Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2020-00083
F!GAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/10/2020
Parcel: 2S101 BB00301
Jurisdiction: Tigard
Site address: 11834 SW PACIFIC HWY
Project: Jacksons Food Store Subdivision: TIGARD ROAD GARDENS Lot: 1
Project Description: Replacing(4)evaporators and(1)condensing unit for walk-in cooler. The cooler is not being replaced.
Contractor: POLAR REFRIGERATION INC Owner: PACWEST ENERGY LLC
8819 NE 117TH AVE 3450 COMMERCIAL CT
VANCOUVER,WA 98682 MERIDIAN, ID 83642
PHONE: 360-852-3939 PHONE: 208-888-6061
FAX:
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 02/06/2020 $328.04
Class of Work: ALT Type of Const: Plan Review 02/06/2020 $82.01
Occupancy Grp: B Occupancy Load: 12%State Surcharge-Mechanical 02/06/2020 $39.36
Stories: Info Process/Archiving-Sm$0.50(up to 02/06/2020 $2.00
11x17)
Project Valuation: $9,257.00 Misc Administration Fee 02/10/2020 $5.00
Fuel Air Handlers
Fuel Types: Electricity 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 $456.41
Hoods: Comm Incinerators:
Required Items and Reports(Conditions)
Woodstoves: Gas Fireplaces:
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc: evaporators
Duct Work: and
Fire/Smoke Dampers:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you,to follow the rules,,adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-00 9 u may 6 in a copy of the rules
or direct questions to OUNC (ling 503.232.1 87 or 1.800 .23
Issued By: Permittee Signatur
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR 01 I R I. I 'NE O1L1
City of Tigard Received
Permit No.: /�
13125IA SWHallBlvd.,Tigard,OR 9722CCEIVED Y �I ` �i ` tt
3. L..�! Plan Review
Phone: 503.718.2439 Fax: 503.598.19 0 DateBy: .. Other Permit: 7 7 ."s lie(' +.
Inspection Line: 503.639.4175 �� d(
T I G A K D FEB30 Date Ready/By: n funs H See Page 2 for
Internet: www.tigard-or.gov EQ �"� .otified/Method:(2 ( _ Supplemental Information
CITY OF TIGARD
TYPE OF W( LDING DIVISIO CO CIAL FEE= SCHEDULE—,USE CHECKIAST
Mechanical permit fees*are based on the value of the work
❑New construction [(Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,�overhead,and profit
//�,,
Value:$ C
CATEGORY OF CONS I itUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ 1-and 2-family dwelling CommerciaI/indusMal ❑Accessory building For special information use checklist
❑Multi-family ❑Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Job site address: � Air conditioning 46.75
f 18 3 t4 S E-'4" = 6 `f Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: G�r C.i f CI"'7 .-3' Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: J I Project name: 3a C ) o Heat pump 61.06
�J .h? Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
�/ (� /i Residential boiler(radiator or
t I 1 t' ( S t.3JG(t'd e r) - 1 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: I Lot no.:
Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION,OF WORK , Gas fireplace/insert 33.39
L Flue vent for water heater or gas
Re..,o )a Gk [T lei{i ,i✓Ca is ° fireplace 23.32
I CO ���[[{€ -t v (JO.4 �` Log lighter(gas) 23.32
Wood/pellet stove 33.39
{� ,( tor..Go ( 3 ( eau., Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
tPROPERTY OWNER I ❑ TENANT , Other: 23.32
;, Environmental exhaust and ventilation:
Name: i4">` ' Range hood/other kitchen
x equipment 33.39
Address: /'' . 1 .;_ € , . :'ter" -- "" Clothes dryer exhaust 33.39
�'r, r, i rar: -, °") 1 ° Single-duct exhaust(bathrooms,
City/State/ZIP: �.'J7 t E� �
.. toilet compartments,utility rooms) 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
APPLICANT 0:CONTACT PERSON Other. 23.32
Business name: (Pp l / Fuel piping:
� 1 t r-�.Ct'®n $1415 for first four,$4.03 for each additional
Contact name: ` r 1l� iz'0 Furnace,etc.
Address: gJ t l q Ai f ( '911. ,./e , 5 7 Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: �y'} (6 �.h tf-p f- if q866c. Water heater
Phone:(Q) C3 Q/ ) ? Fax::( ) Fireplace
E-mail: Q ' V} ems' i`(` . J Range
I c. C.n` rGf'7.I Barbecue
1 CONTRACTOR• Clothes dryer(gas)
Business name: 5 e_e_ L DP 1d Other:
MECHANICAL PERMIT FEES*
Address:
Subtotal
City/State/ZIP: Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee)
CCB lic.: / -7 00 f TOTAL PERMIT FEE
l This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signa s Fee methodology set by Tri-County Building Industry Service Board
Print name: ciy.l i fg,' Date: -.. iitt/
n
11BuildingTem its\MEC_PennitApp_o40113.doc,1 617r(11/0211C0M/WEB)