Permit F �'r, } r CITY •F TIGARD MASTER PERMIT
`
j j n
' ' ' COMMUNITY DEVELOPMENT Permit #: MST2009 00223
,g fin, Date Issued: 02/02/2010
�
raw.s ':'. C.i' T[ C,/1R 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
; Parcel: 2S102DCO3800
Jurisdiction: Tigard
Site address: 13871 SW ANDREW TER
Subdivision: MCDONALD WOODS Lot: 11
Project: McDonald Woods
Project Description: New SF.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 4 First: 1305 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 23 Bathrooms: 3 Second: 1469 sf Garage: 427 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes
Total: sf Value: $299,722.77 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Catch Basins: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Other Fixtures: 0
Tubs /Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100
Drains: 0
Bckflw Prevntr: 0
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 5 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Furn >= t 00K: 1
ELECTRICAL
Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits
1000 sf or less: 1 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr 0
Ea add 500 sf: 5 20 1 -400 amp: 0 201 -400 amp: 0 1st W/O Svc /Fdr:
Limited Energy: 401 -600 amp: 0 401 -600 amp: 0 Ea addl Br Cir,
601 -1000 amp: 0 601 +amp- 1000v: 0
1000 +amp /volt: 0
ELECTRICAL - RESTRICTED ENERGY
SF Residential
Audio 8 Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Other: N Other Description: Ecompasing: Y
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
Owner: Contractor: Required Items and Reports (Conditions)
GERTZ CONSTRUCTION CO INC GERTZ CONSTRUCTION CO INC 1 MST Requires Electrical Signature
19200 SW 46TH AVE 19200 SW 46TH AVE 2 MST Requires Plumbing Signature
TUALATIN, OR 97062 TUALATIN, OR 97062 3 MST Ersn Cntrl 503
PHONE: 503- 692 -3390 PHONE: 503 - 692 -3390
FAX: 503 - 692 -5433
Total Fees: $16,832.26
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 -00 1 through OAR 95,?- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: , ... : . i�.. _ A . i. __ Pe rmittee Sig nature:
' Building Permit Application
Residential RECEIVED OR OFFICE Y
IUED USE ONLY'
Received
II q City of Tigard V 2 5 2009 !, Permit No.:MI-2a. • i. ..... 3
�22333�� Date :
13125 SW Hall Blvd., Tigard, OR 972 Plan Review ►
C , Phone: 503.639.4171 Fax: 503.59 Date/By: �� ( Other Permit: *0�,a00Q�Q! 10
TIGARD
Inspection Line: 503.639.4175 � I`IOF TIGARD Date Rea. ` n J n , /y Juris El See Page 2 for
Internet: www.tigard - or.gov BUILDING DIVISION Noted: �j r 09 Z2.0 r c"'� Supplemental Information
fv �.
A , 1 9.49 Op -1
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
® New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
® 1- and 2-famil dwelling Valuation: 42-247 - 7 22.:7 •- 7
y g ❑ Commercial /industrial �
❑ Accessory building El Multi-family Number of bedrooms: 4
❑ Master builder ❑ Other: Number of bathrooms: -2:
JOB SITE INFORMATION AND LOCATION Total number of floors: 2
Job site address: 13871 SW Andrew Terr New dwelling area: 2774 square feet
City /State /ZIP: Tigard OR 97223 Garage /carport area: 427 square feet
Suite/bldg. /apt. no.: Project name: Covered porch area: square feet
Cross street/directions to job site: 92 " off McDonald Deck area: square feet
Other structure area: • J2O 1 square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: McDonald Woods I Lot no.: 11 Permit fees* are based on the value of the work performed.
Tax map /parcel no.: 2S102DC 03800 Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
New Home Valuation: $
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name: Gertz Construction Co INc Type of construction:
Address: 19200 SW 46 Ave Occupancy groups:
City /State /ZIP: Tualatin, OR 97062 Existing:
Phone: (503)692 -3390 Fax: (503)692 -5433 New:
® APPLICANT ❑ CONTACT PERSON NOTICE
Business name: Gertz Construction Co Inc All contractors and subcontractors are required to be
Contact name: Ken Gertz licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 19200 SW 46 Ave jurisdiction in which work is being performed. If the
City /State /ZIP: Tualatin, OR 97062 applicant is exempt from licensing, the following reasons
apply:
Phone: (503-) 692-3390 I Fax: : (503) 692-5433
E -mail: Ken @Gertzco.com
CONTRACTOR
Business name: Gertz Construction Co Inc BUILDING PERMIT FEES*
Address: 19200 Sw 46` Ave (Please refer to fee schedule
Structural plan review fee (or deposit):
City /State /ZIP: Tualatin, OR 97062
FLS plan review fee (if applicable):
Phone: (503) 692 -3390 I Fax: (503) 692 -5433 .
Total fees due upon application:
CCB lic.: 34350 diAS t!
�7 Amount received:
Authorized signature: T his permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Kenneth Gertz Date: 11/24/09 * Fee methodology set by Tri- County Building Industry
Service Board.
1: \Building\Permits\BUP -RES PermitApp.doc 10/01/09 440- 4613T(I 1 /02 /COM /WEB)
1400 an. !t or lest
l 166.54
169.54
Q
ill
Ea_ Adel S00 aq. R. Or pardon
• 33.92
. Q_
Lusted energy,
twill aeo.e sy. n J
67.34
6734
2
Lhulttd mop, motti•frendy
tt tfol (goresAaves.. ej
6734
2
Servlcasaw(lcer.kt4tamp -•,.. dlbretion,mdferfel.titi00
1
200 amps or leas 100.70
201 ones 16 400 ., r.• 13336
2
40 l maps 10600 t1inpi 20034
2
601 r i In L 000 mops 301,04
2
2
OW 1,000 craps or volts 59226
67.64
2
A. Poo for branch circular oink
attovc Strike fit ILedar foe,
cacti brio cti circuit
7.42
B. Fec fist beanie clnrut6
we�emW tithes Or fooda See,
ent
f brmh drank
56,19
2
Snob odd'1 branch drain
7.42
2
Allatelltrseetta (service or actor not iocloart )
* Each menutietur d or ntoeltdar
dwellM ccasbllorI eder
67.84
2
Meant= only
67.64
2
Aonpar Irdi atIen circle
67.64
2
Sign et outthm %heng
67,84
2
8110131 arN it(s) Or Vanier*
energy pond, alteratIOn, or
=Wen . Dascribr
2
2
RECEIVE
DEC 1 4 2009
111' , ,1 ENE
C"it
fENGINEE
%eV .2 5 NOS
OF TIGARD
13125 SW Ilan Riot, Tigard, OR 97223
Ftw 363. 639A171 Paw: 503.590.1960
feria 2tmr Lint !03.6394175
fin y
eroot r tigan��
o ConnncrciaBmmduief ❑ 0y bolding
❑ Maslcrbailder • Oher
` 171ty�ih per. ~t'
Owner .. - latioo: This inalallsaton lo king made O1L prop T r flat l 0+rm which is rwl
imatded for so o, ) rem te or eettchenga, according to ORS 44T, 449.67(. and 701_
Owner si(tid1 m: Dam
imutielaperine at-r Amulet revel.)
L d
E LZL6b9 U79
PIC®c ah a I that apply (submit 2 arts of fuses *have choked eralewl:
❑ Savior a Griner 100 asps or woo ❑ e�leaatovet cos Prom
Viers etc svm worst tdb+a cosh 0 Maim= aadboaryarda
exceeds 10.000 tote= e at ISO veltt w 0 Ploy belldleaa.
0 Oyes o s aorlmoltand
bmldlap.
❑ tmsdtdioa of 71 KVA a
latest. selaaoaely QortrW off
e�aaseeavy.
❑ Reen runs! .erode (sofa.
13 Sappy %Wrap far erato ester
sea vent tmratnd.
few m gtomd. or strew 14,000
rmm. to aft attar irreb0stions,
OFir pump.
Er
❑ agcocy imam,
❑ MOtiaa of new ts04401O14 or
WOW or tom. sn
Q Ofnorots widow maw.
f7 Hex�
LIDe I0cih
Q Aa m (b
;odot lions.
❑ S®.ita or leech 600 emu er etas
•40.4HSty icsamemoi
ew V00 edinl stalk mar tmalb� ®fy dwa
ltmtdtlQm ogr ode d ®arr�,
ry
Temper servitor, of ratline ipmauttatlev, alteration, sadlor
relocation
59.36
. 20 car arias
701 romps to 400 traps 125.08
40( amps toS99 amps 168.54
tireall» — Cams a. or tate0aiea. DOP Oano1
seek nentlonas tvap1c0031 ova' olhgrabill in s
Pcr iargpvEdmp
lnveeti tier boor
Worlds) plant per !tsar
Ia7 rant)
6615
Plait review PS%of peach Fork
stun) tparalte me (L216 of paean fee)-
TOTAL P RMR' FEE
e m
Tess meal agnostics avian Its paean boat ebtalr atf atab4n 100
days after It Fps Even rmt prod as j�
• ?ember of team to s as 1 - ? .. e �
LattiC .r_ r t k
DIa1O213 N31HJI 4E :80 60 b L oea
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard RECEI I , , 1 d Permit No.: oaf- a9
q
13125 SW Hall Blvd., Tigard, OR 97223
1 C .' • Phone: 503.639.4171 Fax: 503.598.1960 Other Permit:Q a to 9/36
T I G A R D Inspection Line: 503.639 NOV 2 5 ZIER
Date Read /B Juris: El See Page 2 for
Internet: www.tigard - or.gov �'. ified/Method: Supplemental Information
CITY OF TIG
TYPE OF WORK BUILDING DIVISION COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
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 ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
® 1 - and 2- family dwelling 0 Commercial/industrial RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ Accessory b uilding
❑ Multi- family ❑ Master builder ❑ Other: For special information use checklist.
Description Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 13871 SW Andrew Terr Air conditioning
(requires site plan showing placement) 46.75
City /State /ZIP: Tigard OR 97062 Furnace 100,000 BTU (ducts /vents) 1 46.75 4(e •7'j
Furnace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: Project name: Heat pump 61.06
Cross street/directions to job site: 92 off McDonald Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision: McDonald Woods Lot no.: 11
Flue /vent for any of above 23.32
Other: r 23.32
Tax map /parcel no.: 93- 1161500 Other fuel appliances
DESCRIPTION OF WORK Water heater 1 23.32 32--
Gas fireplace 1 33.39 =7
New Home Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood /pellet stove 33.39
Wood fireplace /insert 23.32
❑ PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 23.32
Other: 23.32
Name: Environmental exhaust and ventilation
Range hood/other kitchen
Address: equipment 1 33.39 33
�3
City /State /ZIP: Clothes dryer exhaust 1 33.39 '3 •
Single -duct exhaust (bathrooms,
Phone: ( ) Fax:
( ) toilet compartments, utility rooms) � 23.32 I
® APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Other: 23.32
Business name: Gertz Construction Co. Inc. Fuel t to
P g
Contact name: Ken Gertz $14.15 for first four; 54.03 for each additional
Address: 19200 SW 46 Ave Fumace, etc.
Gas heat pump
City /State /ZIP: Tualatin, OR 97062 Wall /suspended/unit heater
Phone: (503) 692 -3390 Fax: : (503) 692 -5433 Water heater 1
Fireplace 1
E -mail: Ken @Gertzco.com Range
CONTRACTOR Barbecue
Business name: Oregon Comfort Heating Clothes dryer (gas)
Other:
Address: P.O. Box 190 MECHANICAL PERMIT FEES*
City /State /ZIP: Eaglle Creek, OR 97022 Subtotal ? eft
Minimum permit fee ($90.00)
Phone: (503) 655 -0221 Fax: (503) 650 -2993 Plan review (25% of permit fee)
CCB lic.: 42519 State surcharge (12% of permit fee) •Z
TOTAL PERMIT FEE 33'7 e 1 1
Authorized Signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Ken Gertz Date: 11/25/09 • Fee methodology set by Tri- County Building Industry Service Board
1:\Building\Permits \NEC- PermitApp.doc 10/01/09 440- 4617T(II/02 /COM/WEB)
. ' PluMbing Permit ApplicationRECEIVED
Building Fixtures ,�j FOR OFFICE USE ONLY
City of Ti and NOV 2r " 2009
�, Received
`� g
DateBy: �/
Permit No.: *v?e:V QD 3
lig a 13125 SW Hall Blvd., Tigard, OR 97223
C ; Phone: 503.639.4171 Fax: 503.598.1 %OTY OF TIGARD Plan Review
Date/By: Other Permit No.6G049009'
TIGARD Inspection Line: 503.639 BUILDING DIVISION Date Ready /By: Juris: See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
® New construction ❑ Demolition For special information use checklist.
Description 1 Qty. 1 Ea. 1 Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
® I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
❑ Accessory building ❑ Multi- family SFR (3) bath 1 500.32 �c7b 32
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 13871 SW Andrew Terr Catch basin or area drain 18.76
Drywell, (each line, or trench drain 18.76
City /State /ZIP: Tigard, OR 97223 Footing drain (no. linear ft.: _) Page 2
Suite/bldg. /apt. no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: 92 off McDonald Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: `) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: _) Page 2
Subdivision: McDonald Woods I Lot no.: 11 Fixture or item:
Tax map /parcel no.: 2 @102DC 03800 Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
New Home Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name:
Fixture /sewer cap 25.02
Floor drain /floor sink/hub 25.02
Address:
Garbage disposal 25.02
City /State /ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
® APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Gertz Construction Co. Inc Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: Ken Gertz
Roof drain (commercial) 12.51
Address: 19200 Sw 46 Ave Sink/basin/lavatory 25.02
City /State /ZIP: Tualatin, OR 97062 Solar units (potable water) 62.54
Phone: (503) 692 -3390 Fax: : (503) 692 -5433 Tub /shower /shower pan 12.51
E -mail: Ken @Gertzco.com Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: Threefoot Plumbing Inc. Water piping/DWV 56.29
Address: P.O. Box 274 Other: 25.02
City /State /ZIP: West Linn OR 97068 Subtotal 5CQ. 'L
Phone: (503) 557 -7585 Fax: (503) 650 -8212 Minimum permit fee: $72.50
Plan review (25% of permit fee)
CCB Lic.: 103792 Plumbing Lic. no.: 3 -259pb p/ State surcharge (12% of permit fee) a ,Q/_
Authorized signature: TOTAL PERMIT FEE ?�.yQ 3(
Print name: Marshall Threefoot Date: 11/25/09 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
I:\ Building \Permits\PLMU•PermitApp.doc 10 /01/09 440- 4616T(10 /02 /COM/WEB)
i.
•
Ctity of Ta and Oregon 0 13125 SW Hall Blvd. 0 Tigard, OR 97223 RI
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December 24, 2009
Threefoot Plumbing Inc
PO Box 274
West Linn OR 97068
Re: Gertz Construction, McDonald Woods Subdivision, Lot 11
You have been listed as the plumbing contractor for this new residential construction. We are
required to have a signature on file prior to any plumbing inspections being performed. Please sign
the attached application form and return by mail, or you can fax this signed form back if you prefer.
You can fax the form to 503- 598 -1960. If you have any questions regarding this matter please give
us a call at 503 -718 -2439, thank -you.
Debbie Adamski
Sr :Permit Technician
Phone: 503.639.4171 o Fax: 503.684.7297 o www.tigard - or.gov o TTY Relay: 503.684.2772
City of Tigard al
13125 SW Hall Blvd.
• 1111
Tigard, OR 97223 i
v.
Phone: 503 - 639 -4171
: :TIGARD
FAX TRANSMITTAL
Date December, 2009
Number of pages including cover sheet 2
To: From: Debbie Adamski
Co: Threefoot Plumbing Inc Co: City of Tigard
Fax #: 503 -650 -8212 Fax #: 503- 598 -1960
Ph #: 503 - 718 -2450
SUBJECT: MST2009-00223, 13871 SW Andrew Terrace, Gertz Construction
MESSAGE:
We require an authorized representative's signature to be on file for this permit. Please sign the
attached application and fax it back to our office. Thank you for your attention to this matter. Please
contact me if you have any questions.
I:1ENGTAX. DOT
Elev 230
•� Elev 230
43.62' •� •
56.25' o •_
ID
L OT 11X'
26 ,167 . 500
I RECEtVED NOV 5 2009
5.66 '
0) ,� — 1 CITY OF TIGARD
o =, El 229.5 �°° BUILDING DIVISION
0 10/0x15/6 GREAT RM N
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2* CAR GARAGE '�'�'II I v 1 ' 1 v
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--I D Grov I Drive . D K
1— o for rosio 6 ,1/
otie�1 het
_______ -_
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�I i • ° .. .•Efev •226 O M —I
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WARNING.
ANDREW TERR. ______ _______ itf '. OBTAIN LOCATES PRIOR TO ANY
Siltfence , S EXCAVATION
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7
CONSTRUCTION
HOME SQUARE FOOTAGE 1. ERTZ COMPANY INC.
MAIN FLOOR =1305 SQ.FT.
UPPER FLOOR =1469 SQ. FT. BUILDING (�'J\
CUSTOM HOMES SINCE 1977 �� \.1
TOTAL = 2774 SQ. FT. (503) 692 -3390
GARAGE = 427 SQ.FT. 13871 SW Andrew Terrace
Lot 11 McDonald Woods
SCALE 1" = 20'
GERTZ CONSTRUCTION COMPANY INC.
PLOT PLAN 11/25/09
■ • • -
. - --
....... -
BUILDINGPERMITNO: YT
CITY OF TIGARD. SITE PLAN R
PLANNING DIVISION:
Required Setbacks: Er Approved 0 Not Approved
. •
Side. 5 Street Side: j -5
„,--
Froni .9 9a rag e: s2t)..._ Rear: 1 --
Visiia; Clearance: 0 .Approved 0 Not Approved
Maximum Bun! Height
CI.V• Servi Pr icier Letter R eq u ! rk-.J r. . ri No
4
ENGINEERIN DEPARTMENT:
Actual lope: " % Ei Approved 0 Not Approved
Site P,- : Eg Approved 0 OM ' 'proved
B : AL. '41 Date: 1 2 6
Notes:
CITY OF TIGARD - SITE PLAN REVIEW
;UILDING PERMIT NO: .a ii, - • • • . 4, .. .....
Street Trees: 14 Approved 0 Not Approved
Protected Tre_cu. 1 id Approved 0 Not Approved
B : / 1 , (0,, Date: Id ? 0
Notes:
Oregon Residential Specialty Code 8318.2 • _
67 60).23
MOISTURE CONTENT ACKNOWLEDGEMENT FORM
I, c6(> l ati t , am the general contractor or the owner- builder
at the following address:
Site Address: / 3 �( 7/
/ V
City: l lyi4-i?A9 f 2 Z2-
Permit #: 2_0 _ � � ��
Subdivision/Lot #:
and /or
Map and Tax Lot #: //
To conform with the 2008 Oregon Residential Specialty Code (ORSC), Section R318.2 and
OAR 918- 480 -0140, I am notifying the building official that I am aware of the moisture content
Requirement of ORSC Section R318.2 and have taken steps to meet this code requirement.
[Section R318.2 is provided for reference].
R318.2 Moisture Content: Prior to the installation of interior finishes, the building
official shall be notified in writing by the general contractor that all moisture- sensitive
wood framing members used in construction have a moisture content of not more than 19
percent by dry weight of dry framing members.
Signature: / Date: g j 1 //D
eral Contractor or Owner- Builder �/
I: \Bui lding\ Form \RES- MoistureSensitiveWood.doc 09/25/08
•
•1
Oregon Residential Specialty Code N1107.2
HIGH - EFFICIENCY INTERIOR LIGHTING SYSTEMS
Permit No.: 2 ( 4 _ Z 2,3 Jurisdiction:
Site Address: (3 ? / (-( 7
Subdivision/Lot #:
/ v
and/or
Map and Tax Lot #: l
By my signature below, I certify that a minimum of fifty (50) percent of the permanently
installed lighting fixtures in the above mentioned building have been installed with compact or
linear fluorescent, or a lighting source that has a minimum efficacy of 40 lumens per input watt.
(Oregon Residential Specialty Code N1107.2)
Signature: ` Date: V/ d /a
Own-. - enera Contractor /Authorized Agent
. Print Name: 4 -� J2 l , e_
' ORSC Section N1107.2. High - efficiency interior lighting systems. A minimum of fifty (50) percent o the
permanently installed lighting fixtures shall be installed with compact or linear fluorescent, or a lighting source that
has a minimum efficacy of 40 lumens per input watt. Screw -in compact fluorescent lamps comply with this
requirement.
The building official shall be notified in writing at the final inspection that a minimum of fifty percent of the
permanently installed lighting fixtures are compact or linear fluorescent, or a minimum efficacy of 40 lumens per
input watt.
•
I: \ Building\ Forms \RES- HighEfficiencyLighting.doc 07/01/08