Permit I CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2016 00679
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/26/2016
Parcel: 2S 106DC 11400
Jurisdiction: Tigard
Site address: 17372 SW JEAN LOUISE RD
Project: Polygon at West River Terrace, Lot 114 Subdivision:POLYGON AT WEST RIVER TERRACE Lot: 114
Project Description: Installation of A/C unit. Placement must meet manufacturers installation requirements.
Contractor: APEX AIR LLC Owner: ADLV LAND HOLDINGS LLC
2210 W MAIN ST STE 107-272 7600 EAST DOUBLETREE RANCH RD, STE
BATTLEGROUND,WA 98604 SCOTTSDALE,AZ 85258
PHONE: 360-342-8109 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Air Conditioning 09/26/2016 $46.75
Type of Use: SF 12%State Surcharge-Mechanical 09/26/2016 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 09/26/2016 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 47--- 2)747t Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Applicati i , i +
FOR OFFICE USE ONLY
71 City of Tigard Received�r
Date/By: / �a //� Permit Nq/��L►�^f 4-400�
13125 SW Hall Blvd.,Tigard,OR 97223 26 ?016 �`v
■- tj I-_P Plan Review
Phone: 503.718.2439 Fax: 503.598.1960
Date/By: Other PermitEleept f/,a-007
T 1 G A R D Inspection Line: 503.639.4175 A GGyy YJ
Internet: www.tigard-or.gov � "� Date Ready By: inns: ® See Page 2 for
Notified/Method: Supplemental Information
4U1LU1NG DPI'.
1
EigigleAttitilUNIVM,is T `PE OT Ot Rl ** frE *cwELE .. U$EC m
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 0 Other: mechanical materials,equipment,labor,overhead,and profit.
`ATEG Y' i F CO TR•.ICTiQQ+ll �C188111
Value $
®
1-and 2-family dwelling ❑Commercial/industrial �S�
❑Accessory building For special information use checklist. t•
0 Multi family 0 Master builder
❑Other: Description I Qty. Ea. I Total
JO . ITE INF1► T.I I'1 �.C zjatok
_, Heating/cooling:
Air conditioning 1 46.75 46.75 �,
Job site address: (i-2.)--1 --,(A.) i pkn LoL�,„ e. L\ Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard,OR 97224 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name:Polygon at West River Ter Heat pump 61.06
Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
Residential boiler(radiator or
hydropic) 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:Polygon at West River Terrrace Lot no.: t 'l i Other: 23.32
'1 Other fuel appliances:
Tax n lo.:
Water heater 23.32
D ION*L Gas fireplace/insert
°: 33.39
Flue vent for water heater or gas
Add AC j fireplace 23.32
KA�� ”- D 0 _ ( i(Sck Log lighter(gas) 23.32
€�`V l •� Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
>I .?RGPRTX Gbit ❑ TEN. .. r. 23.32
to
Environmental exhaust and ventilation:
Name:ADVL Land Holdings,LLC Range hood/other kitchen
Address:7600 E Doubletree Ranch Road equipment 33.39
Clothes dryer exhaust 33.39
City/State/ZIP:Scottsdale,AZ 85258 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(602)694-4031 Fax:( )
pd �1h .kNT i ❑ S 1t ... ........ craw p ce fans
Atric/ Is a 23 32
Other: 23.32
Business name:William Lyon Homes,Inc. Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name:Angela Grajewski Furnace,etc.
Address: 109 East 13th Street Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Vancouver,WA 98660 Water heater
Phone:(360)695-7700 Fax::(360)693-4442 Fireplace
Range
E-mail:Angela Grajewskianpolygonhomes.com
Barbecue
t... 1< t.. ....;... arTOl : -• .... Clothes dryer(gas)
Business name:Apex Air LLC Other:
Address:18004 NE 72nd Ave
_ *:*:: l...:.:: ALP F3lfEE
Subtotal
City/State/ZIP:Vancouver,WA 98686 Minimum permit fee($90.00)
Phone:(360)342-8109 Plan review(25%of permit fee)
Fax:(360)326-1769 State surcharge(12%of permit fee)
CCB lie.:203034 TOTAL PERMIT FEE
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 Tri-County Building Industry Service Board
Print name:Angela Grajewski Date:8/22/16
I:ABuildingVPermits\MEC_PermitApp_040113.doc 440-46171(1 I/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi Family Fee Schedule:
$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\Pem its\MEC_PermitApp_040113.doc 2
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
17372 SW JEAN LOUISE RD, SHERWOOD, OR,
97140
Residential - Mechanical
699 Mechanical final
PASS - No C of O
MEC2016-00679
Mark VanDomelen
Violation Summary:
Inspector Contractor