Permit (10) 1114CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2017-00103
TrGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/08/2017
Parcel: 2S110AC01101
Jurisdiction: Tigard
Site address: 11290 SW BULL MOUNTAIN RD
Project: Jacksons Food Stores Subdivision: None Lot: None
Project Description: 9,000 BTU Ductless mini split system installation.
Contractor: POLAR REFRIGERATION INC Owner: PACWEST ENERGY LLC
8819 NE 117TH AVE BY PAC WEST
VANCOUVER, WA 98682 3450 COMMERCIAL CT
MERIDIAN, ID 83642
PHONE: 360-852-3939 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 02/08/2017 $142.74
Class of Work: ALT Type of Const: Plan Review 02/08/2017 $35.69
Occupancy Grp: Occupancy Load: 12%State Surcharge-Mechanical 02/08/2017 $17.13
Stories: Info Process/Archiving-Sm$0.50(up to 02/08/2017 $1.00
11x17)
Project Valuation: $2,846.00
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 $196.56
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces: Required Items and Reports(Conditions)
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 req .es you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 9 •-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: 6
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 Application j Fotz(HAI( t SF ONLY
City of Tigard "� Received
;. a 13125 SW Hall Blvd.,Tigard,OR 9 3 ,t ice"'IN
Date/By: l) Permit No.: L
i `
® Phone: 503.718.2439 Fax: 503.59 Plan Review
Date/By: Other Permit:
TI G AR D Inspection Line: 503.639.4175 r P
Internet: www.tigard-or.gov %t� Date Ready/By: loris See Page 2 for
D * Notified/Method: �i"Te, Supplemental Information;
41 { a1` ` 4 .,I I ' ,-:rxnan �urnt pi « wtrsr,r tiln rieitt
1_
❑New construction -, cx Mechanical permit fees*are based on the value of the work
®Addition/alter ement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
'' .. Value:$$2,846.00 AT dQR OdON Th/ ll114 '
*" ll 11th? NlIAt0Dati N' Y*E $IEES
❑ 1-and 2-family dwelling ®Commercial/industrial
❑Accessory building For special information use cheekiest.
❑Multi family 0 Master builder
0 Other: Description
Qty. Ea. Total
I(lR SITE IN1ORUAT1t7N llAl).l;fl4`-dFit1N Heating/cooling:
Job site address:11290 SW Bull Mountain Road
Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard,OR. 97224 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name:JFS 530 Heat pump 61.06
TLi lry3 .4,Arts Duct work 23.32
Cross street/directions to job site:southwest corner of the intersection of Hydronic hot water system 23.32
SW Pacific Hwy and SW Bull Mountain Road Residential boiler(radiator or
hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,Ill-UUL.L,JUSFGIIUGU,GR.. `ill.I,)
Flue/vent for any of above 23.32
Subdivision: Lot no.: Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater
11:011 Q1, o o - Gas fireplace/insert
23.32
33.39
Installation of Daikin ductless 9000 btu cooling/heating system Flue vent for water heater or gas
fireplace 23.32
1 ...t..ht....I,....., -12 Z')
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
tea 13I�T 6' II Al Environmental exhaust and ventilation:
Name:Jackson's food stores Inc Range hood/other kitchen
Address:3450 E.Commercial Court equipment 33.39
Clothes dryer exhaust 33.39
t.11y/JLa1G/L.11 1YlnL
el]Ula ,U . OJu'sL -
toilet compartments,utility rooms) 23.32
Phone:(208)888-6061 Fax (888)369-0657 Attic/crawlspace fans 23.32
4.0:41AN ❑;C N;)`O1E oN� Other:
v
23.32
Business name:Polar Refrigeration Inc Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name:Don Bernard Furnace,etc.
Address:8819 NE I I'7'Ave Bldg B Gas heat pump
iA/anlci.enPndPAh.nit haatPr
City/State/ZIP: Vancouver,WA. 98662
Water heater
Phone:(503)545-7903 Fax::(360)882-2711 Fireplace
E-mail:don@polar-refrigeration.net Range
Barbecue
t7.0N1044r rd$1 Clothes dryer(gas)
Business name:Polar Refrigeration Inc Other:
Address:PO Box 821127 $.0V0.CAL EE
Subtotal i
City/State/Z1P:Vancouver,WA. 98682 Minimum permit tee($90.00)
Phone:(360)891-6783 Fax:(360)882-2711 Plan review(25%of permit fee)
State surcharge(12%of permit fee)
CCB lic.:170015 TOTAL PERMIT FEE Pi 4f..
54)
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: 11)4....A.."N,••••4\1‘..),,,Q____ * Fee methodology set by Tri-County Building Industry Service Board
Print name:Don Bernard Date:2/8/2017
l:UiultumgU'ermusuMt c,_rermnApp—U iU l l s.aac 44U-461/1 11 1102/1,UMJ W tSS)
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11290 SW BULL MOUNTAIN RD, TIGARD, OR,
97224
Record Type: Record ID:
Commercial - Mechanical MEC2017-00103
Inspection Type: Inspector:
699 Mechanical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor