Permit (83) CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2023-00370
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/14/2023
Parcel: 2S107AD01000
Jurisdiction: Tigard
Site address: 16834 SW BEEMER LN
Subdivision: SOUTH RIVER TERRACE Lot: 10
Project: South River Terrace, Lot 10
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: 1510 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 25 Bathrooms: 3 Second: 2218 sf Garage: 685
g sf Front: 12 Smoke
Dwelling Units: 1 Third: 0 sf Right: 3 Detectors: Yes
Total: 3728 sf Value: $682,823.40 Rear: 0
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
Footing Drain: 100 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Bckflw Prevntr: 0
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Noes Air Conditioning: Y Vent Fans: 5 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 5
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
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 3728
Owner: Contractor:
TAYLOR MORRISON NORTHWEST LLC WILLIAM LYON HOMES INC Required Items and Reports(Conditions)
703 BROADWAY ST STE 710 703 BROADWAY STREET,SUITE 510 1 1-HR Fire Rated Eaves
VANCOUVER,WA 98660 VANCOUVER,WA 98660 2 Ersn Cntrl 503-639-4175
PHONE: PHONE: 360-695-7700
FAX:
Total Fees: $41,700.88
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work
will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of Issuance, or if work is suspended for more
the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
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Issued By: ' ( 7 Permittee Signature: f Y c ( t-�e row
Call 503_639_4175[E917:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the iob site at the time of each inspection.
' Mechanical Permit ApplicatlOiRECElVE FOR OFFICE USE ONLY 2
Received % I hr� k1, Vitt\
City of Tigard Date/By Permit No- w tl\l 11V1
" 13125 SW Hall Blvd.,Tigard,OR 97223 AUG 2 2023 plan Review
t — Phone: 503.718.2439 Fax: 503.598.1960 Dd1e/By. Other Permit:
T It t e, 1I i Inspection Line: 503.639 175 CITY OF TIGARD Dale Ready/By: .turfs_ H See Page 2 for
Internet wtivw.tigard-or.gov Noti6ed/Method: Supplemental Information
BUILDING DIVISION
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
®New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑ Other: mechanical materials,equipment,labor,overhead.and profit.
Value:$ L2 065"
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT I SYSTEMS FEES*
® 1-and 2-family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist
I j Multi-family ❑ Master builder ❑ Other. Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 1 46.75
Job site address: i Ili% 5 v4 Vcket- zip. Furnace 100,000 BTU(ducts/yews) 1 46.75
City/State/ZIP:Tigard,OR 97224 Furnace 100,000+BTU(duets/vents) 54.91
Suite/bldg./apt no: Project name: South River Terrace Heat pump 61.06
Duct work 1 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: South River Terrace Lot no.: I 0 Other 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
New construction-Type SFU fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 2332
Chimney/liner/flue/vent 23.32
® PROPERTY OWNER El TENANT Other 23.32
Environmental exhaust and ventilation:
Name:Taylor Morrison Northwest LLC. Range hood/other kitchen 1
equipment 33.39
Address:703 Broadway St Ste.510 Clothes dryer exhaust 1 33.39
City/State/ZIP:Vancouver,WA 98660 Single-duet exhaust(bathrooms,
toilet compartments,utility rooms) 1 2332
Phone:(360)695-7700 Fax:( ) Attickrawispacefans 23.32
® APPLICANT 0 CONTACT PERSON Other: 23.32
Business name:Taylor Morrison Northwest LLC. Fuel piping:
514.15 for first four;54.03 for each additional
Contact name: CR r2&J g.0 e2rS France,ctc. 1
Address:703 Broadway St,Ste 510 Gas heat pump
Wan/suspended/unit heater
City/State/ZIP:Vancouver,WA 98660 Water heater
Phone:(360)695-7700 Fax: :(360)693-4442 Fireplace 1
• Range 1
E-mail:permitsubmittais(taylormorrison.com Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:Pro Heating&Cooling Other
MECHANICAL PERMIT FEES*
Address: NW Alociek Dr,Ste. 1104 Subtotal
City/State/G1P:Hillsboro,OR Minimum permit fee(S90.00)
Plan review(25%of permit fee)
Phone:(360)270-1590 Fax:( )
State surcharge(12%of permit fee)
CCB lie.:209001 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: �Q' �' ' • Fee methodology set by Tri-County Building Industry Service Board
Print name:EGa Duran Date: G(2s 23 71,-
, Electrical Permit ApplicatiorR EIVED I111\ Ih1
City of g AUGH �0�� Dare/By: P.
UV �V
Tigard Permit#"
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.19 Date/By: Related Permit#:
Inspection Line: 503.639.4175 TY OF TIGARD Ready Date/By: _Tunis: See Page 2 for
TIGARD IInternet: www.tigard-or.gov BUILDING DIVISION Notified/Method: l ®Supplemental Information
TYPE OF WORK PLAN REVIEW
NIN
New construction ❑ Addition/alterationreplacement Please check all that apply.(submit 2 sets of plans w/items checked).
❑Service or feeder 400 amps or more ❑Building over three stories.
0 Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
lD1- and 2-family dwelling ❑ Commercial/industrial ❑ Accessory building ess to ground,or exceeds 14,0 0 Commercial-use agricultural
amps for all other installations. buildings.
❑ Multi-family ❑ Master builder 0 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: f 68 91 5 vo Frk�-� IOOHP or more. ❑"A","E","I-2","1-3",
City/State/ZIP: Tigard,Oregon 'p�Z2t{ ['Six or more residential units. occupancy.
y g g ( 0 Recreational vehicle parks.
❑Health-care facilities.
Suite/bldg./apt.#: Project name: S - -eweiL TnaziAce-• ❑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- South River Terrace Lot#: i 0 Includes attached garage.
1,000 sq.ft.or less I 168.54 4
Tax map/parcel#: Ea.add'I 500 sq.ft.or portion 33.92 t
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00
New home construction
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
0 PROPERTY OWNER I 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: Taylor Morrison Northwest LLC 200 amps or less 1 100.70 2
Address: 710 Broadway St,STE 710 201 amps to 400 amps 33.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: Vancouver, WA 98660 601 amps to 1,000 amps 301.04 2
Phone: (360 )695 7790 Fax: ( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: PermitSubmittals@taylormorrison.com relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 t
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
0 APPLICANT j 0 CONTACT PERSON Branch circuits-new,alteration,or extension, .er panel
A.Fee for branch circuits with
Business name: Taylor Morrison Northwest LLC above service or feeder fee, 7.42 2
each branch circuit
Contact name: C't'HR"S 1VA 1:Q.C5 B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address: 710 Broadway St,STE 710 branch circuit
City/State/ZIP:Vancouver,WA 98660 Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone: ( 360 625 7700 Fax: : ( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email:PermitSubmittals@taylormorrison.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Sunlight Electric Inc Sign or outline lighting 67.84 2
Address:2804 NE 65th Ave, Sutie D Signal lterationt(s)orlimited-energy 0 See Page 2 2
panel,alteration,or extension.
city/state/zIP:Voncouver WA 98661 Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
Phone: ( 971) 222-5758 Fax: ( ) Investigation(I hr min) 90.00/hr
Email:Peter@SunlightElectriclnc,com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.:172549 Electrical Lie.:C 0 Suprv. Lie.:6652S specifically listed(t/)hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: ® 4 Subtotal:
Print name:Yegor Shevchenko ��'Date: ❑Plan Review Required(25%of permit fee):
�� ���iii State surcharge(12%of permit fee):
Authorized signature: ii!S TOTAL PERMIT FEE:
000777•"' This permit application expires if a permit is not obtained within 180
Print name:Peter Kozarez Date: G/Lfi/�3 days after it has been accepted as complete.
Number of inspections allowed per permit.
1:113uldingsPermits\ELC_PermitApp_ELR ERli.doc Revll6/17/2015 44(1-4615T(1 1/05/COM/WIiB f(-,
Plumbing Permit Application RECEIVED
Building Fixtures FOR OFFICE USE ONLY
City of Tigard AUG 2 2023 Received Permit Na ' ` ' ,
11111 n 13125 SW Hall Blvd.,Tigard,OR 97223 V Plan Review
a Phone: 503.718.2439 Fax: 503.598.1960 CITY OF TIGAR tie RiZ Other Permit No.:
TIGAAD Inspection Line: 503.639.4175 BUILDING 1]IVISIODate Ready/By: tuns. 0 See Page 2 for
lntemer www.tigard-orgov D Notified/Method. Supplemental Information
TYPE OF WORK FEE* SCHEDULE
ID New construction ❑Demolition For special information use checklist.
---- - Description Qty. I Ea. i Total
❑ Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 I 1
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 I 25.02
❑Master builder ❑Other: Fire sprinkler( sq.R) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: t $`3`1 S 1, 1 . Kl;�. Li...)
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.: Project name:South River Terrace 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.: 1 Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: South River r Terrace Lot no.: t 0 Fixture or item:
Tax map/parcel no.: Bacleflow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
Clothes washer 1 I 25.02
New construction-Type SFU
Dishwasher 1 1 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER 0 TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name: Taylor Morrison Northwest LLC.
Floor drain/floor sink/hub 25.02
Address:703 Broadway St.,Ste 510 Garbage disposal 25.02
City/State/ZIP:Vancouver,WA 98660 Hose bib 25.02
Phone:(360)695-7700 Fax:( ) Ice maker 12.51
® APPLICANT I ❑ CONTACT PERSON Interceptorigrease trap 25.02
Business name: Taylor Morrison Northwest LLC. Medical gas(value:5 ) Page 2
^� Primer 12.51
Contact name: Cl.(R,(S ?0 ' Roof drain(commercial) 12.51 4
Address:703 Broadway St.,Ste 510 Sink/basin/lavatory 25.02
City/State/ZIP: Vancouver,WA 98660 Solar units(potable water) 62.54
Phone:(360)695-7700 I Fax: :(360)693-4442 Tub/shower/shower pan 12.51
Urinal 25.02
E-mail:permitsubmittals@polygonbomes.com
Water closet 25.02
CONTRACTOR Water heater 37.52
Business name:G&B Plumbing&Sons Inc Water piping/DWV 56.29
Address:P.O.Box 92 Other 25.02
City/State/ZIP:St.Paul,OR 97137 Subtotal
Phone:(503)868-1417 Fax:(971)727-8170 Minimum fee: $7250
Plan review (25%of permit fee)
CCB Lic.: 184372 Plumbing Lie,no.:pb634 State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Thispermitapplication expires if a permit is not obtained within 180 days
LPrint name:Steve Fowler Date: �'/2� after it has been accepted as complete.
*Fee methodology set by TO-County Building Industry Service Board •
IABluldintlPermisTLMII-Pe<uvrApo.doc 10/01N9 440-4616T(10/01COM1^NEH) ,V
IPII
2 G ,,,A--- Building Division
One & Two-Family Dwelling
T I G A RD Fees Checklist
PERMIT INFORMATION: Application Date - FEE VERSION Uv( 4/ Z02-al
Permit#: S ZOZ3_c�3Za Plan #: (18Z� �� Floors: 2-
Valuation: Covered Porch: *al{'1 Basement
Bedrooms: S - Deck: 15 .-- 1"Floor ' S 1 0
WC (toilets) 3 Deck Cover: 2nd Floor 22
Lavatories S` Patio Cover 3`d Floor
Tub/shower Li Accessory Struct. R-3 Total 3-7 r�
Laundry Tray �__ Water Heater ( / Gas CO 8 S
(flee) Garage C/
Exhaust Vents Gas Flue Vents Total for Elec.
4(113
Backflow Prey. um ce Heat Pump AC # for Electrical
BBQ „---- Gas Fireplace `LS #Fuel Lines 3
FEES: Description: Fee Applies: Fee Entered:
DC Prov Revw: Planning `//
Info Proc/Arch: Lg$2.00 (over 11x17) Z I
Info Proc/Arch: Sm$.50 (up to 11x17) d'S
Metro CET: Residential Use
School CET: District: l 6& !."-
Tigard CET: Admin
Tigard CET: ODHCS ✓
Tigard CET: AH L/
Electrical Permit: Permit Fee: ✓
Limited Energy: t....'---
12% State Surcharge
Mech. Permit: Permit Fee:
12% State Surcharge
Plumbing Permit: Permit Fee:
12% State Surcharge ✓
Erosion Control: w/Permit- Ping
I:\Building\Forms\ResPlanCheckFees_Dec2022_AA.doc 12/21/22
Page 1
City of Tigard
: ' COMMUNITY DEVELOPMENT DEPARTMENT
• ■
Building Permit Review - Residential
T I(„1RD
Building Permit #: MS f w Vic O 1()
Site Address: 16834 SW Beemer Lane ❑ Verified in Accela
Project Name: South River Terrace Lot/Unit #: 10
Proposal: New Single Detached Small Form Residential Zone: RES-D
Housing Type: RI SFR(® Single Detached ❑ Duplex❑Triplex❑ADU) ❑ Rowhouse❑Cottage Cluster 0 CYU ❑Quad❑Other
Required Site Plan Elements:
51 3 copies of site plan on max 11x17"
gi Drawn to standard scale IE-Rcterined trees, drip-line/ tree pretcetion
® North arrow IX Street and site trees shown / labeled
Cj Site address, project name, lot # canopy at maturity
IIX Street names (N/A for SFR)
Ilg Applicant name and phone #
IX Lot and setback dimensions ❑ Vibiuii deal alice tila.iglc
Utility locations &easements
M Footprint of new structure and FFE It Property corner elevations
ISI Sidewalk/driveway dimensioned ❑ LIDA(>1,000 f di,t.rbe.ee)
® Lot area and lot coverage percentage ISa Erosion control
Required Elevation Plan Elements:
(For SFR: calcs needed only on street-facing) Summary table with calculations for:
IX Drawn to standard scale IX Total facade area
IIfl Building height dimensioned IX Total window and door area
IA Facade dimensioned
IX Windows and doors dimensioned
3 Garage doors dimensioned -Garage door= 32% of frontage
Require Elements:
(Not required for SFR) 0 Summary table that includes
O Each story dimensioned loor area
❑ Each story floor area calculated 0 Floor area per
Planning Review
The following standards have been met:
12'bIdg
Setbacks Front: g'porch Rear: 0'alley Side: 3 Min/Max Street Side: _ 8 / Garage: 20'
Height /Max. Height: 35 Proposed Height: 25
I9 Yes 0 N/A Landscape
❑ Yes X N/A Screening (Quad only)
51 Yes ❑ N/A % Window Coverage
® Yes ❑ N/A Garage (SFR Only) Parking (Other Res)
R Yes ❑ N/A Entrance (SFR, Rowhouse, Quad only)
O 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 0 N/A Unit Count:
❑ Yes In N/A Lot Width and Size
❑ Yes 0 N/A Pathway
Additional standards for Courtyard Units and Cottage Clusters only:
❑ Yes ❑ N/A Unit Area:
❑ Yes ❑ N/A Floor Area (per story)
❑ Yes ❑ N/A Courtyard
O Yes 0 N/A Fence
❑ Yes ❑ No INN/A Clean Water Services - Service Provider Letter (lot platted prior to 9/10/1995)
❑ Yes ❑ No INN/A Public Facilities Improvement (PFI) Permit:
Required: ❑ Yes ❑ No
Applied For: ❑ Yes 0 No, stop intake
l Sensitive Lands: 0 Yes NJ No
K I Main Land Use Case #s: PDR2016-00 03/PDR2021-00003 ❑ Conditions met
❑Applicant notified of land use expiration •
Approved By Planning: _ ate: 7/26/23 /a/.2.3
Notes
Revision 1: 0 Approved ❑ Not Approved Date:
Revision 2: 0 Approved ❑ Not Approved Date:
Building Permit Submittal Original Submittal Date: �1 U Z1
Site Plans #:
Building Plans #:
Building Permit #: EYBuilding permit # entered on page 1
Workflow Routing: 6YPlanning Engineering Permit Coordinator building
Workflow Sign-off: t'Sign-off for Planning (include notes from planning review)
Route Documents: 'Engineering: (1) copy of permit application, (1) site plan, (1) building plan
aul original plan review routing form.
Building: original permit application, site plans, building plans, engineer and
q beam� calculations and trust details, if applicable, etc. Q
Permit Technician: _ "mil f`u" V VY\ �1� Date: 0 rs 1262;3
Notes:
Engineering Review
0 PFI Permit:
It Slope at building pad: %
le onditions met prior to issuance of permit
t Easements (encroachments) per engineering conditions of approval and plat
VWater Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes kilo
Assess Water Quantity Fee in-lieu: ❑ Yes rd'No
�/ LIDA Facility on lot: CI Yes t-No Add Fee: CI Yes CI No
/ Final Plat Recorded
❑ NOT Approved: Date:
Notes:Approved By Engineering: �' Date: 6 D
��s72,_
Revision 1: 0 Approved ❑ N Approved Date:
Revision 2: 0 Approved ❑ Not Approved Date:
Permit Coordinator Review
Conditions met prior to permit issuance
Approved, NOT Released: Date notified applicant:
4 ENG Revisions Required: Date notified applicant:
DC Exemption: ❑ Applied for ❑ Received •es not apply
DC Fees Entered: Wash Co Trans Dev Tax: C Yes ❑ N/A �� /�
Tigard Trans SDC: C Yes ❑ N/A ❑ Deferred+-�//�J2il/�C/Parks SDC: q Yes ❑ N/A ❑jDeferred
LIDA LI Yes p N/A
,.. OK to Issue/Approved by Permit Coordinator: Date: �' (�`
Revision 1: CI Approved ❑ Not Approved ` Date:
Revision 2: 0 Approved 0 Not Approved Date:
City ofTigard RECEIVED
Deferral Until Occupancy Request AUG 2 2023
CITY OF TIGARD
TIGARD Washington County Transportation Development Tax (11)1),TratfilpthEUNGrakitSteakks 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: /21/702-3 Site Address: ri�`3� LA
(e � sue) Q M - �lJ
Project ( Land Use Case or
Name: S, 2,,,,o,,z,,m2.4ct Building Permit#:
Tax Lot Total Parks
#: Amount*:
TDT Total TSDC
Amount: Amount*:
*The total TSDC amount shown above is the sum of$ for TSDC-Improvement, $ for TSDC-
Reimbursement, and$ for TSDC-River Terrace,if applicable..
*The total Parks SDC amount shown above is the sum of$ for Parks-Improvement,$ for Parks-
Reimbursement,and either$ for Parks-Neighborhood or$ 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 (honer. Date: o//li ,'-2,023
Developer: Date: �2 /2e) /rafil)
Permit Coordinator: Date: