Permit „ CITY OF TIGARD MECHANICAL PERMIT
t COMMUNITY DEVELOPMENT Permit#: MEC2021-00753
Date Issued: 10/5/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S104CB01100
Jurisdiction: Tigard
Site address: 13245 SW ASCENSION DR
Project: STANDEVEN Subdivision: HILLSHIRE WOODS Lot: 27
Project Description: Install gas fireplace
Contractor: FIRESIDE CONTRACTING SERVICES LLC Owner: STANDEVEN,WILLIAM C&MARGOT
18389 SW BOONES FERRY RD 13245 SW ASCENSION DR
PORTLAND,OR 97224 TIGARD, OR 97223
PHONE: 503-684-8535 PHONE:
FAX: 503-620-5699
FEES
Specifics: Description Date Amount
Gas Fireplace 10/04/2021 $33.39
Type of Use: SF 12%State Surcharge-Mechanical 10/04/2021 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 10/04/2021 $56.61
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
Issued By: No4,L� Vativ De.Wege Permittee Signature: Ow Ar�O�l Gfx�ft CTw
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
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Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard
Received
Date/By: `t 23\24 Permit No.:� ,�S 3
1413125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
' s Phone: 503.718.2439 Fax: 503.598.1960 otter Permit:
Date/By:
T I G n R I J Inspection Line: 503.639.4175 Date Ready/By:qA-231v LV Juris: Page
Internet: www.ti and-or. ov S See 2 for
K K Notified/Method Supplemental Information
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TYPE OF WORK COMMERCIAL FEE* SCHEDULE —USE CHECKLIST
�/ Mechanical permit fees*are based on the value of the work
❑New construction l sddition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
® I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist
❑Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address:13245 Sw, Ascension Dr Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard OR 97224 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name: Duct work 23.32
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 map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 1 33.39
Flue vent for water heater or gas
We are installling a gas fireplace fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
ElPROPERTY OWNER 0 TENANT Other: 23.32
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
❑ APPLICANT 0 CONTACT PERSON Other: 23.32
Fuel piping:
Business name:Fireside Home Solutions
$14.15 for first four;$4.03 for each additional
Contact name:Deavon Ruud Furnace,etc.
Address:Same as below Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax: :( ) Fireplace
Range
E-mail:order-retail-or@firesidedist.com Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:Fireside Home Solutions Other:
MECHANICAL PERMIT FEES*
Address:18389 SW Boones Ferry Rd Subtotal 3-t,3y
City/State/ZIP:Portland OR 97224 Minimum permit fee($90.00) cr. (st
Plan review(25%of permit fee)
Phone:( )503-595-3733 Fax:( ) _ State surcharge(12%of permit fee) L 0, )C)
CCB lie.:201593 TOTAL PERMIT FEE lam•$k
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature:Z:7(u24i464,, ,( * Fee methodology set by Tri-County Building Industry Service Board
Print name:Deavon Ruud Date:9/23/2021
L1Buildiag\Permits 5MEC_PermitApp_040I 13.doe 440-4617T(I I/02/COM/WEB)