Permit al CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT
Permit#: MEC2021-00123
13125 SW Hall Blvd.,Ti Date Issued: 2/24/2021
T[�:�ALL� and OR 97223 503.718.2439 9
Parcel: 2S102CB03600
Jurisdiction: Tigard
Site address: 10010 SW GARRETT ST
Project: Haulpt Subdivision: FREWING'S ORCHARD TRACTS Lot: 10
Project Description: Install gas insert and liner kit for fireplace
Contractor: GO SALES INC Owner: HAUPT, ROBERT ADAM
14210 SE STARK ST 10010 SW GARRETT ST
PORTLAND, OR 97233 TIGARD, OR 97223
PHONE: 503-256-3473 PHONE:
FAX: 503-254-1011
FEES
Specifics: Description Date Amount
Gas Fireplace 02/24/2021 $33.39
Type of Use: SF Chimney/Liner/FlueNent 02/24/2021 $23.32
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 02/24/2021 $10.80
Occupancy Grp: Minimum Fee Adjustment-Mechanical 02/24/2021 $33.29
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
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 503.232.1987 or 1.800.332.2344. 7�
Issued By: HOUy VAi fD Nle/Wege Permittee Signature: O fit/Applf cattLwwt
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.
Mechanical Permit Application 1(Ill t 11 I I( I l .I t i\l
City of Tigard Received
Datc/By:2'211IZ� Permit�o.: Z�. +
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960S:
Date/By: 2.3
Other Permit:
Inspection Line: 503.639.4175
Internet: nvwvv.tigard-or.gov De[i1Re cthod:By Z\ v` A`. El See Page 2 for
Supplemental Information
i• OF WORK 1 COMMERCIAL FILE* SCHEDULE—USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction ddition/alteration/replacement performed. Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:S
1 CATEG4RY OF CONSTRIKI1UN 1
ars*NnAL EQUIPMENT/SYSTEMS FEET
` 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND!LOCATIO Heati■gltooling:
Job site address: C)Ott) 4.♦ �&,'re, �� 4 AirFurnace100,000
conditioning 46.75
1 -.tb(/ 1 BTU(duets/vents) 46.75
City/State/ZIP: rya D 12 9 7,22 3 Furnace 100,0004 BTU(ductsrvents) 54.91
�r f �� ! Duct pump 61.06
SuiteJbldg./apt.no.: Project name: - Duct work 233.322
Cross street/directions to job site: 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
— -- Other fuel appliances:
Tax mapiparcel no.: Water heater 23.32
i DEStan moN OF WORK ' 1 Gas fireplace/insert 1 33.39 '?jV5R
/ r Flue vent for water heater or gas
1 n /j4..S !lZ ,el- Q K1 /i n, hi' fireplace 23.32
J Log lighter(gas) 23.32
.� J n Wood/pellet stove 33.39 1
el 4S d/eA J n 14 1 '!��/c—e Wood fireplace insen 23.32
J Chimney/liner/flue/vent ! 23.32 yA-;7-
Other: 1 23.32
❑ PROPIEII�TX OWNER I ❑ TENANT Environmental exhaust and ventilation:
Name: Range hood/other kitchen
equipment 33.39
Address: Clothes dryer exhaust 33.39
City/State,ZIP: Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( ) Fax:( ) Attic%crawlspace fans 23.32 _
0 APPLICANT I I❑ CONTACT PERSON Other: 23.32
Fuel piping:
Business name:
_ S14.15 for first four;S4.03 for each additional
Contact name: Furnace,ctc. L
Address: Gas heat pump -
-� Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax::( ) Fireplace
Range
E-mail: Barbecue
NTRACTOR i Cther: dryer(gas)
Business name: 6 s / r ' Other:
MECHANICAL PERIM FEES*
Address: 14/ 0 5 f7,-4 .0 Subtotal 56./ 1
City/State/ZIP: PO,- ),// D q77 Minimum permit fee(S90.001 qb
i ! Plan review(25%of permit fcc)
Phone) 2 - ,r3" Fax:(, 3) ds!U/tY/ state surcharge(12%of permit fee) f g -it
CCB lie.: /9c{/%� _ 1 1 TOTAL PERMIT FEE /O p*S O II
` J This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: • Fee methodology set by Try-County Building Industry Service Board
Pnnt name: YY 6 e,,, _ Date. Z_Z/f_Z j 1
I Bwldusg'Pcrm,u MEC_PcrmitApp_0101 I?Jaw 440-4417T I I I/02/COM/WEE)