Permit II o CITY OF TIGARD MASTER PERMIT
0 ' . COMMUNITY DEVELOPMENT Permit #: MST2009 -00191
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/23/2009
Parcel: 1 S 136AD01800
Jurisdiction: Tigard
Site address: 6805 SW PINE ST
Subdivision: Lot: 0
Project: Cardenas
Project Description: Install new exterior french door.
BUILDING
Floor Areas Required Setbacks Required
Stories: Bedrooms: First: sf Basement: sf Left: Parking Spaces:
Height: Bathrooms: Second: sf Garage: sf Front: Smoke
Dwelling Units: Third: sf Right Detectors:
Total: sf Value: $2,000.00 Rear:
PLUMBING
Sinks: Water Closets: Washing Mach: Laundry Trays: Rain Drain: Catch Basins:
Lavatories: Dishwashers: Floor Drains: Sewer Lines: SF Rain Other Fixtures:
Tubs /Showers: Garbage Disp: Water Heaters: Water Lines: Drains:
Bckflw Prevntr:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: Clothes Dryers:
Heat Pump: N Hoods: Other Units:
Fum<100K: Vents: Woodstoves: Gas Outlets:
Fum > =100K:
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 0 -200 amp: 0 -200 amp: W/ Svc or Fdr:
Ea add' 500 sf: 20 1-400 amp: 201 -400 amp: 1st W/O Svc/Fdr:
Limited Energy: 401 -600 amp: 401 -600 amp: Ea add! Br Cir:
601 -1000 amp: 601 +amp- 1000v:
1000 +amp /volt:
ELECTRICAL - RESTRICTED ENERGY
SF Residential
Audio 8, 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)
CARDENAS, MICHAEL H /SANDRA J HEARTHWOOD CONSTRUCTION INC
6805 SW PINE ST 14993 SW 164TH AVE
TIGARD, OR 97223 Tigard, OR 97224
PHONE: PHONE: 503- 939 -4082
FAX: 503- 941 -5184
Total Fees: $163.10
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 acco wore 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. A - ' ION: Orego law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -0 • -0010 through OAR 9 !01-0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Iss =d By:� L_ �� /� �1 , r Permittee Signature: ei4A----
k (i4Jir1. f
' Building Permit Application Received Residential FOR (_)FFICE USE ONLY
of Tigard CEIVED Daten3 : 3 0 Permit No.: Wiz -€)019/
° 13125 SW Hall Blvd. Tigard, OK 97223
g Plan Review Other Permit:
Phone: 503.639.4171 Fax: �503.598.��D 2 `�,� 2009 Date/B
l G n it �� Inspection Line: 503.639.4175 Date Ready/By: ® See Page 2 for
Internet: www.tigard or.gov
CITY O(F��TIGARD Notified/Method: Supplemental Information
TYPE HMR tRIr" DIVISION REQUIRED DATA: 1- AND 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 the
CATEGORY OF CONSTRUCTION work indicated on this application.
® 1- and 2- family dwelling CI Commercial /industrial
Valuation: $1000.00
Accessory building Number of bedrooms:
❑ ry g ❑ Multi - family
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 6805 SW Pine Street New dwelling area: square feet
City/State/ZIP: Tigard, OR 97223 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: Covered porch area: square feet
Cross street/directions to job site: 71" & Pine Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Villa Ridge Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Adding exterior door Valuation: $
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City /State /ZIP:
Existing:
Phone: ( ) Fax: ( ) New:
® APPLICANT ® CONTACT PERSON NOTICE
Business name: Hearthwood Construction Inc. All contractors and subcontractors are required to be
Contact name: Doug Cook licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 14993 SW 164 Ave jurisdiction in which work is being performed. If the
City/State /ZIP: Tigard, OR 97224 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 939 -4082 Fax: : (503) 941-5184
E -mail: cookbuilder @yahoo.com
CONTRACTOR
Business name: Hearthwood Construction Inc. BUILDING PERMIT FEES*
Address: 14993 SW 164 Ave (Please refer to fee schedule)
City/State /ZIP: Tigard, OR 97224 Structural plan review fee (or deposit):
Phone: (503) 939 -4082 Fax: (503) 941 -5184 FLS plan review fee (if applicable):
CCB lic.: 117607 /0 tip Total fees due upon application:
/ Amount received:
Authorized signature: T his permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Douglas Cook Date: 9 -14 -09 * Fee methodology set by Tri -County Building Industry
Service Board.
I:\Building\Permits\BUP -RES PermitApp.doc 11/6/07 440 -4613T(I1 /02 /COM/WEB)
Electrical Permit Application ■ FOR OFFICE USE
City of Tigard RECEIva Da teB eived 9
, 7 0 USE Permit No.: y7 9� �/ �/
IN ° g Da 13125 SW Hall Blvd., Tigard, OR 97223 S E P 2 9 200 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit:
I' I I: I) Inspection Line: 503.639 Date ReadyBy � HI See Page 2 for
Internet: www.tigard - or.gov CITY OF TIGAR IP Notified/Method: Supplemental Information
TYPE OF WORK BUILDING DIVISION 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 ", "I -2 ", "1 -3 ",
Job no.: Job site address: 100HP or more. occupancy.
p � ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: 05 CO ' 14 / f� 1 ce) , d ( 1 4 f ❑ Health - care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: 11 7...7 ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee, I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map /parcel no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
t Limited energy, multi - family
Ldl j( t t( N residential (with above sq. ft.)
75.00 2
Ill ^ ^^ "` ,tyt r/ Services or feeders installation, alteration, and/or relocation
�� Af v l 200 amps or less 80.30 2
PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
n A �� \ 401 amps to 600 amps 160.60 2
Name: H 1 C }�'�"p Z.+ or 5" ODla 1A eA tv� 601 amps to 1,000 amps 240.60 2
Address: /4245 fi p, foe � -� . Over 1,000 amps or volts 454.65 2
City/State /ZIP: ` / f a, pi-2.., P D , 9 Via. 3 Temporary services or feeders installation, alteration, and /or
relocation
Phone: (5y' 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, le r -r t or exch ge, according to ORS 447, 449, 670, d 701 401 amps to 599 amps 133.75 2
9 25/0 Branch circuits- new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2
, each branch circuit
Business name:
L�� #0 J (5P B. Fee for branch circuits .
without service or feeder fee,
Contact name:. ` t6,u L ,( p first branch circuit 46.85 2
Address: III-91�3� ) I bi''ro Each add'I branch circuit 6.65 2
111 �" Miscellaneous (service or feeder not included)
City/State /ZIP: 1 V I4 q12-P4 '4 Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: ( 5) IN - 061,- Fax:: ( ) Reconnect only 66.85 2
E -mail: c•�,/j (f q ( 6 1 r � Y1 4( Pump or irrigation circle 53.40 2
(� Y �-�/ �+ _tr Sign or outline lighting 53.40 2
Business name: (`' IL f t€-- Signal circuit(s) or limited -
energy 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 PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
Print name: Date:
Plan review (25% of permit fee):
State surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEE:
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.\ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(1l /05 /COM/WEB
' Electrical Permit Application �j FOR OFFICE USE ONLY
City of Tigard
Date/B / el3 P ���"Cb /p/
Permit No.:
lig
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
' C ' Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit:
I' I GA K D Inspection Line: 503.639 Date Ready/By ® See Page 2 for
Internet: www.tigard Notified/Method: r Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ 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 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 ", "I -2 ", "1 -3 ",
Job no.: Job site address: 1001W or more. occupancy.
�
13 Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: lo$ O7 r i n e / ( ( e, � ❑ Healthcare facilities. ❑ Supply voltage for more than
.�� 11 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: C l 7 ?/1? ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 I
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
c / Limited energy, multi - family 75.00 2
.611/14/ �/ ������ � residential (with above sq. ft.)
1 •�/ VA. i -n v I v` u J • Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
Eir PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
1�A 401 amps to 600 amps 160.60 2
Name: 5" tJ`9
I two 4... � Q/} y ' 601 amps to 1,000 amps 240.60 2
Address: /4665' A P ^)€ 6 . n Over 1,000 amps or volts 454.65 2
City/State /ZIP: 017.6, i'I I O2 9 7 713 Temporary services or feeders installation, alteration, and /or
relocation
Phone: (i) I Fax: ( ) 200 amps or less 66.85 I
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, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
. Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: > hB vov C 13. Fee for branch circuits .
Contact name: t B,/ /L fr without service or feeder fee, I 46.85 2
o'" first branch circuit
Address: l fier V I b/ �' Each add'l branch circuit 6.65 2
1 Miscellaneous (service or feeder not included) _
City/State /ZIP: V /4 ' Q � 7� Each manufactured or modular 90.90 2
Phone: ( ) VO Fax: dwelling, service and/or feeder
� ' !/ ax :: ( ) Reconnect only . 66.85 2
E -mail: go iw (/ ( 61 Pump or irrigation circle 53.40 2
I + ON1`RACTOR Sign or outline lighting 53.40 2
OW i-• f , /J Signal circuit(s) limited- , or
Business name: l�� energy 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 (I hr min) 62.50
CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
•
Plan review (25% of permit fee):
Print name: Date:
State surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEE:
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:\Building\Permits \E1.C- PermitApp.doc 05/23/06 440-4615T(I1/05 /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:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ 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
❑ Boiler Controls
El Clock Systems
El Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
El Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
Cl Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: _
*No licenses are required. Licenses are required
for all other installations
I: \ Building \Pertnits\ELC- PermitApp.doc 03/23/06