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Permit n CITY OF TIGARD MASTER PERMIT I II a COMMUNITY DEVELOPMENT Permit #: MST2012 -00088 T I GA R L7 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/24/2012 Parcel: 1 S136CA09100 Jurisdiction: TIGARD Site address: 11041 SW LEGACY OAK WAY Subdivision: WHITE OAK VILLAGE Lot: 12 Project: White Oak Village, Lot 12 Project Description: New SF BUILDING Floor Areas Required Setbacks Re Stories: 3 Bedrooms: 3 First: 636 sf Basement: 0 sf Left: 3 Parking Spaces: 0 Height: 30.5 Bathrooms: 3 Second: 1006 sf Garage: 364 sf Front: 10 Smoke Dwelling Units: 1 Third: 523 sf Right: 3 Detectors: Yes Total: 2165 sf Value: $239,757.08 Rear: 13 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: Rain Drain: 1 Urinals: 0 Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100 0 Tubs /Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: 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: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 4 Furn > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits 1000 sf or less: 0 0-200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0 Ea add! 500 sf: 0 201-400 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: N 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 - 245 -9715 PHONE: 503- 245 -9715 FAX: 503- 598 -9081 Total Fees: $17,530.61 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. TION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 1 -0010 through OA - 1- 90. You may obtain a copy of the rules or direct questions to OUNC • - ' 32.1987 or 1.800.332.2344."` Is ued By: Permittee Signa re: • � _ _:i i ' / Coc----- Call 503.639.4175 by 7:00 a.m. for the next available Ins • • , , This permit card shall be kept In a conspicuous place on the job site until compleJjeff of the project. Approved plans are required on the job site at the time of each Inspection. z RECEIVE R T ��� �fl�t�ml�� � .(J � I I ILL L L �j ti ` I r' _ - -! 7 2012 :- - APR 2 � ' , : 1 City ®f Miga � < ,1 P 1 P-arm: OJT � , • . Hall CITY OF TIGA'B '� 7 r ' 13125 SW . OR 972 ., PM= 503.7182439 Fax: 503.598.1960 J�1 G• F�mit�' a /a-OQ� `� BU ILDING DIVI ® �_� I nspection I S0 3.639.4175 :.. L - LGr _ D ■ latemet wwwtigard•or.gov 1::..... �% �� TYPE OF WOR REQUIRED DATA: 1- AND 2-FAMILY DWELLING ',New contraction ❑ Demolition Permit fees' are based on the value of the work preowned. Indicate the value (rounded to the nearest dollar) of all ❑ Add tion/altewli ❑ Other: egmpimmt, materials, labor, avedurad, and the profit fin CATEGORY OF •CONSTRUCTION - work indicated ®lineapplication. yil 1- and 2- family dwelling ❑ Coannemialfindustrial Valuation. S 22?-9 ) 76 - 7. Q ❑ Accessory wag El Multi-family Number of bedroa®s: 0 Master builder ❑ Other: Number of bathrooms: � r dOP. PM 1M� 1,TR11'9:A 0610.1. ICA'11DN .. . Total number of floors: 3 t� i J Job site address: ad / ISO 1 t y aA � New dwelling area Z, (J square feet cit l i ihe,o, .0,8 17223 Garge'carportarea` - square feet es Suitelbldglapt no.: I Project name: 41)/L/ ` i Kzo-- Covered porch area 9. I square feet ler6 Cross street/directions to job site: • D area: - square feet Other structure ores: 7_r square feet W 5 REQUIRED DATA: COMMERCIAL -USE CHECKLIST . Subdivision: Wki 11 ax v I Lot no.: / a Permit fees' are based on the value of the work performed. Tax map/parcel no.: 5 36 ��{ / . Indicate the value (m®ded to the nearest dollar) of all `o equipment, materials, labor, overhead, and the pmfrt for the DESCRIPd7ON OF WORK work indicated on this application. /� O � �! 3 , M A I � , ` e_ Valuation: $ c,/� 6 Existing building area: square feet New building area square feet ❑ PROPERTY OWNER I 0. T$Nf1* Number of stories: Name: • Type of construcction: Address: Occupancy groups: City/State/ZIP: Existing: Phone: ( ) Fax: �� ( ) New VW / APPLICANT ❑ COMCF IEISSQN • BUILDINC . • Business name: ST4 '',) a 77/' S v iew a roe (or d e o s i t): ale) p Structural plan re fee (or depo Contact name: /60ti 4j — jail 57 D,84tr�i FLS plan review fee (if applicable): Liz 6 70 S�/ 6a= 4✓ . ST n O Total fees due upon application: o: / (6Y Y q 2,L .- ? � __ Aioiuit ?,D C 03 2r3 J ") • 4 5 . 0414 ' t 6.71 1V Plumbing Permit Applic Building Fixtures ENED • F. O I: F I c i U c ,, O,,:1 City of Tigard Received J7 /� Ne : j 1 � -�xrG 8 13125 swain Blvd, Tigard,OR 2 7 2012 DPoert?1�allo : `� /a -cr7� Phone: 5 °.718 7139 Fas 503398.1960 Datay: InspedlonLme: 5°.639.4175 CITY OF TIGARD weRe�y: Inds la aee2for T G `� )` �� Ramat www. a r gov WILDING DIVISION I � t "�° • New conahnaron I ❑ Demolition I Qty. Ea Taint ❑ Addition/alteration/repkacement ❑Other: New t- 2- hunly dwellings (includes 100 ft. for each utrTdyconnection) . SFR (1) bath 1 312.70 • CAIEG9Bll OF �ONSTRUCTIQN� : (Z) bath 437.78 Ibl � y dwelling ❑ SFR (3) bath Q 50032 , -- ❑ Accessory building ❑ MY Each additional 25.02 ❑ Master builder - ❑ Other: Fire sprinkler (_ s4- $) Page 2 ;OB TE". l *T F AU ii47 Site Whin: : //// basin or 18.76 Job site address / _. - f S Drywall, leach fine, or trench drain 18.76 City /s ue' Ar [,'. ! Footing dram (no. linear $: __) Page 2 no.: Project name: r lid: /` .;i` Manufactured home Mies 50.03 Cross street/diredions to job site: Manholes 18.76 Rain drain cmmector 18.76 Sanitary sewer (no. linear ff.:._) ( Page 2 Storm sewer (no. linear $: __) / Page 2 Water service (no. linear $: _, I Page 2 Subdivision: V//i f 4 , f i 1 „' Lot no.: Fixture or item: i BackOow praventer 3117 , Tax map /parcel no.: / / " fed je Backwater valve 1251 DESCRIPTION OF WORK =: �4r 51 % /G �( 25.02 Drinking fountain 25.02 . Ejectors/sump 25.02 ❑ PROPERTY OWNER I j WWI' Expansion tank 12.51 - - • Name: Fixturelsewer cap 25.02 -' Floor drain/floor sink/hub 25.02 Address: Garbage disposal i 25.02 City/State/ZIP: Hose bib Y 25.02 Phone: ( ) Fax: ( ) Ice maker ` 25.02 �P]CICANT r r 12.51 • ❑ � CONTACT PERSON Interceptor/grease hap Bminess name: 241,4' 1.' ,4 Medical gas (value: $ ) Page 2 - , Primer 12.51 ' ntact name: , : / ';,' l; 1 �l4 < �, !6- Roof drain (commercial) 1231 ,ss: e �/ 00 Sink/basin/lavatory 25.02 ?ZIP: Solar wits (potable water) _ - - 62.54 3 711 / TO 17 /, � ^ � ' (1 �� /shower/showerpan 0 l 9 .51 Y. 4 4 44 ,,,.--- ( (4 oex7140 -.6V ;y" b346 /7,4.( A //mss 6 s 76,071414- ..„- •/ P2GJrl:3 NA/`1 &- : /2 /4h go ;,. �7l.,1 r Electrical Permit Applic CEIVED FOR OFFICE L'sE ()NIX City of Tigard APR 2 7 2012 CI 6-7 /9- 1 PerdtNo.: I�15ra )/a - aa0gg l 13125 SW Hall Blvd., Tigard, OR 97223 pi Review C Phone: 503.7182439 Fax: 5 D /By; Other Permit VWd'.01 l" 16 n R a inspection Line: S(8.639.4175 v F �G� � Date Ready/By. lark RI See Page 2 for Internet www48 BUILDING DIVISION Notified/Method: Snpplcmeatallnformation TYPE OF WORK - • ,�, -.;. . - P7 AN .c : • - ,�New construction ❑ t�dditicm/alteration/replacement Plea all that apply (submit of plans ;items below): ❑ Demolition other: ❑ or f 400 maps or more ❑ Working over stories. where the available fait current ❑ Marinas and boatyards. • ' CATI0Q$Y OF. CONS'138UCITON 10,000 amps at 150 volts or ❑ Floating bu ld ngs. dwelling has to ground, or exceeds 14,000 ❑ Commercial -use agricultural and 2-family lling ❑ C ommercial mdustrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi- family ❑ Master builder ❑ Other. ❑ Foe pump. ❑ Installation of 75 RVA or ❑Emergency systm larger separately derived system. • • JOB SITE INFORMATION An LOCATION., ., . • • ❑ Addition of new motor load of ❑ "A ", "B", "1 -2 ", "1 -3 ", Job no.: Job site address: // I � / " _ ! / l€6-46y ate Six � residential units. ❑ Recreational vehicle tom. /�., �h.� tin. ❑ Supply voltage for more than City/State/ZIP: I j �' �� �l , aj ❑H ['Hazardous locations. 600 volts nominal. Suite/bldgJapt no.: Project name: A 04 g ❑ Service or feeder 600 amps or more. FEB • • SCHEDULE. Cross street/directions to job site: Dervipum I Qtr. I Fee. I- Total I • New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: iliN-tr. Dog v U - Lot no.: 1,000 sq. it or less I 168.54 W Ea. add'1500 sq. ft. or portion 33.92 I •(4i 1 Tax map /parcel no.: Limited energy, residential �..t77` & DESCRIPTION /1/ �`5 � OF WORK. (with above sq. R) 75.00 ..75.E 2 a/�5! /4 v1 U 1 Limited r si energy, residential (with multi-family 75.00 2 ��� residential (with above sq. ti) Services or feeders installation and/or relocation 200 amps or less 100.70 2 ❑ PROPERTY OWNER I ❑ •TINA 201 amps to 400 amps 133.56 2 Name: 401 amps to 600 amps 200.34 2 • 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation, alteration, and/or City/State/ZIP: relocation Phone: ( ) l Fax: ( ) 200 amps or less 59.36 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 to 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 branch circuits with APPLICANT I 0 CONTACT PERSON above service or feeder fee, - 7.42 2 each branch circuit Business name: ‘$ , A/01 .. E 5 B. Fee for branch circuits without service or feeder fee, first 56.18 2 Contact name: /o6 AND :av J'lr Cf pl`X/D4Ip,� branch circuit Each add'I branch circuit 7.42 2 Addres /a 610 $/ �qf� —j` zif j/ Q Miscellaneous (service or feeder not intended) Each manufactured or modular 67.84 2 City /State/ZIP: 7 i e.,0 / Og- 17 2,3 3 dwelling, service and/or feeder Phone: Is-gm-10g Reconnect only 67.84 2 D )5 77 , p74 Fax: (� 3 I Pump or irrigation circle 67.84 2 E - mail: • Sign or outline lighting 67.84 2 CONTRACT CIF. Signal circuit(s) or limited-energy Business name: GG e q / / a l t7 � ! panel, alteration, or extension Pa 2 = Each additional inspection over alloy: a','- ; /'35 ;3 • Arklitir �1 ;ction hr min) � / '3 -Z Z i 93. A f.QP9 977 — 715/ A riir 7-01- 1t-42 6 r, 7 3 / c-C- . 6 � : / 2,4 ) 6494, . 7 491 5 si6-Atemozp 1/40 9. / y 4'EP2 /,rte :T yrft s q ' 5 — a-L(— i -)_— litactianicall Permit Aophicata ECEIOIE 7 17.014. 01717 1 cr U:' E ON 1_,) ' ; ' 1 City a ox 97223 APR 2 7 2012 '/'7 7 P Na: � S aci /a- oX ' k.-: ; Phone: 50/7182439 Fax 503.99&1960 O P� p� 00/ ? . 7 i T , 6 , R D 5 �5 CITY OF TIGARD Dc midi ® sco ph _ I Internet vavw.tigankir.gov BUILDING DIUISIO 1 .. ?wool: ;:" GI New construction ❑ naam�/alte�ti pen�nitf es° are based mat value of the work pert need .Iudiratetilevalue(roandedtotI rnuestdollar) ofa1 ❑ Demolition ❑ ONE: l materials, equipment, labor, ova and prat Velum $ 1i1 I- a n d 2 - f a m t l y dwelling ❑ Commereialfindastird ❑ M e mo r y building For tgedal Information we eke ffiet ❑ Mufti-family ❑ Master builder ❑ Other: Desmiption Qty. I Ea. 1 Total Jab site address � "y� F� " I I 11 ! '_• /; % " ! ; (reyuimss eptanabawinsn� 46.75 Ci1.y Z P: / ; 0 , /NW Furnace 100,000 BTU (dodsvenia) I 46.75 Ai' • I , SW,..." Furnace 100,000+ BTU (dmdslvmm) 5491 Suite/bldg./apt no.: - Project name: f�d6 �,Q/G Heat pump '**� �,s�. t.d/r� (egouas aim Wan ahowrosPlacement) 61.06 Cross street /diredians to job site: Ductwork 2332 • Hydroaic hot water system 2332 Residential boiler (radiator or hydronic) 2332 Unit heaters (f ml -type, not electric), in -wall, in -duct; suspended, etc. 46.75 Subdivision: wirer_ Lento.: 1 V Flue/vent Sur any of above 2332 Tax map/parcel no.: p - , Other: - I � 23.32 1 5 / (',9- 090V _ Other fuel appliances: DESCRIPTION OF WORE Water heater I 2332 eg Gas fireplace r 3339 Flue vet for water heater or gas fireplace 2332 Log lighter (gas) "2332 ' Wood/pellet stove 3339 • Wood fireplace/iosert _ 2332 ❑ PROPERTY OWAllgR I Q TENANT Chrmney/Imer/flnehtent 2332 Other 2332 • Name: Environmental exhaust and ventilation: Address: Range hood/other kitchen equipment I 3339 City/State/ZIP: Clothes dryer exhaust - ( 3339 Single-duct exhaust (bathrooms, lap Phone: ( ) Fam ( ) toilet compartments, utility rooms) . , kO ` J 2332 (((o 4.E �1[CAIV'1' ` q �ACF PERSON Attickxawlspace fans - 2332 Other: Business naru.: f Ll 1 L �� s "'�' — 2132 Cora ^, $14.15 far Suit Slur; SUB for each additional //4 rei � i �� ? Ole, v``C" d�C . etc. - �'� �� t he 573 -CS-063 s(_) rt-,19 I � /iii q -3 / • \ d t_ 7.t 6 /042... bt) Art..-C ?P a°177- ‘1(n(1), t 0 . , 1 . cam L---o---1 / — l AO karel. Oak LO 1 o . B uilding Division Development Code Provision Review T I G A R D ,.---- Residential Projects Building Permit No: H 4. 31 - 9 ( L- - czog8 CWS Service Provider Letter Received: Yes ❑ No ❑ N/A yit: Routed Plans: Original Plan Submittal Date: 'I/ //2 1st Revision Submittal Date: ❑ Site Plan Only 2nd 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 t ll � eff `` o �� nly if approved. ` Planning Review (contact �Nu4� l at 503 -7 718 - oliK I or s @tigard or.gov) Land Use Casej'lo. 5 a, 42001# `00 Name t,)41 ry DA.- VII,146% ❑ Zoning w ❑ Setbacks: . Front ID Rear 1 3 Side 3 Street Side IS Garage o ❑ Maximum Building Height ,g Actual Building Height 4t) Z � . ❑ Visual Clearance Ptt' ❑ Easements g OA ❑ Sensitive Lands Type: Notes: Original Plan: Approved el Not Approved ❑ Date: 46'11/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) An Actual Slope: 5 iyo Notes: Original Plan: Approved Not Approved ❑ Date: s (/ / L Revision 1: Approved ❑ Not Approved ❑ Date: I Revision 2: Approved ❑ Not Approved ❑ Date: (Review Continues on Page 2) Page 1 of 2 1 City Arborist Review (contact Todd Prager at 503- 718 -2700 or todd @tigard - or.gov) l treet Trees LY Protected Trees Notes: • Original Plan: Approved Er Not Approved ❑ Date: p /3a! a 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) ❑ 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 Appli t Okay to Issue Pernut: Yes No ❑ • ., . _ Date Routed to Building: 5// • Page 2 of 2 ® RECIE/v . ` ' ; � ' ; CI 8 2 1 2012 p ee UI(p/ O Diver.. " GAR MARK STEWART N HONE DESIGN --f 4144--- (0 13 _0" / 4 , I _0 1. 1�� �0" I m .E. 0.0' 73. 9 P.U.E. E.E. 0.0' \ _ - — — — — — — — — — — -- 3 N.W. 9TH AYE. . • SE = ss ® PORTLAND, OR 91209 \ ----,w- a d usze% (503) 8899311 P L--U. • • • O (609) 5134132 P .. � o:: o • O „ O i wa"umarlceteWerl.cM N.15. PLAN -OAK MODE : o , 0 3 0 O 2,I65 SQ. FT. I • I • o ,• o 00 ; Oc4 = 2.5 BATH I p e ' : l Z Z „ ® � x c� ' _ ' O 1 61 T \ -- I 2 cv I . a _ _ I -� -+- I CrRAGE / c ° o N Q to q 3' 1 ® -_ • I SA I i \ 4 .............. „..:,„: , h I 'sssossss000s� e :.............. I PNOi�IE I i N. c{1 • _ _I CABLE — — — — r- � \ P C-c.E. � � •..••.v.-......• • : ❖. ❖• ❖, - s . TER - -- - \ - - — _ -_ _.- n� ' Stook Horns Plans E.. 0.0' 73.0 0 E.E. 0.0' 8i11d� M� trng Interior Design &Inca 1982 131-0” / 40 201-0" W .p.a d __ , ."v .4 MIA LOT INFORMATION IMPERVIOUS AREA'S: L ®7' ife 1 2 maw Ran& LOT AREA 1,911 SQ. FT. 121 SQ. FT. DRIVEWAY IMPERVIOUS COVERAGE 1,350 SQ. FT. 25 SQ. FT. PORCH 7.:L• ▪ „:210.2„4 BUILDING COVERAGE 6 8% '=l "°. 60 SQ. FT. WLAK SCALE: 1/8 ® „ BUILDING HEIGHT APPROX - 29 -9 60 SQ. FT. PATIO a.ae�. .m«e � +�a. 122 SQ FT. OVERHANGS ° "v w..1 °a°" 983 SQ. FT. BUILDING COVERAGE OD Putt Ramses ANY ""°''°"°' °° w a o rW ▪ r orptimix U. raqpa..�1y or U. exa 1,350 TOTAL SQ. FT. IMPERVIOUS AREAS dos: '°b°°" tow Im °m ad ..e..•o.... U.gow.e r eaten t • .roans. v�.o U. •v.e� d .b plrbAly aed. a Agd�v •110 = WOODEN CURB RAMP _ Ell = CATCH BASIN PROTECTION 0 . ° = WORK STAGING/ MATERIAL STORAGE WESTLAND HOMES mw • OAK MODEL = CONSTRUCTION ENTRANCE COVERED STOCKPILES aPxu 2012 Rave = SEDIMENT FENCE NB = COVER ALL AREAS OF BARE SOIL UNTIL PERMANENT LANDSCAPE IS IN PLACE ) j J , STREET TREE TIGARD CERTIFICATION I , c6 /4,),i_7_,), , owner / agent for Ut i S%C NO o crs i el f c , (PLEASE PRINT) (PERMIT HOLDER) do hereby certifil 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.: /Pi ST o 1 - C7OQD& Sri E ADDRESS: 1 /0 f( S to ( .6.7etcY 044- y SUBDIVISION: 014 '77 vu._ LOT #: 1 SIGNATURE: ea." DA'1E: / 2 -16 -12_ (OWNER/AGENT) RE CEIVED & VERIFIED BY DA 1 E: (CITY OF TIGARD) I 1 Tree location verified per approved site plan. 1: \ Building \ Forms \ StreetTreeCertificate 04/01/2011 Oregon Residential Specialty Code R318.2 MOISTURE CONTENT ACKNOWLEDGEMENT FORM I 46 4N�O , am the general contractor or the owner- builder at the following address: Site Address: / /Ow 541 / j 1- /4-K II/ Y City: ilt,1-D Permit #: / 57"69-1)l 9- - 0 oa Subdivision/Lot #: J i and /or vt/ 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: / - Gen Contractor or Owner- Builder I:\Building\Form\RES- MoistureSensitiveWood.doc 09/25/08 Oregon Residential Specialty Code N1107. HIGH - EFFICIENCY INTERIOR LIGHTING SYSTEMS Permit No.: /yJ d-ota -0co Qs Jurisdiction: /4446 Site Address: ,/09/ 51 teems y 4 y Subdivision/Lot #: Al /� ,� 4445_6, Z — and/or Cl�!' 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) .4 Signature: AS7 Date: / — 0 - 4 4 tree eneral Contractor /Authorized Agent Print Name: /26 4 /V ORSC Section N 1107.2. 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 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, Mc. (PECI) is a Program Management Contractor for Energy Trust of Oregon. First Inspection Second Inspection 9 -19 -12 Date: Verifier Name: prc.ton kuckuck Date: 1 1 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 File #: (required from verifier if 1 2 project is ENERGY STAR) Site Address: 1 1041 sw legacy oak way city: tigard State OR Zip: ltlnattached ❑ Attached Number of Stories: / Total Building Square Footage: 1 i (i5- Number of Bedrooms 3 Basement ❑ None ❑ Full Basement ❑ Half Basement xX] Crawlspace Type ❑ Garage /basement combo ❑ Slab on grade ❑ Other oak plan east Electric Provider E] PGE ❑ PAC ❑ Other: Gas Provider ] NWN ❑ CNG ❑ Other: Electric Meter Number: 3 1 1 1 1521 Gas Meter Number (must apply to permanent meter) (must apply to permanent meter) 41932427 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 LI 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 El Solar Ready Electric (SRPV) ❑ Solar Ready Water Heating (SRWH) Energy El Qualifies for Solar Ready Incentive (must attach checklist) Solar Installer: Name: Company: Low Income ❑ Yes E 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 El 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 ♦ Portland, Oregon 97204 1.877.283.0698 • Fax 1.855.575.4315 newhomes ©energytrust.org yli 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 Ventilation Energy Trust Mechanical lc Exhaust Mfe�ts Energy Trust Mechanical Ventilation Requirements System Ventilation Requirement I f Supply ❑ Yes ❑ No ❑ Exhaust & Supply ❑ Heat Recovery ERV /HRV Model #: Ducts ❑ Ducts Inside % ducts inside: % Ducts in Conditioned Space 1N.,liming incentives for ducts inside, check one of the following: El Ducts Tested ❑ Visual Inspection per RTF specs Duct Insulation R- K Duct Location 50/50 attic & crawl 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. Duct Cubic Feet Per Minute Duct Leakage Air Handler In Yes Air Handler Present LJ Yes Leakage: (CFM) © 50Pa: 1/0 IN7Pass ❑ Fail Conditioned Space ❑ No During Test ❑ No Fan Pressure ❑ DG3 Fan Ring Type ❑ 0 t 2 Leakage Test Total Leakage Gauge p(DG700 Pressure: 70 (check one) ❑ 1 ❑ 3 Method ❑ Leakage to Outside Duct Blaster 13. l 11 I (' Location: \1 11I1 I �'l lli i1 Pressure Tap Location: Area Tested: Whole House Air Changes per Hour Envelope Tightness Cubic Feet Per Minute Leakage: (ACH) @ 50Pa: Q Pass ❑Fail (CFM) @ 50Pa: 945 House Volume: Best Practices Requirements (All requirements must be met to receive an Energy Performance Score) • Thermal Enclosure Checklist Complete ® Pass ❑ Fail Thermal Enclosure Checklist attached? ❑ Yes • Insulation Quality Inspection Performed 0 Yes ❑ No 4 (complete insulation verification section below) • Approved Mechanical Ventilation Installed 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 CA Pressure: Pa If not applicable, please explain: a I I cl (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 verifier Preston Kuckuck Date: 11/26/12 Signature: Preston Kuckuck Name: 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 \li Form 640S mil\ 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 Category Type Actual Value Equipment Details & Notes Insulation Flat Ceiling R- 49 Insulation Type: bib Framing Type: Vaulted Ceiling R- 38 Insulation Type: Batt El Standard Scissor Truss R- Insulation Type: 7Q Intermediate Above Grade Walls R- Insulation Type: bib ❑ Advanced 23 Framing Below Grade Walls R- Insulation Type: Size: Floor Over Unheated Space R- 30 Insulation Type: ba tt Floor Over Garage R- Insulation Type: Slab Floor (unheated) R- ❑ Full Slab ❑ Perimeter Doors Door R- Windows Windows U- .30 SHGC: .30 Window Frame Material: vinyl Skylights U- SHGC: Window Area (Glazing) % Total window area: Lighting Indoor and Outdoor a� # fixtures: 30 24 80 # of ENERGY STAR fixtures or CFLs: Appliances ENERGY STAR Dishwasher ❑ Yes ❑ No EF Cooling Air Conditioning SEER: Btu /Hr: Primary Heat ❑ Fireplace AFUE: 95.5 Brand: fraser johnston Outdoor Unit (for heat Source 6 Gas Furnace pumps) I:1 Electric HSPF: Model #: TG9SO6OA1OMP11A ❑ Boiler Model #: [ Gas Heat Pumps: SEER: Serial #: W1G1169987 CI Other: Serial #: ❑ Air Source (ducted) COP: Btu /Hr: 60,000 ❑ Mini Split (ductless) ❑ Ground Source Location: ECM: ❑ Yes!] No Heat pump commissionin g ❑ Radiant Floor Heat �c ort attached or re ❑ Cadets Electronic Air Cleaner: El Yes :No p cond confirmation for ground El Zonal Backup fuel: ❑ Electric ❑ Gas ❑ Other source heat pumps that CI Other: space X manufacturer's start up procedure was performed El Additional notes on primary heating: Notes on secondary heating: Water Heater ❑ Storage Gallons: Brand: rinnai ❑ Electric XkTankless 1 Gas EF: 82 Model #: r1751 Location: Serial #: db. ca- 012369 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