Permit (130) CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2017-00745
T[GARD[GAR13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/28/2017
Parcel: 2S103AA00500
Jurisdiction: Tigard
Site address: 12130 SW TIEDEMAN AVE
Project: HARSHMAN Subdivision: None Lot: None
Project Description: Wood stove installation.
Contractor: REFINER'S FIRE SERVICES Owner: HARSHMAN, MICKIE E
19105 S LYONS RD 12130 SW TIEDEMAN AVE
OREGON CITY, OR 97045 TIGARD, OR 97223
PHONE: 971-275-7592 PHONE:
FAX: 971-223-3232
FEES
Specifics: Description Date Amount
Wood/Pellet Stove 09/28/2017 $33.39
Type of Use: SF 12%State Surcharge-Mechanical 09/28/2017 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 09/28/2017 $56.61
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: j __-- Permittee Signature: tC ILLit+
a,��rl(v
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONL\
Received /}
City of Tigard s.te/B1� PetmitNo.:�� ....ti
;�
11/ mil13125 SW Hall Blvd.,Tigard,OR 97223 ,w r 1,4 1 ° y l� NV
R Phone: 503.718.2439 Fax: 503.598.1960 z ' '° s . . Other Permit:
TI G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: H See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
FP 28 2111;
TYPE OF WORKury COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
l A i ' ` F ll, P Mechanical permit fees*are based on the value of the work
❑New construction 0 Addition/alteratip$rJaeynt performed.Indicate the value(rounded to the nearest dollar)of all
i i mechanical materials,equipment,labor,overhead,and profit.
❑Demolition 0 Other: eq P
Value:$
CATEGORY OF.CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ 1-and 2-family dwelling 0 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 LOCATION Heating/cooling:
�"s, Air conditioning 46.75
Job site address: 12130 5t0""1 lCLt,,- Av,f G Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: -71,u Q jrd OK ci7' 3 Furnace 100,000+BTU(ducts/vents) 54.91
�f 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
-'4,,,,,A. j I, ,(0'„.,,..44--C9
7 ' oRK "!,� - Gas fireplace/insert 33.39
,lk,,,"' -••:,,,.." >.„. Flue vent for water heater or gas
-get sfra 1 'VJ Oocts* /e. fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove / 33.39 3:3 p
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
` 0 PitOPER�'`� ;.01'1'NEI�k 41C-14 ��
Other: 23.32
xt ,,._ TE Environmental exhaust and ventilation:
Name: (Ylk,,kit FE514„n Range hood/other kitchen
equipment 33.39
Address: 12,{3 p S W -r f f) Aut. Clothes dryer exhaust 33.39
City/State/ZIP: j-J Gi 7a�3 Single-duct exhaust(bathrooms,
6 toilet compartments,utility rooms) 23.32
Phone:(Cf?0) a fb Fax.( ) Attic/crawlspace fans 23.32
"AP 1CAIVT s NTA ARSON'` s', Other: 23.32
Fuel piping:
Business name: fv�/SEa B 13r _
CYC $14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc.
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax::( ) Fireplace
Range
E-mail: Barbecue
` :. OR Clothes dryer(gas). y>. - ,, ., ;I i
ne.$ Other:
Business name:
50o-� lcui�.(r" /
(c,23 .Fe.
t ��* �'IECHANiPERl�'t" ES* :", '''l"
Address: . V. `��
Subtotal
City/State/ZIP: De ./{-UI 0 k '37 l l' Minimum permit fee($90.00) ekr,.
—
Phone:(11 t) 2 t i 231+4 Fax:( ) Plan review(25%of permit fee)
State surcharge(12%of permit fee) (cy !
CCB lic.: ICI 04 C ,1, TOTAL PERMIT FEE LOj,di
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: 1 r Ikkjit,(4)et(46kAtILDI,M.- * Fee methodology set by Tri-County Building Industry Service Board
Print name: mic k,,C. s Gu .tn Date: 1-als.-j 7
I:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(11/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial& Multi-Family Fee Schedule:
Total,Valuation: Permit Fee:
$0.00 to$500.00 Minimum fee$69.06
$500.01 to$5,000.00 $69.06 for the first$500.00 and
$3.07 for each additional$100.00 or
fraction thereof,to and including
$5,000.00.
$5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and
$2.81 for each additional$100.00 or
fraction thereof,to and including
$10,000.00.
$10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and
$2.54 for each additional$100.00 or
fraction thereof,to and including
$50,000.00.
$50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and
$2.49 for each additional$100.00 or
fraction thereof,to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first$100,000.00 and
$2.92 for each additional$100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
I:\Building\Permits\MEC_PermitApp_040113.doc 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12130 SW TIEDEMAN AVE, TIGARD, OR, 97223 October 24, 2017 at
12:33:43 PM
Record Type: Record ID:
Residential - Mechanical MEC2017-00745
Inspection Type: Inspector:
695 Misc. inspection David Young
Result:
FA I L
Comments:
Wood stove to close to back heatshield and wall per manufacturers installation
instructions.
Reduced clearance to 10 1/2 inches allowed.
Provide installation instructions showing reduced clearance to 5 1/2" as installed
for approval.
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12130 SW TIEDEMAN AVE, TIGARD, OR, 97223 November 1 , 2017 at
11 :18:20 AM
Record Type: Record ID:
Residential - Mechanical MEC2017-00745
Inspection Type: Inspector:
699 Mechanical final David Young
Result:
PASS - NoCofO
Comments:
Fireplace installed per manufacturer installation instructions.
Violation Summary:
Inspector Contractor