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Permit CITY OF TIGARD MASTER PERMIT Iii 1 : • COMMUNITY DEVELOPMENT Permit #: MST2012 -00128 T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/28/2012 Parcel: 1 S136CA09700 Jurisdiction: TIGARD Site address: 11096 SW LEGACY OAK WAY Subdivision: WHITE OAK VILLAGE Lot: 18 Project: White Oak Village, Lot 18 Project Description: New SF BUILDING Floor Areas Required Setbacks Required Stories: 3 Bedrooms: 3 First: 713 sf Basement: 0 sf Left: 3 Parking Spaces: 0 Height: 30 Bathrooms: 3 Second: 950 sf Garage: 180 sf Front 10 Smoke Dwelling Units: 1 Third: 520 sf Right: 3 Detectors: Yes Total: 2183 sf Value: $234,646.76 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 Dry■ell- 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 SrvclFeeders Branch Circuits 1000 sf or less: 1 0 - 200 amp: 0 0 - 200 amp: 0 W/ Svc or Fdr: 0 Ea add! 500 sf: 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 8, Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All asin Other: N Other Description: Ecom P 9: Y BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SF VB R - 3 2183 Owner: Contractor: WESTLAND INDUSTRIES INC WESTLAND INDUSTRIES Required Items and Reports (Conditions) 621 SW ALDER ST, STE 605 12670 SW 68TH AVE STE #400 1 Ersn Cntrl 503 - 639 -4175 TIGARD, OR 97223 TIGARD, OR 97223 PHONE: 503 -780 -0626 PHONE: 503- 245 -9715 FAX: 503 - 598 -9081 Total Fees: $17,470.79 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 s - =nded for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification ter. T - se rule are set forth in OAR 952 - 001 -0010 t 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503. �r0 432 44. Issued By: ` Permittee Signature: • A.arie.... Call 503.839.4175 by 7:00 a.m. for the next available Inspection d This permit card shall be kept In a conspicuous place on the Job site until comp! , •n of the project. Approved plans are required on the job site at the time of each Inspection. `Building Permit Application Residential RECEIVED FOR OFFICE USE ONLY City of Tigard Received /, . Permit No.: I1bre '-.. 111 C 13125 SW Hall Blvd., Tigard, OR 97223 � � 2 2012 Plan Review ) ,,, Other Permit: p�C�Y'� T � - 2 E5 1 Phone: 503.718.2439 Fax: 503.598.1960 Date /B : /WA% 4 . T I G n R D Inspection Line: 503.639 / n n Date Ready /By: / t Juris: ® See Page 2 for Internet: www.tigard- or.gov CITY OF YItLIARD 4 7L4.L &) ed/Method: Cf 010 G Supplemental Information BUILDING DIVISION 2, , TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING Vew 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 1- and 2- family dwelling ❑ Commercial /industrial Valuation: $ 2 44t.0 ❑ Accessory building ❑ Multi- family Number of bedrooms: ❑ Master builder El Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: N ew dwel area: 'Zt square feet f1o9 G �r> �cY O� � � City /State/ZIP: 176 - {� - / 0� ' f� 2 7 233 Garage/carport area: Op square feet 0 Suite/bldg. /apt. no.: Project name: /f7-j71 (1.f-e' U /6GrffrL Covered porch area: 36 square feet q 0 Cross street/directions to job site: Deck area: square feet 7r3 Other structure area: 23'3 4'3 square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: MI 176 0,,,_ I Lot no.: 4 Permit fees* are based on the value of the work performed. Tax map /parcel no.: `s 3,6 C� �� 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. /0/G �� /C7- /14-0 /14-0 7 I/ 4/// /j/ / / 4 Valuation: $ Existing building area: square feet New building area: square feet e1 PROPERTY OWNER ❑ TENANT Number of stories: Name: aigefigtO › 'A e5 t Type of construction: Address: ( 203 /„ _ 8 40 Occupancy groups: City/State/ZIP: r0 6 die-. q72.2- 3 Existing: Phone: ( t( f o - m � Fax: (Q) C et � 96) I New: BUILDING PERMIT FEES* (Please refer Business name: �� r,•T ,?/, _Tit/nci,r,a j�' . foG schedule) �T ( Structural plan review fee (or r fee deposit): ,r� Contact name: /206 / l ,t//cesO, 1 / ,J / ��X/Q,e0, -- FLS plan review fee (if applicable): Address: 4,26 70 S � �v8 -xii, v � Total fees due upon application: ere) City/ State/ZIP: /%� , �� 9 7 2 23 ,E ! Amount received: Phone: (03 ) 577- Fax: : 93 ) 533 -9 E -mail: jrobei ,c) 06nivt .Can/ PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Commercia1 and residential prescriptive installation of CONTRACTOR �) roof -top mo ed PhotoVoltaic Solar Panel S m. Business name: 1,O �� ( �� ; f • Submit two (2) -ts of roof plan with c ction details and fire departme access, alon the 2010 Oregon Address: ( 110 c ites oeb4I l} Solar Installation Sp' •a/ e checklist. City/State./ZIP. (i I Permit Fee (inc plan review $180.00 ?' F - an.: • minis <tive fees): Phone: (y.,) • Fax: ( ewg69 t State su • arge (12% of pe fee): $21.60 CCB lic.: , 2 1)�-,z� _ Tota fee due upon applicati • $201.60 Authorize. • _9Y.•• - This permit application expires if a permit is not obtained Jig J within 180 days after it has been accepted as complete. t nan I. h� Date: w/ I * Fee methodology set by Tri-County Building Industry • 1 0 � /Q./ I_-� Service Board. I:\ Building \Penni.. \BUP- RESPennitApp.doc 02/ 24/ 2011 440 - 4613 T(11 /02 /COM /WEB) • ' Plumbing Permit Application • Building Fixtures RECEIVED. FOR OFFICE UST ONE,\• City Of Tigard `ee ® = Pe®itNo.: 11 ��y 1 g III 13125 SW Hall Blvd, Tigard,OR c, - Phone: 503.7182439 Far 5i i. 8. 98B 20 2 Other Permit No.: 40/ .49/ /5" 7 a G n fl D Inspection Line: 503.639.4175 DateReady/By: rmi El See Page Information Internet www.tigardorgq�ITY Notified s ® ew construction ❑ Demolition For spedal information use rherJlfcst Description I Qty. I En. I Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2-family dwellings (includes 100 IL for each utility comedian) SFR ( 1 ) b l f I 312.70 I CATSGOIbIf O ON3PRiJCTION :: • I l J 2 -fnnily dwelling SFR (2) bath 437.78 SFR (3) bath It 50032 Gj Cam• " 7-- ❑ Accessory building ❑ Multi - family Each additional bath/kitchen 25.02 ❑ Master builder - ❑ Other. Fire s per m (__ sq. ft.) Page 2 JOB SITE rfflopgiltec APPW LOC.AToN . • Site utilities: r r7 /1 /� Catch basin or area drain 18.76 Job site address . -- A ._- if ell, leach line, or trench drain 18.76 City/State/ZIP: / , ) r q Footing drain (no. linear ft.: _, Page 2 Suite/bldgJapt. no.: I Project name: (D 4j v j Manufactured home utilities 50.03 Cross street/diredions 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 t: _) 1 I Page 2 Subdivision: I j - i , I ; Lot no.: Fixture or item: / 7 • r ' 3127 Tax map /parcel no.: / / 9 � C A D r Of) Bacl�ow preventer Backwater valve 12.51 DESCRIPTION OF WORK �,� � Z ��j Clothes washer / 6 �" �fAJI�,e- _citing /0 Dishwasher I 6611 5r4ef 10{ ( 25.02 Drinking fountain 25.02 . Ejectors/sump 25.02 �ROPERTY OWNER I ID TENANT Expansion tank 12.51 Name: /j I A� ; , Fixture/sewer cap 25.02 W � Floor drain/floor sink/hub 25.02 Address: / / �, /Ifi f Garbage disposal r 25.02 City/ State/ZIP: , r# 1 57 err Hose bib 7.---- 25.02 Phone: (0 • ., ( A - / . _ . I ''- --- Q . . / Ice maker ( 1251 • l! APPTdCANT ❑ " CONTACT PERSON . . Interceptor/grease trap 25.02 Business name: i .0 ' .01 tic Medical gas (value: $ ) Page 2 CJr Primer 12.51 Contact name: r7/ a / I C/7/ti s4 Roof drain (commercial) 12.51 Address: t )4376 �L g Sink/basinfavatory S" 25.02 City/ State/ZIP: li& �� 41 X, Solar units (potable water) 62.54 Phone: ( - y - a , .. I Fax: : ( t as`q / Tub/shower /shower pan 12.51 � �° ,, ) � f �� j ��/'� Urinal 25.02 ? wU `'l' ' L!1 JI r Water closet 25.02 CONTRACTOR 1 Water heater J 37.52 Business name: /am Po ( 1. (_ Water piping/DWV 56.29 Address: da? D, Other 25.02 City/ State/ZIP: 4 / 6-0-t) 4 to - Subtotal _ M Phone: ( ) Fax ( ) Minimum permit fee: $72.50 l // S Plan review (25% of permit fee) CCB Lic.: 3 o Plumbing Lic. no.: r State surcharge (12% of permit fee) Authorized signature: TOTAL PERMIT FEE t This permit applieatioa expires if a permit is not obtained within 180 days Print nam = t ell L (,t(/yt Da ./ / after It has been accepted as complete. 'Fee methodology set by Tri -County Building Industry Service Board. L•\ Budding WermitslPLMU - PennitApp.doc 10/01/09 4404616T(10/02/COMIWEB) Mechanical Permit A licati FOR OFFICE USE ONLY City of Tigard CEIVED R ate/By: PermitNo.: ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review / ' Phone: 503.718.2439 Fax: 503.598.1960 Other Permit 6 &L .0 /2_. (Z) JUN 1 2012 Date/By: T 1 G A R D Inspection Line: 503.639.4175 _ . Date Ready/By: Juris: la See Page 2 for Internet: www.tigard or.gov Or OF 11O 6 RI) Notified/Method: Supplemental Information BUILDING DIVISION COMMERCIAL FEE* SCHEDULE - USE CHECKLIST . TYPE OF WORK • • Mechanical permit fees* are based on the value of the work ew 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 land 2- family dwelling ❑ Commercial/industrial ❑ A ccessory building For special information use checklist ❑ Multi- family ❑ Master builder ❑ Other: Description Qty. I Ea. I Total JOB S INFORMATION AND 'LOCATION Heating/cooling: /J ! Air conditioning Job site address:i" /_' � k J ay_ 1 j / (requires site plan showing placement) 46.75 City/State/ZIP: O / ) / h Q `i 11 ~` l ^'t Furnace 100,000 BTU ( ducts/vents) ` 46.75 City/State/ 1( CN 97 li2;3 Furnace 100,000+ BTU (ducts/vents) 54.91 Suite/bldg. /apt. no.: Project name: G L� v i Heat pump v,1 (requires site plan showing placement) 61.06 , �J�� Cross street/directions to job site: 5 , \ '). Duct work 23.32 Hydronic hot water system 23.32 Residential boiler (radiator or hydronic) 23.32 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 46.75 Subdivision: (/ Ai f lei _ V 1 U 7 , j ' Lot no .t g Other: Flue/vent for any of above 23.32 �r 11 ` v Tax map /parcel no.: 1 5 l 3 C /� 9f/) Other fuel appliances: DESCRIPTION O WORK Water heater ( 23.32 COPY-jilt/If � t Gas fireplace ' 33.39 fG 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 ' U PROPERTY OWNER . ❑ TENANT Chimney/liner /flue/vent 23.32 � _` Other: 23.32 Name: J l ' ) Environmental exhaust and ventilation: Address: 7D / n # Range hood/other kitchen lY equipment 1 33.39 City/State/ZIP: i Oiv Clothes dryer exhaust 33.39 " � p Single -duct exhaust (bathrooms, t Phone: ( 9 Z.. Fax: ( S J . !Q ' tfIS / toilet compartments, utility rooms) �' 23.32 (1.6,4 APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans ( 23.32 l' 1` Other: 23.32 Business name: , � 1• v 1, t � • Fuel piping: Contact nameV,t "� 1 ' -i'0� r. $14.15 for first four; $4.03 for each additional Furnace, etc V616 Address: 7 �� tL/S� /' L - Gas heat pump City/State/ZIP: 11(3.1414 t!9 Wall /suspended/unit heater Phone:3 )c7 t as 1000044P. : ( ()'j q , 9 ii) Q f Water heater 1 � l Fireplace 1 E -mail: P. f. i ! ') 1 i ' ( ji1► _. 1 A _, i i I ) Range 1 _ CONTRACTOR Barbecue r gs v \ Clothes dryer (gas) Business name: �j Other: Address: fi • t5 cp 0 /T / , i 1 MECHANICAL PERMIT FEES* T� H City/State /ZIP: ` t / - Subtotal 'G� Minimum permit fee ($90.00) Phone: ( !b��' " v • 5 Sl , Fax: ( ) Plan review (25% of permit fee) CCB lic.: I" %.,1 c7 l State surcharge (12% of permit fee) 1 • TOTAL PERMIT FEE Authorized signature: This permit application expires if a permit is not obtained within 180 1' f()// days after it has been accepted as complete. Print name: �T` l ( 0 C 1 i I Date` > * Fee methodology set by Tr Building Industry Service Board \ P I:\ Building erm \ M itsEC- PennitApp.doc 09/09/10 4400-4617T(1I /02/COM/WEB) • a , Electrical Permit Aim licatimi FOR OFFICE LU S E O iN L 1 ' City of Tigard CE D �t /a / Z Permit Na: JAS o/� �/ 2 g :711 2 ° 13 125 SW Hall Blvd., Tigard, OR 97223 Plan Review Other permit n ^ _,? —40 ly 6 ---- Phone: 503.718.2439 Fax: 503.598.196g UN 1 2 2012 Date/By: /� - I - I G :1 R D Inspection Line: 503.639.4175 Dace Ready/By: runic E1 See Page 2 for Internet www.tigard cr OF TIGARD Notified/Method: Supplemental Information •• T Y P E OF WINDING DIVISIOW . , . . .,. •' 0 AN . - PF!.. :', ", •., • • Please check all that apply (submit I sets of plans wfitems checked be low): ,SNew construction ❑ Addition/alteration/replacement ❑ service or feeder 400 amps or mote ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault cement ❑ Marinas and boatyards. • CATFROBY O CON31RUC•11TON . - exceeds 10,000 amps at 150 volts or ❑ Floating buildings. • less dwelling ❑ Com industrial ❑ Accessory building amps ground, a exceeds o 14,000 ❑ Commercial-use ing. agricultural and 2-family thug ory g amps for all other installations. buildings. ❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pimp. ❑ Installation of 75 KVA or • ❑ Emergency system. larger separately derived system. • JOB SITE INFORMATION Al LOCATION - ... ❑Addition of new motor load of ❑ "A",13", "1 - 2", "1 - ", • Job no.: • Job site address / 100BP carom occupancy. p � �� ❑ six or more residential units. ❑ Recreational vehicle parks. � �� t1 City/State/ZIP: r ��� ❑ He a locations. ❑ Supply voltage for more than El Hazardou zatdo0s locations. 600 volts nominal. Suite/bldgiapt no.: Project name: l rf Ob i g,,416- ❑ Service or feeder 600 amps or mote. • FEE SC13EDULE Cross street/directions to job site: nrac iption I Qty. I Fee. I Total I • New residential single- or multi- family dwelling unit Includes attached garage. Subdivision: f /- tr O4.K 0GLAVc.- Lot no. :/ 1,000 sq. ft or less _ t 168.54 4 Ba. add'l 500 sq. ft. or portion 5 33.92 (01:7C, 1 Tax map /parcel no.: /5 /36 C14 ap 7/Z) Limited energy, residential ( 75.00 2 DESCRD'TION OF WORK (with above sq. R) Limited energy, multi - family 75.00 2 6 ,u5 72J C4 4 " � 5C4 ��IE residential (with above sq. ft.) 444"' 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 Name: 401 amps to 600 amps 200.34 2 • 1J T 601 amps to 1,000 amps 301.04 2 Address: / 76 Vtd f( 0 per 1,000 amps or volts 552.26 2 City/State/ZIP: �C d 7 �i Temporary services or feeders installation, alteration, and/or • Phone: cm, Q . (xp42.4 , Fax: (l. RY / 200 amps or less 59.36 1 Owner AStallationMis installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2 401 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 brunch circuits with APPLICANT I a CONTACT PERSON above service or feeder fee, 7.42 2 each branch circuit Business name: g_57200./.0 TiJDU57"� f F S B. Fee for branch fee, without service or feeder f ee, first 56.18 2 Contact name: /f v f�774 I ic. branch circuit ` —N ®d I TIIK Each add'l branch circuit 7.42 2 Address: / a- 6 7i i 7 l�D Miscellaneous (service or feeder not included) taterziP: 7 Each manufactured ormodular 67.84 2 eityis T6. - ,eta / © - 172/53 3 dwelling, service and/or feeder Phone: K )5n - 0 7 4 4 l Fax: : ( b 3 fie - ? 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 • E Business name: panel, alteration, or extension. Page 2 2 L �/U/9f/!¢ 7� s Each additional inspection over allowable in any of the above Address: i S3 5E- ,2 3, ! , Additional inspection (1 hr min) 6625/ hr c Investigation (1 hr min) 6625/ hr City/State/ZIP: i j ' / ' ° • eh le7 Industrial plant (1 hr min) 78.18/ hr Phone: Inspections for which no fee is 90.00/ hr (53) 3 —6/g67 Fax: ( g) � ) 71 �i_ ��t specifically listed ('hr min) CCB Lic.: 6 6 if ( Electrical Lic.: 2 , % Suprv. Lic. <V > 3 ELECTRICAL - , PERMIT FEES Subtotal: Suprv. Electrician signature, required: Plan review (25 %of permit fee): Print name: ( f l 1U7/l Date: (�! y State surcharge (12 %ofpt permit fee): 1 � �„ TOTAL PERMIT FEE: Authorized signatur : This permit application after it expires has been if a permit accepted is as not complete. ab ed within 180 Print name: Date: • N um b er of inspections allowed per permit • 1: 1Buildisa \PermitdEtC-PermitApp.doc 07/01/10 49046157(11105/COM/WEB //o 9 64 16.(12 44'4? 1 e ° Building Division Development Code Provision Review T I G A R D Residential Projects Building Permit No: I ` ''? aC 1g-- CC /As CWS Service Provider Letter Received: Yes ❑ No ❑ N/A ,ea Routed Plans: //- Original Plan Submittal Date: CP�f / 9 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 left only if approved. Planning Review (contact C he'll C a neJ at 503 -718 - a 31 or C. he r' / C, @tigard- or.gov) Land Use Case No.0P17i? tor/ - 00001 Name Whit Oa.. V; (/ a., e- 9 1, Zoning - to P v /_,�,1 © B - { 6 Setbacks: CY Front l 0 Rear 13 Side 3 Street Side ' Garage aD 0 Maximum Building Height -35 Actual Building Height Visual Clearance - me 6 - 10444 is s ho ,..b r. O ^ - p 1 a + kst Easements IA Sensitive Lands Type: FUI A Notes: Original Plan: Approved A Not Approved ❑ Date: (v - 13 — I c. Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: En veering Review (contact Mike White at 503- 718 -2464 or MikeW @tigard- or.gov) Actual Slope: S Notes: Original Plan: Approved Not Approved ❑ Date: 6 15 12...., Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: (Review Continues on Page 2) Page 1 of 2 City . , rist Review (contact Todd Prager at 503 -718 -2700 or todd @ tigard - or.gov) n treet Trees L% Protected Trees • Notes: Original Plan: Approved Not Approved ❑ Date: C 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 Applicant Okay to Issue Permit: Yes . ,. N o, , ❑ _,.,. ' ; ; - , , , _ , ., - Date Routed to Building: 1 a e� i Q ' • ), • r , C .. • r + • • Page 2 of 2 FOR OFFICE USE ONLY - SITE ADDRESS: HO O ( g)- This form is recognized by most building departments in the Tri -County area for transmitti g 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 IIIII a Transmittal Letter e r i c:; A i( F) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard- or.gov TO: DATE AT i ! DEPT: BUILDING DIVISION I, ,.,� . 1 r 442m JUN 2 7 2012 FROM: ( p h Sri CIT° OF flGf D BUILDING 1 .)I \/'6SION: COMPANY: 1:6:1 PHONE: r - jj 3 - 1r0 - aearco g 503 -57a —OVA RE: Ht-)r CX> /2-g i/O ` 0 (Site Address) / (Perini m e `y r) � V r ject ame or s 'vision name and lot num.er) ATTACHED ARE THE FOLLOWING ITEMS: Copies: I Description: I 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): REMARKST LL J C) �L • mil■ _ r 4 / '' - .i i _ // FOR OFFICE USE ONLY Routed to Permit Technician: Date: (�a1 12_, Initials: ►s_:t ,_ Fees Due: II Yes WO Fee Description: Amount Due: $ $ $ $ Special Instructions: Reprint Permit (per PE): ❑ Yes ❑ No ❑ Done Applicant Notified: Date: Initials: (:\Building\ Forms \TransmittalLetter - Revisions.doc 05/25/2012 RE CEIVED • ,;UN 12 2012 CITY OFTIGA1 D BUILDING DIVISION It (9) . - e ,,° 10 11 /3i 2.. CAL opd � R D E E ASH \) \(J•' ' \ „ ' RAYWOO PLANTING STRIP d U?lit 4 1 /7 )-- CAMBRIDGE WALK �( TREE �� 1 4 V 3i).).' 2 ,. G / EE. 0.0' 0 Y o / P` ,C - -1- 6.5 PUE / P5E X k k 1f SAN. SEWER LINE °®°"°`° 1- i" GAS L INE i '" - - ---��- / -t" I �' O 6b PETAL W6M1AC + P.v.C. WATER MAIN ,,•� - ® i ■ -- 4 ' - -- li i t N n , i4 III it 7i , . 11-II 0 -l. I i I ;i s f L U-� I i D © I O C' I: 0 �- --1 a_ DRIvE AY I � R f -- �: - 1- I- - CS5- X u 4- x 1 EE. 0.0' -1 3 EE. 0.0' Na a --- SCJ •• \li , t Oregon Residential Specialty Code R318.2 MOISTURE CONTENT ACKNOWLEDGEMENT FORM I, g , am the general contractor or the owner- builder at the following address: Site Address: // $ ' 4, 6 :4 Zi/el_r City: 776141A Permit #: A5 / d 5 Subdivision/Lot #: /,� � 0 V ite _ 466. L /6 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: / Gf - raI Contractor or Owner - Builder I:\Building\ Form \RES- MoistureSensitiveWood.doc 09/25/08 • !Pm STREET TREE TIGARD CERTIFICATION I, ,, 47' ) - 7 - )9-1151. 1 t/ii , owner / agent for �J1 (PLEASE PRINT) (PERMIT HOLDER) do hereby certify 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.: f/( S -r,Z P - £O/ SITE E ADDRESS: // 1 0g. 5& Le i0fr SUBDIVISION: Uht /re. 46 -E LOT #: / SIGNATURE: DA1 E: -10 -12._ (OWNER /AGENT) RE CEIVED VERIFIED BY DATE: (CITY OF TIGARD) Tree location verified per approved site plan. I: \Building\ Forms \StreetTreeCertificatc 05 /30/2012 Oregon Residential Specialty Code N1107.2 HIGH - EFFICIENCY INTERIOR LIGHTING SYSTEMS Permit No.: A _ Da /aze Jurisdiction: /,, Site Address: l � o%a6 Sa) dr y /J ,_ a4 y ---72;seo k 52 3 Subdivision/Lot #: / t /n O X-1-/itere 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) 4/ , Signature: / /��� - Date: 9 — /; 2 / titer/ ene al ontractor /Authorized Agent Print Name: 1 . Aif 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 Ali Form 640S Program Use Only �l Completion Certification —Site Inspection FastTrack ID EnergyTrust New Homes Program — Single Family of Oregon Data check by To be completed by verifier (initials) Portland Energy Conservation, Inc. (PECI) is a Program Management Contractor for Energy Trust of Oregon. First Inspection Second Inspection Date: 8 -2 -12 Verifier Name: Preston Date: 12 9 -12- Verifier Name: Preston Incentive Payee Company Name: Builder or Company: Westland ind Contact Name: Performance Testing Company: fireside home solutions Technician Name: Site Information Development Lot Number: REM /Rate SCO Project ID: Name: white oak village 18 File #: (required from verifier if project is ENERGY STAR Site Address: City: State OR Zip: ❑ Unattached ❑ Attached Number of Stories: 2 Total Building Square Footage: 2271 Number of Bedrooms 3 Basement ❑ None ❑ Full Basement ❑ Half Basement ❑ Crawlspace yes Type ❑ Garage/basement combo ❑ Slab on grade ❑ Other Electric Provider ❑ PGE yes ❑ PAC ❑ Other: Gas Provider ❑ NWN yes ❑ CNG ❑ Other: Electric Meter Number: 31111525 Gas Meter Number: 41933570 (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 yes ❑ 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 XDoes this project qualify as Low Income? (must provide documentation from builder) Accessory ❑ Yes ❑ No X Is this home an ADU? Dwelling Unit ❑ Yes ❑ No X 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 4 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 Form 640S rlC 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- Insulation Type: ❑ Standard Scissor Truss R- Insulation Type: ❑ Intermediate Above Grade Walls R -23 Insulation Type: bib ❑ Advanced Framing Below Grade Walls R- Insulation Type: Size: Floor Over Unheated Space R- 30 Insulation Type: batt 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 80 % # fixtures: 45 # of ENERGY STAR fixtures or CFLs: 36 Appliances ENERGY STAR Dishwasher N 0 Yes ❑yes EF Cooling Air Conditioning SEER: 13 Btu /Hr. 2.5 ton Primary Heat ❑ Fireplace AFUE: 95.5 Brand: Fraser Johnston Outdoor Unit (for heat Source ❑ Gas Furnace x pumps) ❑ Electric HSPF: Model #: tg9s060a10mp1la ❑ Boiler Model #: ❑ Gas Yes Heat Pumps: SEER: Serial #: w1g1169983 ❑ Other. ❑ Air Source (ducted) COP: Btu/Hr. 60,000 Serial #: ❑ Mini Split (ductless) ❑ Ground Source Location: cond ECM: ❑ Yes ❑ NoX Heat pump commissionin ❑ Radiant Floor Heat space p p g ❑Cadets Electronic Air Cleaner. ❑ Yes ❑ No X report attached or confirmation for ground ❑ Zonal Backup fuel: ❑ Electric ❑ Gas x ❑ source heat pumps that ❑ Other. 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 ❑ Tankless yes ❑ Gas yes EF: Model #: RL 75i Location: cond Serial #: ca- 018775 space Btu/Hr. Form 640S v10 120101 Page 2 of 4 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 ■lam Form 640S 41 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 Meets Energy Trust Mechanical Ventilation Requirements System Ventilation Requirement ❑ Supply yes ❑ Yes ❑ yes No ❑ Exhaust & Supply ❑ Heat Recovery ERVlHRV Model #: Ducts ❑ Ducts Inside no % ducts inside: Ducts in Conditioned Space If claiming incentives for ducts inside, check one of the following: ❑ Ducts Tested ❑ Visual Inspection per RTF specs yes Duct Insulation R- 8 Duct Location Duct Sealing w/Mastic Paste ❑ Yes ❑ x No Performance Testing & Duct System Information Duds 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. Cubic Feet Per Minute Duct Leakage ❑ Duct (CFM) @ 50Pa: 120 Air Handler In ❑ Yes x Air Handler Present Yesx Leakage: ❑ Pass ❑ yesFail Conditioned Space ❑ No During Test ❑ No Fan Pressure ❑ DG3 Fan -70 Ring Type ❑ 0 ❑ 2 x Leakage Test ❑ Total Leakage Gauge ❑ DG700 x Pressure: (check one) ❑ 1 ❑ 3 Method ❑ Leakage to Outside Yes Duct Blaster 2retum Pressure Tap Location: hall bath Area Tested: 2271 Location: Whole House Air Changes per Hour Envelope Tightness Cubic Feet Per Minute House Volume: 18912 Leakage: (ACH) @ 50Pa: 3.2 ❑ Pass yes ❑ Fail (CFM) @ 50Pa: 1010 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 ❑ Yes x ❑ No - (complete insulation verification section below) • Approved Mechanical Ventilation Installed ❑ Yesx ❑ No 4 (complete mechanical ventilation section below) • Zonal Pressure Relief — All zones comply ❑ Yes x ❑ No I If no, state reason for failure: • Combustion Appliance Zone Testing Net CAZ Pressure: Pa If not applicable, please explain: all d.v. (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: Form 640S v10 120101 Page 3 of 4 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 Form 640S 'l' 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. 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 Preston Kuckuck Date: 9 -12 -12 Signature: Name: Red Tag Inspection (if needed): Signature: Name: Date: Form 640S v10 120101 Page 4 of 4 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@energytrustorg