phone: 503.718.2439 Fax: 503.598.1960 , ,,qq DateBy
Inspection Line: 503.639.4175 ,:1
15 [4f.J Ready Date/By: J°ris. ® See Page 2 for
I,_i,A RD Internet: www.tigard-or.gov Notified/Method_ Supplemental Information
TYPE OF. WORI& . --." : ... c°..) PLAN REVIEW
•New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
El Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
II I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
El Multi-family ❑Master builder ❑Other: 0 Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system, larger separately derived
El Addition of new 15611 S W M I SSO U R I AVE 100HP or more.motor load of system.
Job#: Job site address: ❑'•A","E",`9-2","1-3",
City/State/ZIP: o Six or more residential units. occupancy.
ri Tigard / O R / 97 2 24 ❑Health-ca a facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: River Terrace Crossing Lot 154 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total I "
New residential single-or multi-family dwelling unit.
Subdivision: Crossing At Bull Mountain Lot#: 154 Includes attached garage.
Tax map/parcel#: 2S108DC TL#154 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK 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 ❑ See Page 2
• PROPERTY OWNER _ 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: ICHIJO USA CO., LTD. 200 amps or less 100.70 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
Branch circuits—new,alteration,or extension,per panel
111 APPLICANT ❑ CONTACT PERSON A.Fee for branch circuits with
Business name: ICHUO USA CO., LTD. above service or feeder fee, 7.42 2
each branch circuit
Contact name: Naoki Yamaoka B.Fee for branch circuits without
service or feeder fee,fast Address: 3800 SW Cedar Hills Blvd. Ste 131 branch circuit 56.18 2
City/State/ZIP: Beaverton / OR / 97005 Bach add'lbranch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503) 430-7413 Fax: :(503)430-7621 Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: nao@ichijousa.com
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 El See Page 2 2
Address: 1834 SE 8TH AVE panel,alteration,or extension.
City/State/ZIP: PO RTLAN D, 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(1 hr nun) 90.00/hr
Email: OFFICE@WESTSIDEELECTRIC.COM Industrial plant(1 hr min) 78.18/hr •
Inspections for which no fee is 90.00/hr
CCB Lie.: 13306 Electrical Lie.: 26-135C Suprv.Lie.: 5698S specifically listed(1/2 hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: 'y .U.)shil. Subtotal:
Print name: BRENT WALL 5698-S Date: 06/15/2023 ❑Plan Review Required(25%of permit fee):
,/ 7 State surcharge fee):
Authorized signature: TOTAL
PERMIT
FEE:
This permit application expires if a permit is not obtained within 180
Print name: N ao ki Yam a o ka Date: 06/15/2023 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:tBuilding\PermitstELC_PermirApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(1 l/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
Description ] Qty. Each l Total
Fee for all residential systems combined: $75.00 Renewable 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 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
❑ Garage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
El Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
El Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
El 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('/a hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page I):
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
n Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
El HVAC
I Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
El Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
n Other:
Total number of commercial systems: _
*No licenses are required. Licenses are required for all
other installations
•
laBuilding\Permits\ELC_PermitApp_ELR_ERE.doc Rev 0 6/1 720 1 5
. Plumbing Permit Application
r
Building Fixtures .-,c aI1 _ FOR OFF It I: I SE ONLI'
14 "'`'.si i"ie li 'Received
City of Tigard Receive Permit No.;�s�y 3�u Z�
13125 SW Hall Blvd.,Tigard,OR 97223 ,,_, q 26� , aV
U Phone: 503.718.2439 Fax: 503.598.1960 1 I ) yL� P a°Review Other Permit No.:
DatelBy.
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: rods. 65 See Page 2 for
Internet: www.tigard-or.gov Notifcd/Method: Supplemental Information
TYPE OF WORK ! FEE* SCHEDULE
1111 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)
a54_ 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 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 15611 SW MISSOURI 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.._) Page 2
Suite/bldg./apt.no.: I Project name: River Terrace Crossing Lot154 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 Lot no.: 154 Fixture or item:
Tax map/parcel no.: 25108DC TL#154 Backtlow 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
III PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: ICHIJO USA CO., LTD. Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 3800 SW Cedar Hills Blvd. Ste. 131
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. Medicalgas(value:$ ) Page2
Primer 12.51
Contact name: Naoki Yamaoka
Roof drain(commercial) 12.51
Address: 3800 SW Cedar Hills Blvd. Ste. 131 Sink/basin/lavatory 6 25.02 I
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
Urinal 25.02
E-mail: na0@IChljousa.COm
- ---- 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
CCBLic.: 174351 PlumbingLic.no.: PB297 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name: Naoki a m a o k a 7 Date:06/15/2023 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.
I:tBuilding\Permits\PLMU-PerutitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
.j
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 $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
Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee:
$1.00 to$5,000.00 Minimum fee$72.50
Storm&Ram 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
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
-Jacuzzi/Whirlpool engineer.
Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive Thu as defined in OAR918-780-0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: Commercial 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 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
IceMaeh.Befrig.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
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
' Building Division
One & Two-Family Dwelling
TIGARD Fees Checklist
PERMIT INFORMATION: Application Date -FEE VERSION �V lc..i 2 o1
Permit#: 5 t 2.4„: o .T7(P Plan #: (3 - ` I'1_ Floors:
Valuation: (.{(1(/574i,t+U Covered Porch: Basement
Bedrooms: 1.-i Deck: 1"Floor 5-8
WC (toilets) 3 Deck Cover: 2nd Floor
Lavatories S Patio Cover 5(.4o 3`d Floor
Tub/shower L( Accessory Struct. R-3 Total
Laundry Tray Water Heater [ 40/ Elec Garage
Exhaust Vents c. Gas Flue Vents Total for Elec. `�
Backflow Prey. ---, Furnace / c eat Pum / AC # for Electrical 5
BBQ 1/„�� Gas Fireplace - #Fuel Lines 3
FEES: Description: Fee Applies: Fee Entered:
DC Prov Revw: Planning
Info Proc/Arch: Lg$2.00 (over 11x17) a�
Info Proc/Arch: Sm$.50 (up to 11x17) ZO
Metro CET: Residential Use
School CET: District:
Tigard CET: Admin
Tigard CET: ODHCS
Tigard CET: AH 1 .
Electrical Permit: Permit Fee:
Limited Energy:
12% State Surcharge
Mech. Permit: Permit Fee:
12% State Surcharge f
Plumbing Permit: Permit Fee: ti�
12% State Surcharge
Erosion Control: w/Permit- Ping
Notes: RS — ` -B7a- 1 SO , e'7 y3 / 2-9b ,(aq
p 3 C�
�{ o le. . �{, = 2la SCa 7 b Caster >C p, 2 ( = (P
awl SCE 3 l , l�� l ,�
L\Building\Forms\ResPlanCheckFees_Dec2022_AA.doc 12/21/22
Page 1
J
City of Tigard
: m " COMMUNITY DEVELOPMENT DEPARTMENT
IN
Building Permit Review - Residential
TICrAR.D
Building Permit #: Md 1'IAM-LAJ U1I0
Site Address: 15611 SW Missouri Ave X Verified in Accela
Project Name: River Terrace Crossing Lot/Unit #: 154
Proposal: New Single Detached SFR Zone: RES--C
Housing Type: X SFR(Xj Single Detached ❑ Duplex❑Triplex❑ADU)❑ Rowhouse ElCottage Cluster❑ CYU ❑Quad❑Other
Required Site Plan Elements:
N 3 copies of site plan on max 11x17"
X Drawn to standard scale
X North arrow 1g1 Street and site trees shown / labeled
X Site address, project name, lot #
Nl Street names (N/A for SFR)
X1 Applicant name and phone # ❑ C.,..I L,..,J ,....L,.,,yl, d;.,,,,.,; ..,_J (;f.:,F,Ik ible)
X Lot and setback dimensions
❑ C �L y L , l Q f l 7 181 Utility locations & easements
N Footprint of new structure and FFE N Property corner elevations
N Sidewalk/driveway dimensioned ❑ LIDA (`1,000 cf dicturbanco)
X Lot area and lot coverage percentage N Erosion control
Re - levation Plan Elements:
(For SFR: calcs only on street-facing) Summary table with calculations for:
❑ Drawn to standard sca ❑ Total façade area
❑ Building height dimensioned ❑Total window and door area
El Fayade dimensioned
❑ Windows and doors dimensioned
❑ Garage doors dimensioned
Requir n Elements:
(Not required for SFR) ❑ Summary table that includes
❑ Each story dimensioned oor area
❑ Each story floor area calculated ❑ Floor area pe
Planning Review
The following standards have been met:
Setbacks A Front: 8' Rear: 10' Side: 3' Min/Max Street Side: 8' / Garage: 20'
Height /Max. Height: 35' Proposed Height: 22
❑ Yes ❑ N/A Landscape
❑ Yes ❑ N/A Screening (Quad only)
❑ Yes ❑ N/A To Window Coverage
❑ Yes ❑ N/A Garage (SFR Only) Parking (Other Res)
❑ Yes 0 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 L[ N/A Lot Width and Size
❑ Yes L!lN/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
0 Yes N/A Fence
❑ Yes El No XN/A Clean Water Services - Service Provider Letter (lot platted prior to 9/10/1995)
❑ Yes ❑ No 116N/A Public Facilities Improvement (PFI) Permit:
Required: ❑ Yes ❑ No
Applied For: El Yes ❑ No, stop intake
a4 Sensitive Lands: ❑ Yes 181 No
El Main Land Use Case #s: PDR2016-00016/PDR2018-00005 ❑ Conditions met
X Applicant notified of land use expiration "" : 3/ / 6
Approved By Planning: Date: f
Notes
Revision 1: ❑ Approved ❑ Not Approved Date:
Revision 2: El Approved ❑ Not Approved Date:
Building Permit Submittal � ,
Original Submittal Date: It it
Site Plans #:
Building Plans #:
Building Permit #: 'Building permit # entered on page 1
Workflow Routing: 'Planning VIngineering Permit Coordinator VBuilding
Workflow Sign-off: V ign-off for Planning (include notes from planning review)
Route Documents: l Engineering: (1) copy of permit application, (1) site plan, (1) building plan
an5I 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: -11k", P •%1 Date: -Date: C0( 1lO2S •
Notes:
Engineering Review
❑ PFI Permit: p
"Slope at building pad: 4'/+►
Li-Conditions met prior to issuance of permit
a Easements (encroachments) per engineering conditions of approval and plat
jkl-Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: El Yes t1No
Assess Water Quantity Fee in-lieu: ❑ Yes C io
LIDA Facility on lot: ❑ Yes 141/No Add Fee: ElYes ❑ No
ifa rinal Plat Recorded
0 NOT Approved: Date:
Notes:
Approved By Engineering: --- Date: ��3d���'
Revision 1: ❑ Approved ❑ Approved _ Date:
Revision 2: ❑ Approved ❑ Not Approved Date:
Permit Coordinator Review
ygConditions met prior to permit issuance
❑ Approved, NOT Released: Date notified applicant:
❑ ENG Revisions Required: Date notified applicant:
SDC Exemption: ❑ Applied for El Received 'Does not apply
'SDC Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A
Tigard Trans SDC: Yes ❑ N/A El Deferred
Parks SDC: Yes ❑ N/A El Deferred
LIDA ❑ Yes J1/A
K to Issue/Approved by Permit Coordinator: - D' ,`cX �")
Date: �� - �" 2�
Revision 1: ❑ Approved El Not Approved Date:
Revision 2: 0 Approved 0 Not Approved Date:
r , .., _ �v LI,J
City ofTigard ,
` :3
' Deferral Until Occupancy Request rr;, -,: ,; ,�, ,
T l c;A it fD Washington County Transportation Development Tax (EDT),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: 6/2/2023 Site Address: 15611 SW MISSOURI AVE
Project River Terrace Crossing Land Use Case or �;
Name: ichijo Building Permit#: \ ` � 5� 7„OJj)%
zoc� . 11�
Tax Lot 2S108DC Total Parks
$11,830.00
#` Lot 154 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 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: 6/2/2023
Developer: c Date: r.Z?
Permit Coordinator: Date: / - 5 - L