Permit (100) CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2023-00420
Date Issued: 09/19/2023
TI t_A I'.is 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S108DC29500
Jurisdiction: Tigard
Site address: 15503 SW MISSOURI AVE
Subdivision: CROSSING AT BULL MOUNTAIN Lot: 150
Project: River Terrace Crossing, Lot 150
Project Description: New detached dwelling w/180sf patio cover.NO FINAL INSPECTION UNTIL DEFERRED SDC
FEES HAVE BEEN PAID.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 3 First: 1923 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 14.5 Bathrooms: 2 Second: 0- sf Garage: 663 sf Front: 12 Smoke Yes
Dwelling Units: 1 Third: 0 sf Right: 3 Detectors:
Total: 1923 sf Value: $378,526.71 Rear: 10
PLUMBING
Sinks: 1 Water Closets: 2 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 3 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Drains: 0 Storm Sewer: 100
Tubs/Showers: 2 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: Y Vent Fans: 4 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Vents:Furn<t00K:
1 0 Woodstoves: 0 Gas Outlets: 4
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 WI Svc or Fdr: 0
Ea add'I 500 sf: 4 201-400 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/voll: 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 1923
Owner: Contractor:
CND-RIVER TERRACE LLC STONE BRIDGE HOMES NW LLC Required Items and Reports(Conditions)
1111 N POST OAK RD 4230 GALEWOOD STREET#100 1 Ersn Cntrl 503-639-4175
HOUSTON,TX 77055 LAKE OSWEGO,OR 97035
PHONE: PHONE: 503-387-7577
FAX: 503-387-7615
Total Fees: $23,453.48
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. ATTENTIO : 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: Permutes Signature: Iii;1At ' C-rKl `A--)
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.
Building Permit Application
Residential J3274 FOR OFFICE CSE ONLY
City of Tigard RTC 150 Received g
g Date/By.
. $/ � '�3 ; Permit No. s i 13-7-- . Li 2,6c
13125 SW Hall Blvd.,Tigard,OR 97223MI
Plan Review, (4 ddd� A•n/� ptherPermit� .OPI`��\
Phone: 503.718.2439 Fax: 503.598.1960 Date/sy: K (!r� V uuu«<+++ "'
T I G A R D Inspection Line: 503.639.4175 Date Ready/B /� ill n', kris: H See Page 2 f
Internet: www.tigard-or.gov RECEIVED Notified/Method:�l M I (�V Z�' p TX—Cs Supplemental Information
��,{{rr +y G.''"+-ll ti l /.
•
TYPE OF woAgG 2 L 21' ?`iATA;I-AND 2-FAMILYDWE a ;,a
I New construction ❑p l pn Permit fees*are based on the value of the work performed.
l i I i V f l I�7ARD Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement R*I1INS DIVISION equipment,materials,labor,overhead,and the profit for_tlie it
a „ '' =-.g x work indicated on this application. .
g• CATEGORY OF CCONSTRUCTION �
Valuation: $ 96
l I-and 2-family dwelling 0 Commercial/industrial
Number of bedrooms: 3
ElAccessory building 0 Multi-family
❑ Master builder ❑Other: Number of bathrooms:2
4o# SITE INFORMATION AND LOCATION 1. Total number of floors: 1 1-5 4
Job site address:15503 SW Missouri Ave. New dwelling area:1,923 square feet (qZ3
City/State/ZIP: Tigard, OR 97224
Garage/carport area: 663 square feet
Suite/bldg./apt.no.: Project name: River Terrace Crossing Front Covered porch area:199 square feet
Cross street/directions to job site: Back Patio: 180 square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: River Terrace Crossing 1 Lot no.: 150 Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
D a i t#m x t work indicated on this application.
New, single family residence Valuation: $
Would like to request SCD deferral Existing building area: square feet
New building area: square feet
E1 PROPERTY OWNER 0 TENANT i Number of stories:
Name: Stone Bridge Homes NW, LLC Type of construction:
Address: 423-Galewood St. Suite#100 Occupancy groups:
City/State/ZIP: Lake Oswego, OR 97035 Existing:
Phone:(503)387-7577 Fax:( ) New:
Ila(APPLICANT 0 CONTACT PERSON HOLDING PERMIT FEES*
(Please refer au fee schedule)
Business name: Stone Bridge Homes NW, LLC
Structural plan review fee(or deposit):
Contact name: Permit Tech
FLS plan review fee(if applicable):
Address: 4230 Galewood St. Suite#100
Total fees due upon application:
City/State/ZIP: Lake Oswego, OR 97035
Amount received:
Phone:( 503) 387-7577 Fax:: ( )
PANf.I YFEES
E-mail: portlandpermits@stonebridgehomesnw.com �PB,�� $fl .� �i ,<.� � , M *...�
Commercial and residential prescriptive installation of
. r ' t .e t„:, ,OR roof-top mounted Photovoltaic Solar Panel System.
Business name: Stone Bridge Homes NW, LLC Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: 4230 Galewood St. Suite#100 Solar Installation Specialty Code checklist.
City/State/ZIP: Lake Oswego, OR 97035 Permit Fee(includes plan review $180.00
Y 9 and administrative fees):
Phone:(503)387-7577 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.: 173318 Total fee due upon application: $201.60
Authorized signature: f� �� This permit application expires if a permit is not obtained
gn �tir` fc �/��' within 180 days after it has been accepted as complete.
Print name: Tiara Rudolf Date: 8-21-2023 *Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(I 1/02/COM/WEB)
Mechanical Permit Application
FOR OFFICE USE°NIA
City ofW Tigard C C r t Permit No.:rn5 69.—ab�im
1111 1' City
Hall Blvd.,Tigard,OR 97223 R C C G
Phone: 503.718.2439 Fax: 503.598.1960 Plan Review
T I G A R D Inspection Line: 503.639.4175 , ,�/�Y Other Permit:
Jens Su
Internet www.tigard-or.gov AUGtiUO Ready/ey: Page 2 for
Notified/Method: Supplemental Information
CITY OF TI • : - i
TYPE K OF WORK- . ... .�... �,. „I; :.�CDMIHlaRCle}LFEE* SiM. '.v ,- ,.
,,:USE CHECKLIST
0 New construction El Addition/alteration/replacement Mechanical permit fees"are based on the value of the work
performed.Indicate the value(rounded to the nearest dollar)of all
❑ Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
CAT t OF CONSTRUCTION Value:$
g.,
�X I-and 2-family dwelling ❑Commercial,/industrialRESIDENTIALEQUIPMonuseYSckM EES*,,
0 Accessory building
❑ Multi-fa Forspeaattnfomtationseeheiist
y ❑Master builder D Other: Description
x,�, I Qty. I Ea. I Total
€' FORMATION AND LOCATION Heating/cooling:
'
Job site address:15503 SWMISSOUfI AVe. Air conditioning
(requires site plan showing placement) 1 46.75
City/State/ZIP: Tigard, OR 97224 Furnace 100,000 BTU(duets ven s) 1 46.75
Furnace 100,000+BTU(duets/vents) 54.91
Suite/bldg./apt.no.: Project name: River Terrace Crossing Heat pump
Cross street/directions to job site: (requires site plan showing placement) 61.06
Duct work 23.32
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
Subdivision: River Terrace Crossing I Lot no.:150 Flue/vent for any of above 1 23.32
Tax map/parcel no.: Other: 23.32
°s Other fuel appliances:
Water heater 1 23.32
New, single family residence Gas fireplace 1 33.39
Flue vent for water heater or gas 2
fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
. """,X,.? : R I ❑ TENANT Chimney/liner/flue/vent
23.32
Name: Stone Bridge Homes NW, LLC Environmentalther: 23.32
Address: 4230 Galewood St. Suite#100 exhaust and ventilation:
Range hood/other kitchen 1
City/State/ZIP: Lake Oswego, OR 97035 equipment 33.39
Clothes dryer exhaust 1 33.39
) Single-duct exhaust(bathrooms, -1"-'
cri
Phone:( 503)387 7577 Fax:
toilet compartments,utility rooms) 1 23.32
►.1 APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans
23.32
Business name: Stone Bridge Homes NW, LLC Other: 23.32
Contact name: Permit Tech Fuel piping:
514.15 for first four;S4.03 for each additional
Address: 4230 Galewood St. Suite#100 Furnace,etc. 1
City/State/ZIP: Lake Oswego, OR 97035 Gas heat pump
Wall/suspended/unit heater
Phone:(503) 387-7577 Fax:: ( ) Water heater 1
E-mail: portlandpermits@stonebridgehomesnw.com Fireplace 1
Range 1
� z.. CONTRACTOR Barbecue
Business name: Comfort Zone Clothes dryer(gas)
Address: 1032 NW Corportate Dr. Other:
—"'";''''':.---'2'"'tlLECHANfCAL PERMIT FEES*City/State/ZIP: Troutdale, OR 97060
Subtotal
Phone:( 503)667-5595 Fax:( ) Minimum permit fee($90.00)
CCB lie.: 110091 Plan review(25%of permit fee)
State surcharge(12%of permit fee)
TOTAL PERMIT FEE
Authorized signature: .x>co A-Y../ c:1,' 1.,p.Print name: David Heldstab
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Date:8-21-2023 I * Fee methodology set by Tn-County Building Industry Service Board
I:\BuildinglPermitsMEC-PermitApp.do<09/09/10
aao-eel err(!vovconvwen)
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard
ReceiDate/Bvedy: Permit 8
-y.,� W
13125 SW Hall Blvd.,Tigard,OR RECEIVED Plan Review rV Srvr, 6
030
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Related Permit#:
Inspection Line: 503.639.4175 q 2023
Internet: www.tigard-or.govReady Date/By: lurls Ei See Page 2 for
TIGARDAUG L 2 Notified/Method. Supplemental Information
s ;- .. - TS''PE-OF W tii.3 1 4 c Yali `7 r't ';. , =
❑X New construction ❑Addition/alteSt on�e� �SO l Please check all that apply(submit 2 sets of plans w/items checked):
v ' ' 0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
z.�, r c^cz "":it-,-». ---`"^_ ^%'" "- r "rr exceeds 10,000 amps at 150 volts or floating buildings.
t' ' Yisf` x "ifVTRYICTION
less to ground,or exceeds 14,000 0 Commercial-use agricultural
X❑ I-and 2-family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
ON AND L t i t, 0 Emergency system. larger separately derived
0 Addition of new motor load of system.
Job#: 3274 Job site address: 15503 SW Missouri Ave. IOOIIP or more. ❑"A",`E","1-z","t-3",
❑Six or more residential units. occupancy.
( ity/State/ZIP: Tigard, OR 97224 ❑Health-care facilities 0 Recreational vehicle parks.
,
Suite/bldg./apt. ['Hazardous locations 0 Supply voltage for more than
#: Project name: River Terrace Crossing 600 volts nominal.
0 Service or feeder 600 amps or more.
Cross street/directions to job site:
Description Qty. Each Total •
New residential single-or multi-family dwelling unit.
Subdivision:River Terrace Crossing Lot#: 150 Includes attached garage.
1,000 sq.ft.or less 1 168.54 4
Tax map/parcel#: Ea.add'I 500 sq.ft.or portion 2 33.92 1
DESCILrTION OF WORk, Limited energy,residential 75.00 2
New, single familyresidence (with above sq.ft.)
g Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2
0X� PROPERTY 11.Lt.°,.;> 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: Stone Bridge Homes NW, LLC 200 amps or less 100.70 2
Address: 4230 Galewood St. Suite#100 201 amps to 400 amps 133.56 2
401 amps to 600 amps 20034 2
City/State/ZIP: Lake Oswego, OR 97035 601 amps to 1,000 amps 301.04 2
Phone:( 503) 387-7577 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: portlandpermits@stonebridgehomesnw.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
,,,.,. _(4 urp*ANT 0 CONTACT PERSON A Fee for branch circuits with
Business name: Stone Bridge Homes NW, LLC above service or feeder fee, 742 2
each branch circuit
Contact name: Permit Tech B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address: 4230 Galewood St. Suite#100 branch circuit
City/State/ZIP: Lake Oswego, OR 97035 Each add'l branch circuit 7 42 2
Miscellaneous(service or feeder not included)
Phone:( 503)387-7577 Fax: : ( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: portlandpermits@stonebridgehomesnw.com Reconnect only 67.84 2
4%` CONTRACTOR _ Pump or irrigation circle 67.84 2
4 Business name: Garner Electric Sign or outline lighting 67.84 2
....-- _ Signal circuit(s)or limited-energy ❑ See Page 2 2
Address: 2920 SE Brookwood Ave. Suite A panel,alteration,or extension.
Co Each additional inspection over allowable in any of the above
City/State/ZIP: Hillsboro, OR 97123cs Additional inspection(1 hr min) 6625/hr
to Phone:( 503)648-4552
Fax:( ) Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email: Chelsea@garnerelectrlc.com Inspections for which no fee is
sr ctficall listed(%hr min) 90.00/hr
CCB Lic.: 2322691 Electrical Lic.:34 305C Suprv.Lic.: 3'Ib1S d(14 hr RICAL PERMIT FEES
Suprv.Electrician signature,required: � e0, gaa41.44T b X .\0 I)I ,s Subtotal:
Print name: Charles Garner Date:$-21-2023 ❑Plan Review Required(25%of permit fee):
U State surcharge(12%of permit fee):
TOTAL PERMIT FEE:
Authorized signature: �ior+a iii r-//tom
This permit application expires if a permit is not obtained within 180
Print name: Tiana Rudolf Date: $-21 2023 days after it has been accepted as complete.
" Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 06/17/2015 440-4615T(11/05/COMIWEB
Plumbing Permit Application
Building Fixtures p g� p FOR OFFICE I F ONLY
City of Tigard REL E I V I. Receives Permit No. ��
DateBy:
• 13125 SW Hall Blvd.,Tigard,OR 97223
S 2023 Plan Review
Phone: 503.718.2439 Fax: 503.598.1.96OG 2 2 DateBy. Other Permit No.:
T R�A Fi D Inspection Line' 503 639 4175 Date By Ready h,,i
Internet. www ti and-or_gm ET See Page 2 for
8 • - * Notified/Method: Supplemental Information
' TYPE OF., u'- , FEE* SC yJ
®New construction 0 Demolition For special information use checklist
Description I Qty. I Ea. 1 Total
❑Addition/alteration/replacement ❑Other: New I-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY„: SFR(1)bath 312.70
❑X 1-and 2-family dwelling El Commercial/industrial SFR(2)bath 437.78
El Accessory buildingSFR(3)bath 500.32
❑Multi-family
Each additional bath/kitchen 25.02
❑ Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
JOB SI r 'i D LOCATION Site utilities:
Job site address: 15503 SW Missouri Ave. Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/Z1P: Tigard, OR 97224 Footing drain(no.linear ft.: ) 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 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.:150 Fixture or item:
fax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 1 25.02
New, single family residence Dishwasher 1 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY O.t-^ --, , I ❑ TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name: Stone Bridge Homes NW, LLC
Floor drain/floor sink/hub 25.02
Address: 4230 Galewood St. Suite#100 Garbage disposal 1 25.02
City/State/ZIP: Lake Oswego, OR 97035 Hose bib 2 25.02
Phone:( 503)387-7577 Fax:( I Ice maker 12.51
IR] APPLICANT , --III CONTACT PERSON Interceptor/grease trap 25.02
Business name: Stone Bridge Homes NW, LLC Medical gas(value:$_) Page 2
Primer 12.51
Contact name: Permit Tech Roof drain(commercial) 12.51
Address: 4230 Galewood St. Suite#100 Sink/basin/lavatory 5 25.02
City/State/ZIP: Lake Oswego, OR 97035 Solar units(potable water) 62.54
Phone:(503 )387-7577 Fax::( ) Tub/shower/shower pan 2 12.51
E-mail: portlandpermits@stonebridgehomesnw.com Urinal 25.02
Water closet 2 25.02
CONTRACTOR
Water heater 1 37.52
Business name: Edward Mullen Plumbing Water piping/DWV 56.29
Address: S. E. River Road Other: 25.02
City/State/ZIP: Hillsboro, OR 97113 Subtotal
Phone:( 503) 640-0113 Fax:( ) Minimum permit fee: $72.50
CCB Lic.:92689 Plumbing Lic.no.: 34-260PB Plan review (25%of permit fee)
D State surcharge(12%of permit fee)
//
Authorized signature:r Fes. TOTAL PERMIT FEE
Print name: Jeremy Crace Date: 8-21-2023 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.
1.1Building\Permus'PLMU-PermitApp_doc 10/01/09 440-4616T(10/02/COM/WEB)
City of Tigard
Ie " COMMUNITY DEVELOPMENT DEPARTMENT
- Building Permit Review - Residential
TIGARD
Building Permit #: V1���U)'O�-1 OU
Site Address: (SSO"3 NJ.) /lMSCOUCI "Fe - ❑ Verified in Accela
Project Name: (Z►V& TCrnaC2 CfoSS"tl Lot/Unit #: ISO
Proposal: SU`3.Q etaaireGI, Stil, Zone: S•C
Housing Type: FR /Single Detached ❑ Duplex❑Triplex❑ ADU) ❑ Rowhouse ❑Cottage Cluster 0 CYU OQuad❑Other
Required Site Plan Elements:
,3 copies of site plan on max 11x17"
.Drawn to standard scale -El-Retained trees, drip line/ tree protection
Ar North arrow , Street and site trees shown / labeled
4 Site address, project name, lot # 0 Table-calculating tree canopy at maturity
/Street names (N/A for SFR)
AApplicant name and phone # e-€amtyard rectangle dimensioned (if applicable)
ja Lot and setback dimensions ❑ Vision clearance triangle
-B-Existing structures &square footage 4 Utility locations &easements
,Footprint of new structure and FFE 6 Property corner elevations
XISidewalk/driveway dimensioned L-LID^ (>1,000 sf disturbance)
i6 Lot area and lot coverage percentage ,Erosion control
Re uired Elevation Plan Elements:
(For R: calcs needed only on street-facing) Summary table with calculations for:
❑ wn to standard scale ❑ Total facade area
❑ Bui • g height dimensioned O Total window and door area
O Facade ' ensioned
❑ Windows an ors d' nsioned
O Garage doors di 'oned
Required Flo Ian Elements:
(Not requi for SFR) ❑ Summary table that includes
❑ ch story dimensioned 0 Total floor area
Each story floor area calculated loor area per story
Planning Review
The following standards have been met:
Setbacks yrFrOnt:VI-it Rearr10 ttiliD Side: 3 Min/Max Street Side: 8 / Garage:
Height ,Z(Max. Height: NA Proposed Height: i4•S
XYes ❑ N/A Landscape
o Yes 0 N/A Screening (Qua. only)
❑ -s ❑ N/A % Window Co erage
❑ Ye • N/A Garage (SF: Only) Parking (Other Res)
❑Yes • /A Entrance FR, Rowhouse, Quad only)
❑Yes ❑ Other b Iding design standards (Rowhouse only)
❑Yes 0 N/A Acces .ry Structure Standards
❑Yes ❑ No a.ua ' ing pre-existing unit exempt from standards (Cottage unit only)
Additional stan. ds for Courtyard Units, Cottage Clusters, Rowhouses, and Quads:
❑Yes ❑ N/A U it •unt:
❑Yes ❑ N/A of Widt and Size
O Yes 0 N/A Pathway
Additional andards for C. rtyard Units and Cottage Clusters only:
❑Yes ❑ A Unit Area:
❑Yes 0 /A Floor Area (per sto, )
❑ Yes FA N/A Courtyard
0 Ye- 0 N/A Fence
Cl Yes ❑ No;V/A Clean Water Services - Service Provider Letter(lot platted prior to 9/10/1995)
,0-Yes ❑ No EN/A Public Facilities Improvement (PFI) Permit:
Required: ISYes ❑ No
Applied For: eYes ❑ No, stop intake
,PfSensitive Lands: ❑ Yes .f No 0-Main Land Use Case #s: P19p-1O1(o -000i if , PIN-7,o18- S ?'//
Conditions met
/a-Applicant notified of land use expiration date: 2427/2-r
Approved By Planning: Date: t2212,3
/
Notes <44,0nal RT Havida✓dl don't aff6 r
Revision 1: ❑ Approved ❑ Not Approved Date:
Revision 2: ❑ Approved ❑ Not Approved Date:
Building Permit Submittal
Original Submittal Date:
Site Plans #:
Building Plans #:
Building Permit #: L9' uilding permit # entered on page 1
Workflow Routing: CYPlanning dEngineering EPermit Coordinator 'Building
Workflow Sign-off: IVSign-off for Planning (include notes from planning review)
Route Documents: ilEngineering: (1) copy of permit application, (1) site plan, (1) building plan
anal 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: VI"1 ` \\A., Date: 151'7' /./i)ZZ
Notes:
Engineering Review
❑ PFI Permit:
f SIope at building pad: 2—,
conditions met prior to issuance of permit
'Easements (encroachments) per engineering conditions of approval and plat
'Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes C1410
Assess Water Quantity Fee in-lieu: El Yes 44.No
LIDA Facility on lot: ❑ Yes iYNo Add Fee: ❑ Yes ❑ No
❑ Final Plat Recorded
0 NOT Approved:
Notes: Date: //
Approved By Engineering: Date: o/Z47Z 3
Revision 1: El Approve Not Approved Date: !!
Revision 2: ❑ Approved ❑ Not Approved Date:
Permit Coordinator Review
Conditions met prior to permit issuance
El Approved, NOT Released: Date notified applicant:
❑ ENG Revisions Required: Date notified applicant: _
SDC Exemption: ❑ Applied for ❑ Received `Woes not apply
DC Fees Entered: Wash Co Trans Dev Tax: Yes 0 N/A
Tigard Trans SDC: Yes ❑ N/A lJ Deferred
Parks SDC: ❑ Yes 0 N/A Deferred
LIDA ❑ Yes C N/A
ta
to Issue/Approved by Permit Coordinator: � Date: �` Z�' �
Revision 1: ❑ Approved El Not Approved Date:
Revision 2: El Approved ❑ Not Approved Date:
q Building Division
One & Two-Family Dwelling
TIGARD Fees Checklist
Application Date - FEE VERSION ( J 1/ '1aZ'3
PERMIT INFORMATION:
Permit#: ty\ ,Ltzt) Plan #: 355 T-41%,S Floors: 1
Valuation: '.1$ i�(I it_ l Covered Porch: I e�L Basement ��
I�
Bedrooms: 3 Deck: - 15` Floor 1 9 2
WC (toilets) Z
Deck Cover: ------ 2°d Floor L—
Lavatories 3 Patio Cover I(6° 3rd Floor ,....-----
Tub/shower 2 Accessory Struct. -.------- R-3 Total V,Q' D,-3
Laundry Tray \t..)2_, Water Heater 1 / as Elec Garage ki2(2,S
Exhaust Vents Lj\ Gas Flue Vents _ Total for Elec. 2 g(
Backflow Prey. Fu lac Heat Pump 0
- # for Electrical U
BBQ --- Gas Fireplace ,�S #Fuel Lines9
FEES: Description: Fee Applies: Fee Entered:
DC Prov Revw: Planning ✓/
Info Proc/Arch: Lg $2.00 (over 11x17) 11
Info Proc/Arch: Sm$.50 (up to 11x17) s l
Metro CET: Residential Use
School CET: District < <
Tigard CET: Admen
Tigard CET: ODHCS
Tigard CET: AH
Electrical Permit: Permit Fee: f
Limited Energy:
12% State Surcharge
Mech. Permit: Permit Fee: t/
12% State Surcharge f
Plumbing Permit: Permit Fee: f
12% State Surcharge ✓-
Erosion Control: w/Permit-Ping
I:\Building\Forms\ResPlanCheckFees_Dec2022_AA.doc 12/21/22
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