Permit (121) CITY OF TIGARD MECHANICAL PERMIT
N-. COMMUNITY DEVELOPMENT Permit#: MEC2018-00640
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/15/2018
T I t r\r fi g Parcel: 2S106DA01100
Jurisdiction: Tigard
Site address: 13273 SW 169TH AVE
Project: River Terrace East,Lot 11 Subdivision: RIVER TERRACE EAST Lot: 11
Project Description: Adding NC unit. Placement of A/C unit must comply with manufactures requirements.
Contractor: PRO HEATING AND COOLING INC. Owner: ADLV LAND HOLDINGS LLC
2095 NW ALOCLEK DR, SUITE 1103 BY FORSUM, MICHAEL
HILLSBORO, OR 97124 7600 E DOUBLETREE RANCH RD STE 1
SCOTTSDALE,AZ 85258
PHONE: 503-443-5692 PHONE: 602-694-4031
FAX:
FEES
Specifics: Description Date Amount
Air Conditioning 08/15/2018 $46.75
Type of Use: SF 12%State Surcharge-Mechanical 08/15/2018 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 08/15/2018 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may •4 ain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ‘,/". /��/�i/.��� e�rmittee Signature:, _
Call 503.639.4175 by 7:00 a.m.for the next available in ection Fate.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application c, FOR OFFICE USE ONLI
Received
II Cityof Tigard / Permit...
DateB g/
13125 SW Hall Blvd.,Tigard,OR 97223 AUG G 1 5 2013 y • / f�� fl �/
_ Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 DateBy: Other Permit:
T I G A R D Inspection Line. 503.639.4175 r,�(ate Ready/By: Juris ® See Page 2 for
Internet: www.tigard-or.gov0.'' `Notified/Method: Supplemental Information
TPW1Z " It #I"IG * SCIEULL = " IlECRiISTYOF, GK
Mechanical permit fees*are based on the value of the work
®New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition D Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
T, ..:": AT>aGC I., b ` CONSTRI.ICTION
��,� �E�Illi19�'IAL EQUIPMENT 1S'1fS7"E14T5 FEES*
® 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
0 Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
Heating/cooling:
+11Q� SITE �. ... TIQ�Q�1 �tA'��I '
Air conditioning46.75 A-16,45
Job site address: l'3 273 s o '1,11-14 Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: ISEpc%'Ell -rb 1j t o1ti el-*ooh Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name:East River Terrace Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
I 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 Lot no.:
I 1 Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
D QF,WORK : ' Gas fireplace/insert 33.39
Flue vent for water heater or gas
AbLi „A-}—y A& U 1,1 i-r fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
,s
PROPERTY UWNE12 r . .. . 0 TENANT
Environmental exhaust and ventilation:
Name:ADVL Land Holdings LLC Range hood/other kitchen
equipment 33.39
Address:7600 E Doubletree Rd Clothes dryer exhaust 33.39
City/State/ZIP:Scottsdale,AZ 85258 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(602)6944031 Fax:( ) Attic/crawlspace fans 23.32
►i:0;hPPLICAI'iIT "' ' ,...." : t)
CONTACT PERSON] 1�
Other: 23.32
Fuel piping:
Business name:Polygon WLH LLC
$14.15 for first four;$4.03 for each additional
Contact name:Tom Dicianno Furnace,etc.
Address:109 E 13th St Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Vancouver,WA 98660 Water heater
Phone:(503)577-4160 Fax: :( ) Fireplace
Range
E-mail:tom.dicianno@polygonhomes.com Barbecue
r ; ,. 0l`11TI T, , : Clothes dryer(gas)
Other
Business name: tTabIrktirri1‘.SG
1, 1, MEC11C 1,NICAL PERMIT FEES*
Address: sac!5. iu. PsLoc.t Ie_ N,,LI Subtotal
City/State/ZIP: 1,E t LLS tbDpl-p , D a. g 7 2-13/4 s u- FE, 11014. Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(co3) 2:.O —q 2144 Fax:( ) State surcharge(12%of permit fee)
CCB lic.: 2 0 9 00 I SD 3 27'b • b �f/ (,)6� / 7/ /Aid). TOTAL PERMIT FEE /�,d
�`t/ V C This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature.' tY t s-/f9 * Fee methodology set by Tri-County Building Industry Service Board
Print name: G ezA s rt„.."S Date: 41 /18
1\Building\Permits\MEC_PermitApp_040113.doc 440-46I7T(11/02/COM/WEB)
a •
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi-Family Fee Schedule:
Total:Valuation: ,
Permit F "
$0.00 to$500.00 Minimum fee$69.06
$500.01 to$5,000.00 $69.06 for the first$500.00 and
$3.07 for each additional$100.00 or
fraction thereof,to and including
$5,000.00.
$5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and
$2.81 for each additional$100.00 or
fraction thereof,to and including
$10,000.00.
$10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and
$2.54 for each additional$100.00 or
fraction thereof,to and including
$50,000.00.
$50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and
$2.49 for each additional$100.00 or
fraction thereof,to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first$100,000.00 and
$2.92 for each additional$100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
I:\Building\Permits\MEC_PennitApp_040113.doc 2