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Permit
CITY OF TIGARD MASTER PERMIT '`'�'9 4 "' COMMUNITY DEVELOPMENT Permit #: MST2011 -00175 Date Issued: 10/20/2011 TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel: 1S136AD01800 Jurisdiction: Tigard Site address: 6805 SW PINE ST Subdivision: VILLA RIDGE Lot: 2 Project: Cardenas Project Description: 555 square foot addition BUILDING Floor Areas Required Setbacks Required Stories 1 Bedrooms 2 First 555 sf Basement 0 sf Left 0 Parking Spaces 0 Height 12 Bathrooms: 1 Second 0 sf Garage 0 sf Front 0 Smoke Dwelling Units 1 Third. 0 sf Right 0 Detectors Yes Total 555 sf Value $57,745 83 Rear 0 PLUMBING Sinks 0 Water Closets 1 Washing Mach 0 Laundry Trays 0 Rain Drain 0 Urinals 0 Lavatories 2 Dishwashers 0 Floor Drains 0 Sewer Lines 0 SF Rain Storm Sewer 0 Drains 0 Tubs /Showers 2 Garbage Disp 0 Water Heaters 0 Water Lines 0 Catch Basins 0 Bckflw Prevntr. 0 Footing Drain 0 Ice Maker. 0 Hose Bib 0 Backwater Value. 0 Drywell- Trench Drain 0 Other Fixtures 0 Other Fixture Units MECHANICAL Fuel Types Air Conditioning N Vent Fans 1 Clothes Dryers 0 Heat Pump N Hoods 0 Other Units 1 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! 500 sf 0 201 -400 amp 0 201 -400 amp 0 W/O Svc /Fdr 3 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 N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ADD SF VB R -3 555 Owner: Contractor: CARDENAS, MICHAEL H /SANDRA J HEARTHWOOD CONSTRUCTION INC Required Items and Reports (Conditions) 6805 SW PINE ST 14993 SW 164TH AVE 1 Ersn Cntrl 503- 681 -4444 TIGARD, OR 97223 TIGARD, OR 97224 PHONE PHONE 503 - 939 -4082 FAX 503 - 941 -5184 Total Fees: $2,438.03 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 through OAR 952 - 001 -0090 You may obtain a copy of the rules or direct questions to OUNC by calling 50. ' 32 1987 or :00 3324 -.. 411111111111, Issued By: — .� Permittee Signature: . 1 5us '.4175 by 7:00 a.m. for the next available inspection date. This permit can s all 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. Buildin Permit A lication Residential CEI VED F OR OFFICE. USE ONLY City of Tigard Received Permit No ►, /s I q 14 `J g OCT 1 1 2011 Date/BV ,, // /r e!./ ' !�� /. !/0/ 7 ° 13125 SW Hall Blvd , Tigard, OR 97223 Plan Review .. Phone 503.718 2439 Fax 503 598 Date a G Other Permit Line 503 639 . OF TIGARD Date Ready /By / Juris See Page 2 for TIGARD B UILDING DIVISION /0 o Supplemental Information Internet• www tigard-or.gov Notir; d /( LO/ / � S u TYPE OF WORK REQUIRED TA: 1 AND 2 FAMILY DWELLING ID New construction CI 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 CATEGORY OF CONSTRUCTION work indicated on this application. ®1 - and 2-family dwelling Valuation: '° `�.5 Z � 7 , C� y g ❑ C ommercial /industrial 111 Accessory building El Multi-family Number of bedrooms: 2 111 Master builder 1:1 Other: Number of bathrooms: I JOB SITE INFORMATION AND LOCATION Total number of floors: 1 ' Job site address: 6805 SW Pine Street New dwelling area: 555 square feet City /State /ZIP: Tigard, OR 97223 Garage /carport area: square feet Suite /bldg. /apt. no.: Project name: Covered porch area: (0 1 square feet Cross street /directions to job site: Deck area: square feet 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 : 1S136AD01800 equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK . work indicated on this application. Addition Valuation: $ Existing building area square feet New building area: square feet ® PROPERTY OWNER ❑ TENANT Number of stories: Name: Mike & Sandy Cardenas Type of construction: Address: 6805 SW Pine St. Occupancy groups: City /State /ZIP: Tigard, OR 97223 Existing: Phone: ( ) Fax: ( ) New: ® APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* (Pleaserefer to fee schedule) Business name: Hearthwood Construction, Inc. �� �� p Structural plan review fee (or deposit): Contact name: Doug or Angie Cook — 17 0 g 2/ �y S1 . 1 40 FLS plan review fee (if applicable): Address: 14993 SW 164`" Ave 1 4 ,5, Total fees due upon application: R 2 City /State /ZIP: Tigard, O 9 Amount received: 9r5:03• 57 Phone: (503) 939 - 4083 Fax::( ) E - mail: cookbuilder @yahoo.com & acook @arborhomes.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Commercial and residential prescriptive installation of CONTRACTOR roof -top mounted PhotoVoltaic Solar Panel System. Business name: Hearthwood Construction, Inc. Submit two (2) sets of roof plan with connection details and fire department access, along with the 2010 Oregon Address: 14993 SW 164" Ave • Solar Installation Specialty Code checklist. City/State/ZIP: Tigard, OR 97224 Permit Fee (include p l a n r y g and administrative fees): /r $180 00 Phone: (503) 939 - 4083 Fax: (503) 941 - 5184 State surcharge (12% of permit fee): / $21.60 CCB lie.: 117607 /eV/ (I/ 7 Total fee due upon application:. $201.60 Authorized signature: ( This permit application expires if a permit is not obtained w 1 within 180 days after it has been accepted as complete. Print name. Angie Cook Date: 10/6/11 * Fee methodology set by Tri- County Building Industry Service Board I:\ Building \Permits \BUP- RESPermitApp.doc 02/24/2011 440- 46I3T(11/02/COM /WEB) / Ei Ap (,I r)l I ( E; ('til: ON'L1 RECEIVED I .. lectrcal Permit i t Received ` J 7 O/ / /7 6 City of Tigard Daceive. ,/,,,, Re / /*/ i Permit Nn. • �` r • 13125 SW Hall Blvd., Tigard, OR 97223 0 C T 1 1 2011 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit: 1-1(; A R I) Inspection Line: 503.639.4175 Date Ready/By: runs: ®Su Page 2 for Internet: www.tigard- or.gov CITY OF TI GA R D Notified/Method: � .DIIVG DIVISIO Supplemental Information TYPE OF .. r • ?'i;.u: PLAN aprizw ire - • • ❑ New construction Addition/alteration /replacement Please check all that apply (submit a 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 130 volts or 0 Floating buildings. dwelling less to ground, or exceeds 14,000 ❑ Commercial -use agricultural I - and 2-family g ❑ Commercial/industrial ❑ Accessory building amps for all other installations, buildings. ❑ lulu- family 0 Master builder ❑ Other: ❑Fuepump 0 Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "t -3 ", Job no Job site address: I! X 05 tfL,l t 5 +` Six or or more occupancy, ❑ Six or more restdenual units ❑Recreational vehicle parks City/State/ZIP: T 7 q ❑ Health -care facilities ❑ Supply voltage for more than 1 t r'� i 7(..-C.. _ ❑ Hazardous locations 600 volts nominal Suite /bldg. /apt no.. Project name: 4/ 441,0,, ,s ❑ Serviceorfeeder600ampsormore. � I ,..; . ; . , .1%'::;,:. ; y FEEs'SCHEDU es . _. Cross street/directions to job site: Description I Qt,. l Fee. " I Total 1 • New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4 Ea. add'I 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential ' DESCRIPT ON OF WORK (with above sq. ft.) 67.84 2 • E g e d i 1 - 1 �� Limit a den tia l ( wi (with above sq it ) 67.84 2 �( -.,�( itia abovo ft Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 ❑ PROPERTY OWNER 1 ❑ TENANT 201 amps to 400 amps 133.56 2 Name: '�„ �,, 401 amps to 600 amps 200.34 2 !r -'' S& 1 j4 1 A 601 amps to 1,000 amps 301.04 2 Address: (f Over 1,000 amps or volts 552.26 2 City /State /ZIP: 04 Temporary services or feeders installation, alteration, and/or relocation Phone ( ) Fax: ( ) 200 amps or less 59.36 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 _ 2 Branch circuits — new, alteration, or ex tension, per panel Owner signature: Date: A. Fee for branch circuits with ❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, each branch circuit 7.42 2 Business name: 1 � to et .___ � 6•� B. Fee for branch circuits Contact name: r 1 �� C1 without service or feeder fee, t' O ( first branch circuit 1 56 18 %, Jg 2 Address: t 1 / r 3 S L,/ (04 ,(), - Each add'l branch circuit Z 7.42 ��, V 2 / , V Miscellaneous (service or feeder not included) City /State /ZIP �' rsy,c 612,. i 1 L t (� Each manufactured or modular 67.84 2 dwelling, service and/or feeder Phone: (SD (331- t1D 821. Fax.: ( ) Reconnect only 67.84 2 E -mail: Pump or irrigation circle 67.84 2 CONTRACTOR Sign or outline lighting 67.84 2 - e /,, �- Signal circutt(s) or limited- Business name: an t cm 5 (am► t ' l k" �-/f t C rk ( - energy panel, alteration, or Address: 79b ) Cv V S)— - extension. Describe: Page 2 2 City /State /ZIP: l /� J U Ue 976 3 Each additional inspection over allowable in any_of the above } Fax: Per inspection 66.25 Phone. ( 3 Z -787 (5 ) Z6 6° - 55i43 Investigation per hour (t hr min) 66.25 , CCB Lie.: 26,0 Electrical Lie.: 3 _ )Z Suprv. Lie.: Z/ 2. 5 Industrial plant per hour 78.18 _ Suprv. Electrician signature, required: ! ELECTRICAL;;PERMTA' : :FEESi� ::;'•1.: ; ". Lj/, Q ' -�, Subtotal: 7 - • Print name: � f A Date: Plan review (25% of permit fee): �� t Cpl V t �� State surcharge (12% of permit fee): g , Authorized signature: TOTAL PERMIT FEE: 7 C 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 I •:BmldmgPermitstELC- PermstAppdoc 10/01/09 440- 4615T(11 /05 /COMAVEB lI . . ,. . • • , - • ' . . • • • • I Mechanical Permit Applicati ,,,,._. _ :•:, ,,, .0Forucpuict,A..sE.O.NEN ,. :, r• ,,,r r..,,, •-. ,-.. :: City of Tigard Received /0 Al Permit No 4' 7 Il '.. 13125 SW Hall Blvd., T igard, OR 97223 Date/By Plan Review Phone 503 718.2439 Fax' 503 598 1960 O 1 -1 2011 Date/By Other Permit Inspection Line 503.639.4175 T 1,GAItlY Date Ready/By Jurts Er See Page 2 for Internet www tigard-or.gov CITY OF TIGARD Notified/Method Supplemental Information „„, „ ,„ BUILDINGDIVISIM -- - Pw igit:2- Ar" :zoopt*wronwiiiiic„ =o , :45:,.; Arifl , -q,QTYKPIc4r.FiKE';sc.#E„D.ii.v1:-:: ' Mechanical permit fees* are based on the value of the work 0 New construction LE] Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all 0 Demolition 0 Other: mechanical materials, equipment, labor, overhead, and profit Value $ :41011,640 " 2P., %ICA., TedoklijiaeNSTiliWITiN i l-A1,,,V::''S ' '.„;54, r---- - ',' r--""'' - ' - tr"'"' '" ' -"vr'''"'"""' - '--- 21 „: . „..,:::::::: :::::,.....,..",.......„, , ,..„, , ..,...„,, FE ". ,..„,,,, z 1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist. 0 Multi-family 0 Master builder 0 Other: Description Qty Ea Total tWITIVAtilaitE ‘, 14 - ,, ,7 410;4 ,,, ' ;1E Heating/cooling: ' ,6, -' - - ' "' - '. 545555 ' 5 L 5 "" 141 '''' ' 54.4 - Air conditioning Job site address: 6805 SW' Pine St. (requires site plan showing placement) 46 75 Fumace 100,000 BTU (ducts/vents) 46.75 City/State/ZIP: Tigard, OR 97223 Furnace 100,000+ BTU (ducts/vents) 54.91 Suite/bldg./apt. no.: Project name Heat pump (requires site plan showing placement) 61 06 Cross street/directions to job site: . Duct work k 23.32 7 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: Lot no.: Other 23.32 Tax map/parcel no.: Other fuel appliances: 7 " '!W - ';M1 Water heater 23.32 Gas fireplace 33.39 Addition Flue vent for water heater or gas fireplace 23 32 Log lighter (gas) 23 32 Wood/pellet stove 33.39 Wood fireplace/insert 23 32 Chimney/liner/flue/vent 23.32 TIOR,A 0 0:i:;: ''T-14,1 lt.'. N:4,„„XN„„f„2" Other 23.32 Name: Mike & Sandy Cardenas Environmental exhaust and ventilation: Address: 6805 SW Pine St. Range hood/other kitchen equipment 33.39 City/State/ZIP: Tigard, OR 97223 Clothes dryer exhaust 33 39 Single-duct exhaust (bathrooms, Phone: ( ) Fax: ( ) AV toilet compartments, utility rooms) 1 23 32 20:52-- .74111i log k Vtiiiiiip*TrMEps,5-6"NArti' ,,` Attic/crawlspace fans 23.32 23 Business name: Hearthwood Construction, Inc. Other .32 Fuel piping: Contact name: Doug or Angie Cook $14.15 for first four; $4.03 for each additional Address: 14993 SW' 164 Ave Furnace, etc Gas heat pump City/State/ZIP: Tigard, OR 97224 Wall/suspended/unit heater Phone: (503) 939-4082 Fax: : ( ) Water heater Fireplace E-mail: cookbuilder@yahoo.com Range def+dZiefaesifYrrto.rqgft, . ' 4*.--,-,7-:NA B arbecue Business name: m , j,„}c,. Clothes dryer (gas) Other Address: / ,60 5-9 6 fric e_ap_A kj i ,- It. City/State/ZIP: .---. Subtotal Ak ( , LA- ty/State/ZIP: 0 kr...4 6- c....7-7-i" , 02 7643 - Minimum permit fee ($90.00) Phone: ( 92)) e: 6S / e Fax: ( ) Plan review (25% of permit fee) CCB lie.: 73/8/ V7/,(43 State surcharge (12% of permit fee) i 0 1.- TOTAL PERMIT FEE I This permit application expires if a permit is not obtained within 180 Authorized signature: . A tied / ,. — Date: days after it has been accepted as complete. Print name: * Fee methodology set by Tn-County Building Industry Service Board I \Building \Permits \MEC-Pe itApp doe 09/09/10 440-46I7T (1 I/02/COM/WEB) Plumbing Permit Application • Building Fixtures 7FOR ,O ONLY a r , • City of Tigard y Received t/r7 / //' i Permit No M f ` ,� 6/75 Ill RI 13125 SW Hall Blvd , Tigard, OR 97223 O C T 1 Y Q g Plan Date/By Rewew Phone 503 718 2439 Fax 503 598. Date /By Other Permit No Inspection Line. 503 639.4175 TA GA OF TIGARD RD' p Date Ready/By Juris El See Page 2 for . Internet www tigard or.gov BUILDING DIVISION Notified/Method Supplemental Information .. ,;...tit.,,, „� ,t.... -� - t.. •,- .;-; «: . , - ���s�» <�. .; , «- � �..t� : ��' %fir a"; `,R�:.. :���•>t;�:... -:o_. i `tR C �a , �� i x Eg; e.t . -v. e.E't• €a; - x�i ,.�RET:�, ° „•:” K > � FEE..= SCHEDULE: _� ``a•: �; .= .'u �YPE�� F -•WO " 2:':8 "i-` i : ' ER.:. t, , < -. t erms; • ; - <,,\ ` " .. z `�1�Tx Sn� � , dk.. ❑ 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) -... \: - (1) ?CA EGOR . �OF..COIVSTRUC'T'ION S 1 bath 31270 ® I - and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78 SFR (3) bath 500 32 ❑ Accessory building ❑ Multi- family Each additional bath/kitchen 25 02 ❑ Master builder ❑ Other: Fire sprinkler ( sq ft) Page 2 , ,5• '�` "A l0 Site utilities: - -; ..., .1(113 .fi, TTE �1NFORMAT101\ • D; ,. Job site address: 6805 SW Pine St. Catch basin or area drain 18 76 Drywell, leach line, or trench drain 18 76 City /State /ZIP: Tigard, OR 97223 Footing drain (no linear ft _ ) Page 2 Suite/bldg. /apt. no.: I Project name: 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: Lot no.: Fixture or item: Tax map /parcel no.: Backflow preventer 31.27 . t •. Backwater valve 12 51 -` ;: >tt : DE OF WORK : ` -s , n, ' ;- .:.:•,• ..;f, r Clothes washer 25.02 Addition _ Dishwasher 25.02 Drinking fountain 25 02 Ejectors/sump 25 02 r:` �� : «�s;c -;.. � = ;,� -_,, . _ ... � „t, • - Expansion tank 12 51 g-': ROPERTY.OWNER° ,.'' ` ❑ :�.. � r= w��:. : •.,,. �'�t.. I kris,. .. fit r:. ,.a '�� . €I?,.,. �' E Fixture /sewer cap 25 02 Name: Mike & Sandy Cardenas Floor drain/floor sink/hub 25.02 Address: 6805 SW Pine St. Garbage disposal 25 02 City /State /ZIP: Tigard, OR 97223 Hose bib 25.02 Phone: ( ) Fax: ( ) Ice maker 12 51 : w f . t ~ " °J t ,- ) "-',�" ;,= Interceptor /grease trap 25 02 - _s;�� `�''ttiLICA ' Business name: Hearthwood Construction, Inc. Medical gas (value. $ ) Page 2 Primer 12.51 Contact name: Doug or Angie Cook Roof drain (commercial) 12.51 Address: 14993 SW 164 Ave Sink/basin/lavatory 2 25 02 13C2, • ,- City /Stale /ZIP: Tigard, OR 97224 Solar units (potable water) 62 54 Phone: (503) 939 - 4082 Fax: : ( ) Tub /shower /shower pan 2 12 51 z'j OZ E - mail: cookbuilder @yahoo.com & acoo ")arborhomes.com Urinal 25 02 r• Water closet i 25.02 , O ,`.'.,r' \i - `r(,t�rir. 'R.« ;;El'_ 'r . €EC >3, a: „' *_..;:;`?:r;`.> `5. �� � ': ?w%x > "� ;� ` � '� Water heater 37.52 Business name: ' M444 A tari. ' e,,,, �h .,„6 J4 Water piping/DWV 56.29 Address: /t;.C� �" C .`�' %% Other 25 02 City /State /ZIP: A 4 1 � Subtotal 1,1a Q 7 a 33 Minimum permit fee $72 50 Phone: (5 ) jf` —. d 7 v Fax: ( ) Plan review (25°/n of permit fee) CCB Lie.: 4` Plumbing Lic. no.: Pe �� � o � � 1 3 State surcharge (12 /o of permit fee) (Z,0" Authorized signature: 7 /,i, -1 TOTAL PERMIT FEE 1 I '2 i./ This permit application expires if a permit is not obtained within 180 days Print name: Date: after it has been accepted as complete. *Fee methodology set by Tn- County Building Industry Service Board I \Butldmg\Permits\PLMU- PermitApp doc 10/01/09 440- 46t6T(10 /02 /COM/WEB) Building Division Development Code Provision Review TIGARD. Residential Projects Building Permit No: H CI` 69o/ /-a 5 CWS Service Provider Letter Received: Yes ❑ No 1. N/A ❑ r e...4 4 l.k_ Routed Plans: Original Plan Submittal Date: /O7/ / 4 1st Revision Submittal Date: l0/ /3l // St Site Plan Only 2nd Revision Submittal Date: ❑ Site Plan Only To the Applicant: Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies to the Building Division. Only checked (✓) items are approved. Items not approved and those listed in the notes must be revised prior to re- submittal. For questions please contact the appropriate staff person(s) listed above each section. Staff: please check items alon left only if approved. Planning Review (contact 1r t S41 PJ at.fw�re at 503 -718- t,q c tor �Ci, t s -tt e., @tigard - or.gov) Land Use Case No. Name L� n Zoning Ir.. • 44 . S' • l'etbacks: Front ZO Rear /5 Side . Street Side , Garage ' L Maximum Building Height 3 0 Actual Building Height /2... 13'yisual Clearance Gr asements If Sensitive Lands Ty. e: /� Notes: JO ..> ' - " w.∎ _. _ /IL L =- - �'�9 , Original Plan: Approved ❑ Not Approved ❑ Date: ice/ t 4 C7w.. Revision 1: Approved Not Approved ❑ Date: /0V/ 3/// Revision 2: Approved ❑ Not Approved ❑ Date: Engineering Review (contact Mike White at 503 - 718 -2464 or MikeW @tigard - or.gov) 2 Actual Slope: (— Notes: Original Plan: Approved Not Approved ❑ Date: / 1 1 U Revision 1: Approved Not Approved ❑ Date: / 13 t I Revision 2: Approved ❑ Not Approved ❑ Date: (Review Continues on Page 2) Page 1 of 2 City Arborist Review (contact Todd Prager at 503- 718 -2700 or todd @tigard - or.gov) I ' treet Trees L] Protected Trees Notes: Original Plan: Approved Not Approved ❑ Date: /oO)a Revision 1: Approved E Not Approved ❑ Date: 10/13 Revision 2: Approved ❑ Not Approved ❑ Date: Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert @ tigard - or.gov) ❑ Conditions of Approval Prior to Issuance of Building Permit Notes : i i / 'I' /„. :��t c2' �.��/� /• 0-, t Original Plan: al tESent to Applicant: Revision 1: Date Sent to Applicant Revision 2: Date Sent to Applicant Okay to Issue Permit: '/ 'i No Date Routed to Buil.., . / _ / 4 Id • ., 9 Page 2 of 2 S(P 82.86' N 89 °58'00" E 1 KO - , - I RECEIVED E F : o OCT 13Z011 SITE PLAN CITY OF TIGARD o; 1 = 20' -0° BUILDING DIVISION pl 6805 SW PINE STREET, o, TIGARD, OR 97223 m ' b I o 15,286 S.F. S t o o, 1 3 ‘-w _ OLD PROPERTY LINE H e tee5f 0(3 ' g 22'-0- 4 r "-----"-- ---- ''''''....\ , rZ PROPOSED ADDITION IW 9 r , 0" 3 8'- 8"x16' - \ O � / / 18• —O- O O . , \ 1 , i 0 OCZ O, 10 A 0 o I EXISTING HOME 1V-5" --31 ... 0. ... ., 0 4 8' -0• ; 6- ,, ' . , . . 1 e —° a as a a 4 o . , w EXIST'G DRIVEWAY — J:i - --- -- --- -- 94.80' e S 89 °58'00 " W 3e0 Sc Z' SW PINE STREET DOUG COOK I CARDENAS ADDITION _ doff Gernerg -- 2 J 9 S NAM St an 18195 SW. Butternut St. ftwom10/O/D011 B=- ;;; ; L°7 ' " 97 Drafting Sc Design 10 /12/2011 (5 03) 453 -6206 H O CT 4 2011 O 1 1...1 2011 _,j ..............._.......... ------. p ECal ED CITY OF TI GAR D otA • � Clean Water Services File Number G eanWate ` Services — 7:75777 Sensitive Area Pre- Screening Site Assessment 1, Jurisdiction: City of Tigard • • • ' 2. Property Information (example 15234A501400) 3. Owner information Tax lot ID(s): 1S136AD01800 Name: Mike & Sandy Cardenas Company: Address: 6805 SW Pine Street Site Address: 6805 SW Pine Street City, State, Zip: Tigard, OR 97223 City, State, Zip: Tigard, OR 97223 Phone /Fax: Nearest Cross Street E -Mall: ' 4. Development Activity (check all that apply) S. Applicant Information • ® Addition to Single Family Residence (rooms, deck, garage) Name: Angie Cook • I Lot Line Adjustment © Minor Land Partition Company: Hearthwood Construction, Inc. ® Residential Condominium j Commercial Condominium Address: 14993 SW 164t1>. Ave E( Residential Subdivision ® Commercial Subdivision © Single Lot Commercial 0 Multi Lot Commerciai City, State, Zip: Tigard, OR 97224 Other Phone/Fax: (503) 939 -4082 , • E -Mail: acoolc@arhorbomes.com • S. Will the project involve any off-site work? DYes IN No 0 Unknown Location and description of off -site work • 7. Additional comments or Information that may be needed to understand your project This application does NOT replace Grading and Erosion Control Permits, Connection Permits, Building Permits, Site Development Permits, DEW 1200 -C Permit or other permits as issued by the Department of Environmental Quality, Department of State Lands andlor Department of the Army COE, All required permits and approvals must be obtained and completed under applicable local, state, and federal law. By signing this form, the Owner or Owner's authorized agent or representative, acknowledges and agrees that employees of Clean Water Services have authority to enter the project site at all reasonable times for the purpose of inspecting project site conditions and gathering information related to the project site I certify that I em familerwith the information contained in this document, and to the best of my knowledge and belief, this information Is true, complete, and accurate, Print/Type Name Hearthw • od Constructio ., • • •e Cook Print/Type Title Secretary ' Signature 41(f ',1( Date 10 -11 -12 FOR DISTRICT USE ONLY 0 Sensitive areas potentially exist on site or within 200' of the site. THE APPLICANT MUST PERFORM A SITE ASSESSMENT PRIOR TO ISSUANCE OFA SERVICE PROVIDER LETTER. If Sensitive Areas exist on the site or within 200 feet on adjacent properties, a Natural Resources Assessment Report . may also be required, ❑ Based on review of the submitted materials and • best available information Sensitive areas do not appear to exist on site orwithin 200' of the site. This Sensitive Area Pre-Screening Slte Assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas if they are subsequently dl covered. This document will serve as your Service Provider letter as required by Resolution and Order 07 -20, Section 3.02.1. All required permits and • pprovels must be obtained and completed under applicable local, State, and federal law. eased on review of the submitted materials and best available information the above referenced projectwill not signMoanty impact the existing or potentially sensitive area(s) found near Mesita, This SerrsltiveArea Pre- Screening Site Assessment does NOT eliminate the need to evaluate and protect addllionalwater quality sensitive areas if they are subsequently discovered, This document will serve as your Service Provider letter as required by Resolution and Order 07 -20, Section 3.02.1. AU required permits and approvals must be obtained and completed under applicable local, state and federal law. ❑ This Service Provider Latter Is notvalid unless CWS approved site platee) are attached. ❑ The proposed activity does not meet the definition of develo mentor the lot was platted after 919195 ORS 92.040(2), NO SITE ASSESSMENT OR SERVICE PROVIDER LMER IS REQUIRED. Reviewed by /1- 4/i • ' • • -Z- s} Date / 01/1 l 2650 SW Flitisbo,o iiiginvay • I•lilisboro, Oregon 07123 • 'Phone: (503)601 1 ;100 fax: (003) 8131.4439 - INuw.cieamwatcrservices.ary • co pos seJ / S i This form is recognized by most Building Department's in the Tri- County area for transmitting information. Please complete this form when submitting information for plan review responses and revisions. This form and the information it provides helps the review process and response to your project. City of Tigard Buildin g Division T[GARD TRANSMITTAL LETTER 1 TO: ........-40"•"' _ 1 . ( 3__Q-- DATE RECEIVED: DEPT: BUILDING DIVISION RECEIVED • FROM: at 4 NOV 2 9 2011 . CITY OF TIGAR 0 COMPANY: / BUILDING DI ; ION , , PHONE: `t 3 - elo $ a '� 4 -7,(4,-7,/,_ i By: ' RE: (Q .05 _, 1 l - 60 /75 (Site ddress) (Permit Number) roject name or su ivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: I Copies: Description: Additional set(s) of plans. Revisions: Cross section(s) and details. Wall bracing and/or lateral analysis. Floor /roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. v Other (explain): hi L,) 23 OkJ Ai ,/A/f0 . REMARKS: 50 Z 'i T- -/° _Y Ge y ,-»9 - LEA Td "77 ° ,4 rc rvi � J � /2 eo-Py FOR O�FICF USE ONLY Routed to Permit Techn�ici�a ' Date: (I �� (// f� / Initials , , Fees Due: El Yes L J o Fee Description: Amount ue: $ $ $ $ Special Instructions: Reprint Permit (per PE): ❑ rf ' Applicant Notified: Date: // r// l Initia ,_; 11 '" ) 1 9^ I:\ Building\ Forms \TransmittalLetter - Revisions.doc 02/08/2011 q� A I . -• 1.1.4- 04 . RECEIVED i e--a te-v•-,_ a . .... t Electrical Permit Application isssist.,4,416 IQ. J.,: , ,2,,,,,mat,1 1 : 4 , , ,Kli.k.mi, . PoAwen , . twigiaMaNk;$40.0 .-,,k maturr r,,nm'> Agit- . ,, City of Tigard NOV 2 9 2011 Rec,,,,,ed Daw13,,, o iffifillirl r---N- Wsriza--70/7 . _ a 1 3 1 2 5 S\\ Hall Blvd., Tigard, OR 07223 Plan Res a. Phone: 503.639.4171 Fax: 5030Ty6OF TIGARD ..a. ,. D Lin pawl Permit, . Inspection e 503.639.4175 • • or BUILDINGDIVISI R ON liti . ,,ilajklovi.:,!%, Date eady:Hy: Jura 1 El See Page 2 tor rn Inteet: www.. .et !Tar a oi us NctiliedWethod Supplemental Information . . .. .. TYPE OF WORK PLAN REVIEW F 0 New construction Eg Addition/alteration/replacement Please check all that apply: 1 OService over 225 amps, comb! 0 Hazardous location 1 0 Demolition [I Other: no.: Project name: 7 3 dd'l 500 sq FEE* SCHEDULE Qt'. I rec. Total i ** Cross street/directions to job site: New residential single- or multi-family dwelling unit. I Includes attached garage. - 1,000 sq. ft. or less ' 145.15 4 1 I Subdivision: i Lot no.: ft Ea. add'I 500 sq. 6. pinion 1 t---- 33.40 Limited energy, residential • 75.00 1 2 1 Tax map/parcel no.: ...._ _ Lin:tiled energy, non-residential 75.00 I 1 DESCRIPTION OF WORK Each manufactured or modular dwelling, service and/or feeder 90.90 1 ... 50 r1/4" 4 $ ,- 1,,a,-(1_-t. c- A Ab rir tczt-i Services or feeders installation, alteration, and/o • relocation _. C3 INER 0 TENANT ...._ 200 amps or less 201 atnps to 400 amps 401 amps to 600-amps 1 80.30 106.85 160.60 2 PRO ERTY V 2 ___ 2 Name: C - Pt4L0e.i- 4 5 601 amps to 1,000 amps 240.60 2 Address: S A. .AS Aa. 4e. Over 1.000 amps or volts 454.65 2 .... — Reconnect only 66 85 2 City/State/ZIP: Temporary services or feeders installation, alteration. and/or relocation Phone: ( ) I Fax: ( ) 200 amps or less 1 66.85 1 _..... ....._ Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 1 100.30 2 intended for sale_ lease, rent, or (IX change, according to ORS 447, 449. 670, and 701. 401 umps to 600 amps 1 133.75 2 Owner signature: ..._ ........ Date: _ new, Branch circuits: new alteration, or extension, per panel , L 0 APPLICANT 0 CONTACT PERSON A. Fee for branch circuits with service or feeder fee, each 6.65 Business name: bnineh circuit B. Fee for branch circuits Contact name: without service or feeder fee, 1 / 46.85 1 _ each branch circuit Address: , Each-addl branch circuit 1 ..... 6.65 2 City/State/ZIP: Miscellaneous (service or feeder not included) Pump or irrigation circle 53.40 2 Phone: ( ) I Fax: : ( ) Sign or outline lighting 53.40 2 E-mail: Signal circuit(s) or limited- CONTRACTOR energy panel. altendion, or extension. Describe: Page 2 2 Business name: 0......Tyi--.1 3=-3 , tt- . s.,, crw ,. c.... AAddress: ' _ 1Z , / eila. i s, 1 ? '— 4 ti-e Each additional inspection over allowable in any of the aim 'e Per inspection 62.50 City/State/Z f P: 1 A L. ATI I C....." N., 1/4.c...,• ci:?-cxe:,z, investigation per hour (1 tic do) 62.50 Phone: (S C. 5 2. - I ( f 2. 53 4-, ..- . / r Fax: ( 5\3,4) - r e ., 5 ,,,,,, -, 7_ Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES* CCB Lie.: if:::)q'Ck 1 Electrical Lic.:, - ..-; Supt-v. Lie.: - e--r., f . 5 (i ?Or Subtotal ' --- --- _ _ Suprv. Electrician signature, required: C.71-5---...— Plan review (25% of permit fee) Print name: L4 P,e-iiii.- le - e - t-- Date: /',/ ill — State surcharge (8% of pennit fee) - TOTAL PERMIT FEE j Authorised signature. a ( This permit application expires if a permit is not obtained within ISO days after it has been accepted as complete Print name: J elt nx Date: / 2 - 2 ;1 =- Fecm ethdology sct by Tri.County Building Industry Service m rd :slumber of inspections pee permit allteed. ■ Ho/line / Pr/iv/Ls FIX-Permnisop,/loc /2 03 440-15I5T1 10 02 C'OM WEB Form for Taxpayer Give form to the (Rev October 2007) Identification Number and Certification requester. Do not Department of the Treasuy send to the IRS. internal Revenue Service Name (as shown on your income tax return) Duit Level Tool Company m Business name, if different from above a Conduit Electric 0 o c Check appropriate box: ❑ Individual /Sole proprietor 0 Corporation ❑ Partnership Exempt ❑ Limited liability company. Enter the tax classification (D= disregarded entity, C= corporation, P= partnership; ' I p payee • ❑ Other (see instruclrons) _ c Address ( number, street, and apt. or suite no.) Requester's name and address (optional) °- o 19461 SW 89th Avenue City, state, and ZIP code r n Tualatin, OR 97062 List account number(s) here (optional) rn I?art 'Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 to avoid Social security number backup withholding. For individuals, this is your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. or Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose Employer identification number number to enter, 93 , 0991003 at#III Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (ORS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and 3. I am a U.S. citizen or other U.S. person (defined below). Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your lax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must provide your correct TIN. See the instructions on page 4. Sign Signature of C /r/ Here U.S. person t+ Date a �J Z / ( t General Instructions Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are: Section references are to the Internal Revenue Code unless s An individual who is a U.S. citizen or U.S. resident alien, otherwise noted. s A partnership, corporation, company, or association created or Purpose of Form organized in the United States or under the laws of the United A person who is required to file an information return with the States, IRS must obtain your correct taxpayer identification number (TIN) © An estate (other than a foreign estate), or to report, for example, income paid to you, real estate 0 A domestic trust (as defined in Regulations section transactions, mortgage interest you paid, acquisition or 301.7701 -7). abandonment of secured property. cancellation of debt, or Special rules for partnerships. Partnerships that conduct a contributions you made to an IRA. trade or business in the United States are generally required to Use Form W -9 only if you are a U.S. person (including a pay a withholding tax on any foreign partners' share of income resident alien), to provide your correct TIN to the person from such business. Further, in certain cases where a Form W -9 requesting it (the requester) and, when applicable, to: has not been received, a partnership is required to presume that 1. Certify that the TIN you are giving is correct (or you are a partner is a foreign person, and pay the withholding tax. waiting for a number to be issued), Therefore, if you are a U.S. person that is a partner in a 2. Certify that you are not subject to backup withholding, or partnership conducting a trade or business in the United States, provide Form W -9 to the partnership to establish your U.S. 3. Claim exemption from backup withholding if you are a U.S. status and avoid withholding on your share of partnership exempt payee. If applicable, you are also certifying that as a income. U.S. person, your allocable share of any partnership income from The person who gives Form W -9 to the partnership for a U.S. trade or business is not subject to the withholding tax on purposes of establishing its U.S. status and avoiding withholding foreign partners' share of effectively connected income. on its allocable share of net income from the partnership Note. If a requester gives you a form other than Form W -9 to conducting a trade or business in the United States is in the request your TIN, you must use the requester's form if it is following cases: substantially similar to this Form W -9. a The U.S. owner of a disregarded entity and not the entity, Cat. No 10231X Form W -9 (Rev 10 -2007) Nov 01 11 02:49p OC Heating & Cooling Inc. 503 - 657 -4413 p.2 - Mechanical Permit Application � '" FOR OFFICE:t:SE ONLY City of Tigard Received // aA1 Permit No. - L f a // . ..45/ / P S 4 13325 SW Hall Blvd.. Tigard, OR,"...2V . n0 \1 Plan Review ' ' Phone 503.718.2439 Fax: 503.5' : i609 ® N. Date/By: Other Permit: T [ GP R Inspection Line: 503.639.4175 � , '�� Date Ready /By fun RI See Page 2 for Internet www.tigard -or goy \v �( (�� �f �.� tdohried'Method CY \V�� Supplemental Information G c)' TYPE OF WOI \\ COMMIERCL&L FEE* SCHEDULE – USE CHECKLIST r v Mechanical permit fees* are based on the value of the work El New construction �Additio nf alteratia replacement performed. Indicate the value (rounded to the nearest dollar) of all ❑Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. Value. $ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES* j v] 1 -and 2 - family dwelling ❑ Commercial/industrial ❑ Accessory building For speclol information use checklist. ❑ Multi- family ❑ Master builder ❑ Other' Description 1 Qty. Ea Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning Job site address: (requires site plan showing placement) 46.75 ti\ti City/State/ZIP p � 7 Furnace 100,000 BTU (duets/vents) I !� l Y 1� f �� Furnace 100,000+ BTU (ducts vents) 54.91 Suitelbidg./apt. no_: Project name: Heat pump re.mres site .tan shown , •Iacement 61.06 Cross street/directions to job site: Duct work 23.32 Z3 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 p 46.75 Subdivision Lot no.: Flue /vent for any of above 23.32 Other 23.32 Tax map /parcel no.: Other fuel appliances: DESCRIPTION OF WORK Water heater 23.32 Gas fireplace 33.39 Addm y S'C 1 /pl / �! /, /� 'v L- �J Flue vent for water heater or gas / / 7 fireplace 23.32 It 0 �'� Log lighter Igas) 23.32 l _ _ Wood/peIlet stove 33.39 CJIti� 41,1111111"... ��� a Wood fireplace/insert 23.32 ❑ P ' : ' E Y 0 NER I 0 TENANT Chimney/liner /due /vent 23.32 Other _ 23 32 Name: Ld/AC Environmental exhaust and ventilation: tldress Range hood/other kitchen equipment 33.39 City /Stale " '' Clothes dryer exhaust 33.39 Single -duct exhaust (bathroom. / Phone: ( ) ax: toilet compartments, utility rooms) / 23.32 0 APPLICANT ❑ CONTACT PERSON Attic/crawl space fasts 23.32 Business name: 4/ a, J -/ r � 1 l Z 22i/w Other. 23.32 ` n / T /dA� r!i f ' f Fuel piping: c r Contact name: ,T, Fl iing: $14.15 for first four, 54.03 for each additional Address: U , go 1/ �/ Furnace, etc. go /` Gas heat pump City /State/ZIP Q re a i � 9 70 L� L Walt /suspended/unit heater Phone: ( ) P_ 5 -9,_ • (i Fax: ' )6,x7 5 i./i f / 3 Water heater E -mail: lV 7 ! Fireplace Range CONTRACTOR Barbecue Business name: C �� 1 C dryer (gas) e: M 0 ()/6 ... 0 ()/6 ... d ik J Other: Address: f Cdr MECHANICAL PERMIT FEES" City /State/ZIP: (9Cefo (/ Q]de-j-- Subtotal I lJ CC �� Minimum permit fee ($90 00) _V 1 }/ Phone: { /, 7 ) 5 Fax: (3 ) 6 s'?` LT `/ Plan review (25 °l0 of permit fee) / lv . CCB lie.: 2? 7 State surcharge (12% of pennit fee) n ir 5 f �? l 0 (f TOTAL PERMIT FEE Thie permit application expires if a permit is not obtained within 180 Authorized si attire: days after it has been accepted as complete. Print name: G� 1ve Date r - f f 1. Fee methodology set by Tri-County Building Industry Service Board I V I\ Buddme \PermiIOMEC- PermitAip.doc 09;09110 440 4617T(I192tCOMIWEB)