Permit (28) CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2017-00350
T f GAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/23/2017
Parcel: 2S1060001500
Jurisdiction: Tigard
Site address: 13486 SW BEACH PLUM TER
Project: River Terrace Northwest,Lot 204 Subdivision: RIVER TERRACE NORTHWEST Lot: Multiple
Project Description: Installation of A/C unit. Placement of A/C unit must comply with manufactures installation requirements.
Contractor: ANDERSEN HEATING, INC. Owner: ADLV LAND HOLDINGS LLC
16285 SW 85TH AVE STE 410 BY FORSUM, MICHAEL
TIGARD, OR 97224 7600 E DOUBLETREE RANCH RD STE 1
SCOTTSDALE,AZ 85258
PHONE: 503-992-6664 PHONE:
FAX: 503-536-6615
FEES
Specifics: Description Date Amount
Air Conditioning 05/22/2017 $46.75
Type of Use: SF 12%State Surcharge-Mechanical 05/22/2017 $5.61
Class of Work: NEW Type of Const: Investigation Fee 05/22/2017 $90.00
Occupancy Grp: Investigation Mechanical 12%State 05/22/2017 $10.80
Stories: Surcharge
Fuel
Fuel Types:
Gas Pressure:
Total $153.16
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:
Al(c/4 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 ApplicatiRECEIVED FOR OFFICE USE ONL
City of Tigard ReceivedDate/By: ' /// PermitNo.:/, TO
13125 SW Hall Blvd.,Tigard,OR 97223 MAY 2 2 2017 Plan Review /
G Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit* S U G ,_
Inspection Line: 503.639.4175 CITY OF TIGARD Juris: Bi See Pae2for
t3GARD Internet: www.tigard-or.gov Notifed/M�od: Supplemental Information
BUILDING DIVISION
v tx; •isi m ` s- 1„ 70 x c ' xG � .*p>€47.70- Y ' 1-L."
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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.
Value:
$
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❑
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
a,a44 �set,& - Al ' i ;" cr mg`e , �( e1. 1� Heatingeoling:
;4' `..-6 4' , ar� Al,:, Nt4•:.e, .. .. , 1, , a
Air conditioning I 46.75
Job site address:f 43Litsw e,,,,,,, /'4J 4 T j Furnace 100,000 BTU(duets/vents) 46.75
City/State/ZIP:Tigard,OR 97224 Yv I`- Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: t 1 Project name:.���i �i� .'�i�t✓1'tc^2,�Li Heat pump 61.06
`t o tsilE� 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: . Ve.y "rte - orti wef- 1 Lotno.: 2 ) Other: 23.32
`"r'1 �"`�' { Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
? gxdiAril- r .:..,'-'-°;1.4'1 °A di.,a.. t ;.11'-'v4, `•
axr . rP2 C
$ ,.,1j ' ,..1.!'T• ' as fireplace/insert 33.39
Flue vent for water heater or gas
fireplace 23.32
Log lighter(gas) 23.32 •
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
mt,As1J ' sera, �u H u3n. x � Other:
23.32
•'-- - --' ''''''14 ' j '1.1'.( '`'' ." , ' ' "': -:' Environmental exhaust and ventilation:
Name:ADVL Land Holdings,LLC Range hood/other kitchen
equpment 33.39
Address:7600 E Doubletree Ranch Road 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:( •) Attic/crawlspace fans , 23.32
x 1 x "�,4, "�' r A.S"'i d JK' aR' '+y .�'4;. ° Other: 23.32
. .r:3F+irJA/.• - ,T,L4..:m,;., ,Q>�•C` .r,'-" 0 x'..11.,,...,,h014:41. . r i `. ,,,F 4ta �,xa, " :.t-,,
Business name:William Lyon Homes,Inc. Fuel piping
$14.15 for first four;$4.03 for each additional
Contact name Al h ate! 7-1,7,01,pe_ 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 1 Fax::(360)693-4442 Fireplace
n Range
E-mail: V
• e,wu 2O Barbecue
` ' ,-14 ' pl .17A' fki���-;',7440,we s1,4, o,' " k �i, Clothes dryer
(gas)i. rr � , 4 x � u , '+a s p 4y" am.
Business name:Andersen Mechanical,Inc. Otho as w
z.. >P-10'%44. .�+a' :xt l€i' :a lea t v",- y','i r';
Address: 16285 SW 85'Ave �Subtotal
City/State/ZIP:Tigard,OR 97224 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(503)992-6664 Fax:(503)536-6615 State surcharge(12%of permit fee)
•
CCB lie.:168214 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 181) -
days after it has been accepted as complete.
Authorized signature: / • Fee methodology set by Tri-County Building Industry Service Board
Print name:. lte`okm)k_Thh Date:
V.1L7
I:1Building'Permits\MEC PermitApp 040113.doc ;44617T(I t/07JCO9/WEB)