Permit II CITY OF TIGARD MECHANICAL PERMIT
• . . COMMUNITY DEVELOPMENT MECHANICAL
MEC2020-00643
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/8/2020
Tt�' tRI Parcel: 1S136DB00201
Jurisdiction: Tigard
Site address: 11565 SW PACIFIC HWY
Project: Fred Meyer Subdivision: None Lot: None
Project Description: Condenser unit replacement.
Contractor: POLAR REFRIGERATION INC Owner: FRED MEYER STORES INC
8819 NE 117TH AVE STORE#375
VANCOUVER, WA 98682 1014 VINE ST
PROPERTY TAX 7TH FLOOR
CINCINNATI, OH 45202
PHONE: 360-852-3939 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 10/05/2020 $69.06
Class of Work: ALT Type of Const: Plan Review 10/05/2020 $17.27
Occupancy Grp: Occupancy Load: 12%State Surcharge-Mechanical 10/05/2020 $8.29
Stories:
Project Valuation: $500.00
Fuel Air Handlers
Fuel Types: Units< 10000 cfm:
Gas Pressure: Units>10000 cfm:
Furnaces Boilers&Compressors
Furnaces<100K BTU: 0-3 HP:
Furnaces>= 100K BTU: 3-15 HP:
Floor Furnaces: 15-30 HP:
Unit Heaters: 30-50 HP:
Vents w/o Appliances: 50 or Greater HP:
Air Conditioning:
Heat Pump: 1
Appliances
Vent Fans: Vent Systems: Total $94.62
Hoods: Comm Incinerators:
Required Items and Reports(Conditions)
Woodstoves: Gas Fireplaces:
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work:
Fire/Smoke Dampers:
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: �� � Permittee Signature: r G
tag
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 Apr)heat/RECEIVED , ,,,,,,,„ , „ , , s.,, ,,.., s,
City of Tigard Raxived -.. •I 4
Dateilly: vop49/81.-) . - Permii ts- / r613
I 13125 SW Hall Blvd.,Tigani,OR 97223 JUL 2 7 2020 Plan Rem
' 6. Phone: 503.718.2439 Fla: 503.598.1960
Date/13y. (f. 'le„1444,44/%04:41. Other Permit
Inspection line: 503.639.4175 CITY OF TIGARD Date Rea:Iv/Br brit 65 See Page 2 for
Internet: www tigard-orgov B1.111 n,INC-'. DIVISION Notifiecvmethoorf Rd -. supptenteme Information
- ' - TYPE'OF WORK ' ' - COMM e1A7Sel1EDIILE - USX CRECkLIST
' Mechanical penult fees*are based on the value of the work
LI N ew construction Addition/alteration/replacement perfonned.Indicate the value(rounded to the nearest dollmf)loaft) 42
0 Demolition 0 Other: mechanical materials,equipment,labor,overh• « :, d « o .,A
Value.S ....,...,.:10=, 0-- V7
CATEGORY OF CONSTRUCTION , • 4 44 r.44' 444k' '' 44''''4'' Av
..„"is ' ' -' - `• ' - '' ' --'t"' .' I''''': vat't.',. ItISWEIS110,1«.EQULTIM-- 1:'.'-' • , ' • ' • •*.e'll' r«
• D 1-and 2-family dwelling 1„M Commercial/industrial 0 Accessory building For special information use checklist.
44114'
D Multi-family 0 Master builder 0 Other: Description Qty. I Ea. Total
AND, PC"
Heattigi/eooling: ihilio,
,A,AcII
Air conditioning 46 75
dar?
lob site address: i I 56'5- s() RL. -e.-, tc, --- Furnace 100,000 BTU(duets/vents) 46.75
City/Stater/IP: 7,7 ef a,,,,,t oi._ q -7 --J3' Furnace 100,000+aru(duets/mem) 54.91
Heat munp 61.66 Suite/bldg./apt.no.: k,.../ Project name: ,.0%2-&----e:s i5,4 ,,-7.e....4../
Duct work 2332
Cross street/directions to job site: hi lef q 4 f S 4-) -7/-5 Hydrottic hot water system 2332
Residential boiler(radiator or
Ivydronic) 23.32
Unit heaters(bad-type,not idectnc),
ct frt/ini Kt( : Fie) re4A-e.4.,), Unity Cly-
in-wall,in-duct,suspended,etc. 46.75
34ri 1;2,10*rt c44.1-shae-iy Flue/vent for arty of above 23.32
Other: 2332
Subdivision: 1?fr V Lot no.:
Other fuel antiliances: —
Tax mapiparcel no.:
Water he,ater 23.32
- 1RIPTION
...Li « -,,,-- OF WORK Gas fireplace/insert 33.39
: ,iii r..o„,,entis.«..,n--.)«. ' - ' Flue vent for wader h, r or gas
04-00" d 401- e b.,(-16,s?,-- fireplace 23.32
±-
Log lighter(gas) 23.32 ..
woodipellet stove 33.39
Wood fireplace/insert 23.32
Chboiney/tiner/flueivent 23.32
,, Other 23.32
ft'A;i1:4,,, ikkktROPKRTY OWNER , n' El 'FENANT --
Environmental exhaust and ventilation:
Name: Fr„i Tyi i,i, i....,--- Range hood/other kitchen
equiPment 3339
Address: 38o0 .. .a.„ ,:yk. 14 ve_. _ Ciothes dryer exhaust 33.39
City/State/MP: ar-f i 0.,-, d of- q—?,9 c )— Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phomt:( ) Fax:( )
Attiolannvispaee fans 23.32
----
t'''FP“CANT 0,CONTACt PERSON 77.: Other: 23 32
-
Fuel piping:
Business name: '...F0 /64.....,.-- 1-,c_'_-(4,-7, ye.ei-4,4, crA
S14 IS for first foul S4.03 for each addidonal
Contact name: jL•ky) -11,.‘/E„,2. r-R t.'?() Furnace,etc.
I Address: e 6 / cir I 1 - .6,-.. 4,,,,e_ 5 7-&--- 4.. Gas bea___t_m_s)
Wel I/suspended/quit heater
City/State/ZIP: 1/1;111 LALAq. de 6',. ._ Wm:Theater
I-- ((.1 ()Lot,-
Phone:(ell I) .41:.,A ef5/ 0 Fax::( ) - Fireplace
E-mail: 0.0 , la.(-
co1i4crolt. . - .. . .../ , , -....,yrtlt Clothes dryer
.....
1 Sut.iness name: Po ite.."1" A 'er .0,1g(-4- kit.1, Other:
- 1
i--
ae4:„ MECHANICAL PERM/T tItli.8*
Address: SCt rUJZ,...._
Subtotal
1
_
i Ci:y/State/ZIP:
Minimum permit fee(S90.00)
Plan review(23%of parnit fee). --:
Phone:( ) I Fax:( )
7' •
State surcharge(12%of permit fee)
-1 CCE 0 lie.: 1 ...-7 (,) /
I _ TOTAL PERMIT FEE
This Permit application expires it a peradt is not oblakted within t Po
7....-. )... _.,
days eller it has beer,accepted rat complete-
Authorized signature:
* Fee usettiodoicia set by Tri-Cowity Building Industry Service Board
I 2r;rri.name- :-.E C._ Datej.)
e•aildb0Pc-raitstMEC_PerrtutApp 04011343c . 440-46171(I I WA"i 0,11/WT4 tr.
City of Tigard
and
• COMMUNITY DEVELOPMENT DEPARTMENT
C
Building Permit Review — Commercial - No Land Use
TIGARD
Building Permit #: MEC2020-00643
Site Address: 11565 SW Pacific Hwy Suite/Bldg#:
Project Name: Fred Meyer
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: Ground level condenser replacement
Existing Business Activity: Sales-oriented retail
Proposed Business Activity: Sales-oriented retail
❑ Verify site address/suite #exists and active in permit stem.
O River Terrace Neighborhood: ❑ Yes L"I No
❑° Zoning: C-G
❑° Permitted Use: L_l Yes U No U Spec Space
❑r Confirm no land use required.
❑r Business License: N/A
Exists: ❑ Yes ❑ No, applicant was provided a business license application
Notes:
Approved by Planning: Date: 9/30/20
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: 9Pv/av -- kr inArg : Feld revile )644/9.
Site Plans: # {yu,n 69
Building Plans:
Building Permit#: ❑ Enter buildin permit# above. 64. Sh t.iS. gbd foo
Workflow Routing: ❑ Planning Permit Coordinator ❑ Building �>
Workflow Sign-off: ❑ Sign-off for Planning(include notes from planning review)
Route Application Documents: ❑ Building: original permit application, site plans,building plans,engineer and
Q / beam calculations and trust details,if applicable,etc.
Notes: /%l s f riev1 &i/O?J-dcjl ,fi r
By Permit Technician:
Date: 17s�0 ' ' •
1:\Building3Fomu\Bl dgPerm itRvw_COM_N oLand U se_111819.docx
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
❑ Approved, NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent . Applicant:
Revision Notice 2: Date S= t to Applicant:
Revision Notice 3: Da ent to Applicant:
❑ SDC Fees Entered: 'ash Co Trans Dev Tax: ❑ Yes ❑ N/A
Tigard Trans SDC: ❑ Yes 0 N/A
Parks SDC: ❑ Yes ❑ N/A
❑ OK to Issue t -rmit
Approved : Permit Coordinator: Date:
I:1Bui I ding\Forms\B IdgPermitRvwCOM_NoLan dUse_111819.docx
Branden Taggart
From: #Building Permit Technicians
Sent: Wednesday, September 30, 2020 4:47 PM
To: 'Anthony Rico'
Subject: RE: Order Receipt 6755704: MEC2020-00643 - 11565 SW Pacific Hwy
Attachments: Invoice.pdf
Importance: High
Hi Anthony,
Per our phone conversation, I have created the Fred Meyer Mechanical Permit for the condenser unit
replacement. Regarding permit fees, we used the minimum valuation of$500.00 to assess fees. The balance due is$-
94.62, and I have attached an invoice above for you to reference. The permit fees can be paid online through our
1 website: https://aca.accela.com/tigard/Default.aspx. From there, click on the Building tab, enter the permit number
(MEC2020-00643) in the Record Number field, and click Search. Once paid, please notify us at
TigardBuildingPermits@tigard-or.gov, and I will email the permit paperwork to you. Please let me know if you have
questions.
Thank you,
Branden Taggart
a City of Tigard
ppg
I r.�, Senior Permit Technician
Community Development
TIGARD
13125 SW Hall Blvd
Tigard, OR 97223
(5031718-2449
brandent@tigard-or.gov
From: Anthony Rico<anthony@polar-refrigeration.net>
Sent:Tuesday, September 1, 2020 1:58 PM
To: #Building Permit Technicians<TigardBuildingPermits@tigard-or.gov>
Subject: FW: Order Receipt 6755704
Caution!This message was sent from outside your organization.
Can we get this permit issued?Thank you!
Anthony J. Rico
1 Project Administrator I Polar Refrigeration I Construction
M: 971.218.4510
E: Anthonv(c polar-refrigeration.net
A:8819 NE 117th Ave.Vancouver WA.98662
www.polar-refrioeration.net
1
From: PayGov <no-reply@paygov.us>
Date: Tuesday, September 1, 2020 at 1:56 PM
To: Anthony Rico <anthony@polar-refrigeration.net>
Subject: Order Receipt 6755704
17.11
This email is a confirmation of your Online Payment for PERMIT CENTER
Cardholder Name: Kasey Smith
Telephone : : (971) 218-4510
Credit Card Type :Visa
Last 4 digits :4XXX XXXX XXXX 5476
Confirmation Number: 6755704
Card Auth Code : 045616
Transaction ID : 1768264481
Agency Payment Amount : $1,096.07
Convenience Fee : $32.88
Total Amount Charged : $1,128.95
First Name:Anthony
Last Name:Rico
Your payment to PERMIT CENTER has been processed by PayGov, LLC.
NOTICE.Two charges will appear on your credit card or bank statement.
One is for the Tax, Fine, or Fee owed to the government agency and will reflect the name of the agency.
The other is for the convenience fee assessed by PayGOV.US and will reflect "Convenience Fee" on your statement.
For questions or concerns contact PayGOV.US at 1-866-480-8552.Transaction disputes will result in a $40 charge to the
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