Permit CITY OF TIGARD MASTER PERMIT
lig !s COMMUNITY DEVELOPMENT Permit #: MST2012 -00101
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/30/2012
T t G.A.R.O 9 Parcel: 2S110AB01000
Jurisdiction: Tigard
Site address: 14245 SW 112TH AVE
Subdivision: COLE'S ACRES Lot: 5
Project: Burton
Project Description: Remove existing chimney and replace with new.
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 st Garage: 0 sf Front: 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 0
Detectors: Yes
Total: 0 sf Value: $4,275.00 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
Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 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: 0 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 0
Fum<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'I 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 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:
OTR SF VB R -3 0
Owner: Contractor:
BURTON, ROBERT 8 SHIRLEY M PORTLAND CHIMNEY INC Required Items and Reports (Conditions)
14245 SW 112TH AVE 1441 SE 122ND AVE STE M
TIGARD, OR 97224 PORTLAND, OR 97233
PHONE: 503 -684 -9827 PHONE: 503- 256 -9140
FAX: 503- 256 -3020
Total Fees: $267.06
This permit - , . • subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be don= accordance , 'th 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: Orego requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-•01-0010 through OAR • • -001- 0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Iss =d By: / / Permittee Signature:
Call 503.839.4175 by 7:00 a.m. for the next available inspe o n 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
Residential FOR OFFICE USE ONLY
Received �� i
City of Tigard Received 5 /? Permit No.: /6 ', /,/� - 00 0/
13125 SW Hall Blvd., Tigard, OR 97223 'MEWED Plan Review
' �JUv Date/By: 4 ! 1 � - (� ether Permit
I� , Phone: 503.718.2439 Fax: 503.598.1960
TI G A R D Inspection Line: 503.639 q Date Ready /By: _ � a l uris. ® See Page 2 for
Internet: www.tigard - or.gov 1 :''-f 1 r i 701 Notified/Method: ft C Supplemental Information
'MAD olY� to/ 6,
TYPE OF WORK (+1n( OF 'MAD REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction
❑ Dep><i,HaDIN- DIVISI Permit fees' are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
`IJ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
I- and 2- family dwelling ❑Commercial /industrial
Valuation: $ L1 2.
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
a Job site address: ' 4 2. 5-%) I l 1 1 q t,L New dwelling area: square feet
QJ City /State /ZIP: er v tl a� 0?.- e l-Z . L) Garage /carport area: square feet
, Suite/bldg. /apt. no.: J Project name: &, .f 0 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: 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
1 DESCRIPTION OF WORK work indicated on this application.
Q t."..4vt- et.t.S. ^l C'1tMn q ,�
e.� Valuation: $
` 13,..,0 ^kw J C.1"-t. Existing building area: square feet J
New building area: square feet
4
[PROPERTY OWNER ❑ TENANT Number of stories:
Name: S t A, f IC./ i 3 u t � Type of construction:
Address: � L.I 211 .5 I L Q v� Occupancy groups:
City /State /ZIP: `j ()�
`421-4 Existing:
Phone: ( Sul ) 6 ay . V) Z Fax: ( ) New:
APPLICANT ErCONTACT PERSON BUILDING PERMIT FEES*
0 M (Please refer to fee schedule)
Business name: 111 11
u f ') lM� t /`iy °I�4J� AS Q'A r i Structural plan review fee (or deposit):
Contact name: . 1 l f. -
S� 11.,/ FLS plan review fee (if applicable):
3 A ddress:
1y ✓( S /-` Total fees due upon application:
City /State /ZIP: 1 pr i 1 oid p i t q L33 39 a
Amount received:
Phone: (Su3) S6' S �{ Fax: : (�3) ZS6 3 —
E -mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Ci CONTRACTOR Commercial and residential prescriptive installation of
roof -top mounted Photo Voltaic Solar Panel System.
Business name: porjka..J Ll\s,.^tey Fn3 /ViO4 6A7 Submit two ( • tsof roof plan with connect' .n details
46 7 and fire departmen . cess, along with t . .1 0 Oregon
.( Lt (
Address: 1 t SE 1 2. i rt(- GI.,c. S'k e, At Solar Installation Spec,.. Code • • list.
}133 Permit Fee (includes r review
t: City /State /ZIP: Pp r.1 a�� 0 \Z-- y $180.00
and ad trative ; __
Phone: (Sol ) Z S G - 1.l k p -ax:( SLI) 2C 6- 3 b L O State sure u . • - ' (12% of permit fee): ` $21.60
CCB lie.: Li q I A �
`� `) ( ` Total fee due upon application: $201.60
Authorized signature: k.T 'CO— This permit application expires if a permit is not obtai • d
within 180 days after it has been accepted as complete.
Print name: I3 A Cos kr Date: * Fee methodology set by Tri- County Building Industry
Service Board.
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