Permit CIT O TI GARD MECHANICAL PERMIT
• DEVELOPMENT SERVICES PERMIT #: MEC2003 -00020
c � J II 13125 SW Hall Blvd., T igard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/22/03
PARCEL: 1 S135DD -00600
SITE ADDRESS: 11831 SW PACIFIC HWY
SUBDIVISION: HOFFARBER TRACTS NO.2 ZONING: C -G
BLOCK: LOT: 040 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm:
> GAS OUTLETS:
10000 cfm:
Remarks: Installation of new gas piping and vent system for new crematory.
Owner: FEES
YOUNG'S FUNERAL HOME INC Description Date Amount
11831 SW PACIFIC HWY
TIGARD, OR 97223 [MECH] Permit Fee 1/22/03 $72.50
[TAX] 8% StateTax 1/22/03 $5.80
Phone: Total $78.30
Contractor:
ARROW MECHANICAL
10330 SW TUALATIN RD
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone: 692 - 1565 Gas Line Insp
Mechanical lnsp
Reg #: LIC 5193 Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes •
and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -00
i
Issued By:
I � %` / /�� Permittee Signature: 4
all (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
.. o
`Mechanical Permit Application
Date received: //2,/D3 Permit no.:i f(C 20 0 3 - 000x0
� �' arli ECEIVED
�; ,,� �� Ci of �lg Project/appl. no.: Expire date: •
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: ByReceiptno.: .
Phone: (503) 639 -4171 JAN 21 2003
Fax: (503) 598 - 1960 /6 ,,, Case file no.: I Paymenttype:
Land use approval: CITY OF TIGARD Building permitno.:
• T O P P ERMIT __ ..
O 1 & 2 family dwelling or accessory . O Commercial/industrial O Multi- family ❑ Tenant improvement
❑ New construction C Addition/alteration/replacement ❑ Other:
JOB SITE INFORMATION " COMMERCIAL VALUATION SCHEDULE
Job address: kx R31 SW p al.. ; Ci,_ 1.kohi !,4?'. Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map/tax lot/account no.: profit. Value $ Z5 .
Lot: I Block: I Subdivision: 'See checklist for important application information and
Project name: ypOn �g a n t f 4I jurisdiction's fee schedule for residential permit fee.
City /county: -t-; j, , Jas k . I ZIP: f 113 - 1 & 2 FAMILY DWELLING PERMIT FIE SCHEDULE
Description and location of work on premises: gas Pipe. AND COMMERICALIINDUSTRIAL EQUIPMENTSCIIEDULE
b Cr•QM0,-6r1 . V 2h Fee(ea.) Total
Est. date of completion/inspection: I (,. e--L Description Qty. Res. only Res. only
Tenant improvement or change of use: -1;x, HVAC:
Is existing space heated or conditioned? al -Yes ❑ No Air handling unit CFM
g p Air conditioning (site plan required)
Is existing space insulated? -Yes ❑ No Alteration of existing HVAC system
MECHANICAL m CONTRACTOR 1 . its
Boiler /compressors
Business name: AY YAtiI G� h i g t a1 C -0 State boiler permit no.:
1 (l1 HP Tons BTU/H
Address: VI 336 SO TIA. k r (ll - Fire /smokedampers/duct smoke detectors
City: T A 1a� n ( I State: 4g I ZIP: Q10(a7_ Heat pump (site plan required)
Phone: 6,12 - /st I Fax: 69 - /fix I E -mail: Install/replace BTU /H
1 Including ductwork/vent liner O Yes 0 No
CCB no.: SI9 3 Install/replace/relocate heaters - suspended,
City /metro lic. no.: . - . •. °rite
Name (please print): Sc if ge_WLy Vent for appliance other than furnace ) j
CONTACT PERSON e era - --
Absorption units BTU/H
Name: C t1 Chillers HP
Com ressors HP
Address: Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
Phone: if - OM Fax: E -mail: Dryer exhaust
OWNER Hoods, Type U II/res. kitchen/hazmat
hood fire suppression system
Name: Exhaust fan with single duct (bath fans)
Mailing address: Exhaustsntem apart from acing or AC
City: ''Fuel piping a distribu 'on (up to 4 outlets)
y 1 State: I ZIP: PG 1 / NG Oil
Phone: Fax: E - mail: Fuel pi • ing each additional over 4 outlets
ENGINEER . ' rocess piping (schematic required)
Name: • Number of outlets
Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP:. Insert - type
Phone: I Fax - mail: Woodstove/pellet stove
Applicant's signature: I Date: / - �j,�pf her
Name (print): 5c d it cd-
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ 7.2 3
❑ Visa 0 MasterCard Notice: This permit application Minimum fee $
P lan review (at %
Credit card number: / / expires if a permit is not obtained ( %) $
Expires within 180 days after it has been State surcharge (8%) .... $ -5 i eD
Name of cardholder as shown on credit card accepted as complete.
. $ TOTAL $ 1 F r
Cardholder signature Amount 440 -4617 (6/00/COM)
•
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Ti ar3 OR q, L1.3
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30
J d o ,4a 1 , 4 is
( O^ 3' " vas} 1"
1.9 m Woo Qrki 8'
O�/ / Cremator.,
CITY OF TIGARD MAY(U - PaCl'vrear `s lcw cr 144
Appro " "ed • [ ,--1-
randitionally Approved [ ) �•� f i y� • y I v�,s +vc.J C � } - i 0 � •Far only the wor s describe in: y
PERMIT NO. " 0200. - OOO 0 24 n
See Letter to: Follow [ ) If `° -! J • 40 K lt vt 5 le L vvi
Attach .4 • • • • • ••• •
Job A dress: /i�P�i r4) 14;164* 4, _
Sy: Date: / -2/ .,Ce - . . • • • • • •
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CITY OF TIGARD 24 -Hour
BUILDING . Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested / � / ,a AM PM BUP
Location _MU /I 231 r Suite MEC 7D63 - 6 2 - 0
Contact Person Ph (C. -L ) 3 - 4 PLM
Contractor Ph ( ) �l�— ISIS SWR
BUILDING Tenant/Owner ...' - _ - i I_ I A - • � ELC •
Footing / ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Fi
/ 1 " PART FAIL
1
�� BING
.ost & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Smoke Dampers
PART FAIL
E CTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final i Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA Approach/Sidewalk Date // Z // 3 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL