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Permit CITY OF TIGARD MASTER PERMIT ' • COMMUNITY DEVELOPMENT Permit #: MST2012 -00066 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/20/2012 Parcel: 1 S 136CA09200 Jurisdiction: TIGARD Site address: 11039 SW LEGACY OAK WAY Subdivision: WHITE OAK VILLAGE Lot: 13 Project: White Oak Village, Lot 13 Project Description: New SF BUILDING Floor Areas Required Setbacks Required Stories: 3 Bedrooms: 3 First: 636 sf Basement: 0 sf Left: 3 Parking Spaces: 0 Height: 29.5 Bathrooms: 3 Second: 1006 sf Garage: 358 sf Front: 10 Smoke Dwelling Units: 1 Third: 523 sf Right: 3 Detectors: Yes Total: 2165 sf Value: $239,520.44 Rear: 13 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0 Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100 Tubs /Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Drywall- Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 5 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Fum <100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4 Fum > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits 1000 sf or less: 1 0 -200 amp: 0 0-200 amp: 0 W/ Svc or Fdr: 0 Ea addl 500 sf: 4 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 0 Mfd Home /Feeder /Svc: 0 401 -600 amp: 0 401 -600 amp: 0 601 -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: NEW SF VB R -3 2165 Owner: Contractor: WESTLAND INDUSTRIES WESTLAND INDUSTRIES Required Items and Reports (Conditions) 12670 SW 68TH AVE STE #400 12670 SW 68TH AVE STE #400 1 Ersn Cntrl 503 - 681 -4444 TIGARD, OR 97223 TIGARD, OR 97223 PHONE: 503 -572 -0746 PHONE: 503- 245 -9715 FAX: 503- 598 -9081 Total Fees: $17,527.82 • This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicab = -law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 day -.•i ... - .spended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification . • ose rules are set forth in OAR 952 -001 -0010 through 0 R 952 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 50 ' .1987 or 1.800.332.2344. Issued By: Permittee Sig • = ure: Call • .3.6 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 e project Approved plans are required on the job site at the time of each inspection. Building Permit Application RECEIVED Residentia r f,l: or! ic:r, us r, ()Nix City oftcEIVED 5 . ,Y4 PermitNo.: 09rag6/ - 4 13125 Blvd., Tigard, OR 97223 Plan , ' '' Phone: 824 3.5 v ,s I. 3 ED EqTY OF TIGARD Det 1 �a •`� /2-�S3 T f G Al: ll hrspeelon Line 503.63. Date ltead RI see Page 2 for sip BUILDING DIVISION � ; �/ / - :.e. I , liglifttrAI B $ , fn ..0D. .i_ , r 141 i F 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 j d1- and 2-family dwelling ❑ Commercial/mdustrial Valuation: $ L ,1 3 -2 0,4 4 ,- ❑ Accessory building ❑ Multi- family Number of bedrooms: 2 j El Master builder ❑ Other: Number of bathrooms: JOB• SSiTE INFOR144ATION A D L OCATiIN Total member of floors: a 1�D37 'SG L C it ail -g m `I New dwelling area: A'ip - aqua feet Job site address: J G,� _ City /State/ZIP: / / 6ihe,O OA / 7z 23 Garage/carport area 15 , ,,e feet 52 Suite/bldg./apt. no.: I Project name: &/f /Th 'a'4& gii„�� Covered porch area: 9_ + square feet (e Cross street/directions to job site: . Deck area: -& . square feet (6 Other strrrct re area: `2. 23 square feet 21,5 REQUIRED DATA: COM RRCIAL -USE CHECKLIST . Subdivision: OH 11 Lot no.: /' Permit fees* are based on the value of the work performed. Tax map/parcel no.: ` /36 e 09 ° • • ` 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. /1' 7Wer ,9 S � �� de_ t Valuation: $ U/ ' Existing building area square feet New building area: square feet ❑ PROPERTY OWNER I ❑: TENANT Number of stones: Name: Type of construction: Address: Occupancy groups: City/State/ZIP: Existing: Phone: ( ) Fax: ( ) New - [I APPLICANT ❑ CONTACT PERSON _BUILDING PER1kJLT kERS *. Business name: /44 774 c/0 4asT� S v ie w z s it ): le) p Structural plan review fee (or deposit): Contact name: /60{i 4/4)(44-A0 - gym., 5, ,e4ter-- FLS plan review fee (if applicable): Address: ` 6 70 Sld 68.f.-4/ .5_ sr rA2 Total f ees due upon application s City/State/ZIP: ; ��,0 0,e, "[ 77_2 5 Amount received t' f 7 f • Phone: (5O) . 7X -07 I ' r F ax:: (� 77) � 1 /�q E-mail: jr iS q a17 1,¢I L . c//6 0401 colt/( _ FHOTbVOLTATC SOLAR PANEL SYSTEM VI FEES* Commercial and residential prescriptive installation of CONTRACTOR roof -to ....noted PhotoVoltaic Solar Panel :., • Business name: 4itlgsr /) STz /£s Submit ) sets of roof plan with , n details and fire dep . .. • ent access, along • : • . 1. e 2010 Oregon Address: P6 tii ip/ cL' a< ST 50:2 Solar Installation ' . -dally • , e checklist. City/State./ZIP: �4- g2 / 'f 2-3 5 Permit Fee (inc n plan review .. .. 4 c e fees): Phone: (, j03) 7 8 0 -06 2._ I Fax: 60 j ) 0 - gag( sta : : (12% of . - .d $21.60 CCB lic.: 030,9 Total ' fee due upon application: , $201.60 � This permit application expire if a permit is t obtained Authorized signature: f" _ within 180 days after it has been accepted as complete. L Print name: * Fee methodology set by Tri- County Building Industry �� 20 i .V G� Date: �j • g • � � Service Board. I :\ Building \Permits\I3UP- RESPermitApp.doc 02/242011 440-4613T(11 /02/COM/WEB) - , FOR 011 ICI; IJSI 01\1,1 ' ' Electrical Permit Aaplicat EIVED nn //�� City of Tigard � �JI/� rit®d xo : /`�5/ i/, // / i • --- 13125SWHBUBlvd,Tigard,OR 97 R 3 l�`f Plan R 0/w Older ]?ermit a Phone: 503.718.2439 Fax 503.598.1960 — B See Page 2 for � . Inspection >me Internet www.t or.gov / Notified/Method. SupplemmfalInformation B DING 1 .. sat IMAM!? .. TYPE OF WORK ' '7'.'".... • -' • ,•: , r. ::: • . RUILDI a' DIV 'I� IC N p cheer erg ad apply (submit 3 seta of plans wluems checked below): New construction ❑ Addition /alteration/rep ['Service ar 400 amps or mom ❑ Building over three series. ❑ Demolition ❑ Other: where the avaaable fault cuuent ❑ Mamma and boatyards. • • CA•><'EGQRY OF CONS'TgUC(t'ION . - • exceeds 10,000 amps at 150 volts or ❑ Flooding buildings. less to gated, or exceeds 14,000 ❑ Commercial -use agricultural and 2- family dwelling ❑ CommerciaUmdustrial ❑ Accessory building amps for all other installation. buildings. ❑ M u l t i - f a m i l y ❑ Master builder ❑ O t h e r : O r e . . . ❑ Installation of T5 KVA or ifE FORMA INTION LOCATION.... ❑> system. > "1 - JOB S ", ,, ❑ AddAi® afnew motor load of ❑ °A °, E°, °1 -2 °, °1 -3', occupancy. Job no.: • Job site address' /03; L -�y t /�! / ❑six om residential units. ❑ vehicle parks. City/State/73P: / r i � 747 �/ , e ❑ 600 volts nominal. than ❑Hazardous loxarions Suite/bldg./apt no.: I Project name: Ali, D v /L ❑ Service or feeder 600 amps or mare. FEE SCHEDULE • Cross street/directions to job site: Detc;iption I Qtv. I Fee I Told 1 • New residential single- or multi - family dwelling unit Includes attached garage. Subdivision: iihtirc. ( 4 01,«t ., Lot no.: f3 3 1,000 sq. ft. or lam 1 I 168.54 (�.� 4 / S / 3 G � `/'9L {1 - G L 500 sq. ft or t i l l ` 33.92 �'sf J 1 Tax map /parcel no.: Li mited iced energy, reideotiei DESCRIPTION OF woRx.. (with above sq. ft.) \ 75.00 75, �� 2 d ��... ��yy����� / /� Limited energy, multifamily 75.00 2 /57 e c1- /I/ , 5cie A�fg residential (with above sq. ft) Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 ❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name: 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 552.26 2 Temporary rary services or feeders installation, alteration, and/or City/State/ZIP: Phone: ( ) I Fax: ( ) 200 amps or less 5936 1 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not 401 amps 599 amps 168.54 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits— new, alteration, or extension, per panel Owner signature: Date: A. Fee for breach circuits with APPLICANT I ❑ CONTACT PERSON above service or feeder fee, • 7.42 2 each branch circuit Business name: g572A.Nd) .✓OU57'4,/l; S B. Fee for branch t ire fee, without service or feeder fee, , first 56.18 2 Contact name: /2.06 /�a ®dv /I/0,k D/� Each add'l branch circuit 7.42 2 Addre / a.. 6 70 510 ��� � $ a 0D Miscellaneous (service or feeder not included) City/State/ZIP: ' , D I - 7 z3 3 Each el ingnl�le and/or d/ r modular 67.84 2 ty t dwelling, service and/or feeder 05 )$ ., 7 2 ._ 07 Phone: Fax: : ( 4 1 ) 3 )Slje ' lo g Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E - mail: • Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited-energy • • panel, alteration, or extension. _ Page 2 2 Business name: eL e q / C :)4 I7 / o Each additional inspection over allowable in any of the above Address: j65/S3 SE_ ,23, a? _, Additional inspection (1 hr min) 6625/ hr City/State/ZIP: �} 5 C . ' Ae 7 ® 19 Investigation plant ( 1 hr min) 78.18/ hr min) 78.18/ hr J a Industrial plait (1 Phone: ( )) 35 — 6 �gq Fax: ( g11) 7 i (- 3 j ; 0 Inspections for which no fee is 90.00/ hr � specifically listed (A hr min) CCB Lic.: 6 6 e (j. Electrical Lic.: 2e„).. j ( / Suprv. Lic. j/ ELECTRICAL PERMIT FEES Suprv. Electrician signature, ,s Subtotal: 3 . - C7-- , Su P ln�r'e, �u�: Plan review (25% of permit fee): Print name: i f ' • Date: . . "C State surcharge (12% of permit fee): 5 , Tj f �ilF.� %J/ TOTAL PERMIT FEE: 4- .4 , ✓Z Authorized signature: • This permit application expires it a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. N um b er of inspections allowed per permit L •.BuildinglPermitslBLC-PermitApp .doe 07/01/10 440- 46157p1/05RCOM/WEB RE EWER • • Mechanical Permit A p p li c a t i o n r O 1 < OFFICE I J S E ONLY City of Tigard MAR 1 ' I IT 1, " / Permit No.: Q a 13125 SW Hall Blvd., Tigard, OR 97213 . p Mate/By: Phone: 503.7182439 Fax 503.515. •', : 4 T 1 R JS, 3 jgy � t tic p�1W,Q A09.. Tr I c A I: D Inspection Line: 503.639.4175 G DI N > ® see Page 2 for Internet www.figard-or.gov DUI 1 1N CITY I F TI , ', R t „ Supplemental information BUILDING DI , IS1ON • or woi�K .030 a*L ill - "car:-:'•: • New construction Mechanical permit ke:' are based on the value of the work ❑ Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other. mechanical materials, equipment, labor, overhead, and profit. Value: $ CATEGORY OF . CONSTRUCTION �� �- : FS • _ RID >�PPIIAL /. SY3!'ElS)�FE&S'• RJ t- and 2- family dwelling ❑ Commercial/mdustrial ❑ Accessory building For !pedal Information are &ed itiet ❑ Multi -family ❑ Master budder ❑ Other. Description I Qty. I Es. 1 Total • soli srrE INFORMATION AND LOCA'IION Healing/cooling: Air conditioning Jab site address / fc37 . L / /� / City /StaCity/State/ZIP: 11-610 v Furnace 10,000+ BTU(dncli/vents) 54.91 Suite/bldg./apt. no.: roject name: 1� f G tt L fitig Heat pump "r , d' `�� ,• r rs^z - (regauims site plan showing placement) 61.06 Cross street/directions to job site: Duct work 23.32 Hydronic hot water system 2332 Residential boiler (radiator or hydronic) 2332 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 46.75 Subdivision: f t/ •, / Flue/vent for any of above 2332 Lot no.: Tax map /parcel no.: / per+ (i � � I ^ [/ T3 J , Other. 2332 Other fuel appliances: DESCRIPTION OF W IRK Water heater 1 2332 Gas fireplace 1 3339 -1_'_ 1/ _ At Flue vent for water heater or gas fireplace 2332 Log lighter (gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 2332 El PROPERTY OWNER I Q TENANT • Chimney/liner /flue/vent 2332 Other. 23.32 Name: Environmental exhaust and ventilation: Address: Range hood/other kitchen P equipment 1 33.39 City/State//ZIP: Clothes dryer exhaust 1 3339 Single -duct exhaust (bathrooms, toilet compartments, utility rooms) Phone: ( ) Fax: ( ) 6 2332 I t 6(1 Ct nPPLICANT 0 CONTACT PERSON Attic/crawlspace fans 2332 Business name: i , yam Other: 2332 Fuel piping: Contact name: Lai/ i _ $14.15 for first four; $4.03 for each additional Address: ; / a , ` . Nit Furnace, ace, etc ( 1'4' P l e 5 Gas heat pump City/StateJZiP: � u j �F �' a f 4 Wall/suspended/unit heater Phone: (r) s ` 6'76.3 Fax: : ( - Water heater ( Fireplace E -mail: Range CONTRACTOR Barbecue Business name: / I' V Clothes dryer (fats) Other: Address: / MECHANICAL PERMTP FEES' City/State/ZIP: A / 1 re / '� f a e 20 Subtotal , Phone: ( I t � �r 1 r•" Fax: ( `^" �} — Minimum permit fee ($90.00) /1O� Fa Plan review (25% of pennitfee) CCB lic.: ( State surcharge (12% of permit fee) .1 2. = TOTAL PERMIT FEE �1 This p ermit application expires if a permit is not obtained within 180 Authorized signature: d ays after it has been accepted as complete. Print name: t!4 ( D 2 , I . 0.,"' I • Fee methodology set by Tri- County Building Industry Service Board \ B I:uilding1Pennit� MEC-PermitApp.dae 09/09/10 e 440-4617T (I l / 02/COM/WEB )) Plumbing Permit Application ' CEIVED Building Fi r eERECEIVED MAR i i • o r r i c E U S E r_1:�� i. V n , 2 City of Tigard ' R :114 . , diftM I ' Permit No.: 6TO - .1� , ,� II , 13125 SW Hall B14.,LTard,O I* , OF TI t t RD Plan Beview �,� - Phone: 503.7182439 Fax 503.598.19 OtherPemrit 0 i I / 2,_06 7 e s I np dio n L ine : �S < . 5 I IGAI ].DING DIVI • �' �.: lurk ® BoePa®ea tor �ricniti� Internet .. .._ ' r_iaii : : :il a 1 ■ In1S•rmati® lir OF WORic . ' :. - . ii ew construction ❑ Demolition For O° use ehe t Destaiplion Qty. Ea Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 R. for each utility connection) �(1)� I' 312.70 :" - � CAT&GAR,Y O�'FON�YR[jG°Ir101y.'. : . � . ;.� � R., : • t j� y � : _ - s (2) 437.78 SFR Accessory ❑ Multi- family ) Q 500.32 / Each additional bath/kitchen 25.02 ❑ Master builder ❑ Other. Fire sprinkler L_ sq. ft) Page 2 • • !OB Aug... i . ii . v FIOIF. AND L i-e. T t�N' . Site utilities: ; ' �� �' ^ i � Catch basin or area dram 18.76 :11 I / -'►j - Drywall, leach line, or trench drain 18.76 ` 'vfn /Al `i i , • / _3 Footing drain (no. linear ft.: _) Page 2 Suite/bldgJaptno.: Project name: ` � ! /ir t 11 i , �• /1 Manufactured 50.03 Cross street/directions to job site: 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 ti u y +i f .• i Lot no.: / Fixture or item: Tax map /parcel no.: / / 7h C / 'A -0 Backflow preventer 31.27 DESCRIPTION OF WORK `V v Backwater valve 12 51 ,A' & Clothes washer 25.02 _ ./ ; _/ 11/ ,, . - i1// /f6 i /% Dishwasher II, 25.02 Drinking fountain 25.02 . Ejectors/sump 25.02 • ❑ PROPERTY OWNER I C] Turf Expansion tank 12.51 Name: • - Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: Garbage disposal 25.02 City /State/HP: Hose bib 25.02 Phone: ( ) Fax: ( ) Ice maker 12.51 VAPPLICANT ❑ • CONTACT PERSON Interceptor /grease trap 25.02 Business name: , t / n , �WCY ,', /J /At Medical gas (value: $ ) Page 2 , Contact name: se- I" ; : , / 1 ; , . der 12.51 Roof dram (commercial) 12.51 Address: f > ' i A 79/ - `111 Sink/basin/lavatory Will 2102 • City/State/ZIP: f � �, 1 Solar units (potable water) 62.54 Phone: (619 r 1 - A . - Fax: ( r e; i . _ .. /: I Tub/shower /shower pan �� 12.51 E-mail: lJr/r . . 9,, e e . A . t � ,, / •1 Urinal 25.02 • CONT l/ Water closet 25.02 Water heater 37.52 Business name: /" C Pei a � fr r (1-3-c._ t Water pip ing/DWV 5629 Address: - da bs R Other 25.02 City/State/ZIP: / Mb 41f b Subtotal Phone: ( • ) Fax: ( ) / Minimum permit permit fee: $72.50 ii 3 r .. A ` Plan review (25% of permit fee) CCB Lic.: , 1 g ,r Plumb' Lic. no.: 7 J State surcharge (12° /a of permit fee) .., ■ Authorized signature: TOTAL PERMIT FEE - . r 3 • Print °51 • f Wok IJ 1 D a t e: ` 3 q - / This permit application expires tf 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. l BmldingPermitsWWLMU _PermitApp,doe 10/01/09 4464616T(10/09/COM/WHB) ,-. tOht_:,t Qu V,' A I 4 ? & , Ld III B Di ' i n // 9 �� 0 g V1S O L2 a l , Development Code Provision Review T i c e Ez Residential Projects Building Permit No: 1 'ST ab 1 9 - 6006940 CWS Service Provider Letter Received: Yes ❑ No ❑ N/A Routed Plans: Original Plan Submittal Date: / 9 Pt Revision Submittal Date: '1EI Site Plan Only 2 Revision Submittal Date: ❑ Site Plan Only To the Applicant: Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies to the Building Division. Only checked (✓) items are approved. Items not approved and those listed in the notes must be revised prior to re- submittal. For questions please contact the appropriate staff person(s) listed above each section. Staff: please check items along left only if approved. Planning Review (contact at 503 - 718 - .Z Si or @tigard- or.gov) Land Use Case No. S1L . Cv .-oOe' Name ' itM - tTE OAK- V I u..44L E a Zoning l� -(,3. CP 0, 13 Setbacks: Front 10 Rear 1 3 Side 3 Street Side V Garage AO Cr Maximum Building Height 35" Actual Building Height. IX Visual Clearance CrzE, asements 4 5' PuU 61J Sensitive Lands Type: N l A ' Notes: Original Plan: Approved Not Approved ❑ Date: AI S hi-- Z Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: Engineering Review (contact Mike White at 503- 718 -2464 or MikeW @tigard - or.gov) Actual Slope: Notes: Original Plan: Approve•Not Approved ❑ Date: 1L Revision 1: Approved ,Er Not Approved ❑ Date: 1L /1 L Revision 2: Approved ❑ Not Approved ❑ Date: (Review Continues on Page 2) Page 1 of 2 . City .rborist Review (contact Todd Prager at 503 - 718 -2700 or todd @tigard - or.gov) L7 treet Trees L7 Protected Trees - / r - Notes: b 3Tti If t c ;3 /ty nni ur to f Original Plan: Approved ❑ N ot Approved B" Date: 10). Revision 1: Approved Not Approved ❑ Date: 5'7 Revision 2: Approved ❑ Not Approved ❑ Date: Permit Coordinator Review (contact Albert Shields at 503 -718 -2426 or albert @ tigard- or.gov). ❑ Conditions of Approval Prior to Issuance of Building Permit Notes : Original Plan: Date Sent to Applic t: Revision 1: Date Sent to App • ant Revision 2: Date Sent to A cant / Okay to Issue Pernut: Yes o,. {�`Y " • Date Routed to Building. 1 • • ti Page 2 of 2 F , Building Permit Application RECEIVED Residenti� ,; ; r�i; 01 I I LSL O�L1 '1,+ City ®f ■ll dg � M1 1 v 2 12 1 � Ira PermitNo.: 1 /�OS f ∎ 4 i -- 11/41 < 1 SWAMI Blvd., Tigard, OR 97223 '" Ran Review PariAt a 4 QQTY OF TIGARD Da • otter � °� / 2` _ 37I8.243 a� 03.598.1 5 T[GA Inspection 5O3.639.i'7 BUILDING DIVISION D � d''�" ® See Page 2far y_ ,,....._.:'_, Inte c.r: o ar D Not�ed/Metbad: Supplemental Information 11 ht11C BI ril IJInlG D _ r l 6 F WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING New constriction J � ❑ 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. g , 1- and 2- family dwelling ❑ Commercial/mdustria( Valuation: $ 3 ID Accessory building ❑ Multi- family Number of bedrooms: ❑ Master builder ❑ Ogg; - Number of bathrooms: 2 . JOB• SITE INFORMATION :*3 LOCATION Total number of floors: 3_ Job site address: / /D21. Si) L g ey t 2 I o - y New dwelling area: L I 10� - squa feet City / State/ZIP: �/ / 6- ✓ f J), 40,Q / Q 7z 23 Garage/carport area:' ? S .n feet Suite/bldgJapt. no.: I Project name: W/ 'OW AL/5£ Covered porch area: 9_ I square feet Cross street/directions to job site: Deck area: - square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST a Subdivision: OH ire /4 V ,/ jL 4416 I Lot no.: /3. Permit fees* are based on the value of the work performed. Tax map /parcel no.: / 5/36 eh (9 _ 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. 646772_06T � s/N6 l / � , Valuation: $ • //34'16... Exiyting building area: square feet New building area: square feet ❑ PROPERTY OWNER Q. TENANT Number of stories: Name: Type of construction: ' Address: Occupancy groups: City/State/ZIP: Existing: Phone: ( ) Fax: ( ) New: • [APPLICANT ❑ CONTACT PERSON BUILDING PER1an ,EERS *. • Business name: /��� (Please refer to fee sclreeal� . �" �ST''/a 4 l<ST'P 1 E S Structural plan review fee (or deposit): Contact name: /e /1 0 - gm, SSrAuO,e/ FLS plan review fee (if applicable): Address: `a, 6 70 6-4/ 6B4' e„ ... u Sled Total fees due upon application fir) • City/State/ZIP: /t , 0 ®,ei 973-23 / Amount received: Fr 76 b ' Phone: (.c ) E7)._ Fax:: (en) ;38-//59 /y, �, �� PROTbVOLTAIC SOLAR PANEL SYSTEM FEES* E-mail: J`c 4 C/ Js i2i4 e o f �� Commercial and residential prescriptive installation of CONTRACTOR roof -to . „ousted Photo Voltaic Solar Panel • .., Business name: GtJisTL��o Aidv5T�i£S Submit tw • 2) sets of roof plan with co ,, - ::.n details and fire dep : ent access, along he 2010 Oregon Address: /? ' �� O a r: ,lam �Cr? _ Solar Installation • _ cial a checklist City/State/ZIP: 77,f- j a,e 9 12,3 Permit Fee (Inc °plan review $180.00 a.. ••,,'id•i. :vefees): Phone: ( 3-0 '5 ) 7,5k, --a62-% Fax: (5) ) � 9Q,5 ( Stat , .: (12% of permi $21.60 CCB uc.: p 3 Total fee due upon application: $201.60 Authorized signature: 4°4 This permit application expires if a permit is • . t obtained /`_ within 180 days after it has been accepted as complete. r * Fee methodology set by Tri-County Building Industry Print name: �' 2p N ,Q Date: 5 9 ° .I 1 Servic Board. I:\Building \Permits \BUP- RESPermitApp.doc 02/24/2011 4404613T(11/02/COM/WEB) ■ ■ a 1 , t u i _ t y l .. APR 122012 O " 13' -0 i / 40'-0" )' 20' - 0 I / CITY OF TIGA MARK STEWART HOME DBSIdN / I_ 5 tI BUILDING DIViSiO'' `11 E. O.If./ 1 73. 00 ' P.U.E. E.E. 0.0' - - -- -- -- _ /��) u 9114 AVE *---- -- - - - - -: - - -. I II V ❑ sa�w F+azrLa�,oRSnm9 • : : : : :• 48_0' II tER ............... :•_•_ • :'...'..,•• :_ "— — (903) 889B3r P : :•••• :• : GA — — — : %rrr % ri% (603) 994732 F ............... _ • •... •• •• •• •• •• •.. •• •• •. / IOIYI{Laldfk!lOWCr'AC.OGI :•:•:•:+:•:•:•:•:•:•:•:•:•: PLAN OAK MODEL 1 \ � = r� ............. PNONE Fil ............... .......•.......... I ............... 2 SQ. FT. ®b GAS i ■ % Q - 1 3 BD. RM. T s� o 2 5 BATH I �[ /� 2i9 SG2.�FT. ARACzE c owl Q O — — �@ N I I . O_. :• • N. J L_ i X1 �Z 3 6' .0, 0,40;00 � • I �i , o „o o „oo� � 1 8 - - N. '`,N ({1 � _ •o•o do : o3 It _ :0''010''0 1.____ - I - , , O ,, O O 1 O9 -- W 4�'6 n \ p(i...■, Stock Home Plane — — 1 — — — — — — — — SEUJ ss —� �--� ' — v , Cuetom Design E _ 0.0' E.E. la.0 Builder Marketing Interior Design / 13 ” / 45 O I' / 12 - O ” cn Since ISM Tow -e. w dimes .a.. eu... .e Mk e °� . a..•auoo .e roa LOT INFORMATION IMPERVIOUS AREA'S: LOT #13 t hporient Plecioars _ f` LOT AREA 1,911 SQ. FT. 121 SQ. FT. DRIVEWAY Q. IMPERVIOUS COVERAGE 1,350 S FT. 25 SQ. FT. PORCH b._ BUILDING COVERAGE 68% 33 SQ. FT. WLAK ....�....aa:w. BUILDING HEIGHT APPROX - 29' -9' 60 SQ. FT. PATIO SCALE. 1/V "- 1 '- 0 " w ,�. w 122 SQ. FT. OVERHANGS r ^4•� 983 SQ. FT. BUILDING COVERAGE °EE '"°"'".7 w GOMPLIIIILY U U. 1,350 TOTAL SQ. FT. IMPERVIOUS AREAS mew. m•arns ~b` off OM Os offfronfro tam NO noporabft Ow oonforowoo Ma ° WOODEN CURB RAMP cum • El ° CATCH BASIN PROTECTION °o° ° WORK STAGING/ MATERIAL STORAGE WEST'I.AND HOMES Mae OAK MODEL / ° CONSTRUCT ION ENTRANCE °COVERED STOCKPILES I ,e,.■.lreRcEr 2018 PAM ° SEDIMENT FENCE N . B . ° COVER ALL AREAS OF BARE SOIL UNTIL SI PERMANENT LANDSCAPE IS IN PLACE • • 02/27/2013 16:30 5035981960 CITY OF TIGARD PAGE 01/01 Oregon Residential Specialty Code R318.2 MOISTURE CONTENT ACKNOWLEDGEMENT FORM I, J� 11 941.61W1 , am the general contractor or the owner- builder at the following address: Site Address: , • .0 _ illi V City: Permit #: OA SI bt). - oclob4 Subdivision/Lot #: 1 � j ( y'? & L C and/or �'lJ 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. dik • Signature: /I Date: a • • 1 Gene .I Contractor or Owner - Builder ■ • I:1Building\ Form 1RFS - MoisturcScnsitivcWood.doc 09/25/08 Oregon Residential Specialty Code N1107.2 HIGH - EFFICIENCY INTERIOR LIGHTING SYSTEMS Permit No.: C �I Y, 66 ado Jurisdiction: - Site Address: ii 6 3 5(). 1--GAtt- (AV Subdivision/Lot #: l9 IU I it tit and/or Map and Tax Lot #: 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: 40 ,2 • }A ' 3 Ow. - - ene al Contractor /Authorized Agent Print Name: iJ.:Pi r STREET TREE TIGARD CERTIFICATION I, <\\0\ i r- , owner/ agent for law-a-A.0.g) (PLEASE PRINT) (PERMIT H do hereby cert% that the following location meets City of Tigard land use and development standards for street tree installation and is consistent with the approved site plan. PERMIT NO.: VV S 2 Iy . - QS (01� STl E ADDRESS: 11631 5(.). ii uS1 SUBDIVISION: ' a«. -- AP,ia t i[1 SIGNATURE: ► '1E: (OWNER /AGENT) RE CEIVED d� VERIFIED BY -/ -/3 DA1 E: -- — — (CITY OF TIGARD) ❑ Tree location verified per approved site plan. N O P —R. � E I:\ Building \Forms \StreetTreeCertificate 04/01/2011 Form 640S 1\ Completion Certification —Site Inspection EnergyTrust New Homes Program — Single Family of Oregon To be completed by verifier Portland Energy Conservation, Inc. (PECI) is a Program Management Contractor for Energy Trust of Oregon. Verification Type Actual Value Equipment Details & Notes Category Insulation Flat Ceiling R- 49 Insulation Type: bib Framing Type: Vaulted Ceiling R- 38 Insulation Type: Batt ❑ Standard Scissor Truss R- Insulation Type: ❑ Intermediate Above Grade Walls R- Insulation Type: bib ❑ Advanced 23 Framing Below Grade Walls R- Insulation Type: 30 Size: Floor Over Unheated Space R- Insulation Type: bait Floor Over Garage R- Insulation Type: Slab Floor (unheated) R- ❑ Full Slab ❑ Perimeter Doors Door R- Windows Windows U- .30 SHGC: 3 0 Window Frame Material: vinyl Skylights U- SHGC: Window Area (Glazing) % Total window area: Lighting Indoor and Outdoor % # fixtures: 21 80 # of ENERGY STAR fixtures or CFLs: 17 Appliances ENERGY STAR Dishwasher 6 Yes ❑ No EF Cooling Air Conditioning SEER: no Btu/Hr: ._, Primary Heat Fireplace AFUE: 95 Brand: Fraser johnston Outdoor Unit (for heat Source on Gas Fumace pumps) ❑ Electric ❑ Boiler HSPF: Model #: TG9S060A l OMP 11 A [Gas Heat Pumps: SEER: Serial #: W 1 G1169993 Model #: ❑ Other: Serial #: ❑ Air Source (ducted) COP: Btu /Hr: 60,000 ❑ Mini Split (ductless) ❑ Ground Source Location: ❑ Radiant Floor Heat ECM: ❑ Yesfl No Heat pump commissioning Electronic Air Cleaner: ❑ Yes d No report attached or ❑Cadets cond confirmation for ground ❑ Zonal Backup fuel: ❑ Electric ❑ Gas ❑ Other source heat pumps that space X ❑ Other: manufacturer's start up procedure was performed 0 Additional notes on primary heating: Notes on secondary heating: Water Heater ❑ Storage Gallons: Brand: rinnai ❑ Electric ,ETankless ?CI Gas EF: 8 Model #: 1 .175i Location: Serial #: da. ca- 001490 cond space Btu /Hr: 180,000 Form 640S v10 120101 Page 2 of 3 Return completed form to: Energy Trust New Homes Program - Single Family 100 SW Main Street, #1600 • Portland, Oregon 97204 1.877.283.0698 • Fax 1.855.575.4315 newhomes @energytrust.org �r. Form 6405 Completion Certification —Site Inspection EnergyTrust New Homes Program — Single Family of Oregon To be completed by verifier Portland Energy Conservation, Inc. (PECI) is a Program Management Contractor for Energy Trust of Oregon. Verification Type Actual Value Equipment Details & Notes Category Ventilation Energy Trust Mechanical Exhaust Nets Energy Trust Mechanical Ventilation Requirements System Ventilation Requirement Diu5uppl ❑ Yes ❑ No ❑ Exhaust & Supply ❑ Heat Recovery ERV /HRV Model #: Ducts ❑ Ducts Inside % ducts inside: °h Ducts in Conditioned Space If lfiming incentives for ducts inside, check one of the following: O bucts Tested ❑ Visual Inspection per RTF specs Duct Insulation R- Duct Location Duct Sealing w/Mastic Paste ¥Yes ❑ No Performance Testing & Duct System Information Ducts Duct leakage must not exceed 0.06 CFM @50 x floor area, or 75 CFM @50, whichever is greater. When tested without the air handler, leakage must not exceed 0.04 CFM @50 x floor area, or 50 CFM @50, whichever is greater. Multiple tests may be required. yiC } Duct Cubic Feet Per Minute Duct Leakage Air Handler In ' in Yes Air Handler Present r Yes Leakage: (CFM) @ 50Pa: 84 Pass ❑ Fail Conditioned Space ❑ No During Test ❑ No _p Fan Pressure ❑ DG3 Fan Ring Type ❑ 0 Q Leakage Test in ¥Total Leakage Gauge laDG700 Pressure: 305 (check one) ❑ 1 ❑ 3 Method ❑ Leakage to Outside Duct Blaster Pressure Tap Location: Bath Area Tested: 2165 Location: Main return Whole House Air Changes per Hour I Envelope Tightness Cubic Feet Per Minute Leakage: (ACH) @ 50Pa: ``� ' Pass ❑ Fail (CFM @ 50Pa: 1 189 House Volume: Dpal Practices Requirements (fall requirements Gai2M ix i i EOD Energy Performance Score) • Thermal Enclosure Checklist Complete ® Pass ❑ Fail Thermal Enclosure Checklist attached? ❑ Yes • Insulation Quality Inspection Performed Yes ❑ No 4 (complete insulation verification section below) • Approved Mechanical Ventilation Installed J Yes ❑ No 4 (complete mechanical ventilation section below) • Zonal Pressure Relief — All zones comply ❑ Yes ❑ No If no, state reason for failure: • Combustion Appliance Zone Testing Net CAPressure: Pa If not applicable, please explain: all dv (required) Forced air system operation must not depressurize Combustion Appliance Zone (CAZ) by more than 3 Pascals (Pa.) *All shaded sections are required for Best Practices. Applications will not be processed without these sections completed. Technical Compliance Options (please list all that apply) If any values on this form do not meet Builder Option Package (BOP) requirements, please indicate which Technical Compliance Option(s) allow the variance and explain which component was traded. TCO #: Explanation: Additional Notes: Signature By my signature below, I certify that I have performed the tests as described, that the form is complete, and that all information on the form is accurate. Verifier preston kuckuck Verifier Signature: Name: preston kuckuck Date: 11-26-12 Red Tag Inspection (if needed): Signature: Name: Date: Form 640S v10 120101 Page 3 of 3 Return completed form to: Energy Trust New Homes Program —Single Family 100 SW Main Street, #1600 • Portland, Oregon 97204 1.877.283.0698 • Fax 1.855.575.4315 newhomes @energytrust.org Ali Program Use Only Form 640S FastTrack ID Completion Certification —Site Inspection EnergyTrust New Homes Program—Single Family Data check by of Oregon (initials) To be completed by verifier Portland Energy Conservation, Inc. (PECI) is a Program Management Contractor for Energy Trust of Oregon. First Inspection Second Inspection 9- 119 -12 Date: Verifier Name: preston kuckuck Date: 11 /26/ 12 Verifier Name: preston kuckuck Incentive Payee Company Name: Builder or Company: Westland industries Contact Name: Performance Testing Company: Fireside Home Solution Technician Name: Site Information Development Lot Number: REM/Rate SCO Project ID: Name: white oak 13 File #. (required r ew ENERGY STAR') Site Address: 11039 sw legacy oak way city: tgard State OR Zip: [.lnattached ❑ Attached Number of Stories: 3 Total Building Square Footage: 2 l 65 Number of Bedrooms Basement ❑ None ❑ Full Basement ❑ Half Basement XXJ Crawlspace Type ❑ Garage/basement combo ❑ Slab on grade ❑ Other oak plan east Electric Provider in PGE ❑ PAC ❑ Other: Gas Provider n NWN ❑ CNG ❑ Other: Electric Meter Number: 31111725 Gas Meter Number: 41371 043 (must apply to permanent meter) (must apply to permanent meter) Additional Project Information (please mark all that apply) ❑ Code plus Best Practices (meets minimum Best Practice requirements with improvements above code) ❑ Path 1 EPS Best Practices ❑ Path 2 ENERGY STAR ❑ Envelope Upgrade ❑ Ducts & HVAC Equipment Inside © Equipment Upgrade ❑ Path 3 ENERGY STAR with ducts inside ❑ Path 4 Performance Plus with ducts inside ❑ Path 5 Advanced Performance ❑ Zonal Electric Efficient ❑ Advanced Electric Resistance ❑ Solar Electric (PV) ❑ Solar Water Heating (SWH) ❑ Small Wind Renewable ❑ Solar Ready Electric (SRPV) ❑ Solar Ready Water Heating (SRWH) Energy ❑ Qualifies for Solar Ready Incentive (must attach checklist) Solar Installer: Name: Company: Low Income ❑ Yes ® No Does this project qualify as Low Income? (must provide documentation from builder) • Accessory ❑ Yes © No Is this home an ADU? Dwelling Unit ❑ Yes ` No Is the ADU separately metered? If so, provide meter numbers above Other ❑ Earth Advantage — Certification Level: Certifications ❑ LEED -H - Certification Level: ❑Other (please specify): Form 640S v10 120101 Page 1 of 3 Return completed form to: Energy Trust New Homes Program —Single Family 100 SW Main Street, #1600 o Portland, Oregon 97204 1.877.283.0698 • Fax 1.855.575.4315 newhomes ©energytrust.org EPS EnergyPerformanceScore EPS is a tool to assess a home's energy consumption, cost and carbon footprint. brought to you by EnergyTrust of Oregon EPS' is an energy performance score that measures and rates the energy consumption and carbon footprint of a newly constructed home. The lower the score, the better —a low EPS Location identifies a home as energy efficient with a smaller carbon footprint and lower energy costs. 11039 SW Legacy Oak Way Portland, OR 97223 Estimated Monthly Energy Costs YEAR BUILT 2 SQ. FOOTARTGE: : 2 2,189 EPS ISSUE DATE: 1 -22 -13 Estimated average $98 annual energy costs: Utilities: Gas: NW Natural $1 78* Electric: Portland General Electric Estimated average energy costs per month: Electric $53, Natural gas $45 ENERGY CONSUMPTION: Measured in millions of Btu per year (MBtu/yr). One million Btu = 293 kWh or 10 therms. Energy Score 56 home's energy score 200+ 150 100 9 5.0This MBtu/yr WORST MBtu/yr BEST Similar size 111 69 This home if Oregon home built to code Estimated average energy usage: Electric (kWh): 6,397, Natural gas (therms): 344 This home's qp CARBON FOOTPRINT: carbon footprint Measured in tons of carbon dioxide 0 per year ( y) er ear tons/ r ton One ton = 2,000 miles tons /yr 1 r<_,... WORST ST driven by one car (typical 21 mpg car). ® BEST Similar size This home if Oregon home built to code Estimated average carbon footprint: Electric (tons /yr): 3.4, Natural gas (tons/yr): 2.0 *Actual energy costs are based on many factors such as occupant behavior and weather. A home's EPS takes into account the N f energy- efficient features installed in the home, but does not account for occupant behavior. En e rgyTruSt O� of Oregon • �7