Permit (131) CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT74
Permit#: MEC2017 00269
T f RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/19/2017
a
Parcel: 2S1060002900
Jurisdiction: Tigard
Site address: 13714 SW 175TH AVE
Project: Polygon at West River Terrace, Lot 105 Subdivision: WEST RIVER TERRACE Lot:
Project Description: NC installation. Placement of NC unit must comply with manufactures installation requirements.
Contractor: APEX AIR LLC Owner: ADLV LAND HOLDINGS LLC
2210 W MAIN ST STE 107-272 7600 E DOUBLETREE RANCH RD
BATTLEGROUND,WA 98604 #150
SCOTTSDALE,AZ 85258
PHONE: 360-342-8109 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Air Conditioning 04/19/2017 $46.75
Type of Use: SF 12%State Surcharge-Mechanical 04/19/2017 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 04/19/2017 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By:
"i/.44/(irorddi ---
Permittee Signature: �`�
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit.A.policati CEIVEI ,..:. .. . . .:. ... ..,, .... „).,,,„..VICE.4:.tik:,9tilly:: • • •,',:,:•„::•:;:•-';'.4', .[.",,•••.i.,,.!'.
City of Tigard 117(f 12 Pli pc„„irisio.i/ki
DatelEiy: V/
.... 13125 SW Hell Bird.,Tigard,OR 97223 APR 1 2 2017 Plait Revim
Phone: 503.7182439 Pax: 503.598.1960 Date*: Oliter PenniriVST20/i,__00/3c
,,,,„R.il.Inspection Linn: 503.639A175 atris• ia See Paa,e 2 tor
Interact wmigard-or.gor cin VF TIGARD DN:71iRcittre:'d: Supplemental Information
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Me.ehanieil permit'fees*ate bakd ea the,Value of the work
IS7 New construction 0 Addition/alteration/replacement performed./Miceli:the value(rounded to the armrest dothtr)of alt
0 Demolition 0 Other: mechanical.maierials.aluinment,labor.oredited,and profit.
Value:$
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04
-and 2-family dwelling 0 Commercialtindustrial 0 Accessory building Por speck!iiijiiimaiititt n ,Ireotilo. ,
Multi-family 0 Master builder 0 Other: Description _I Qty. I Ea. Total
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I 46.75 'i'•.7
Job site address: J3-49. Lla'\fiC., Frimate 100.000 tall(dueistranis) 46.75
City/State/ZIP:Tigard,( R 97224 Furnace 100.000+BTU idocistvcraid 54.91
. Heat pump II 61.06
Suileibldg.lept.no.:
Project name: 1M oki+Wesi-A1/4.1tel-e-react Dad work i 23.32
Cross strectidirections 10 job site: llydronic hot water system 23.32
Residential boiler(radiator or
hydronie} 23.32
Link heaters(tbehtype.not electric),
, in-well.in-duct,suspended.etc, 46.75
Flue/vent for any of above 23.32
_.._
Other: 2332 .
. s6I'divisi"; F1/1104 a WIC'''. ll't\le'(l-or'rita- Lot t OS- Other fuetapplia ores:
Tax nutp/patul no.: .Water heater 23.32. _
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Ark-7-4/ z --A., /2.-- - fireplace 23,32.
Log lighter(pas) 23.32
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/4 ..tir.iteirri 11: '._v. 4 ----
11VWoodipel let stove 33.39
Wood firepiacelinsert 23.32
Chinmeyllinertflueivent 23.32
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_
Name:Polygon WLII,LAX ' Range hood/other kitchen
---.- equipment
Address:109 East Fr Street I Clothes dryer exhaust 33.39
City/Stale/ZIP:Vancouver,WA 98660 Singlc-cluti exhaust tbribroen15,
ild compartments,utility rooms) , 23.32
Phone:(360)6954700 Pax:( ) Attieferewlspece fans _ 23.32
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Business name;Polygon WIAL ILC ire l pipingi
514,15 for liral four:84.03 for each additional
Contact name:Angela Grajewski , Furnace,etc,
: Address:109 East 13th Street , Gus heat pump
• -.1 Wallisuspendedlunit heater _
' City/StateiZip:Vancouver,.WA 98660 : Water hiAtti
Phone:.(360).695-7700 , .Fax:::(360)693.4442.
Range
•
• Range
E-mail:Angela.Grajewskqpolygonbornes.cam ,Barbecue .
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Business mune:Apex Mr LEXOther:
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Address:18004 N E•72'4 Ave Subtotal L1 .7
City/State/ZIP:Vancouver,WA 98686 Minimum permit fee(590.00) 4:::f,C ,,,OP
r Flan review(25%of permit fee)
Phone:(360342410 : Fax:(360)326-1769
State surcharge(12%of permit ibe) /0.NI
--
CCB fie,:203034 ,fl- TOTAL.PERMIT FEE 100..qr
-- This permit applicati6n c.o.
If permit is naiddained Wallin 180
days atter it ties been accepted as tarn pinto.
Authorized signature: . t:..inetitodoiegy its by Tri-County Boilcint$Industry service Huard
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