Permit (243) a CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT
Permit#. MEC2018-00033
R AR.LD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/16/2018
Parcel: 2S1060001500
Site address: 13470 SW BEACH PLUM TER Jurisdiction: Tigard
Project: River Terrace Northwest,Lot 202 Subdivision: RIVER TERRACE NORTHWEST Lot: Multiple
Project Description: Installing A/C unit. Placement of A/C unit must meet manufacturer's requirements.
Contractor: ANDERSEN MECHANICAL Owner:
ADLV LAND HOLDINGS LLC
16285 SW 85TH AVE#410 BY FORSUM, MICHAEL
TIGARD, OR 97224 7600 E DOUBLETREE RANCH RD STE 1
SCOTTSDALE,AZ 85258
PHONE: 503-992-6664 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Air Conditioning 01/16/2018 $46.75
Type of Use: SF 12%State Surcharge-Mechanical 01/16/2018 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 01/16/2018 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: /•
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4,41/ ����`��� Permittee Signature: ce 1G[���
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Applica ' t,x.u ,,
:..r
FOR OFFICE USEONLY
CityofTigard ajo-s„ t Received
lAi - n Date/By: II'I��I11 j Permit Na: _ r r
13125 SW Hall Blvd.,Tigard,OR 97223 �i i
Phone: 503.718.2439 Fax: 503.598.1960N'A 1 2 Z 01
�F I. 8 t3therPermit:
TfGARD Inspection Line: 503.639.4175 i y� /ir/
Internet: www.tigard-or.gov CITYC E Date Ready/By. Saris: H ee Page 2 for
L,a1` *! =1fi,. Notified/Method. Supplemental Information
RtJILDI ( f tV S T '
TYPE OF WORK COMMERCIAL FEE* SCHEDULE- USE CHECKLIST
®New constructionMechanical permit fees*are based on the value of the work
0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other; mechanical materials,equipment,labor,overhead,and profit.
CATEGORY OF CONSTRUCTION Value:$
RESIDENTIAL EQUIPMENT/Si STEMS FEES*
❑ 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory buildingspecial information
ist.
:/ Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Job site address: 3 Air conditioning 1 46.75
i qv) # Furnace 100,000 BTU(ductsfvents) 146.75
City/State/ZIP:Tigard,OR 97224
Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg,/apt.no.: pro e r Heat pump 61.06
(I, j ct name:River Terrace Northwest
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:River Terrace Northwest Lot no.: Other: 23.32
° Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF.WORK Gas frreplacetinsert 33.39
Flue vent for water heater or gas
Adding A/c fireplace 23.32
A
'''-'11-1
- Log lighter(gas) 73.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
L PROPERTY OWNER - 0 TENANT Other: 23.32
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:( ) Attic/crawlspace fans 23.32
® APPLICANT 0 CONTACT PERSON Other:
23.32
Business name:William Lyon Homes,Inc. Fuel piping:
814.15 for first four;84.03 for each additional
Contact name:Nichole Thorpe) 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
E-mail:Nichole.Thor pe Gapo!Yg onhomes.com Range
Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:Andersen Mechanical Other:
Address:16285 SW 85t' ave Suite 410 MECI MECHANICAL PERMIT FEES*
Subtotal
City/State/ZIP:Tigard Or 97224 Minimum permit fee($90.00)
Phone:(503)992-6664 Fax:( )
Plan review(25%of permit fee)
State surcharge(12%of permit fee)
CCB lie.:217392 TOTAL PERMIT FEE /00,
This permit application expires if a permit is not obtained within 180
/
e /
days after it has been accepted as complete.
Authorized signature: i * Fee methodology set by'Tri-County Building Industry Service Board
Print name:Nlchole Thorpe Date:1/12/2018
1;1Building\Permits\M C_PermitApp_040113.doe 440-4617' (11/02/COM/WEn)