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Permit v CITY OF TIGARD j MASTER PERMIT III g COMMUNITY DEVELOPMENT Vary Permit#: MST2013 00033 T t G ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/24/2013 Parcel: 1 S135CA10300 Jurisdiction: TIGARD Site address: 9622 SW EVERETT TER Subdivision: EVERETT TERRACE Lot: 2 Project: Everett Terrace, Lot 2 Project Description: New SF. 11/23/13,add a/c, placement of a/c unit must comply with manufacturer's clearance requirements. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 3 First: 624 sf Basement: 0 sf Left: 4 Parking Spaces: 0 Height: 26 Bathrooms: 3 Second: 859 sf Garage: 202 sf Front: 12 Smoke Dwelling Units: 1 Third: 348 sf Right: 4 Detectors: Yes Total: 1831 sf Value: $201,675.68 Rear: 15 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: 2 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 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: Y Vent Fans: 4 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4 Furn>=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 add!500 sf: 3 201-400 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&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 1831 Owner: Contractor: SAGE BUILT HOMES LLC SAGE BUILT HOMES Required Items and Reports(Conditions) 16280 NW BETHANY CT 16280 NW BETHANY COURT 1 Ersn Cntrl 503-639-4175 BEAVERTON,OR 97006 BEAVERTON,OR 97006 PHONE: 503-502-6623 PHONE: 503-502-6623 FAX: 503-533-5164 Total Fees: $17,851.46 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTI Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0 through Rr 95 -0090. You may obtain a copy of the rules or direct questions to OUNC by calli 32,1987 or 1.800.332..2344, Issued y: ` �� Permittee Signature . r. /C�'r[_s-,\ Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept In a conspicuous place on the Job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Mechanical Permit A I I Heat.'nr F '!ED FOR OFFICE,USE ONLY • IIII City of Ti and Received Illi �J g Date/By: /1 di/ / Permit No.: t*r 0/3_6,663 q 13125 SW Hall Blvd.,Tigard,OR '72 3— Plan Review v_ C ' Phone: 503.718.2439 Fax: 503.598.19n v L 6 2 Q 13 DateBy: Other Permit: TIGARD Inspection Line: 503.639.4175 Date Ready/By: Juris: PI See Page 2 for Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information r+t'II rVAtn rlisrfol 'lI I TYPE O'1WORKgI' tJI V iv.Jldd • COMMERCIAL FEE* SCHEDULE — USE CHECKLIST Mechanical permit fees*are based on the value of the work ❑New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* ❑ 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist. ❑Multi-family ❑Master builder ❑Other: Description I Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning 46.75 Job site address: % .1 t c D [1.)6,L€fr ,00144..ct.. Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: Furnace 100,000+BTU(ducts/vents) 54.91 Suite/bldg./apt.no.: Project name: 'J f � z,�,Qfe Heat pump 61.06 Duct work 23.32 Cross street/directions to job site: 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 Flue/vent for any of above 23.32 Subdivision: Lot no.: Q.-- Other: 23.32 Other fuel appliances: Tax map/parcel no.: Water heater 23.32 • DESCRIPTION OF WORK Gas fireplace/insert 33.39 Flue vent for water heater or gas ado 4/e fireplace 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 ❑ PROPERTY OWNER I ❑ TENANT Other: 23.32 Environmental exhaust and ventilation: Name: Range hood/other kitchen equipment 33.39 Address: Clothes dryer exhaust 33.39 City/State/ZIP: Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 23.32 Phone:( ) Fax:( ) Attic/crawlspace fans 23.32 . ❑ APPLICANT ❑ CONTACT PERSON Other: 23.32 Business name: Fuel piping: $14.15 for first four;$4.03 for each additional Contact name: Furnace,etc. Address: Gas heat pump Wall/suspended/unit heater City/State/ZIP: Water heater Phone:( ) Fax::( ) Fireplace Range E-mail: Barbecue • . CONTRACTOR Clothes dryer(gas) Business name: Other: MECHANICAL PERMIT FEES* Address: Subtotal City/State/ZIP: Minimum permit fee($90.00) Plan review(25%of permit fee) Phone:( ) Fax:( ) State surcharge(12%of permit fee) CCB tic.: 'f All TOTAL PERMIT FEE ■�/ Fl`/ / This permit application it expires if a permit c ptis not o obtained within 180 / I days after it has been accepted as complete. Authorized signs t r: �IJ t ' ' ` � * Fee methodology set by Tri-County Building Industry Service Board / Date: r/il I:\Building\PermitsVMEC_PermitApp_040113.doc / 440461 (11/02/ OM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information `` Commercial & Multi-Family Fee Schedule: L Total'Valuation: o „ ° Permit'Fee: �` . 1 $0.00 to$500.00 Minimum fee$69.06 i $500.01 to$5,00.0.00 $69.06 for the first'$500.00 and $107 for each additional$100.00 or ;; fraction thereof,to and including $5,000.00. $5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and $2.81 for each additional$100.00 or ,s fraction':thereof,to and including $10;000:00: $10,000.01 to$50,000.00 $347.71"for the first$10;000:00 and $2.54:for each additional$100.00 or V fraction thereof,to and including ; $50,000:00. $50,000.01 to$100,000.00 $1,363.71 for the first$50,000'.00 and $2.49 for each additional$100.00 or . fraction thereof,,to and including $100,000.00. $100,000.01 and up $2,608.71 for the first$100,000.00 and • ,:^ $2.92 for,each additional$100_.00 or ?il' fraction thereof. �' Note: All new commercial buildings require 2 sets of plans. ,;t. ;r , y l,i • - 'v r :',V fi• 4, '1 S j1 1' 1:\Building\Permits\MEC_PermitApp_040113.doc 2 :•.'1 CITY OF TIGARD MASTER PERMIT r 4 a'.. COMMUNITY DEVELOPMENT Permit #: MST2013 -00033 T LGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/24/2013 Parcel: 1 S135CA10300 Jurisdiction: TIGARD Site address: 9622 SW EVERETT TER Subdivision: EVERETT TERRACE Lot: 2 Project: Everett Terrace, Lot 2 Project Description: New SF BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 3 First: 624 sf Basement: 0 sf Left: 4 Parking Spaces: 0 Height: 26 Bathrooms: 3 Second: 859 sf Garage: 202 sf Front: 12 Smoke Dwelling Units: 1 Third: 348 sf Right: 4 Detectors: Yes Total: 1831 sf Value: $201,675.68 Rear: 15 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 Drains: 0 Tubs /Showers: 2 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Drywell- Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 4 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Furn <100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4 Furn > =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 add! 500 sf: 3 201 -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 & Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All asin Y Other: N Other Description: Ecom P 9 BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SF VB R -3 1831 Owner: Contractor: SAGE BUILT HOMES LLC SAGE BUILT HOMES Required Items and Reports (Conditions) 16280 NW BETHANY CT 16280 NW BETHANY COURT 1 Ersn Cntrl 503 - 639 - 4175 BEAVERTON, OR 97006 BEAVERTON, OR 97006 PHONE: 503 -502 -6623 PHONE: 503 -502 -6623 FAX: 503 - 533 -5164 Total Fees: $17,799.10 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. ATTE . egon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0 10 through OA 52-001-0 90 may obtain a copy of the rules or direct questions to OUNC by calling 503.232. :: of1.8 344. / Issued Permittee Signature: L`�iea LV�' 0 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. 4 Building Permit Application a- Residential RECEIVED FOR OFFICE USE ONLY City of Tigard rf Re e;Bed a.)1 / 3 Permit No 5 / 3- X33 13125 SW Hall Blvd., Tigard, OR 97223 FEB 7 2013 Plan Review ' Phone: 503.718.2439 Fax: 503.598.1960 Date/By: iv-z_ r ' . Other Permit:0! 3 ODOj/ TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready y: c ✓ ' 1u Pi See Page 2 for Internet: www.tigard - or.gov BUILDING DIVISION Notified/Method: q1� �1 r /� Supplemental Information LA(4)lra li 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. ® I- and 2- family dwelling ❑ Conunercial/industrial Valuation: $ j T g ` ❑ Accessory building ❑ Multi - family Number of bedrooms: "'S �° ❑ Master builder ❑ Other: Number of bathrooms: a , S JOB SITE INFORMATION AND LOGAT1ON Total number of floors: O ... Job site address: 962}0. ;1 . 3 re �-E -� � ia c� New dwelling area: i 3 ( square feet City/State /ZIP: i , ��, ; i , lJt 0 � � 7 Garage /carport area: c 20, 9,. square feet Suite/bldg. /apt. no.: Project name: Everett Terrace Covered porch area: ,sV4( square fee 63,4C Cross street/directions to job site: Deck area: 1 &O square fee /9" Other structure area: 2.035 square feet 2_,‘,., REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: Everett Terrace Lot no.: Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. Residential New Construction Valuation: $ Existing building area: square feet New building area: square feet ® PROPERTY OWNER I ❑ TENANT Number of stories: Name: Sage Built Homes LLC Type of construction: Address: 16280 NW Bethany Court Occupancy groups: City/State /ZIP: Beaverton, OR 97006 Existing: Phone: (503)502 -6623 Fax: (503)533 -5164 New: ® APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* Business name: Sage Built Homes LLC (Please rejam fee schedule) Structural plan review fee (or deposit): Contact name: Katie Patterson FLS plan review fee (if applicable): Address: 16280 NW Bethany Court City/State /ZIP: Beaverton, OR 97006 Total fees due upon application: Phone: (503) 502 -6623 Fax: : (503) 533 -5164 Amount received: E- mail: katie @sagebuilthomesllc.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Commercial and residential prescriptive installation of CONTRACTOR roof -top mounted Photo Voltaic Solar Panel System. Business name: Sage Built Homes Submit two (2) sets of roof plan with connection details and fire department access, along with the 2010 Oregon Address: 16280 NW Bethany Court Solar Installation Specialty Code checklist. City /State /ZIP: Beaverton, OR 97006 Permit Fee (includes p lan review $180.00 and administrative fees): Phone: (503) 502 -6623 Fax: (503) 533 -5164 State surcharge (12% of permit fee): $21.60 CCB lic ": 189330 Total fee due upon application: $201.60 Authorized signature: if , i This permit application expires if a permit is not obtained �� P.72'691/ w ithin 180 days after it has been accepted as complete. * Fee methodology set by Tri-County Building Industry Print name: Katie ' erson Date: / /1 Service Board. I:\ Building \Permits\BUP- RESPemiitApp.doc 02/24/2011 440- 4613T(l l /02 /COM/WEB) Plumbing Permit Application �y Building Fixtures E V ft� ED City of Tigard F EB 7 2013 Date/By: 7 / 3 Sr Permit No.luS1 4 )/ 3 • ovo 3 d - n 1 31 25 SW Hall Blvd., Tigard, OR 97223 Phone: 503.718.2439 Fax: 503.598.196 C Plan Review ITY OF TIGARD Date/By: Other Permit No.: Inspection Line: 503.639.4175 D Ready/By: mri : S ee P e 2 for TI GnRD BUILDING o' g Internet: www.tigard- or.gov No tified/Method: 7�� Supplemental Information TYPE OF WORK FEE* SCHEDULE ® New construction 0 Demolition For special information use checklist Description I Qty. I Ea. I Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (I) bath 312.70 ® I- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78 SFR (3) bath , 500.32 Soo .31 ❑ Accessory building ❑ Multi- family 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: g &a, 6C6 F111° Y'L C 1.0 NcYe C Q Catch basin or area drain 18.76 Drywell, leach line, or trench drain 18.76 City/State /ZIP: Tigard, OR , 97aa 3 Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: I Project name: Everett Terrace Manufactured home utilities 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 Subdivision: Everett Terrace I Lot no.: i Fixture or item: Tax map /parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 1 25.02 015 ,0a Residential New Construction Dishwasher 1 25.02 a5 , o2 Drinking fountain 25.02 Ejectors/sump 25.02 t: PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: Sage Built Homes LLC Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: 16280 NW Bethany Court Garbage disposal I 25.02 ,oa City /State /ZIP: Beaverton, OR 97006 Hose bib 25.02 Sa .cL( Phone: (503)502 -6623 Fax: (503)533 -5164 Ice maker I 12.51 id . S 1 ® APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 Business name: Sage Built Homes LLC Medical gas (value: $ ) Page 2 Primer 12.51 Contact name: Katie Patterson Roof drain (commercial) 12.51 Address: 16280 NW Bethany Court Sink/basin/lavatory 5 25.02 05 . I O City/State /ZIP: Beaverton, OR 97006 Solar units (potable water) 62.54 Phone: (503) 502 -6623 Fax: : (503) 533 -5164 Tub /shower /shower pan 2.. 12.51 DS. t.) E- mail: katie @sagebuilthomesllc.com Urinal 25.02 CONTRACTOR Water closet 7) 25.02 75. at, Water heater 1 37.52 37. SL. Business name: Malmedal Plumbing Water piping/DWV 56.29 Address: PO Box 207 Other: 25.02 City/State /ZIP: Banks, OR 97106 Subtotal Phone: (503) 502 -6623 Fax: (503) 533 -5164 Minimum permit fee: $72.50 CCB Lie. :'oa Plumbing Lic. no.: 34- )-11,9 6 Plan review (25 % of permit fee) State surcharge (12% of permit fee) Authorized signature / I , 'v - fry[� TOTAL PERMIT FEE Print name: Katie ' : tt rson / Date: 9 //43 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) . Mechanical Permit Applicatio FOR OFFICE USE ONLY City of Tigard 1`L�� Re eBe 3 sir Y . v 1 3125 SW Hall Blvd., Tigard, OR 97223 Plan Review Permit No.: 57 a 3 - (m 33 Phone: 503.718.2439 Fax: 503.598.1960 FEB 7 2013 Date/By: Other Permit: - TI GAR D Inspection Line: 503.639.4175 Date Ready/By: 3uris: El See Page 2 for Internet: www.tigard- or.gov OF TIGARD Notified/Method: 71 Supplemental Information D1NGDWISION B TYPE OF WORK 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. Value: $ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES* ® 1 - and 2 family dwelling ❑ CommerciaUindustrial ❑ Accessory building For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning Job site address: 969A S ) a et --rpm CQ (requires site plan showing placement) 46.75 City /State /ZIP: Tigard, OR 1 9,9-3 ` ` Furnace 100,000 BTU (ducts/vents) 1 46.75 & • 15 Furnace 100,000+ BTU (ducts/vents) 54.91 Suite/bldg. /apt. no.: Project name: Everett Terrace Heat pump (requires site plan showing placement) 61.06 Cross street/directions to job site: Duct work - 23.3' t- _ 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: Everett Terrace Lot no.: 0,__ Flue /vent for any of above 23.32 Other: 23.32 Tax map /parcel no.: Other fuel appliances: DESCRIPTION OF WORK Water heater 1 23.32 93.32 Residential New Construction Gas fireplace /insert l 33.39 33.39 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 I ❑ TENANT Chimney/liner /flue /vent 23.32 Other: 23.32 Name: Sage Built Homes LLC Environmental exhaust and ventilation: Address: 16280 NW Bethany Court Range hood/other kitchen ' n equipment 33.39 33.31 City/State /ZIP: Beaverton, oR 97006 Clothes dryer exhaust i 33.39 3.1. 31 Fax: 503 533 -5164 Single -duct exhaust (bathrooms, Phone: (503)502-6623 ( ) toilet compartments, utility rooms) Y 23.32 93 - ® APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 1 23.32 „03 . '3I Business name: Sage Built Homes LLC Other: 23.32 Fuel piping: Contact name: Katie Patterson $14.15 for first four; $4.03 for each additional Address: 16280 NW Bethany Court Furnace, etc. t 141 Gas heat pump City /State /ZIP: Beaverton, OR 97006 Wall/suspended/unit heater Phone: (503) 502 -6623 Fax: : (503) 533 -5164 Water heater r Fireplace f E- mail: katie @sagebuilthomesllc.com Range CONTRACTOR Barbecue Business name: The HVAC Team Clothes dryer (gas) Other: Address: PO Box 854 MECHANICAL PERMIT FEES' City/State /ZIP: Sherwood, OR 97140 Subtotal Phone: (971) 322 -5013 Fax: (503) 352 -9349 Minimum permit fee ($90.00) Plan review (25% of permit fee) CCB lic.: 1 6 `1 I U State surcharge (12% of permit fee) TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 Authorized signature: 47/ days after it has been accepted as complete. Print name: Kati , • a • rson Date: 9_1 1 //3 • Fee methodology set by Tri -County Building Industry Service Board I:\ Building\ Permits ,L • •ermit App doc 03/07/ 2 440- 4617T(11 /02/COM/WEB) ' 05 2012 12:55PM ROSS ELECTRIC INC 5036425815 p. • l Eltvrical Permit ADDLicatiq!I RECEIVED I!, 1.7., )1' r 1., p I •, 10 ... 1 1. City of Tigard • 13125 SW Hall Blvd,, Tigard. OR 97323 FEB 7 2013 RiallIEMILM P.inliNogIST -ODU 33 Mae: 503.718.2439 Fax: 503.59E1960 impaction Line: 103.639.4171 D Omer REIMEEEREMII Permit: rvww.ttprd- or.gov CITY OF chu BUILD1N(iDIVISIO odfe 0thad: TYPE OF WORK PLAN itzvalv Q New construction ■ Additlon/alteretfon/replacement ' Please cheek ail that apply CI Demolition 400 a rms or more 0 lidd Damn sateen area iagoee er three o w ■ Other: 0 Soma ce shad 400 arms over the available hull current O Neul dl. rne and boa CATEGORY OF CONSTRUCTION waeeor 10,000 amps at ISO volts at ry0tdr �l • end 2damily dwelling ,ra, to ❑ Flaaling baild0rgr. R ❑ Commercial/industrial [] Accessory building ground, or 14009 O Commerohl•ue agricultural 1:1 Muhl -tftdly ❑ Master builder Faroe pump e8 other installation hildtnae, ❑ Other: ❑ PYn tromp. 0 llunpetloa die IC Vp or J06 8(1 E INFORMATION AND LOCATTON m ❑ L3,nargenoy Drum. larger separately derived 1yatem. n O Addllian of hew otar load of 0"A", ''g'•, •1-2, ••1. ", Job no.; Jab site address: • ( /ma o oHP cr mor ...... y . City /StatdZ(P; I � T . in a more reeidentid Balm. 0 ...... p Reeraetkmd vehicle panes. e_- 9 99 3 ❑1(eahfi<ara on a,. O Supply *chop fbr more HeQy bonbons, CI volt, nominal. $ulte/b1dg. /sip(, no.: Project name: Everett Terrace ❑ Bervin sir feeder 600 amps or more. IM Cram emct/dJrectiong to Job site: pggp Den al • 111•TM 1 MI • _ New re idead etIsingle -oream Ndeml • dwellle8 stall. 5ubdivlelon; $veretl Terrace Includes attached gal rage. Lotno•: :9_ 1.000 a.. It. or tcia 186.54 1(4.S€1 4 Tax map/parcel no.: • Ca. add'l 500 a • . R. or portion 31.92 DESCA8rION OF WORK — "�-- , - a 1 hd a above roe • ant at 1!.120 I9qith sbavc gq. A) 2 Residential New Conetrueflen !.smites energy, muhl•! 2 • retie! , di • • • vi ere . MOO 8ervlcee or • dere oatt)lgllon .ra , :, and/or relocation 200 a.... or lase 10010 • a ® PROPERTY OWNER r 0 TENANT 201 amps to 400 am • . 2 Name: gage Bgflt Horned LLC 2 401 amps to 600 200.34 Address: 16280 NW Bethany Court 601 amps to 1,000 amps 301 2 Over 1,000 amps co volts 333.26 2 City/State/ZIP: Beaverton, OR 97006 emporary sery cgs or dere nMalletloa, a term on, and/or re ca tion Phone: (903)x01.662,1 Fax: (503)533.5164 100 amyl or lope 59.16 I 6 caner ittetalletioel This Instal erica It being made on property that I own which is not 201 amps to 100 aps t i 123.08 2 Intended ibr gale, lease, resit, or exchange, according to ORS 447, 449, 670, and 701, 4nl sense to 599 amps 16g�4 2 Owner signature: __ Date: A. nub &cult, - n hra circuit ken* , or enteaalon, per easy ® APPLICANT A. Fo roh circuit wilt, ❑ CONTACT PERSON abo � aroles or Nader ll. 7.42 2 Business came: cage Built Homes LLC �u B. Pee for branch circuits willow Contact name: Katie f'anereon - service or Resler Re, Ayer branch efrouit 56.16 2 Address : 16280 NW Bethany Court Bach add'1 branch circuit 7.42 i 2 City/State/ZIP: Beaverton, OR 97006 ' Mlaceilaneom eatvke or War lot included) ' Each mmulhctured or modular dwaning, badge 67.84 2 Phone: (503) 502.6623 l Fax:: (503) 533 - 5164 Reconnect only 67.81 2 f3•rnail: Wltleti�segebulithomealle.eotn !'step or irrigation drole 67.94 2 CONTRACTOR - Sign or ouuine llgfttlnj 67.84 2 Business name: Roes Electric 61gna)dreult(e) or limited-energy ,- tVnel.A eeratioe, or catenalon. Pax 2 - - 2 Address: nee R 75 M203 Each Additional Inapeellon over now pia In say 'import .--____ Additional lnepootlon(Ihrminj 66.25/ hr City/State/ZlPt Mahar% OR 97123 Mveetlption (I hrtnln) 66.2!/ hr Phone; (503) 642 - 3800 , Industrial plant (1 hr min) 78.18/ he Fax: (503) 6424515 Inspections iter which no heals Cal Elect Li . u Iwalticelly listed 9i hr min) Lie.: 90,001 hr X 57 89 I 3 •— lj3 e Suprv. Lie. l 5 i ELECTRICAL PERAUT FEES Sum. Electrician signature, required: 1(.., DD,, Plan review 25( 96afma`Itl6eT' r • god' . i Date: Stalls surcharge (11% ofpeamlt t*e): - Authorised signature: / / TOTAL, PERMIT FEC: ` ", +� AM AM Thle punts mire, applicenoa e, Ira permit to oat dolma unit& Igo Pnlnl name; Katie P /ion Date: des efts. le him bawl mimemimed a oampeete, • Plumber of Inspections avowed per smolt. imentinglprmgag • Our irOm a7lgtrI12 6112+61 111I1N5/CpMIWa8 • I Building Division Development Code Provision Review \\ T i G A ft D Residential Projects Building Permit No.: R-( S l ayl - UG,c) 3 3 Site Address: 9 (p al-- - 1) l p2c_. ri - ic rL.(_- Project Name & Lot No.: L.?" 1 2E4 (7' TER-Q, 4-071 - CWS Service Provider Letter Required: Yes ❑ No Er Received: Yes ❑ No ❑ Routed Plans: Original Plan Submittal Date: -/ ' I, 3 sr 1st Revision Submittal Date: A/POil 3 4 ❑ 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. , / ' / /, ,, n Planning Review (contact at 503 -718 19v or A t.�� " @tigard- or.gov) Land Use Case No. '1/�.07t7 /k /i 9/ z . Zoning / -- / Z- Ir1 Setbacks: Front / Z— Rear / 5 Side "( Street Side / 0 Garage 2 ff Building Height: '?> S / Actual Building Height f Visual Clearance ('Easements ❑ Sensitive Lands Type: Street Trees ❑ Protected Trees Notes: • ' , i , / - /,�y 6i t A/ � �� / . Original Plan: Approved ❑ Not Approved LE Date: '' /// /' Revision 1: Approved,2 Not Approved ❑ Date: 7 — 20 - << - Revision 2: Approved ❑ Not Approved ❑ Date: (Review Continues on Page 2) Page 1 of 2 Engineering Review (contact Mike White at 503- 718 -2464 or MikeW @tigard - or.gov) ❑ Actual Slope: cyo Notes: Original Plan: Approved ❑ Not Approved 0 Date: Revision 1: Approved Not Approved ❑ Date: 2 Mi 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 Applicant: Revision 1: Date Sent to Applicant Revision 2: Date Sent to Ap.licant Okay to Issue Permit: Yes W. No ii I Date Routed to Buil • • 7"� ? lI Page 2 of 2 Building Division Development Code Provision Review T I G A R D Residential Projects Building Permit No.: ,5T '0 Project /Subdivision Name: T r . . - 5 1 2 L 712elr Lot #: Site Address: qcv 2 o .e) eU 02.e ( . CWS Service Provider Letter: Required: Yes ❑ No ❑ Received: Yes ❑ No ❑ Plans Routed: Original Plan Submittal Date: Routed By: 1" Revision Submittal Date: ¥ (( (I ( « ❑ Site Plan Only Routed By: 2n Revision Submittal Date: ❑ Site Plan Only Routed By: 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 (1) 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 >/ iifapproved. /,/ Planning Review (contact /�T� at (503) 718 - Y or 44 @tigard- or.gov) r Land Use Case No. JZ1 A4l /'?: Zoning /2 — - Er Setbacks: Front 1 Je Rear / 5 Side / Street Side r Garage Z ❑ Maximum Building Height: Actual Building Height ❑ Visual Clearance ❑ Easements ❑ Sensitive Lands Type: ❑ Street Trees E Protected Trees Notes: � � � G� ' . ' O fr Original Plan: Approved V Not Approved ❑ Date: / Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: (Review Continues on Page 2) Page 1 of 2 I: \CURPLN \Masters \Development Code Provision Review \DCPR_RES.doc Rev. 01/16/13 Engineering lleview (contact Mike White at 503- 718 -2464 or MikeW @tigard- or.gov) .12- Actual Slope: v % . . Notes: • Original Plan: Approved .a Not Approved 0 Date: 4 (51 • Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2:. Approved. ❑ Not Approved ❑ Date: • Permit Coordinator Review (contact Albert Shields at (503) 718 -2426 or albert @tigard- or.gov), D Conditions of Approval Prior :to' Issuance of Building Permit Notes ;: - • Original Plan: Date Sent to Applicant: Revision 1: Date Sent to Applicant Revision 2: Date Sent to Applicant Okay to Issue Permit: Yes?5P No ❑ Date Routed to Building: • • Page 2 of 2 I: \CURPLN \Masters \Development Code Provision Review \DCPR_RES.doc Rev. 01/16/13 FOR OFFICE USE ONLY - SITE ADDRESS: This form is recognized by most building departments in the Tri -County area for transmitting information. Please complete this form when submitting information for plan review responses and revisions. This form and the information it provides helps the review process and response to your project. City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT :. • Transmittal Letter T I G A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: )GC\ f l? �� DATE RECEIVED: DEPT: BUILDING DIVISION R ECEVE O (� APR 1 1 2013 FROM: 1 f CITY OF TIGARD COMPANY: C-� l� \`�' t"�� RUNG DIVISION PHONE: 1� . (p c,g a —� y : RE: - S 6j €M rt 2c�_ • r�SC -0-013 - cros- (Site ddress) (Permit Number) 'E� Lok .g — r o�ec t na me or su division name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies• Description: Additional set(s) of plans. Revisions: ° C.:Y? GL Cross section(s) and details. Wall bracing and/or lateral analysis. Floor /roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. Other (explain): `` ,,�-, pt&n REMARKS: JC e ,Wf ` 4 . `, )P C �� C� &Y (A S - �- FOR OFFICE USE ONLY Routed to Permit Technici : Date: L 2 Z_. Initials' Fees Due: ❑ Yes No Fee Description: Amount Due: Special Instructions: Reprint Permit (per PE): ❑ Yes ❑ No ❑ Done Applicant Notified: Date: Initials: 1: \Building\ Forms \TransmittalLetter - Revisions.doc 05/25/2012 FOR OFFICE USE ONLY - SITE ADDRESS: This form is recognized by most building departments in the Tri -County area for transmitting information. Please complete this form when submitting information for plan review responses and revisions. This form and the information it provides helps the review process and response to your project. City of Tigard • COMMUNITY DEVELOPMENT.DEPARTMENT Transmittal Letter r 1 c: n It n 13125 SW Hall Blvd.'• Tigard, Oregon 97223 • 503.718.2439 • www.tigard- or.gov TO: �� DATE RECEIVED: DEPT: BUILDING DIVISION f FROM: FEB 2 0 2013 CITY OF TIGARD COMPANY: BUILDING DM, PHONE: 5t.D '2 - - - Q 7 , �Y RE: N f 3 Gto 3 3 (Site A dress) (Permit Number) E3 I - 2- (Project name or subdi vision name a nd lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: , Description: Additional set(s) of plans. Revisions: Cross section(s) and details. Wall bracing and/or lateral analysis. Floor /roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. Other (explain): REMARKS: 3 , c • FOR FFICE USE ONLY Routed to Permit Techniciap Date: > 'ZZ Initials�I %,, Fees Due: ❑ Yes E Ito Fee Description: Amount l ue: Special Instructions: Reprint Permit (per PE): ❑ Yes ❑ No ❑ Done Applicant Notified: Date: Initials: I: \Building\ Forms \TransmittalLetter - Revisions.doc 05/25/2012 FOR OFFICE USE ONLY — SITE ADDRESS: This form is recognized by most building departments in the Tri -County area for transmitting information. Please complete this form when submitting information for plan review responses and revisions. This form and the information it provides helps the review process and response to your project. City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT NI Transm Letter T'icn it i) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard- or.gov TO: 7 >in 1 Q1(---D DATE RECEIVED: DEPT: BUILDING DIVISION RECEIVED FROM: ti 42, ',o_k-k-g-(0-1(A APR 1 1 2013 CITY OF TIGA COMPANY: 111164 + Ho\o/b2, BUILDING DIV S PHONE: • - J � By: RE: l 2- SR ` C` _ rns� - ) - (Site • ddress) (Permit Number) 11 WA- roject name or su idivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Description: Additional set(s) of plans. Revisions: CJ Cross section(s) and details. Wall bracing and/or lateral analysis. Floor /roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. Other (explain): 1�-, . pt&n. r. REMARKS: ��j J s �t-�c�� ,�1� Cpl C� ain a �-��'► FOR OFFICE USE ONLY Routed to Permit Technici Date: �. Initials Fees Due: ❑ Yes YNo Fee Description: Amount ue: Special Instructions: Reprint Permit (per PE): ❑ Yes ❑ No ❑ Done Applicant Notified: Date: Initials: I:\Building\ Forms \TransmittalLetter - Revisions.doc 05/25/2012 • . '4 l i RECEIVED APR 1 1 2013 ? m Q 9622 SW EVERETT TERRACE �; CITY N TIGARD o� Z z ■ �Z � r B UILDING DIVISION Q Q Z ° e = o m �� LOT 2 OF EVERETT TERRAC Q a. 1 W. Q y y �o SITE PLAN - I ' ��; �a_,a NOTES EX 1 amt' q , CI STORY Heuv Swag 04 OWNER / BUILDER <•>A O PER SHEET 5,9.10/16 ASSwtTS 2 Ex 8 SANITARY MAIN SAGE «ism HOMES - SCHEMATIC DRAINAGE PROFILE O PER SNEET 49,10/16 MAI AstTtr¢i 16280 NW BETHANY COURT #200 e . +c - E/EAYER7ON �OR 97006 =4887 I 3 NNEC 10 4' Y to TERAL I r O P SHE AAfO SANITAR AS3UL NOTES I ..x ■� a w� I e 4O. .NW 4 CONNECT 70 E X 4' 5717AI LATERAL Ow "— • 6 °° 'O PER SHEET A A10/18'ASBUILTS LOT COVERAGE g • .°� r O YR7CADON PLANTINGS PER 2624' S" 2 I BUILDING ENVELOPE T84 ..,w. MA. `.. SHEET 71/T6 A,BUL (30X) I. ' 1 .. a .ea STREET FANG FACADE ,• T . ,' > 6 Ex TREES TO BE RETAINED PER EAST FACE 295 5 44 25 5 = f SPIMS JA a •78 6 AS3UHL7S QA78NG : 47 SF (isle : ' r 'ti ; •.. ; „ G . i' '',. - .... d TREE PR01EL"TfON FENCING ZONING R -12 5.AL= 'n. iY, `io1' 'v4 m iag our •�Y • :a .C- .1■:.• w� m - ?V+v ,( {maw i a.•o a .. +7 . ., - . , oeaa a..n a r i ., 44% CI nwn •:Y ",_ r Z' : .i_ " "+� rrwv X X TREE PR07EC7fON.FENLE 'Ct' 'i.' .4 r a 441,4 o GENERAL INFORMATION , :: _ .` f 6 G•M�O =��a �"��°°" PROPOTTY CORNER RN • r >-, a Sao Lev Pet .waa am MU ;r: p • aKart •evx toamc STE ADDRESS 9622 SW EVFR£TT 7RERRACE a � "� � °i 1 ■' 1 TAX, If pl: LOT Z EVERETT TERRACE NOTES: p - f7HOV YARD SEIBA 75-FT t t n .en .race • CALCIUM H EUROPEAN HORNBEAM a. GARAGE YARD CIL SETBACK: 16 — R grape mu ±ea 1.11.4 +1.414 2 CALIPER S1DE1YARD SETBACK 4-FT (-ADJUSTED AS PART OF APPROBAL) BOX �� ) - - POT ?LOTS: i 5: 99 0 � a MP 4WD Kram� as w.c YARD SE78AOK 75—FT s w MAW w NORM o .•e°• emus DBE Of PUNTS: ue■ 1144.4s !fFR3ACEOeS ow am asm.a■, . / '� DOUGLAS F1R / L',' 67110,02' Kr 9E CF STS + v _ Ma.m O INCENCE CEDAR VINE MAPLE/RED ALDER 40-2. n Paw oast ISOli 2 CALIPER _ GARAGE LEFT/ ELEVATION V' UD' ,....." ClenoWairSavisa a.o+o I J I CO PO I I I ; I I , ` MI 1 A 3 BM ': "I ll I 1 1 auk I Irt 01111 i 1 40 " Ili= EMI 1 Illita.a !, :2- / WO , • : . ...._ _.1 ill % Mill %, 1 1 Iiiiii ' / - - I O� v iiiiii 1 � 1 I - 1 I v V v • ' I — I - - - -- FL - -- _ � 1 19k1" — I I .1` ' ‘ i J Location: Record Type: Inspection Type: Comments: Inspection Date: Record ID: Result: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 9622 SW EVERETT TER, TIGARD, OR, 97223 Residential - Master Permit 199 Electrical ﬁnal 2013-12-10 00:00:00 MST2013-00033 PASS Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Comments: Inspection Date: Record ID: Result: City of Tigard 13125 SW Hal Blvd. Tigard, OR 97223 Tel: 503.718.2439 9622 SW EVERETT TER, TIGARD, OR, 97223 Residential - Master Permit 699 Mechanical ﬁnal 2013-12-09 00:00:00 MST2013-00033 FAIL 1. Correct ﬁreplace not working, recall when completed Violation Summary: Inspector Contractor 1111 CITY OF TIGARD CERTIFICATE OF OCCUPANCY to : Permit #: MST2013 -00033 COMMUNITY DEVELOPMENT Permit Issued: 07/24/2013 T 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 1S135CA10300 Jurisdiction: TIGARD Site address: 9622 SW EVERETT TER Subdivision: EVERETT TERRACE Lot: 2 Project Description: New SF. 11/23/13, add a /c, placement of a/c unit must comply with manufacturer's clearance requirements. Class of Work: NEW Type of Use: SF Type of Constr: VB Occupancy Group: R -3 Occupancy Load: Fire Sprinkler Required: Project Name: Everett Terrace, Lot 2 Owner: SAGE BUILT HOMES LLC 16280 NW BETHANY CT BEAVERTON, OR 97006 Phone: 503 - 502 -6623 Contractor: SAGE BUILT HOMES 16280 NW BETHANY COURT BEAVERTON, OR 97006 Phone: 503 - 502 -6623 Fax: 503 - 533 -5164 This Certificate issued 12/13/2013 grants occupancy of the above referenced building or portion thereof and confirms that the building has been inspected for compliance with the 2011 State of Oregon Specialty Codes for the group, occupancy, and use under which the referenced permit was issued. Mark VanDomelen Building Official City of Tigard s POST IN CONSPICUOUS PLACE S TREET ET TREE - ° . ..• TIGARD TION , owner/ agent for SoL&e_ Bu c1AA -4 L < (PLEASE PRINT) (PERMIT HOLDER) do hereby certift 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.: — Z-0 — ©©o , 3 ME ADDRESS: 76 z z G �i�o .�T T e�' - 6d S UBDI VISION- �v� r err s LOT #: 2— SIGNATURE: �� / DAZE: /2 /7/ /3 O WNE AGENT C ( R/ ) RE CEIVED & /) VERIFIED BY / - DA 1 E: 1.2/13/13 OFTIGA' • ' ❑ Tree location venfied per approved site plan. I: \Building \Forms \StreetTreeCertificate 05/30/2012 Oregon Residential Specialty Code 8318.2 MOISTURE CONTENT ACKNOWLEDGEMENT FORM I, �e_Lmney f r e, isA ft \4j pi{,5,t t am the general contractor or the owner- builder at the following address: Site Address: City: Tf GA r ,- \) Permit #: / V3 . z7(3 —O © 3 3 Subdivision/Lot #: / Z- 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: /2/7/20 ( 3 General Contractor or 0 - Builder I:\Building\Fonn\RES- MoistureSensitiveWood.doc 09/25/08 Oregon Residential Specialty Code N1107.2 HIGH - EFFICIENCY INTERIOR LIGHTING SYSTEMS Permit No.: Jurisdiction: ■ MSI -2-013 -et0 Cl ‘ sir DF T ^1, (oir Site Address: q� 7:7.- - - -- Te/r/.4�, r v Subdivision/Lot #: ,— 'e T e rrA -!'.P - - 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: . ,,,,/ I2- /y Z e2 / 3 g Owner /Genera - Ito o r /Authorized Agent ` Print Name: GA--GI= 60 i vy_ 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. 1:\Building\Forms\RES- HighEfficiencyLighting.doc 07/01/08