Permit (34) CITY OF TIGARD MECHANICAL PERMIT
IN 2: .' COMMUNITY DEVELOPMENT Permit#: MEC2017-00352
T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/23/2017
Parcel: 2S1060001500
Jurisdiction: Tigard
Site address: 13494 SW BEACH PLUM TER
Project: River Terrace Northwest,Lot 205 Subdivision: RIVER TERRACE NORTHWEST Lot: Multiple
Project Description: Install 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 05/23/2017 $46.75
Type of Use: SF 12%State Surcharge-Mechanical 05/23/2017 $5.61
Class of Work: OTR Type of Const: Investigation Fee 05/23/2017 $90.00
Occupancy Grp: Investigation Mechanical 12%State 05/23/2017 $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:
174414/();( Permittee Signature: cre_ Gti . L/"C
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.
t
' Mechanical Permit Applica :ONLY .�
'r' Reced Permit No.:
City of Tigard Re eiveneDaBy ��tl f. 017-00354
13125 SW Hall Blvd.,Tigard,OR 97223 MAY 1 b 2017 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: a er'emit: s I -6490 A
TI G A R D Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: ® 63 See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
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Mechanical permit fees*are based on the value of the work
®New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit,
b : t •• e, a< �, r rr tea Value $
'` i 3�,cr� :t a.' 4 k a -4^ t. ;s �, a. ,.a.c.�.,e. .. .a s t.,a.
,,,,,#-,14,'`'"e'r•^3n. is iU,° ',,-'):x Ftl 'tc:6 -`.t,ryfF7 '' � ��'{&.'<1'.:irYi, t " ..ri �.... � .*::;14:040. .,� f `'!SDG tW`,,•S'.£,a'.M. '� ��9'` .'�-'M2� 'a
❑ 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building Far special information use checklist
®Multi-family 0 Master builder ❑Other: Description Qty. Ea. Total
A 41 e : ;ROtc ' V;1!,03:1 0 :$ *h 'M; c:P 4„', Heatingle""ng:
• �~ Air conditioning •1 46.75
Job site address: 13 Ll 7/ Svu &et!4r1 OI lam !t°rYrlfi� Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard,OR 97224 + Furnace 100,000+BTU(duets/vents) 54.91
,r.. Heat pump 61.06
Suite/bldg./apt,no.: ,� , Project name: ii/P�Y' jet►[�1I� N =St 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: 2332
Subdivision: gi/&r-Te ,,. mirthwt. Lot no.: 2,p " Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
' " 7t a• 6M p :tg _ i t * i ;' Gas fireplace/inser
33.39
Flue vent for water heater or gas
fireplace 23.32
/1-dal II-7C lighter(gas)
Wood/pellet stove 23.32
33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
r Virg' F trs Other: 23.32
w ,`.: ,' ?.�-' +1 � '''' '' Environmental exhaust and ventilation:
Name:ADVL Land Holdings,LLC Range hood/other kitchen
equipment 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/crawispace fans 23.32
15,1•1',;4402140 : � ! ,4 5,r, �0.01'.4b4-0-ftp Other: 23.32
; '� `� ' ..
Fueliu
t
Business name:William Lyon Homes,Inc. p p g
$14.15 for first four;$4.03 for each additional
Contact name: ,t/(Ch D(e TholeFurnace,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 I Fax::(360)693-4442 Fireplace
Range
E-mail; f / p ha 1 A 1 ',Ai Barbecue
a � tn4; gtz :G- mse a gfrYr YZpr =
Clothes dryer(gas)
Other:
Business name:Andersen Mechanical,Inc. � a� �t� f �� '
xP .of 1
Address:16285 SW 851°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 180 •
days after it has been accepted as complete.
Authorized signature: / /i * Fee methodology set by Tri-County Building Industry Service Board
Print name: /(f rth v jp Th oe!",I Date:FS/al/7
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I:Building\Permits\MEC_PermitApp 040113,doc""• 440-4617T(I