Permit (2) CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT 7Permit#: MST2022-00513
Date Issued: 06/01/2023
Tt(3ATT.O 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S108DC25700
Jurisdiction: Tigard
Site address: 15819 SW BLUEWATER TER
Subdivision: RIVER TERRACE CROSSING Lot: 122
Project: River Terrace Crossing, Lot 122
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: 1164 sf Basement: 0 sf Left: 3 Parking Spaces: 0
Height: 22.5 Bathrooms: 3 Second: 1512 sf Garage: 440 sf Front: 12 Smoke Yes
Dwelling Units: 1
Third: 0 sf Right: 3 Detectors:
Total: 2676 sf Value: $435,582.28 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'I 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
Ecompasing:
Other: N Other Description:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 2676
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 Ersn Cntrl 503-639-4175
131 BEAVERTON,OR 97005 2 (2)layers of 2x fire blocking
BEAVERTON,OR 97005 at area indicated
3 Geo Tech Required
PHONE: 503-430-7413 PHONE: (503)430-7413
FAX:
Total Fees: $24,955.27
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable I
will be done in accordance with approved plans. This p it will expire if work is not started within 180 days of issuance, or if work is six
the 180 days. ATTENTION: Oreg law re ' you t ollow the rules adopted by the Oregon Utility Notification Center. Those rules a
Qc9-nM-M1n thrni inh nAR oc9-0 - non m nhtai rnnv of riirort eat octinnc to CM intr.ha/Tallinn nf19 9 1QA7 nr 1 Ann'119 93d4
r
Issued By: Permittee Signature:
C 3.639.4175 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.
10..04T I 4>14)1b
Building Permit ApplicatillECEIVED
Residential FOR OFFICE USE ONLY
City of Tigard DEC 1 4 2022 Received \ g h
Date/By: i I i e3- .,a p Per 6� q 70 V- 0 5 l
11111 a 13125 SW Hall Blvd.,Tigard,OR 97223 a . iTY Pl eview Phone: 503.718.2439 Fax: 503.598 OF TIGARD DateanBy:R 121
21 i /M- etupizolo — 0a}-�J(^j
TIGARD Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/By: Juris: 0 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: ( /Z'. , Supplemental Information
TYPE OF WORK r ,t ' REQUIRED ATA 1.AND 2 FAMILYDWELL;IT G
111 New construction ❑Demolition Permit fees*are Ybased on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY,OF CONSTRUCTIONS work indicated on this application.dwelling �I
• 1-and 2-familyValuation: $ L��5)5��
El ✓ /
❑Accessory building III Multi-familyNumber of bedrooms: 4
❑Master builder ❑Other: Number of bathrooms: 3
JOB SITE INFORMATION AND LOCATION Total number of floors: 2 3 t`(0
Job site address: 15 819 SW B L U E W AT E R TER New dwelling area: 2676 square feet t S.t
City/State/ZIP: Tigard / OR / 97224 Garage/carport area: 440 square feet I t Li
Suite/bldg./apt.no.: Project name:River Terrace Crossing Lot 122 Covered porch area: 64 square feet u!
Cross street/directions to job site: Deck area: 120 square feet
Other structure area: square feet
REQUIRED DATA COMMERCIAL USE`CHECKLIST
Subdivision: River Terrace Crossing Lot no.: 122 Permit fees*are based on the value of the work performed.
2 S 108 D C 11400 Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OE WORK work indicated on this application.
Single Family Detached Dwelling Valuation: $
Existing building area: square feet
Request the Transportation and Parks SDCs to be deferred to occupancy New building area: square feet
PROPERTY OWNER
` ❑ TENANTt;i 11 Number of stories:
Name: ICHIJO USA CO., LTD. Type of construction:
Address: 3800 SW Cedar Hills Blvd. Ste. 131 Occupancy groups:
City/State/ZIP: Beaverton/OR/97005 Existing:
Phone:(503)430-7413 Fax:(503)430-7621 New:
APPLICANT ❑;CONTACT PERSON BU EES*
ILDING PERMIT F
Business name:
ICHIJO USA CO., LTD. rI'leCefertofeesdedure}° :, a
Structural plan review fee(or deposit):
Contact name: Naoki Yamaoka
FLS plan review fee(if applicable):
Address: 3800 SW Cedar Hills Blvd. Ste. 131
Total fees due upon application:
City/State/ZIP: Beaverton/OR/97005
Phone:(503)430-7413 Fax: :(503)430-7621 Amount received
E-mail: nao@ichijousa.com HOTOVOIfFAICS OLARPAN ELSYSTEMTEES*
ter.
CONTRACTOR t Commercial and residential prescriptive installation of
.i -` . r`.. . - .a ..� _ .. _ _ roof-top mounted Photo Voltaic Solar Panel System.
Business name: ICHIJO USA CO., LTD. Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: 3800 SW Cedar Hills Blvd. Ste. 131 Solar Installation Specialty Code checklist.
City/State/ZIP: Beaverton/OR/97005 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:(503)430-7413 Fax:
(503)430-7621 State surcharge(12%of permit fee): $21.60
CCB lie.. 215360 Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Naoki Yamaoka Date:12/14/2022 *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)
,.. ' }
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE USE ONLY
City of Tigard ReceivedDate/By: Permit No.:
Ill �4 13125 SW Hall Blvd.,Tigard,OR 97223
g Associated permits:
es Phone: 503.718.2439 Fax: 503.598.1960
24-Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical
TiGARD Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ 0
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ❑ ❑ ❑
3 Verification of approved plat/lot. ❑ ❑ ❑
4 Fire district approval required. Name of district: . ❑ ❑ ❑
5 Septic system permit or authorization for remodel. Existing system capacity . ❑ ❑ ❑
6 Sewer permit. ❑ ❑ ❑
7 Water district approval. ❑ ❑ ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑
9 Erosion control 0 plan ❑permit required. Include drainage-way protection,silt fence design and location of catch- ❑ ❑ ❑
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state II ❑ ❑
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
copyright violations exist.
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if ® ❑ ❑
there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements
and driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction
indicator;lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and
surface drainage.
12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size U ❑ ❑
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, I ❑ ❑
furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc.
14 Cross section(s)and details. Show all framing-member sizes and spacing such as floor beams,headers,joists,sub- U ❑ ❑
floor,wall construction,roof construction. More than one cross section may be required to clearly portray
construction. Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings
and foundation,stairs,fireplace construction,thermal insulation,etc.
15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. 1111 ❑ ❑
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full-size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- ❑ ❑
prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing • ❑ ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑
systems,see item 22,"Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists • ❑ ❑
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. IS ❑ ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required I ❑ ❑
for four or more appliances.
22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or • ❑ ❑
architect licensed in Ore_on and shall be shown to be applicable to the .ro'ect under review.
JURISDICTIONAL SPECIFICS
23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". li ❑ ❑
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. II ❑ ❑
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. NI ❑ ❑
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. IN ❑ ❑
27 "Drawn to scale"indicates standard architect or engineer scale. In ❑ ❑
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard ❑ ❑
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, IN ❑ ❑
and protection measures must be drawn to scale and must include the project arborist's signature of approval.
30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, ❑ ❑ MI
including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9,1995.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
•
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Received
PlanDate Review
: Permit No.:
+ 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Re
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Ready/By: Juris: H See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
COl?MERCIAL FEE* SCHEDULE USE CHECKLIST
TYPE.OFWORK � F , ., ,. ..,. ,
Mechanical permit fees*are based on the value of the work
1.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:
$
T CATEGORY QF CONSTRUCION 'RESIDENTIALEQaI NT"ISYSTEMS'FEES*
• 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family 0 Master builder ❑Other: Description Qty. Ea. Total
JOB STI'E INFORMATION ANDgrLOCATION.
Heating/cooling:
"` '' Air conditioning 46.75
Job site address: 15 819 SW B L U E W AT E R TER Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: Tigard / OR / 97224 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 1 61.06
Suite/bldg./apt.no.: Project name: River Terrace Crossing Lot122 Ductwork 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
Other: 23.32
Subdivision: River Terrace Crossing Lot no.: 122
Other fuel appliances:
Tax map/parcel no.: 2 S 108 D C 1140 0 Water heater 1 23.32
DESCRIPTION OE='WORKr. Gas fireplace/insert 33.39
" Flue vent for water heater or gas
Single Family Detached Dwelling fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
.PROPERTY OWNER 0 TENANT ' Environmental exhaust and ventilation:
Name: ICHIJO USA CO., LTD. Range hood/other kitchen
equipment 1 33.39
Address: 3800 SW Cedar Hills Blvd. Ste. 131 Clothes dryer exhaust 1 33.39
City/State/ZIP: Beaverton/OR/97005 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 5 23.32
Phone:(503) 430-7413 Fax:(503) 430-7621 Attic/crawlspace fans 23.32
APPLICANT ` '; ;❑ CONTACT PERSON Other: 23.32
Fuel piping:
Business name: ICHIJO USA CO., LTD.
$14.15 for first four;$4.03 for each additional
Contact name: Naoki Yamaoka Furnace,etc.
ump
Address: 3800 SW Cedar Hills Blvd Ste. 131 Gas he
Wall/suuspspenndede
d unit heater
City/State/ZIP: Beaverton / OR / 97005 Water heater 1
Phone:(503)430-7413 Fax: :(503)430-7621 Fireplace
Range 1
E-mail: nao@p ichijousa.com Barbecue 1
' 6 CONTRACTOR'S Clothes dryer(gas)
Supreme Heating and Cooling LLC other
Business name: .i MECHANICAL PERM_Ti"FEI *
Address: 13009 NE 91ST Circle Subtotal
City/State/ZIP: Vancouver, WA 98682 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(503)333-3213 Fax:( ) State surcharge(12%of permit fee)
CCB lie.: 221270 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: 4 * Fee methodology set by Tri-County Building Industry Service Board
Print name: Naoki Yamaoka Date: 12/14/2022
I:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(11/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi-Family Fee Schedule:
Total; Valuation Permit Fee
$0.00 to$500.00 Minimum fee$69.06
$500.01 to$5,000.00 $69.06 for the first$500.00 and
$3.07 for each additional$100.00 or
fraction thereof,to and including
$5,000.00.
$5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and
$2.81 for each additional$100.00 or
fraction thereof,to and including
$10,000.00.
$10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and
$2.54 for each additional$100.00 or
fraction thereof,to and including
$50,000.00.
$50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and
$2.49 for each additional$100.00 or
fraction thereof,to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first$100,000.00 and
$2.92 for each additional$100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
I:\Building\Permits\MEC_PermitApp_040113.doc 2
•
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Received
Date/B Permit#:
,1111 a 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
m; Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#:
T I G ARD Inspection Line: 503.639.4175 Ready Date/By: Juris: 0 See Page 2 for
., Internet: www.tigard-or.gov Notified/Method: Supplemental Information
„. . < " TYPE OF RK WO
.. ,_..,A *.iw. AA i.. <.„ :: :'PLAN REVIEW, e,: `,,
El New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
❑Demolition ❑Other: ❑Service or feeder 400 amps or more ❑Building over three stories.
where the available fault current ❑Marinas and boatyards.
G OF CONSTRUCTION
€, AEGORS' ;; 2 exceeds 10,000 amps at 150 volts or 0 Floating buildings.
I 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building less to ground,or exceeds 1a,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi family 0 Master builder ❑Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB-SITE INFORMATION;AND'`LOCATION Ai viA-:;-.i.:;.-,-;-- =',:lf, ❑Emergency system. larger separately der ved
❑Addition of new motor load of system.
Job#: Job site address:15819 SW BLUEWATER TER IOOHPormore. ❑"A'>,"E", 1-2","1-s",
City/State/ZIP: Tigard / OR / 97224 ❑Six or more residential units. occupancy.
❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: River Terrace Crossing Lot 122 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 e
New residential single-or multi-family dwelling unit.
Subdivision: River Terrace Crossing Lot#: 122 Includes attached garage.
Tax map/parcel#: 2S 108 D C 11400 1,000 sq.ft.or less 168.54 4
Ea.add'1500 sq.ft.or portion 33.92 1
_: .:`DESCRIP.TION: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
- II'PROPERTY,OWNER 4 '❑',TENANT `, Services or feeders installation,alteration,and/or relocation
Name: ICHIJO USA CO., LTD. 200ampsorless 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
Email: Temporary services or feeders installation,alteration,and/or
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
.. • APPLICAN'T.` =,❑_;CONTACT PERSON . " Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: ICHIJO USA CO., LTD. above service or feeder fee,
each branch circuit 7.42 2
Contact name: N a o k I Yamaoka B.Fee for branch circuits without
Address: 3800 SW Cedar Hills Blvd. Ste 131 service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Beaverton / OR / 97005 Eachadd'lbranchcircuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503) 430-7413 Fax: :(503)430-7621 Each manufactured or modular
Email: na0@ichijousa.com
dwelling,service and or feeder 67.84 2
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
Address: 1834 SE 8TH AVE Signal circuit(s)or limited-energy
panel,alteration,or extension. ❑ See Page 2 2
City/State/ZIP: PORTLAND, OR 97214 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503 )231-1548 Fax:( ) Investigation(1 hr min) 90.00/hr
Email: OFFICE@W ESTS I D EE LECTRI C.CO M Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lie.: 13306 Electrical Lie.: 26-135C Suprv.Lie.: 5698S specifically listed(%hr min) 90.00/hr
Suprv.Electrician signature,required: & .t.4l,,.td v
ELECTRICAL`,P.ERMIT FEES':;
Subtotal:
Print name: BRENT WALL 5698-S Date: 12/14/2022 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE:
12 14 This permit application expires if a permit is not obtained within 180
Print name: N a o k i Yamaoka Date: / /2 0 2 2 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitAppELR_ERE.doc Rev 06/17/2015 440-46I5T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK;ONLY:
Description I Qty. I Each I Total I
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
5 kva or less 100.70 2
Check Type of Work Involved:
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 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
552.26 2
with OAR 918-309-0040)
❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva-no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Each additional inspection is 66.25/hr 1
Other: charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(%hr min)
ELECTRICAL;PERMIT.FEES
"COMMERCIAL=WORK ONLY: Subtotal(Enter on Page 1):
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
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ P• rotective Signaling
❑ O• ther:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I.\Building\Permits\ELC_PermitApp_ELR ERE.doc Rev 06/17/2015
Plumbing Permit Application
Building Fixtures FOR OFFICE ESE ON .
City of Tigard Received
III - PlanDa Re Permit No.:
■ 13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2439 Fax: 503.598.1960 Review
Date/By: Other Permit No.:
T I C A R D Inspection Line: 503.639.4175 Date Read/B -
Internet: www tigard or gov y y' Iu is: See Page 2 for
Notified/Method: Supplemental Information
.TYPE:OF WORK ' : _ FEE* SCHEDULE V i
•New construction ❑Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) _
CATEGORY OF CONSTRUCTION ,. SFR(1)bath 312.70
II 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building ❑Multi-family SFR(3)bath 1 500.32
❑Master builderEach additional bath/kitchen 25.02
❑Other: Fire sprinkler( sq.ft.) Page 2
tt ` JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 15819 SW BLUEWATER TER Catch basin or area drain 18.76
City/State/ZIP: Tigard / OR / 97224 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name:River Terrace Crossing Lot 122 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 Lotno.: 122 Fixture or item:
Tax map/parcel no.: 2 S 10 8 D C 11400 Backflow preventer 31.27
DESCRIPTIQN OFWORK Backwater valve 12.51
Clothes washer 1 25.02
Single Family Detached Dwelling Dishwasher 1 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
;PROPERTY OWNER xi E TENANT Expansion tank 12.51
Name: ICHIJO USA CO., LTD. Fixture/sewer cap 25.02
Address: 3800 SW Cedar Hills Blvd. Ste. 131 Floor drain/floor sink/hub 25.02
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
A � � 1 I2.51
• APPLICANT ❑ CONTACT, PERSON Interceptor/grease trap 25.02
Business name: ICHIJO USA CO., LTD. Medical gas(value:$ ) Page 2
Contact name: Primer 12.51
Naoki Yamaoka
Roof drain(commercial) 12.51
Address: 3800 SW Cedar Hills Blvd. Ste. 131
Sink/basin/lavatory 6 25.02
City/State/ZIP: Beaverton / OR / 97005 Solar units(potable water) 62.54
Phone:(503)430-7413 Fax: :(503)430-7621 Tub/shower/shower pan 4 12.51
E-mail: nao@ichijousa.com Urinal 25.02
.:`: Q. COMM
`' OR "'
Water closet 3 25.02
Water heater 1 37.52
Business name: Pipe It Plumbing LLC.
Water piping/DWV 56.29
Address: PO BOX 1389 Other: 25.02
City/State/ZIP: Boring / OR / 97009 Subtotal
Phone:(503) 544-0477 Fax:(503) 912-0045 Minimum permit fee: $72.50
CCB Lic.: 174351 Plumbing Lic.no.: P B297 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature:
TOTAL PERMIT FEE
Print name: N a o k I a m a o k a Date:12/14/2 02 2 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:\Building\Permits\PLMU-PermitApp.doe 10/01/09 440-4616T(10/02/COM/WEB)
•
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Fee ea.). u..ToalT.- Sci
Fog . :Permit
$121.90
Footing drain-1st 100' 50.03 otoz,000
2,001 to 3,600 $169.69
Footing drain-each additional 100' 37.52 3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52 Valuation: Perm><t Fee
Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Qty Fee(ea) otal; each additional$100.00 or fraction thereof,to
Other-Inspections or Fees ` . 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
each additional$100.00 or fraction thereof.
(minimum charge-1/2 hour)
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`. PIan Review for-��lumbing rinstallations
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
❑ Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
-Jacuzzi/Whirlpool ❑ New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru ❑ Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator ❑ Any multipurpose fire sprinkler system.
Dishwasher: -Commercial
❑ Any complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2"
-3» Isometric orRiser 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 Comments regarding fixture work:
Ice Mach./Refrig.Drains
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 plumbing permit can be issued.
Water Closet-Toilet
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
RECEIVED
City of Tigard DEC 1 4 2022
II 411
COMMUNITY DEVELOPMENT DEPARTMENT
Building Permit Review - Residential CITYNG DIVATIGARD
T1cAi�D AA BUILDING DIVISION
Building Permit#: ,,V`*7- '} —00 t,I.
Site Address: .1 S %;3(41 5 Fl 0 -r- ,ram Nee_ herified in Accela
Project Name: 1' NICE. C►-o < L° I Unit #: 1..
e
Proposal (include housing type):Nw SFR Zone: q.pS - C—
Rerired Site Plan Elements:
E 3 c9pies of site plan on max 11x17"
1,.Drawn to standard scale • , ' ' ctlon
19j orth arrow Street and site trees shown/ labeled
Ef/Site address, project name, lot # dt-malurlty
Of/Street names
/Applicant name and phone #
NI Lot and setback dimensions V Vision clearance triangle
M tility locations &easements
ootprint of new structure and FFE d Property corner elevations
12 f idewalk/driveway dimensioned 2,LIDA (>1,000 sf disturbance)
d Lot area and lot coverage percentage ® Erosion control
Required Elevation Plan Elements:
(For FR: calcs needed only on street-facing) ✓Garage doors dimensioned
l9II rawn to standard scale Supimary table with calculations for:
e : ' a..• .-.•. •imensionfet la'Total facade area
Or . acade dimensioned Total window and door area
7' "in.ows an. •oors dimensioned 1,]/'Total garage area
Requ red Floor Plan Elements: i�J Summary table that includes
1A Each story dimensioned vir/Total floor area
Vd Each story floor area calculated d Floor area per story
Planning Review
The followinig standards 4m been met:
Setbacks i Front: I2 t
/ 0 Rear: I 0 Side: 2 Min/Max Street Side: N- //- Garage:
/, Height dMax. Height: N a Proposed Height: a -' S 3Ab'
Yes ❑ N/A Landscape
❑ es iIN/A Screening (Quad only)
la/Yes 0 N/A % Window Coverage
li Yes 0 N/A Garage (SFR Only)
/ Parking(Other Res)
l 'Yes 0 N/A Entrance (SFR, Rowhouse, Quad only)
uni only)
dditional standards for Courtyard Units, Cottage Clusters, Rowhou uads:
❑ N/A Unit Count:
❑ Yes 0 Lot Width and Size
❑ Yes ❑ N/A Pa
Additional standards fo rtyard - s and Cottage Clusters only:
❑ Yes ❑ N/A Unit Area:
❑ Yes ❑ N/A Floo a (per story)
❑ Yes ❑ N ourtyard
❑ N/A Fence
❑Yes ❑ No /A Clean Water Services - Service Provider Letter(lot platted prior to 9/10/1995)
Q ®N
Yes 0 No ON/A Public Facilities Improvement (PFI) Permit:
Required: es 0 No
Applied For: es ❑ No, stop intake
❑ Sensitive Lands: Yes 0 No Si. ik-a-D i — °ba i l
❑ Land Use Case #: rAkk.2-0lb"O° 16 `r' �'t�Raoig-WOOS E7 Conditions met prior permit issuance
Approved By Planning: /�6 Date: \ /
Notes
Revision 1: 0 Ap roved 0 Not Approved Date:
Revision 2: 0 Approved 0 Not Approved Date:
Building Permit Submittal l
Original Submittal Date:
Site Plans #:
Building Plans #:
Building Permit #: 11 Building permit # entered on page 1
Workflow Routing: .$(Planning 0-Engineering "1%1 Permit Coordinator $Building
Workflow Sign-off: X.Sign-off for Planning (include notes from planning review)
Route Documents: Xi Engineering: (1) copy of permit application, (1) site plan, (1) building plan
and original plan review routing form.
EX Building: original permit application, site plans, building plans, engineer and
beam calculations and trust details, if applicable, etc.
Permit Technician: Date: ` /it
Notes:
Enjgineering Review
Slope at building pad: -
A/P 4�' t onditions met prior to issuance of permit
Easements (encroachments) per engineering conditions of approval and plat
M'Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: 0 Yes fro
Assess Water Quantity Fee in-lieu: 0 Yes *No
LIDA Facility on lot: ❑ Yes It(No Add Fee: 0 Yes 0 No
O Final Plat Recorded
❑ NOT Approved: Date:
Notes:
Approved By Engineering: Date: /2/21fra
Revision 1: 0 Approved 0 of Approved Date:
Revision 2: 0 Approved 0 Not Approved Date:
PermitPe Coordinator Review
,�Conditions met prior to permit issuance
❑ Approved, NOT Released: Date notified applicant:
❑ ENG Revisions Required: Date notified applicant:
DC Exemption: 0 Applied for 0 Received Ga'6oes not apply
XJ SDC Fees Entered: Wash Co Trans Dev Tax: rnes 0 N/A
Tigard Trans SDC: Yes 0 N/A ei2IDeferred
Parks SDC: Yes 0 N/A /l (Deferred
LIDA ❑ Yes /Er N/A
.e1 OK to Issue/Approved by Permit Coordinator: Date: (2(i9'�ZZ
Revision 1: 0 Approved 0 Not Approved Date:
Revision 2: 0 Approved 0 Not Approved Date: