Permit (60) 74CITYOF TIGARD MECHANICAL PERMIT
I COMMUNITY DEVELOPMENT Permit#: MEC2019-00491
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/10/2019
Parcel: 2S 106DA 11600
Jurisdiction: Tigard
Site address: 16650 SW SNOWDALE ST
Project: River Terrace East,Lot 117 Subdivision: RIVER TERRACE EAST Lot: 117
Project Description: AddingAC.
p
Contractor: APEX AIR LLC Owner: ADLV LAND HOLDINGS LLC
2210 W MAIN ST STE 107-272 BY FORSUM, MICHAEL
BATTLEGROUND,WA 98604 7600 E DOUBLETREE RANCH RD STE 1
SCOTTSDALE,AZ 85258
PHONE: 360-342-8109 PHONE: 602-694-4031
FAX:
FEES
Specifics: Description Date Amount
Air Conditioning 07/10/2019 $46.75
Type of Use: SF 12%State Surcharge-Mechanical 07/10/2019 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 07/10/2019 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: _>4).A...A...,
Permittee Signature: Ste, -;;uCtrIc"
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Erie VFP
Mechanical Permit Application Fort OFFICE: usi ONLY
Cityof Tigard JUL. Receivedt � "i—\l
g Date/By: �i�'(1�� S j� Permit No.:M-- r,
Iii ° 13125 SW Hall Blvd.,Tigard,OR 97223 .
t Plan Review
■ Phone: 503.718.2439 Fax: 503.598. 1 i '1 r x e Other Permit.
f 6 Date/By: ����_(����
T I G A R D Inspection Line: 503.639.4175 L(1l .' N G D R I S 1 3 Date Ready/By: Juris: I ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE USE CHECKLIST
Mechanical permit fees*are based on the value of the work
®New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
CATEGORY OF CONSTRUCTION Value:$
RESIDENTIAL EQUIPMENT I SYSTEMS FEES*
25.I-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
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 1 46.75
Job site address: \k_g(. 0 'Svtol.,06,o`1., %.,. Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard,OR 97224 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name:Rwej(2 17 (y St.. Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
Residential boiler(radiator or
hydropic) 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: ktJ ��Q( C,.F" ji e Lot no.: W1
Other. 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
n _`aOb
Flue vent for water heater or gas
m . 1'I c. ()(1�jT 1' 11th Q) fireplace 23.32
Log lighter(gas) 23.32
�i��cJrrVro� �- �u Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
® PROPERTY OWNER 0 TENANT Other: 23.32
Environmental exhaust and ventilation:
Name:Polygon WLH,LLC Range hood/other kitchen
equipment 33.39
Address:703 Broadway St.,Ste.510 Clothes dryer exhaust 33.39
•
City/State/ZIP:Vancouver,WA 98660 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(360)695-7700 Fax:( ) Attic/crawispace fans 23.32
® APPLICANT 0 CONTACT PERSON Other: 23.32
Fuel piping:
Business name:Polygon WLH,LLC
$14.15 for first four;$4.03 for each additional
Contact name:Tonja Morris Furnace,etc.
Address:703 Broadway St.,Ste 510 Gas heat pump
Wall/suspended/unit heater
T-City/State/ZIP:Voneauver,WA-98660
Watt;reams _
Phone:(360)695-7700 Fax::(360)693-4442 Fireplace
Range
E-mail:permitsubmittals@polygonhomes.com Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:Apex Air LLC Other:
MECHANICAL PERMIT FEES*
Address:18004 NE 72"d Ave Subtotal
City/State/ZIP:Vancouver,WA 98686 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(360)342-8109 Fax:(360)326-1769 State surcharge(12%of permit fee)
CCB lie.:203034 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: * Fee methodology set by Tri-County Building Industry Service Board
Print name:Tim Hay Date:04/08/2019
I:Building tPermits'MEC_PermitApp 040II3.doc 440-4617T(II/02COM.,WEB)