Permit (42) CITY OF TIGARD MECHANICAL PERMIT
1111 I COMMUNITY DEVELOPMENT Permit#: MEC2018-00266
and OR 97223 503.718.2439
13125 SW Hall Blvd.,Ti Date Issued: 05/08/2018
T (r;Altf) 9
Parcel: 1 S 136DB00201
Jurisdiction: Tigard
Site address: 11565 SW PACIFIC HWY
Project: FRED MEYER Subdivision: None Lot: None
Project Description: New condensing unit for dairy island,new overhead case piping,and new equipment piping for floral area.
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 05/08/2018 $2,900.71
Class of Work: ALT Type of Const: VB Plan Review 05/08/2018 $725.18
Occupancy Grp: M Occupancy Load: 12%State Surcharge-Mechanical 05/08/2018 $348.09
Stories: Info Process/Archiving-Lg$2.00(over 05/08/2018 $10.00
11x17)
Project Valuation: $110,000.00 Info Process/Archiving-Sm$0.50(up to 05/08/2018 $62.50
11x17)
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:
Appliances
Vent Fans: Vent Systems: Total $4,046.48
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces: Required Items and Reports(Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc: new Dairy
Duct Work: case and
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 t• r.11ow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-4+•S. ou a ay obtain a copy of the rules
or direct questions to OUNC by calling 50 .232.1987 or 1.800.332.2344.
Issued By: `/
Permittee Signature: _L1 `_
Call 503.639.4175 by 7:00 a.m.for the next available in ction 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
FOR OFFICE USE ONLY
City of Tigard 4 '1 ,r i ? ' �� Received
'' Date/By: `�J �+�
11 t 13125 S W Hall Blvd.,Tigard,OR 97223L V/� Permit No.:M
' Phone: 503.718.2439 Fax: 503.598.1960 } Plan Review �'�
Inspection Line: 503.639.4175Iv
Zt11 DateBy: � �'j Other Permit �?/�
TIC>A-RD p !? t7°zt��
Internet: www.tigard-or.gov # Date Ready/By: r°ds: I 0 See Page 2 for
✓, 6 i :G9 Notified/Method:
cy ! t ' �5?s. Supplemental Information
3 /Io;„,,, //�� ��J 1.
TYPE OF WORK COMpRCIAL FEE* SCHEDULE USE CHECKLIST,
Mechanical permit fees*are based on the value of the work
0 New construction ®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:$$110,000.00
❑ 1-and 2-family dwelling ®Commercial/industrialRESIDENTIAL EQUIPMENT/SYSTEMSFEES*
0 Accessory building Fors special jormatioause yhecklist.
0 Multi-family 0 Master builder
0 Other: Description I Qty. 1 Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Job site address: 11565 SW PACIFIC HWY Air conditioning 46.75
Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:TIGARD OREGON 97223
Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: I Project name:fred meyer 375 go-fast Heat pump 61.06
Cross street/directions to job site:hwy 99 w and sw 71st ave ti andDuct work 23.32
g OregonHydronic hot water system 23 32
heading north est on sw pacific hwy towards 217 and I-5 fred myers is on the Residential boiler(radiator or
hydropic) 23.32
left before sw 71"street Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Subdivision: Other: 23.32
I Lot no.:
Tax map/parcel no.: Other fuel appliances:
Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
push/pull of refrigerated cases,piping and overhead for new cases Flue vent for water heater or gas
fireplace 23.32
intall new condensing unit for new dairy island cases Log lighter(gas)
23.32
piping of equipment in floral walk-in Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
® PROPERTY OWNER Other:
❑ TENANT" 23.32
Name:kroger Environmental exhaust and ventilation:
Range hood/other kitchen
Address: 1014 vine st equipment 33.39
City/State/ZIP:Cincinnati,ohio 45202 Clothes dryer exhaust 33.39
Single-duct exhaust(bathrooms,
Phone:(513)762 4012 toilet compartments,utility rooms) 23.32
Fax:(513)762-4012 Attic/crawlspace fans
//' APPLICANT23.32
0 CONTACT PERSON Other: 23.32
Business name:POLAR REFRIGERATION Fuel piping:
Contact name:COREY RICO/DALE SEVERNS JR $1415 for first four;$4.03 for each additional
Furnace,etc.
Address:8819 NE 117T"CT#B Gas heat pump
City/State/ZIP:VANCOUVER,WA 98662 Wall/suspended/unit heater
Water heater
Phone:(360)830-7599 I Fax::( ) Fireplace
E-mail:DALE(ii)POLAR-REFRIGERATION.NET Range
Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:POLAR REFRIGERATION Other:
Address:8819 NE 117T" MECRANI AL PERMIT FEES* '
City/State/ZIP:VANCOUVER,WA 98662 Subtotal
Minimum permit fee($90.00)
44
Phone:(360)891-6783 Fax:(360)882-2711 Plan review(25%of permit fee)
CCB lic.:170015 / State surcharge(12%of permit fee)
`( TOTAL PERMIT FEE
- This permit application expires if a permit is not obtained within 180
Authorized SlgnatltP%�7 -- `` days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry Service Board
Print name:DALE , EN SEV RNS JR I Date:4/17/2018
1\Building\Permits\MEC_PermitApp_0401 13.doc
440-4617T(I 1/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page'
�e,2 - Supplemental Information
Commercial & Multi-Family Fee Schedule:
Total Valuation: Permit Fee:
$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.
l:\Building\Permits\MEC_PermitApp_040113.doc 2
4
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11565 SW PACIFIC HWY, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Mechanical MEC2018-00266
Inspection Type: Inspector:
699 Mechanical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor