Permit CITY OF TIGARD MECHANICAL PERMIT
'� COMMUNITY DEVELOPMENT MECHANICAL
MEC2021-00893
T 1 O A R 0 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/8/2021
Parcel: 2S 110BA03500
Jurisdiction: Tigard
Site address: 11575 SW CLOUD CT
Project: Herboth Subdivision: SHADOW HILLS Lot: 30
Project Description: New duct work vent for new bedroom.
Contractor: OWNER Owner: AGARD, KIRSTEN ERIN
HERBOTH, GLENN ALBERT
11575 SW CLOUD CT
TIGARD, OR 97224
PHONE PHONE:
FAX:
FEES
Specifics: Description Date Amount
Duct Work 11/05/2021 $23.32
Type of Use: SF 12%State Surcharge-Mechanical 11/05/2021 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 11/05/2021 $66.68
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
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
Issued By: HoU,y Va.w De.Wege, Permittee Signature: Qvt,Ato-ptit,cof icro,
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.
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Property Owner Statement
OCT 2 8 2011
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Regarding Construction Responsibilities
C;ITY OF TIGARL
"IUILDING DIVISION I. - , ,,, '- ,Til stAteri,- il trifore .. r-iit I , i penult can hr,-,
IORS 701.325(2))
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L lc ervt,,ed architect and eon 'applicant,c,tYkOmpt from tic:pricing.under ORS 701 010(7),need not
Lint this striternent itliS StalCinenl wilt be filed with the permit
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Pi-hatit,chr.,ci.the aorKr4viAtie't .
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I iinvrii reside. in. .or will reside in the completed structure and my general contractor is
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1 i von Inrorrn rnif general contrarlor that Ali St tbcoritractots who work on the structure roust be
ir I licensed with the Construction Contractors Board
ANlit be perto-mincl walk on property I own a residence that I reside in. or a residence that I WM
reside in It I hire subcontractors I will hoe only subcontractors licensed with the Construction
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Contractors Board If I change my mind and hire a general contractor I will select a contractor
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Trsthe is licensed with the CCB and will immediately give the name of the contractor to the office
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LSSuing this BuJoing Permit
I have read and understand the Information Notice to Homeowners About Construction Responsibilities.
and I hereby certify that the information on this homeowner statement is true and accurate.
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