Permit 11111 CITY OF TIGARD MASTER PERMIT
Is . COMMUNITY DEVELOPME Permit #: MST2012 00009
Date Issued: 01/20/2012
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S110BA02600
Jurisdiction: Tigard
Site address: 14520 SW MCFARLAND BLVD
Subdivision: SHADOW HILLS Lot: 38
Project: BURBACK
Project Description: Replacing chimney.
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: 0 sf Value: $17,940.00 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
Drains: 0
Tubs /Showers: 0 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
Other Fixtures: 0
Drywell- Trench Drain: 0
Other Fixture Units:
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: 0 201 -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
Other: N Other Description: Ecompasing: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ALT SF VB R -3 0
Owner: Contractor:
BURBACK, DARRELL R AND PORTLAND CHIMNEY INC Required Items and Reports (Conditions)
SHIRLEY L 1441 SE 122ND AVE STE M
14520 SW MCFARLAND BLVD PORTLAND, OR 97233
TIGARD, OR 97224
PHONE: PHONE: 503 - 256 -9140
FAX: 503- 256 -3020
Total Fees: $617.04
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 ' • •. •regon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -00 -0010 through OA' 9 -0# 190. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issue. By: ■ Permittee Signature:
Call 503.639.4175 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.
Building Permit Application �_,.j t . „ �,
Residential 9 FOR OFFICE USE ONLY
14 City of Tigard 0� DateB ,
. �� Permit No.: -� ��
• 13125 SW Hall Blvd., Tigard, OR 972 \ 1. Plan Review ��I in
Phone: 503.718.2439 Fax: 503.598.1960 P 1 P � Q iateB : S �,�I fi Other Permit:
T I GA RD Inspection Line: 503.639.4175 C ,Csc S � i Late Ready :y. , El
See Page 2 for
Internet: www.tigazd- or.gov �o 'OVA
Notifr� ethod: l �� i Supplemental Information
�G 0.■ i . ,..t lfr
e ** 4'".5� ' F .k* f t REQUIRED 2-FAMILY DWELLING
EI't DATA:1 -AND 2 -PANIC
❑ 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.
A 1- and 2 -famil dwellin Valuation: $ \ Li o
y g ❑Commercial /industrial `
111 Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: I —1 e i_0 s Gs...) Al ,, i c I An j II , J New dwelling area: square feet
City /State /ZIP: t q , 4 c)‘2... 9 1- 2. 1 LI Garage /carport area: square feet
Suite/bldg. /apt. no.: J Project name: 0, r 6 rtc_ k Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA COMMERCIAL -USE CHECKLIST
Subdivision: I 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.
TA le. c 4,A AC �J "` . � b ftl .t�1�1^ Valuation: $
4/N.1 h.1. L bk iJS t n� ^C M. �C ]h rta I Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER ❑ TENANT Number of stories:
Name: V I I
I i f loci, k 17 Type of construction:
Address: i L SL 0 Sar /lit Fc,, t C.l U t ✓j Occupancy groups:
City /State /ZIP: , c r4 Ott 6 1 i j L LI Existing:
Phone: 0 Fax: ( )
(co S�3 �,.0 336 � _ New:
0I APPLICANT .., ❑ CONTACT. PERSON BUILDING PERMIT FEES*
Business name: i I
`` {FXeese refer *l,te scilse e)
. t; f k.�/k I M K�l •� /"t0. S 0A 7 Structural plan review fee (or deposit):
Contact name:' Fu FLS plan review fee (if applicable): 1
Address: 1 t 1 SC 12,2 4 &.K M Total fees due upon application: � (/�
City /State /ZIP: P6 r 4 tcx, di 4 1 3 L 13
Phone: (Sol ) 2 S 6 '1 I (4 0 Fax:: (S63 ) zSU w 30/ O Amount received: f 3. 0,1
E -mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof -top mounted Photo Voltaic Solar Panel System.
Business name: ii Submit two (2) sets of roof plan with connection details
�ier � � L N .."t AC .• c.ni L /I� ..S tI A f y and fire department access, along with the 2010 Oregon
Address: I L L1 I se i 2 2'"' ti. t S.f M Solar Installation Specialty Code checklist.
City /State /ZIP: pt r fi lam j V it 5 3-Z3_3 Permit Fee (includes plan review $180.00
and administrative fees
Phone: (S j) 25 6- q) t� V Fax: (S,3 ) 216, 3�L 0 State surcharge (12% of permit fee): $21.60
CCB ]ic.: Li C I. 56 Total fee due upon application: $201.60
Authorized signature: T This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: 3l k 0 4C Date: l/i D/ 1 L * F erv t ice Board.gy set by Tri- County Building Industry
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