Permit CITY OF TIGARD MECHANICAL PERMIT
s a COMMUNITY DEVELOPMENT Permit#: MEC2021-00752
Date Issued: 9/23/2021
T[GAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.716.2439 parcel: 2S102CC03700
Jurisdiction: Tigard
Site address: 13990 SW 102ND AVE
Project: Whitman Subdivision: FRELEON HEIGHTS Lot: 5
Project Description: Replace wood insert
Contractor: FIRESIDE CONTRACTING SERVICES LLC Owner: WHITMAN,JANIS R
18389 SW BOONES FERRY RD 13990 SW 102ND AVE
PORTLAND,OR 97224 TIGARD,OR 97223
PHONE: 503-684-8535 PHONE:
FAX: 503-620-5699
FEES
Specifics: Description Date Amount
Wood Fireplace/Insert 09/23/2021 $23.32
Type of Use: SF 12%State Surcharge-Mechanical 09/23/2021 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 09/23/2021 $66.68
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure.
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
Issued By: Hotly Va . De We,4e, Permittee Signature: QI ,Ajyjryl.l,64401+-
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
Received° �.t�r;� :.2.
City of Tigard Date/By:: � 23 . , Permit No. \t\F 1.2c;
Iiii • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
g Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
T l G�R P Inspection Line: 503 639.4175 Date ReadyBy Q,23`2\ \�V Jura: I la See Page 2 for
Internet: www.tigard-or.gov Notified/Method-. - IL Supplemental Information
C.,
;lrri .t• .x.` :ey,
TYPE OF WORK COMMERCIAL FEE" SCHEDULE—USE CHECKLIST _.
Mechanical permit fees*are based on the value of the work
❑New construction ®Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
® 1-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 Beating/cooling:
Air conditioning 46.75
Job site address:13990 SW 102nd Ave Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard OR 97223 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
Other: 23.32
Subdivision: Lot no.:
Other fuel appliances:
Tax map/parcel no.. Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
Replace wood insert fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 1 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
® PROPERTY OWNER 0 TENANT Environmental exhaust and ventilation:
Name:Janis Whitman Range hood/other kitchen
equipment 33.39
Address:13990 SW 102nd Ave Clothes dryer exhaust 33.39
City/State/ZIP:Tigard OR 97223 Single-duct exhaust(bathrooms,
9 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.
Gas heat pump
Address:18389 SW Boones Ferry Rd Wall/suspended/unit heater
City/State/ZIP:Portland OR 97224 Water heater
Phone Fax::( ) Fireplace( )503 595 3733Range
E-mail:order-retail-or@firesidedist.com Barbecue
CONTRACTOR Clothes dryer(gas) .
Business name:Fireside Home Solutions Other:
MECHANICAL PERMIT FEES
Address:Ssame as above Subtotal Z� 32-
City/State/ZIP: Minimum permit fee($90.00) (0(i.(06
Plan review(25/n of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee) \o.lap
CCB lie.:201593 TOTAL PERMIT FEE l00.elC
This permit application expires if a permit is not obtained within 180
/ days after it has been accepted as complete.
72uAuthorized signature: 44,, , �LLC.LL�i ' Fee methodology set by Tr;-County Bu;ldmg Industry Service Board
Print name:Deavon Ruud Date:9/23/2021
I:1Building\PcnnsslMEC PermilApp_040113.doe 440-4617T(I1/02/COMIWEB)