Permit (74) CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2017-00449
T f GAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/20/2017
Parcel: 2S 106DC 13400
Jurisdiction: Tigard
Site address: 17034 SW JEAN LOUISE RD
Project: Polygon at West River Terrace, Lot 135 Subdivision:POLYGON AT WEST RIVER TERRACE Lot: 135
Project Description: Installation of NC unit. Placement of NC unit must comply with manufactures installation requirements.
Contractor: ANDERSEN HEATING, INC. Owner: ADLV LAND HOLDINGS LLC
16285 SW 85TH AVE STE 410 7600 EAST DOUBLETREE RANCH RD, STE
TIGARD, OR 97224 SCOTTSDALE, AZ 85258
PHONE: 503-992-6664 PHONE:
FAX: 503-536-6615
FEES
Specifics: Description Date Amount
Air Conditioning 06/20/2017 $46.75
Type of Use: SF 12%State Surcharge-Mechanical 06/20/2017 $10.80
Class of Work: NEW Type of Const: Minimum Fee Adjustment-Mechanical 06/20/2017 $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: AiZe— /V �2�G Gw^GLS//' Permittee Signature: e �/�^ „� e,.PDOCCC�/JJ��_" �Jll Y��h- Se. �� "` fiYl Gf
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.
Ci of Tigard RECEIVED I R i,.d /
INCity g I)atcil3y: a , I omit No.: Ac y
4. 13425 SW Hall Blvd„Tigard,OR 97223 �, `, �7� t�� �—�-1
Plan Review
Phoae: 503 718.2439 Fax: 503.598.1960. JUN 2 0 2 017 Date/By: other Permit: a a LI
1`i c;:,me i'a Inspection Line: 503 639.4175 Date Ready/By: lush. lea See Page 2 for
Interact www.tigard-or.gov CITY Or rIGARD Notified/Method: Supp mental information
BUILDING DIVISION i
�, ,' TYPEOF,WORKCOMMERCIAL PEE*"SC1tEbtiLEi .':t USE CREC1f1.ISf. :::;
' Mechanical permit fees"arc based on th&value of the work
®New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded t4 the nearest dollar)of all
0 Demolition ❑.Other: mechanical materials,equipment,labor,=verhead,and.mfit
Value:5
CATEGORY OF ONs1RVCTION
` TEG
. ._ aR�sin�r�rr,- �q�zpl�l�r .w. .
01-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information us checklist.
0 Multi-family 0 Master builder 0 Other. Description [city. Ea. Total
JOB SITE INFORMATION AND LOCATION Iieatinglcortli _
=' --"�
-^ Air conditioning ! 46.73
Job site address. Li 1,00,0 kilt/
Furnace 100,000 BTU(ductsvents) E 46.75
efurl
City/State/ZIP:Tigard,OR 97224 Furnace 100,000÷BTU(ducts/wars) 1 54.91
Heat pump I 61.06
Suite/bidg./apt.no.: t r Project name:Polygon at West River Ter Duct work 23.32
Cross street/directions to job site: I3ydronic hot water system I 23.32
Residential boiler(radiator or •
hydronie) I 23.32
Unit heaters(fuel-type,not electric), l
in-wall,in-duct,suspended,etc, I 46.75 IIII
Flue/vent for any of above
Subdivision:Polygon at West River Terrrace Lot no.. Other: ' 23,32
Other fuel appliances: i
Tax map/pat el no.: Water heater I 23.32
RZ SCRIt'i70h1=t)R Wt)1t1�': Gas fireplace/insert __b 33.39
Flue vent for water heater or gas # j
o fireplace i 23.3atilt fict(d 2
Log lighter(gas)" -
Wood/pellet stave i 33:39 ® I
Wood'fireplacc/inscn 1 23.32
Chimney/liner/flue/vent I 23.32
.2:� ; ,i = , 'ItUI'ETtOtOM 4 1t 0:TENA�7._` Other. 23.32
4u -
� ° '" Environmental exhaust and ventilation:
Name:ADVL Land Holdings;LLC Range hood/other kitchen
Address:7600 E Doubletree Ranch Road equipment I 33.39
Clothes dryer exhaust ; 33.39
City/State/ZtP:Scottsdale,AZ 85258 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) i 23.32
Phone (602)694-4031 Fax:-( )- Attic/crawispace fans 1 23.32
3
7,- '''' _"liar TAPPY,I CA'N'1:` x,,0'CCINTACf"PERSON Other ' 23.32
Fuel piping: 1
Business name:William Lyon Homes,Inc: $14.15 for Brat four,$4.03 for tacit additional
Contact name:Angela Grajewski Furnace,etc.
Address:109 East 13th Street Gas heat pump I
Watt/suspended/unit heater I ®®
City/State/ZIP Vancouver,WA 98660 Water heater
Phone:(360)695-7700 Fax::(360)693-4442 Fireplace
Range _ ®®
E-mail:Angeta.Grajewsklr{i7palygAahatnes.cam Barbecue-
r ,,,114t,fai-i' n. t OlV7 LACT(DTt Clothes dryer(gas}
}
Business name:Andersen Mechanical,Inc. Other
Address:
:16285 SW 856'Ave _Subtotal
A
City/S
tate/ZIP:Tigard,OR 97224 Minimum permit fee!($90.00) t
Plan review(25%of ' _'
ptrrttit fa).
Phone:(503)942-6664: Fax:(503)536-6615 State surcharge(12%ofp�e'rmit fee) _ 5
CCB lic.:168214 / TOTAL PERNITFEE
This permit application expires if is permit is not obtained within 180 7
Authorized signature:
days after
tel by Tri-Countyn
is complete
Fee methodol ldinf industry Service Board
Print name:AngelaGrajewski. Date:8/22/16
r.\suildinittP+rrmilAI EC PunutApp_44e11)dot 440.44t7T(3I i1.'CAM/WE13)
1
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
17034 SW JEAN LOUISE RD, SHERWOOD, OR,
97140
Record Type: Record ID:
Residential - Mechanical MEC2017-00449
Inspection Type: Inspector:
699 Mechanical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor