Permit (106) IiiisCITY OF TIGARD MASTER PERMIT
. #
' COMMUNITY DEVELOPMENT Permit#: MST2023-00428
T EGA R.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/14/2023
Parcel: 2S107DA05300
Jurisdiction: Tigard
Site address: 16570 SW MELBOURNE LN
Subdivision: SOUTH RIVER TERRACE PHASE 2 Lot: 108
Project: South River Terrace, Lot 108
Project Description: New detached dwelling. NO FINAL INSPECTION UNTIL DEFERRED SDC FEES HAVE BEEN
PAID.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 781 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 24 Bathrooms: 3 Second: 1094 sf Garage: 429 sf Front: 12 Smoke
Yes
Dwelling Units: 1 Third: 0 sf Right: 3 Detectors:
Total: 1875 sf Value: $342,338.67 Rear: 0
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Drains: Storm Sewer: 100
0
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 100 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Drywell-Trench Drain: 0 Other Fixtures: 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
Furn<100K: 1 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: 3 201-400 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-3 875
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 Ersn Cntrl 503-639-4175
VANCOUVER,WA 98660 VANCOUVER,WA 98660
PHONE: PHONE: 360-695-7700
FAX:
Total Fees: $34,903.56
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work
will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
oc9_nnl-nnin fhrn AP o6911m-nnon ,n, nh$Qin a rnnv of fhe ndoe nr rli rent nnaetinne to r i INC h,,nallinn Sn4 9V9 10R77 if nr'I Ront117 91da
Issued By: Permittee Signature: 6 er' ( , c o 1-7
Call .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.
1
1 - Building Permit Application -r,: . ,
Residential FOR OFFICE USE ONLY
City of Tigard AUG 2 3 2023 RDeacteen3iveyd:
g
6713 3 ci....t. Tc3 ' 004
.143
- • 13125 SW Hall Blvd.,Tigard,OR 972��w1`111
3(u.�i� OD aG
Phone: 503,7182439 Fax: 503.598.A90(TY OF TIGARD Plan DateBRy:eview Jl� Z� ,1+rr`�
Ins ectionLine: 503.639.4175 BUILDING DIVISION DateReady/By. nn `' mrt.: 0 See Page 4for
Internet:r. www.tigard-or.gov � 111
TIGARD P Notified/Method: %d ce s. Supplemental Information
TYPE OF WORK REQUIRED DATA:1-XND 2-FAMILY DWELLING
❑' New construction ❑ Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑ Addition/alteration/replacement ❑Other: equipment.materials,labor,overhead and the profit for th
work indicated on this application.5 '}j ,co
CATEGORY OF CONSTRUCTION
Valuation: $
01-and 2-family dwelling 0 Commercial/industrial
Number of bedrooms:
❑ Accessory building 0 Multi-family
0 Other: Number of bathrooms: 3
❑ Master builder , /
JOB SITE INFORMATION AND LOCATION Total number of floors: — 2" `1
1r1.
Job site address:
4s?() Sf) f `[L.30Cu?.4!l= LA) New dwelling areal square feet
City/State/ZIP:Tigard, OR, 9'f 722.w Garage/carport atl4`._q square feet
Suite/bldg./apt.no.: Project name:South River Terrace 2 Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision:South River Terrace Lot no.: IL]0 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
DESCRIPTION OF WORK work indicated on this application.
.. Valuation: $
New home construction/SFU (plan type)
Please defer TSDC and Parks SDC until occupancy Existing building area: square feet
Project start: New building area: square feet
I PROPERTY OWNER ❑ TENANT Number of stories:
Name:Taylor Morrison Northwest LLC Type of construction:
Address:703 Broadway St. Suite 710 Occupancy groups:
City/State/ZIP:Vancouver,WA 98660 Existing:
Phone:(360 )695-7700 Fax:( ) New:
IN APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
Maus refer to fee w edak)
Business name:Taylor Morrison Northwest LLC Structural plan review fee(or deposit):
Contact name:Chris Roberts FLS plan review fee(if applicable):
Address:703 Broadway St. Suite 710 Total fees due upon application:
City/State/ZIP:Vancouver, WA, 98660
Amount received:
Phone:(503 )313-9449 Fax: :( )
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* 1
E-mail:Permitsubmittals@taylormorrison.com
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
for Morrison Northwest LLC Submit two(2)sets of roof plan with connection details
Business name:Taylor Y and fire department access,along with the 2010 Oregon
Address:703 Broadway St. Suite 710 Solar Installation Specialty Code checklist.
Permit Fee(includes plan review $I80.00
City/State/ZIP:Vancouver,WA, 98660 and administrative fees):
Phone:(360 )695-7700 —1 Fax:( ) •
State surcharge(12%of permit fie): $21.60
CCB lie.:207247 Total fee due upon application: $201.60
This permit application expires if a permit is not obtained
Authorized signature: within 180 days after it has been accepted as complete.
Print name:Chris Roberts Date: 1 "-r
�G *Fee methodology set by Tri-County Building Industry
� f�23 Service Board.
L\Building\Permits\BUP-RESPermitApp.doc 01/25/2023 440-4613T(I!!!I 1/OZ/COM/WEB)
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Receivede:eB
Y Per ,lo°5Ta o?3—day{
't 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
t Cit— � Phone: 503.718.2439 Fax: 503.598.1960 Date/By. Other Permit:
Ylii,,tlLI) Inspection Line: 503.639.4175 DateReadyBy tuns: H See Page 2for
Internet: wtvw.tigard-or.gov Notifed:Method Supplemental Information
TYPE OF WORK COMMERCIAL FEF.* SCHEDULE - USE CFIECKLIST
Mechanical permit fees`are based on the value of the work
®New construction ❑ Add ition/alterationirep1acement performed.Indicate the value(rounded to the nearest dollar)of all
❑ Demolition ❑ Other: mechanical materials,equipment,labor,overhead,and profit.
Value:S 10,214
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES'
® 1-and 2-family dwelling ❑ Commercial/industrial ❑ Accessory building For specie!Information use checklist
i l Multi-family ❑ Master builder ❑ Other: Description Qty. Ea. j Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
*� Air conditioning I 1 46.75
Job site address: Vag TO $w` µ0.0.1 ¢aL Furnace 100,000 BTU(ducts/veats) 1 1 46.75
City/State/ZIP:Tigard,OR 97224 Furnace 100,000+BTU(ducts/vents) I 54.91
Heat pump 61.06
Suite/bldg.lapl no.: Project name: SuwTK 2.veiL ,t,_2 Duct work 1 I 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
Fluelvent for any of above 23.32
Subdivision South River Terrace Z Lot no.: 056 other. 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gras fireplace/insert i 33.39
Flue vent for water heater or gas 1
New construction-Type SFU fireplace I 23.32
Log lighter(Ras) I 23.32
Wood/pellet stove 33.39
Wood firepiace/insert 23.32
Chimney/liner/flue/vent 23.32
OEl PROPERTY OWNER 0 TENANT Environmenta• l 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/L1P:Vancouver,WA 98660 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 1 23.32
Phone:(360)695-7700 Fax:( ) Atticicrawlspace fans 23.32
® APPLICANT ❑ CONTACT PERSON Other: 23.32
Fuel piping:
Business name:Taylor Morrison Northwest LLC.
S14.15 for first four;S4.03 for each additional
Contact name: CHQ„,S 'L�- S Furnace,etc. 1
.Address:703 Broadway St.,Ste 510 Gas heat pump
WaTsuspendedhmit heater i
City/State/LIP:Vancouver,WA 98660 Water heater
Phone:(360)695-7700 Fax: .(360)693-4442 Fireplace 1
Range 1
E-mail:permitsubmittals@taylOrmOf riSon.COm Barbecue
CONTRACTOR Clothes dryer(gas)
I
Business name:Pro Heating&Cooling Other:
MECHANICAL PERMIT FEES*
Address: NW Alociek Dr,Ste. 1104 Subtotal
City/State/ZIP: Hillsboro,OR Minimum permit fee(890.00)
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 ISO
' days after it has been accepted as complete.
th
Authorized sigtature: " �a' ' Fee meodoloq set by Tri-County Building Industry Service Board
Print name:Elia Duran Date: G/29/Z'j 4./
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard ReceivReceived Perrr 47-d-Oa5— 0,044•2 e
y
13125 SW Hall Blvd.,Tigard,OR 97223 plan Review Related Permit N:
i Phone: 503.718.2439 Fax: 503.598.1960 Date/By:
Inspection Line: 503.639.4175 Ready Date/By: 4aris: l0 See Page 2 for
I IGARD Internet: www.tigard-or.gov Notified/Method. Supplemental Information
TYPE OF WORK PLAN REVIEW
® New construction ❑ Addition/alteration/replacement 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 ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑Floating buildings.
less to ground.or exceeds 14,000 0 Commercial-use agricultural
® 1 and 2-family dwelling ❑Commercial/industrial ❑ Accessory building snips for all other installations. buildings.
E 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: ((A RO 51.A.) /4 04o4?'U t t,tiJ I00HP or more. ❑"A" "E""I-T' "1-3"
0 Six or more residential units. occupancy.
City/State/ZIP: Tigard OR 97224 ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bld /a t.#: Project name: South River Terrace j. ❑Hazardous locations. 0 Supply voltage for more than
g. p
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qtv. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: South River Terrace'Z Lot#: 10% Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
(with above sq.ft.)
New home construction. 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: Taylor Morrison Northwest LLC. 200 amps or less 100.70 2
Address: 703 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 )695-7700 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 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 ❑ CONTACT PERSON .W Branch circuits-new,alteration,or extension,per panel
- A.Fee for branch circuits with
Business name: Taylor Morrison Northwest LLC. above service or feeder fee, 7.42
each branch circuit
Contact name: Chris Roberts B.Fee for branch circuits without
- - service or feeder fee.first 56.18 2
Address: 703 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: (503 )313-9449 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: Portland Electric Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy El See Page 2 2
Address: 1915 E 5th St., Ste D panel,alteration,or extension.
Each additional inspection over allowable in any of the above
City/State/ZIP: Vancouver, WA 98661 Additional inspection(I hr min) 66.25/hr
Phone:( 360)314-4915 Fax: ( ) Investigation(I hr min) 90.00/hr
Industrial plant(I hr nun) 78.18/hr
Email:paul@portlandelectric.biz Inspections for which no fee is
CCB Lic.: 194066 Electrical Lic.: C760 Suprv.Lic.:
49205 specifically fisted(rii hr min) 90.00/hr
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: ,. A Subtotal:
Print name: Alex Shalya Da e: 74 70.3 ElPlan Review Required(25%of permit fee):
o State surcharge(12%of permit fee):
-rn
Authorized signature: 333CCVJJ t.w
_7l Q „w, � TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Sere Mishchuk Date: days after it has been accepted as complete.
Q y Zf�ze2l * Number of inspections allowed per permit.
Cleuilding5permits\Iii.C_PermitApp_BI.R_IIRB.doc Rev 06/17/2015 441146 I STT(11/55/COM/WEB A-
Plumbing Permit Application
Building Fixtures FOR OFFICE. USE ONLY
City of Tigard Received 30T=7-
Obq
13125 SW Hall Blvd.,Tigard,OR 97223 DatnRe Pena1�
n Plan Review Other Permit No.:
a Phone: 503.718 2439 Fax: 503.598.1960 Date/By:
T I G A R D Inspection Line: 503.639.4175 Da1e Ready/By: Imss- ED See Page 2 for
Internet: www.tigard-or.gov Notified/Medmd, Supplemental Information
-
TYPE OF WORK FEE* SCHEDULE
®New construction 0 Demolition For special information use checklist.
Description I Qty. I Ea. J 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
,1-and 2-family dwelling SFR(2)bath 437.78
I 0 Commercial/industrial
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: itt qb sue) ma., ¢K0 (_A Catch basin orarea 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: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: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: South River Terrace Z. I Lot no.: tog Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
Clothes washer 1 25.02
New construction-Type SFU
Dishwasher 1 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Fixturrlsewercap 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 0 CONTACT PERSON Interceptor/grim-trap 25.02
Business name: Taylor Morrison Northwest LLC. Medical gas(value:S ) Page 2
Primer 12.51
Contact name: C'40),5 ,jj$iRr 5 Roof drain(commercial) 12.51
,
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 Fax::(360)693-4442 Tub/shower/shower pan 12.51
Urinal 25.02
E-mail:permitsubmittals@polygonhomes.com polygonhomes.com
Water closet 25.02
CONTRACTOR
Water beater 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 permit fee: S72.50
Plan review (25%of permit fee)
CCB Lic.: 184372 Plumbing Lic.no.:pb634 State surcharge(12%of permit fee)
Authorized signature: , ► r TOTAL PERMIT FEE
!
LPrint name: Steve Fowler Date: �. ?6/ZP. 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',BuildinoTermrcsuPLM11-PermaApp doe 10/01A9 440-44616T(Io/02/COMANEB) hlV
City of Tigard
11111 COMMUNITY DEVELOPMENT DEPARTMENT
Building Permit Review - Residential
TIGARD
Building Permit #: /t/LJ-2-0d 3 -009.
Site Address: 16570 SW Melbourne Ln g Verified in Accela
Project Name: South River Terrace - Phase 2 Lot/Unit #: 108
Proposal: New Single Detached Small Form Residential Zone: RES-D
Housing Type: 14 SFR(® Single Detached 0 Duplex Cl Triplex❑ADU) El Rowhouse❑Cottage Cluster❑CYU ❑Quad El Other
Required Site Plan Elements:
RI 3 copies of site plan on max 11x17"
RI Drawn to standard scale El-Retaincd trees, drip line/ tree protection
® North arrow ® Street and site trees shown / labeled
I5 Site address, project name, lot # ❑ Table calculating trcc canopy at maturity
IX Street names (N/A for SFR)
® Applicant name and phone # ❑ Courtyard rectangle dimensioned (if applicable)
IX Lot and setback dimensions ❑ Visit,'i U.leamalicc Liai.glc
® Utility locations &easements
IX Footprint of new structure and FFE RI Property corner elevations
IX Sidewalk/driveway dimensioned ❑ LIDA (>1,000 sf disturbance)
IX Lot area and lot coverage percentage IN Erosion control
Required Elevation Plan Elements:
(For SFR: calcs needed only on street-facing) Summary table with calculations for:
XJ Drawn to standard scale IX Total facade area
IN Building height dimensioned ® Total window and door area
® Facade dimensioned
IX Windows and doors dimensioned
❑ 6ai aye duo,s etimcnaioncd alley-loaded garage, non street facing
Require Elements:
(Not required for SFR) ❑ Summary table that includes
❑ Each story dimensioned loor area
❑ Each story floor area calculated ❑ Floor area per
Planning Review
The following standards have been met:
12'bldg 0'alley 3' 8' 3'-5' alley
Setbacks IE Front: g hRear: Side: Min/Max Street Side: / Garage:
35' ceded garage
Height Ip Max. Height: Proposed Height: 23' 5 3/4"
IX Yes 0 N/A Landscape
❑ Yes IX N/A Screening (Quad only)
IX Yes ❑ N/A % Window Coverage
❑ Yes IX N/A Garage (SFR Only) Parking (Other Res)
6d Yes ❑ N/A Entrance (SFR, Rowhouse, Quad only)
ElYes i N/A Other building design standards (Rowhouse only)
CI 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 ❑ N/A Lot Width and Size
❑ Yes 0 N/A Pathway
Additional standards for Courtyard Units and Cottage Clusters only:
❑ Yes 0 N/A Unit Area:
❑ Yes ❑ N/A Floor Area (per story)
❑ Yes ❑ N/A Courtyard
0 Yes ❑ N/A Fence
1
❑ Yes ❑ No ®N/A Clean Water Services - Service Provider Letter (lot platted prior to 9/10/1995)
❑ Yes ❑ No ®N/A Public Facilities Improvement (PFI) Permit:
Required: ❑ Yes ❑ No
Applied For: ❑ Yes ❑ No, stop intake •
❑ Sensitive Lands: ❑ Yes W No
Main Land Use Case #s: PDR2018-00003/PDR2021-00003 ❑ Conditions met
❑Applicant notified of land use expiation ; .te: 11
Approved By Planning: , - Date: 8/15/23
Notes garage is alley-loaded 1(4'1
Revision 1: ❑ Approved ❑ Not Approved Date:
Revision 2: ❑ Approved ❑ Not Approved Date:
Building Permit Submittal
Original Submittal Date: g/ a'3/ 3
Site Plans #: �!
Building Plans #: '3
Building Permit #: f Building permit # entered on page 1
Workflow Routing: ,8(Planning Engineering Permit Coordinator KBuilding 1
Workflow Sign-off: l ,Sign-off for Planning (include notes from planning review)
Route Documents: gl Engineering: (1) copy of permit application, (1) site plan, (1) building plan
and original plan review routing form.
t Building: original permit application, site plans, building plans, engineer and
\\ beam calculations and trust details, if applicable, etc. Q
Permit Technician: Lrl/�� Date: !/��3a-3
Notes:
Engineering Review 1
❑ PFI Permit: 4
UY lope at building pad: 0 %
0/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 E1'IIo
Assess Water Quantity Fee in-lieu: ❑ Yes &No
LIDA Facility on lot: ❑ Yes 6'No Add Fee: ❑ Yes ❑ No
Final Plat Recorded
❑ NOT Approved: Date:
Notes: pp //
Approved By Engineering: Date: O/ .0_3
Revision 1: CI Approved CI Not A proved Date: `!!!!
Revision 2: ❑ Approved El Not Approved Date:
Permit Coordinator Review
Conditions met prior to permit issuance
Approved, NOT Released: Date notified applicant:
❑ ENG Revisions Required: Date notified applicant:
4-SDC Exemption: ❑ Applied for ❑ Received ligtoes not apply
tDC Fees Entered: Wash Co Trans Dev Tax: Yes ❑ N/A
Tigard Trans SDC: Yes 0 N/A Deferred 4 r ,,,�� j� J
Parks SDC: I1❑ Yes CI Deferred V�S�CJ �J
LIDA 0 Yes
n t pN/A
�/OK to Issue/Approved by Permit Coordinator: �Cd` Date: ' w` ��
l Revision 1: Approved ❑ Not Approved Date:
Revision 2: ❑ Approved ❑ Not Approved Date:
J
City of Tigard
" Deferral Until Occupancy Request
T I GARD Washington County Transportation Development Tax (TDT),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: ‘/Z Site Address: /6 726 SIA.) ilta,661,4e.oe CAJ
Project Land Use Case or
Name: 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 Owner: Date: c-/ 2�7 / ^�
Developer: Date: 6/72 be)a_3
Permit Coordinator: Date:
NI 2
Building Division
One & Two-Family Dwelling
TIGARD Fees Checklist
PERMIT INFORMATION: Application Date - FEE VERSION �v `L{ 207/S
iy Permit#: C���3_0.0y 1 �
_28 Plan #: (ca�� 6 Floors: `'1
Valuation: , Covered Porch: �� Basement c�
Bedrooms: l t Deck: 1s`Floor
WC (toilets) ,i Deck Cover: ,.--.77-----. 2nd Floor
Lavatories t. Patio Cover _....-------- 3rd Floor
Tub/shower 3 Accessory Struct. ,_ R-3 Total t S ""7�
Laundry Tray Water Heater l / Ga lec Garage 4 2l
230
Exhaust Vents Gas Flue Vents Total for Elec. 'i
l 1
Backflow Prey. ac Heat Pump AC # for Electrical 3
BBQ ,_—_-_ Gas Fireplace #Fuel Lines 3
FEES: Description: Fee AppIi : Fee Entered:
DC Prov Revw: Planning ✓/
Info Proc/Arch: Lg$2.00 (over 11x17) . -
Info Proc/Arch: Sm$.50 (up to 11x17) 5a
Metro CET: Residential U e ✓
School CET: District:
Tigard CET: Admin e,' -'
Tigard CET: ODHCS
Tigard CET: AH
Electrical Permit: Permit Fee:
Limited Energy:
12% State Surcharge
Mech. Permit: Permit Fee:
12% State Surcharge r/
Plumbing Permit: Permit Fee:
12% State Surcharge
Erosion Control: w/Permit-Ping kV,/
1
IC
I: uildin Forms ResPlanCheckFees Dec2022 AA.doc 12 21 22 B I
Page 1