Permit (209) 71 . CITY OF TIGARD MECHANICAL PERMIT
1 COMMUNITY DEVELOPMENT Permit#: MEC2018-00571
I G A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/24/2018
T-
Parcel: 2S110AA91321
Jurisdiction: Tigard
Site address: 10771 SW CANTERBURY LN 102
Project: Gibson Subdivision:TONDO SUPPLEMENTAL PLAT NO.2:/ Lot: 13-2
Project Description: Install A/C.
Contractor: TRI COUNTY TEMP CONTROL INC Owner: GIBSON, DAVID A
13150 S CLACKAMAS RIVER DR GIBSON, SUSAN G
OREGON CITY, OR 97045 10771 SW CANTERBURY LN #102
TIGARD, OR 97224
PHONE: 503-557-2220 PHONE:
FAX: 503-557-0919
FEES
Specifics: Description Date Amount
Air Conditioning 07/24/2018 $46.75
Type of Use: MF 12%State Surcharge-Mechanical 07/24/2018 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 07/24/2018 $43.25
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
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued = _ , ^0
Permittee Signature: 2t,(,/ ,9- /,0u C ,,9-77t, . /
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.
j W 1 ,li . titi1O "' 4E tat-vi , U
Mechanical Permit Application . FOR OFFICE USIEONLY
City of Tigard
`i 7/ q ,fill
. a. 13125 SW Iall Blvd.,Tt nd.OR e1!223 �ECE!V1 Phone: 503.718.2439 Fax 503,5'9871-46f1 ,f ).: aFc} ici Other Permit:
TIGARD Inspca non Lint 503.639.4175 „ill.,?,-,1'„,1 ; i p ll rte Reedy[I : Jur ® Sec Page 2 for
Internet: wwa tt and-or gni. ) .1 JL �i? ?LI I0 Notified teihoe7/„'-y�1. Supplemental Information
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47
COMMERCIAL LE USE CI . ISi
:. TYPE OF WORK MA
i 3 s" 1 " �`t) €icc:hantcat permit fees*are based on the value of the work
❑ New construction Addition altetattot Mei ac t performed. Indicate the value(rounded to the nearest dollar)of all
❑ Dettaolition ❑ Other: mIie finical materials,equipment,labor,over read,and profit.
------------_.__. Value:S ,-�, '
❑ .„„ c c;+tt+t��clrst+i t1tyR __� -RESID "11 I.,LQLIIPMENI'ISYSTEMS} ES!
I-and 2-family dwelling - �� Accessory building special cpeal information use checklist.
4uftt t tmily - A ❑ Master builder Eli Other: Description Qty. _Fa. Total
"":./,"4,111!9F4','."," i tle.ating/c.00ling:
744s,
x JOB SITE INFORMATION AND LO AHON
i s r-p ( .__.__ i Airconditioning 46.75
Job site address: i 0 I I I 1 I ; .i)t? t C,1 '`I ,.e
I Furnace ace 100.00013`13 tductsivents) 46.75
City/State./ZIP: 1141 r"� ''. - Furnace 100.000+BTU(ducts-vents) 54.91
• !fen 1.nnnaJ 61.06
.. . _ .___
Suite/bldg./apt.no.: Pruie t name: 7^ ,
. Duet nark �a.3�.
Cross street/directions to job site: 1 Hsdronic hot water system 23.32
— m Residential boiler(radiator or
h',dronte) 23.32
' ((nit heaters t fueltype,not electric),
in wall induct sus ended,etc. 46.75
Flue/vent(or any of above 23.32
Subdivision: LLot no.. Other. 23.32
._ 1 Other tuel alliances:
Tax map/parcel no.: ( Water heater 23.32
DESC'RIP'TION OF t\CORK (las tire>Iacc insen 33.39
.' '. .
1 Flue vent for water heater or rrafi
fireplace 23.32
s { t - - 1 0�lighter(gas) 23.32
i Cl it &V t �'�'g °
Wood,'pellet stove _.. __. 33.39
Wood lireptaceiinsert 23.32
('hinny/liner tluelvent 23.32
Other: 23.32
,; 'P.IROPERTY OWNER n TENANT i
- .___ _—_ I nstrunmental exhaust and ventilation:
Name: " , #0 (ose l 1 Range hood:other kitchen
ct ui einemr. 33.39
Address: Clothes dryer exhaust33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
toilet compitrtments,utility rooms) 23,32
Phone:(q44) 00 f hut. ( ) Atticrcrae+!space fans 23.32
❑ APPL.ICANI ❑_C;ONTAC.T PERSON Otbcr: 23.32
Business name:Same as Contractor
Fuel...ltipinu:
._._ ,_.___. _......_ 514.15 for first four;$4.03 for each additional
Contact name:Diane Mason -Furnace,etc.
Address: - (ow hcatPtump__
_.. Wall;'su tendediunit heater
City/State/ZIP: Water heater
Phone:( ) Fax: t I Fireplace
E-mail; 1 4 zll' 6 "1 if-51-0,11 1 `,C 1~ti PI Barbecue
i`,,_.. . CONTRACTOR .' Clothes diet (fes)
�_—
Other: 1 I
Business name:Tri County Temp Control I - --.—
MMECLIANIcAL PERMIT FEES*
Address: 13150 S Clackamas River Drive "_ Subtotal
City/State/ZIP:Oregon City,OR 97045 Minimum permit fee(590.00)
- Plan review(25%of permit fee)
Phone:(503)557-2220 • F.is (510)55 7,0919 i — —_
i State,surcharge(12%of permit fee)
CCB lie.:72623 'T"OlT:A1,PERMIT FEE
— - This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: . � r �''t. `
�` -
1 Pec niGhodaletgy set by Tri-County E3uilcling Industry Service Board
Print name:Diane Mason 1 Dale:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10771 SW CANTERBURY LN 102, TIGARD, July 26, 2018 at 9:17:06 AM
OR, 97224
Record Type: Record ID:
Residential - Mechanical MEC2018-00571
Inspection Type: Inspector:
699 Mechanical final David Young
Result:
PASS - NoCofO
Comments:
Minor label #ELS 663400
Violation Summary:
Inspector Contractor