Permit - 7/ ,- -1 tA---( 6ce-(6-( u2-6.../ re e_L___,
IN CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit #: MST2009 -00098
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/07/2009
TIGARD Parcel: 2S110AB05100
Jurisdiction: Tigard
Site address: 11422 SW COLE LN
Subdivision: Lot: 0
Project: Cabrera
Project Description: Infill joists to create loft space, 7/2/09, adding (2) branch circuits to scope of work.
BUILDING
Floor Areas Required Setbacks Required
Stones: 0 Bedrooms. 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces* 0
Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 0 Detectors:
Total: sf Value: $2,000.00 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays 0 Rain Drain. 0 Catch Basins: 0
Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Other Fixtures: 0
Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0
Drains: 0
Bckflw Prevntr: 0
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 0
Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Fum > =100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits
1000 sf or less: 0 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0
Ea add9 500 sf: 0 20 1 -400 amp: 0 201 -400 amp: 0 1st W/O Svc /Fdr:
Limited Energy: 401 -600 amp: 0 401 -600 amp: 0 Ea add Br Cir:
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: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
Owner: Contractor: Required Items and Reports (Conditions)
CABRERA, AL & OWNER
OROZCO - CABRERA, BRENDA E,
11422 SW COLE LN
TIGARD, OR 97224
PHONE: PHONE:
FAX:
Total Fees: $170.55
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. AT • •I. • -.•. law requires you to follow the rules adopted by the Oregon Utility Notification Center. T•..se rules are set forth in OAR
952 -0 -0010 through OAR 95 101 -0100. Y. may obtain a copy of the rules or direct questions to OUNC by calling 503 246 • • , r0.332 344.
Is-ued By: Oli.LA, Permittee Signature: X
Llectrical Permit Application FOR OFFICE USE ONLY C�
City of Tigard Received e �e r Permit No.: ��D (' D06
II •
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit:
T I GARD Inspection Line: 503.639.4175 Date Ready/By: kris: la See Page 2 for
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 below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ 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 ❑ Commercial -use agricultural
® 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION - ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: 11422 SW Cole Ln IOOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tig ard, /State /ZIP: Ti d OR 97224 ❑ Health-care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Loft Infill ❑ Service or feeder 600 amps or more.
' FEE ,SCHEDULE., . . . '
Cross street/directions to job site: 99W & Gaarde Description I Qtr. I Fee. I Total I *
New residential single or multi - family dwelling unit.
W. on Gaarde, S. on 114 W. on Cole, i house on left. Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: -
Limited energy, residential
75.00 2
DESCRIPTION. OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
10'x10' loft infill above formal dining room residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
® PROPERTY 'OWNER .. - ❑ TENANT , . 201 amps to 400 amps 106.85 2
Name: Al & Brenda Cabrera 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: 11422 SW Cole Ln Over 1,000 amps or volts 454.65 2
City /State /ZIP: Tigard, OR 97224 Temporary services or feeders installation, alteration, and/or
relocation
Phone: (503)620 -2081 Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, eba v exchange, .ccordin. -to 0 • S 447, 449, 670, d 7p1. 401 amps to 599 amps 133.75 2
Y �• / / /1r nn Branch circuits — new, alteration, or extension, per panel
Owner signature: X_f —4L__.. ._ /',_ Date: 1 'v A. Fee for branch circuits with
® APPLICANT ' ® CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: Al Cabrera without service or feeder fee, 1 46.85 46.85 2
first branch circuit
Address: 11422 SW Cole Ln Each add'l branch circuit 1 6.65 6.65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Tigard, OR 97224 Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: (503) 620 - 2081 Fax: : ( ) Reconnect only 66.85 2
E -mail: albrenda @verizon.net Pump or irrigation circle 53.40 2
' CONTRACTOR - ' . Sign or outline lighting 53.40 2
� ,
Business name: � 0 R- C___ energy a
Signal circuit(s) or in d-
nergy panel alteration, or
Address:
extension. Describe: Page 2 2
City/State /ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( ) Investigation per hour (1 hr min) 62.50
CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMTT `FEES
Suprv. Electrician signature, required: Subtotal: 53.50
Print name: Date: Plan review (25% of permit fee):
State surcharge (12% of permit fee): 6.42
Authorized signature: TOTAL PERMIT FEE: 59.92
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
1:\13uitding\Permits\ELC- PermitApp.doc 05/23/06 440-4615T(t t/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY: •
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ A udio and Stereo Systems*
❑ Burglar Alarm
n Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
n Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
n N • urse Calls
n O utdoor Landscape Lighting*
n Protective Signaling
H Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I.\ Building \Permits\ELC- PermitApp.doc 03/23/06
IN CIT
Y OF TIGARD MASTER PERMIT
: COMMUNITY DEVELOPMENT Permit #: MST2009 -00098
T IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/07!2009
Parcel: 2S110AB05100
Jurisdiction: Tigard
Site address: 11422 SW COLE LN
Subdivision: Lot: 0
Project: Cabrera
Project Description: Infill joists to create loft space.
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 0 Detectors:
Total: sf Value: $2,000.00 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays, 0 Rain Drain: 0 Catch Basins: 0
Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Drains: 0 Other Fixtures: 0
Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines. 0
Bckflw Prevntr: 0
MECHANICAL
Fuel Types Air Conditioning: Vent Fans: 0 Clothes Dryers: 0
Heat Pump: Hoods 0 Other Units: 0
Furn <100K: 0 Vents 0 Woodstoves: 0 Gas Outlets: 0
Furn > =100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc!Feeders Branch Circuits
1000 sf or less: 0 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0
Ea add l 500 sf: 0 20 1 -400 amp: 0 201 -400 amp: 0 1st W/O Svc/Fdr:
Limited Energy: 401 -600 amp: 0 401 -600 amp. 0 Ea add Br Cir:
601 -1000 amp: 0 601 +amp- 1000v: 0
1000 +amp /volt: 0
ELECTRICAL - RESTRICTED ENERGY
SF Residential
Audio & Stereo: HVAC: Security Alarm: Vaccuum System: Garage Opener: All
Other: Other Description' Ecompasing:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
Owner: Contractor: Required Items and Reports (Conditions)
CABRERA, AL & OWNER
OROZCO - CABRERA, BRENDA E,
11422 SW COLE LN
PHONE: PHONE:
FAX:
Total Fees: $110.63
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
952 - 001 -0010 t ough. AR 952 -001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503. 9 .r 1.800.33 • •4.
Issued By: \4 �J- Permittee Signature:
Building Permit Application
Residential FOR OFT ice USE ONLY
1111 City of Tigard Received Date1B : Permit No.: u r 4 . `` bj.
13125 SW HaII Blvd., Tigard, OR 97223 Plan Review
I I ° Phone: 503.639.4171 Fax: 503.598.1960 Date/B : �?. / ' /as Other Permit:
T I GA RD Inspection Line: 503.639.4175 Date Ready/By: ® See Page 2 for
Internet: www.tigard or.gov Notified/Method: IBIM Supplemental Information
TYPE OF WORK ' ' REQUIRED DATA:1- AND 2- FAMILY DWELLING .
0 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 the
•
CATEGO RY OF CONSTRUCTION work indicated on this application.
[� 1- and 2- family dwelling ❑ Commercial/industrial
Valuation: $ 2.-t90,0 , 0 0
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Oth Number of bathrooms:
.JOB SITE, INFORMATION AND LOCATION Total number of floors:
Job site address: 1 \ H ZZ St.) (.pL LA■ t: New dwelling area: square feet
City/State /ZIP: 1 TZ>A.,0, 0 bw+^l t ° 1'77,2' - Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
SW C.a l.8 (417.)11 Q. ) t J ' 1 `'$ i o f-U e Other structure area: square feet
REQUIRED DATA: COMMERCIAL - USE CHECKLIST
Subdivision: Lot no.: 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.
A of 50bST$ 1 a Ji- 'c.t_.. Lot`T sPAce
Valuation: 13 'zov $
Existing building area: 2 & square feet
New building area: , XL.‘ t p square feet
@, PROPERTY' OWNER ❑ TENANT Number of stories: 2,
Name: At_ ¢ Z z DR C-a j7,E4 Type of construction: 1,1 - Feitgero we 00
Address: 11 2z- Si.) . caws' LAo6 '
Occupancy groups:
City/State /ZIP: 1 / pie /' 7 - Z . 'j Existing: / J o 1(
Phone: (6os ) 33) - 6040;1 Fax: ( )
New:
❑ APPLICANT _I `CONTACT PERSON
n NOTICE
At
Business name: 38 A ss j76 g c .,.") 00 4.5 All contractors and subcontractors are required to be
Contact name: 7.....A.14-2:01 � S2 licensed with the Oregon Construction Contractors Board
�[
under ORS 701 and may be required to be licensed in the
Address: 1 t.( 0 0 AA) 1 t'. � - A1 C - 'T IA Y/ 7 jurisdiction in which work is being performed. If the
City/State /ZIP: ? -1i0 / p it — / V applicant is exempt from licensing, the following reasons
apply:
Phone: (5 eat 6 _ 914 66 Fax:: ( )
E -mail: 016 s; v£.s ,„wo,V_S . 661/4.-t . CONTRA OR
Business name:
BUILDING FEES* .
Address: (Please refer to fee schedule)
City/State /ZIP:
Structural plan review fee (or deposit):
Phone: ( ) Fax: ( ) FLS plan review fee (if applicable):
CCB lic.: Total fees due upon application:
' Amount received: 1 Q l 3
Authorized signature: K This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: I Date: I * Fee methodology set by Tri County Building Industry
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