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Permit CITY OF TIGARD MASTER PERMIT II , 3 COMMUNITY DEVELOPMENT Permit #: MST2012 -00170 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/03/2013 T l t' A R g Parcel: 1S136CA08200 Jurisdiction: TIGARD Site address: 11040 SW LEGACY OAK WAY Subdivision: WHITE OAK VILLAGE Lot: 3 Project: White Oak Village, Lot 3 Project Description: New SF BUILDING Floor Areas Required Setbacks Required Stories: 3 Bedrooms: 3 First: 575 sf Basement: 0 sf Left 3 Parking Spaces: 0 Height: 30 Bathrooms: 3 Second: 913 sf Garage: 228 sf Front: 10 Smoke Dwelling Units: 1 Third: 596 sf Right: 3 Detectors: Yes Total: 2084 sf Value: $226,054.60 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 Fum <100K: 1 Vents: 0 Woodstoves. 0 Gas Outlets: 4 Fum > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits 1000 sf or less: 1 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr 0 Ea add'l 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 2084 Owner: Contractor: WESTLAND INDUSTRIES INC WESTLAND INDUSTRIES Required Items and Reports (Conditions) 12670 SW 68TH #400 12670 SW 68TH AVE STE #400 1 Ersn Cntrl 503 - 639 -4175 TIGARD, OR 97223 TIGARD, OR 97223 PHONE: 503- 572 -0746 PHONE: 503 - 245 -9715 FAX: 503- 598 -9081 Total Fees: $17,405.57 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 - spended for more the 180 days. ATTENTION: Ore on law requires you to follow the rules adopted by the Oregon Utility Notificatio. enter T. •se rut s are set forth in OAR 952- 001 -0010 through R 952 -0 1 -0090. Yo may obtain a copy of the rules or direct questions to OUNC by calling s .1 • • •r :00 332 • 444 Issued By: ✓ Permittee Signature: Alt Call 503.639.4175 by 7:00 a.m. for the next available inspectiof d ,. This permit card shall be kept in a conspicuous place on the job site until co I • etion of the project. Approved plans are required on the job site at the time of each inspection. Building Permit Application RECEIV. h CAA / Residential Q 7 � �j FOR OFFICE USE ONLY City of Tigard JUN 28 Lis ''Date /B "' j� n 1/. Es' Permit No.: y /�� � - 1 70 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review�y 1 1 ( /� t I N a Phone: 503.718.2439 Fax: 503.598.1960 CI OF TiGPt > ate /By: " t/�J 1 ~ 1 I Other Permit: �Api'� -Qa/s Inspection Line: 503.639.417 TT a rT• j c. ipat Ready /By: // /"r r or r i s: Supplemental See Page for TIGARD p V i t.:�f�1 f� -.., if 'V �Z Information Internet: www.tigard- or.gov ffd r /Method: VA/ :Jim 5r4- IP Z.MJ l o4'02_ vU sir" TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING ®''New construction ❑ Demolition Pennit 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. r V $ LZ- - ., • 6J Q 1- and 2- family dwelling ❑ Commercial /industrial Number of bedrooms: '� ❑ Accessory building ❑ Multi- family 0 Master builder ❑Other: Number of bathrooms: 3 - l JOB SITE INFORMATION AND LOCATION Total number of floors: 3 Job site address/0 5 scpv for y Q ic" 7 New dwelling area: got square feet City/State /ZIP: Q6_ ' l Dg- • ' 7 2�2 Garage /carport area: ) square feet 6,00_ Suite/bldg. /apt. no.: Project name: ,/,=f-/ Z Mt- a 4/ Covered porch area: 2 square feet { 1"3 Cross street /directions to job site: Deck area: square feet 76 Other structure area: 2 �j (2 square feet REQUIRED DATA: COMMERCIAL - USE CHECKLIST Subdivision: /at /-1- 04K_ 1/_z_,-,6-f- / � Lot no.: 3 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.: /s / 36 CA 0 047%. equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. �>¢/ l Valuation: $ Existing building area: square feet New building area: square feet ❑ PROPERTY OWNER ❑ TENANT Number of stories: Name: Type of construction: • Address: Occupancy groups: City/State /ZIP: Existing: Phone: ( ) Fax: ( ) New: APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* / (Please refer to fee schedule) Business name: 7�k 97 /� __ /„//7 / jT- / f 5 a6._ q � ! Structural plan review fee (or deposit): Contact name: /20r /1,G„9 espv , / J/ J / v,e,tt� ( FLS plan review fee (if applicable): Address: /x 7g f j e j a -Xl/, Total fees due upon application: City/State /ZIP: i -f} , ()/� l 7 Z 2- 3 � 00 (S 5 ) 5. _ 0 �� q07 ) Sf � *,e Amount received: 5� Phone: 7 Fax: E -mail: zi - j rd4 ;k 06 /Z , CIV-1/ PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Commercial and residential prescriptive installation of CONTRACTOR roof -top mounted Photo Voltaic Solar Panel S stem Business name: Lo- tio k w-A 33\v_, Submit two 2) sets of roof plan wit..: r ection detail and fire depart • access, .: g with the 2010 Oregon Address: 7 0 �,eti &+414.4 i4p Solar Installation Spe . • • Code checklist. City/State /ZIP. ( k 2 q Permit Fe- ncludes plan - ''ew $180.00 �i and administrative fees . Phone: ' c?17 -7� `� ) - Fax: ( 29 '-6) f State • rcharge (12% of permit fee): $21.60 ���� CCB lie.: Total fee •u •.. : -: - •' $201.60 ` gib Authorize. '1,0... - This permit application expires if a permit is not obtained — / within 180 days after it has been accepted as complete. al— — / * Fee methodology set by Tri- County Building Industry !► f l 1 � i� Date: 6 •�� • (I' Service Board. 1 I:\ Building \Penni, \BUP- RESPennitApp.doc 02/24/2011 440- 4613T(I 1 /02 /COM /WEB) NI ✓ Plumbing Permit Application Building Fixtures RECEIVE• FOR OH. ICE USE ONLY City of Tigard J UN 2 8 2 C G / asr i2- C a) Permit No.: 1`HSr�ow; -.an/ 76 C • 13125 SW Hall Blvd., Tigard,OR 97223 Plan Review Phone: 503.7182439 Fax: 503. 598.1960 Date ltea d y / By. Other Permit No )/L�j /'_�/5"� T l G A R D Inspection Line: 503.639.4175 CITY OF T:7 rmia: El See Page 2 for Internet: www.tigard -or.gov - • `' l' Al 0 t : Notified/Method: Supplemental Information • TYPE OF WORK - -• FEE S DULE EI construction ❑ Demolition For speaal information use checklist - Description j Qty- I Ea. 1 Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft fnr each utility connection) CATEGORY OF' . `.. , •.... SFR (1) bath 312.70 .d 2- family dwelling ❑ C�� �/ustrie( SFR (2) bath 437.78 SFR (3) bath _ k 500.32 ❑ Accessory building ❑ Multi- family Each additional bath/kitchen 25.02 ❑ Master builder - ❑ Other: Fire sprinkler (__ sq. ft) Page 2 • JOB SITE INFORMATION AND LOCATOON Site utilities: Job site address: II . r'•-• - i / J� 1 Catch basin or area drain 18.76 � S:iL Drywell, leach line, or tenth drain 18.76 City/State/ER f ` l. ! " 1 Footing drain (no. linear ft.: _J Page 2 Suite/bldgJapt no.: Project name: .. Ability if' IA anufacttned 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.: _J / Page 2 Water service (no. linear ft: / Page 2 Subdivision: lull I' 4 / '/ I Lot no.: _ Fixture or item: Tax map/parcel no.: / / 3 6 peR, ^ Backflow preventer 31.27 Backwater valve 12 -51 d e 5 DESCRIPTION OF WORK ,� ,,� �/ Clothes washer J 25.02 £ A 4.10 IC/ ' A/L2 t I //6 %� Dishwasher / ( 25.02 ' ' Drinking fountain 25.02 Ejectors /sump 25.02 ❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 - • Fixture/sewer cap 25.02 Name: Floor drain/floor sink/hub 25.02 Address: 25.02 Garbage disposal j City/State /ZIP: Hose bib 7- 25.02 Phone: ( ) Fax: ( ) Ice maker ( 12.5I Lld'APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 Business name: / 1�� -7 r Medical gas (value: $ ) Page 2 �, primer 12.51 Contact name: f �/� �"11�; Roof drain (commercial) 12.51 Address: ( )4C, 96 ` 64 79/ etrg �/`� ( Sink/basin/lavatory S- 25.02 City/State/ZIP: � �� OA q7 Solar units (potable water) 62.54 Phone: (61 .. l - I Fax: : ( 11 0 i - / Tub/shower /shower pan 12.51 J � �� -� f� Urinal 25.02 1'5 '^�f U y •� / E -mail: !I �� Water closet 25.02 CONTRACTOR 37.52 Water heater Business name: Al 6 P ' (s C Water piping/DWV 56.29 Address: • t7� li 4/� ) V Other. 25.02 City/State/ZZIP: i i[�b - Subtotal Phone: ( ) Fax: ( ) / Minimum permit fee: $72.50 S �„/ Plan review (25% of permit fee) CCB Lic.: ° °° Plumbing Lic. no.: 4- l" - State surcharge (12% of permit fee) Authorized signature: e: TOTAL PERMIT FEE f �� This permit application expires if a permit is not obtained within 180 days Print name Y r M t 3 t. ,,Z , Date: 6 , " ,, . , after it has been accepted as complete fV �" *Fee methodology set by Tri- County Building Industry Service Board. I:\ Building \Permits'PLMU- PmmitApp.doc 10/01/09 440-4616r(IO /02/COMIWBB) wd1 Mechanical Permit Application RECEIVE. FOR OFFICE 11SE ONLY City of Tigard Date/By: 4 ,/r /? ��,JJ Permit No.: f —� jip �V7a Other Per n 13125 SW Hall Blvd., Tigard, OR 97223 JUN 2 8 2 Q': Plan Review mit: Phone: 503.718.2439 Fax: 503.598.1960.. Date/By:� / � ^ � 1 �� T 1 G A RD Inspection Line: 503 CITY OF T:GAh1i Date Ready/By: luris: ® See Page 2 for Internet: www.tigard - or.gov B UI' T, NO IVISIn .11 otified/Method: Supplemental Information TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST Mechanical permit fees* are based on the value of the work 121 w 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 ❑ Co ❑ Ac building For special information use checklist ❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. Total JOB sp INFORMATION AND LOCATION Heating/cooling: H O Az� Air conditioning Job site address: � ���.�/ i l �.}�/ (requires site plan showing placement) 46.75 Furnace 100,000 BTU (ducts/vents) i 46.75 City/State /ZIP: ale_ � ^+l ' 1 'T) 4 17 )..2. Furnace 100,000+ BTU (ducts/vents) 54.91 Suite/bldg. /apt. no.: Project name: LIVN-i -& V 1 L(,,Itt Heat pump (requires site plan showing placement) 61.06 Cross street/directions to job site: . ' i. 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: W ' l f )11.(441.„. rx Lot no.: Flue/vent for any of above 23.32 ! ' - Other: 23.32 Tax map /parcel no.: I S ( 3(A C/.} Q g Other fuel appliances: DESCRIPTION OF WORK Water heater ( 23.32 / ^ J r n ��. I-J / Gas fireple 33.39 ( ( �(,( i( I + r� Flue G vent r water heater or gas fireplace 23.32 Log lighter (gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 ❑ PROPERTY OWNER ❑ TENANT Chimney/liner /flue/vent 23.32 Other: 23.32 Name: Environmental exhaust and ventilation: Address: Range hood/other kitchen equipment 1 33.39 City/State /ZIP: Clothes dryer exhaust 1 33.39 Single -duct exhaust (bathrooms, Phone: �1 ( ) Fax: ( ) toilet compartments, utility rooms) '"T 23.32 El ❑ CONTACT PERSON Attic/crawlspace fans ((l 23.32 er: Business name: - t ' ) ► I 4 / vC , • Fu l piping: 23.32 om .� • It Contact name ` e i 0 Ak S14.15 for first four; 54.03 for each additional Address: ` b., D �� b 41 (1-O Furnace, etc. 1 I. rte' " Gas heat pump City/State/ZIP: 11 l ) Wall /suspended/unit heater Phone: t ( , )S:12_0111 ( le : ( c -- Se , Q �3 i Water heater I ``-- CC�s�' �/�` /� 1 y � U + fi t ,�y� Fireplace t E -mail: q � �� ] IITIIL .( 1�I / 3 It i.) 7( .- )Y-[s(G) Range i CONTRACTOR ( Barbecue AVM `,itL /16741.77A/6-. Clothes dryer (gas) Business name: /�' Other: Address: / L 6,sz - r .9-1/ _ MECHANICAL PERMIT FEES* City/State /ZI Sgvj y - EZ. 976 Subtotal ) Minimum permit fee ($90.00) Phone: ( .50 - .'�.3 �, / Plan review (25% of permit fee) CCB lic.: /9 ° ,t /Y 2 / , Z / State surcharge (12% of permit fee) r j TOTAL PERMIT FEE Authorized signature: This permit application expires if a permit is not obtained within 180 g days after it has been accepted as complete. Print name:17 1 l i e (, , Date: 6 . t / t/ * Fee methodology set by Tri -County Building Industry Service Board I:\ Building \Permits\MEC- PenniitApp.doc 09/09/10 440-4617T(11/07/COM/WEB) x uJdf - Electrical Permit Application aECEINFr FOR ()FFICI :l I: ONLY City of Tigard Dam a G ,fig �� PermitNo.: h 6/ € ' /7i 1111 13125 SW Hall Blvd., Tigard, OR 97223 U N 2 8 20 I t ■ Plan Ravi eview Other Permit: 2,9104.9. _ 422 Phone: 503.7182439 Fax: 503.598.1960 Date/By: I R, : \R p . • r- ^ " Ready/ By: Inspection Line: 503.639.4175 " ° ,P ` Date y: Iris: la See Page 2 for Internet: www.tigard- or.gov ; Notified/Method: Supplemental Information TYPE OF WORK - PLAN REVIEW,:.. - • - ,rNew construction ❑ Addition/alteration/replacement Please check all that apply (submit 2 sets of plans wfitems checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF. CONSTRUCTION . exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi- family ❑ Master builder ❑ Other: ['Fizz pip. ❑ Installation of 75 KVA or ❑ Emergency system. larger separately derived system. JOB SITE INFORMATION AND LOCATION.. ❑ Addition of new motor load of ❑ "A ", "E ", "1-2", "1 -3 ", Job no.: I Job site address ://Q O * L &.4 Six or more a res. occupancy. ate Amy ❑ Six or more residential units. ❑ Recreational vehicle parks. / //r,�/�/� 64 (� � ' ❑ H -care facilities. ❑ Hazardous locations. ❑ Supply voltage for more than City / State/ZIP: / (� A 6 ` 600 volts nominal. Suite/bldg. /apt no.: Project name: Aro. (9/4e &.z.,46--. ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: mince. I Qty. I Fee. I Total I • New residential single- or multi- family dwelling unit. Includes attached garage. .. # r m #4, //f`L4� 1,000 sq. ft. or less 11 168.54 4 Subdivision: 1J Lot no.: Ea. add'1500 sq. ft. orportion S 33.92 1 Tax map /parcel no.: Limited energy, residential 75.00 2 DESCRIPTION OF WORK . (with above sq. ft) Limited energy, multi- family 75.00 2 6�c q - - // 5,C ��� residential (with above sq. ft.) 6 " Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name: 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 552.26 2 Temporary on services or feeders installation, alteration, and/or City / State/ZIP: Phone: ( ) 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 ( .S,/,0 Ti✓DUS .P& 5 B. Fee for branch circuits without service or feeder fee, first 56.18 2 / 7?f - 0/Zld Contact name: pf f/ 7 branch circuit Each add'! branch circuit 7.42 2 Address: id_ 6 iO 5e0 6,p ik.. / 7 040 Miscellaneous (service or feeder not included) �; Each manufactured or modular 67.84 2 City /State/ZIP: / l ie0 © / i g - '172 3 dwelling, service and/or feeder Phone: )579. - 0 Fax:: ( 4 - 0 3 )5 — ?o g l 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 • et_ panel, alteration, or extension. Page 2 2 Business name: £ /64.4 N/9!`/4 77,e1V5 Each additional inspection over allowable in any of the above Address: r1,6413 S £ „23g 44 Additional inspection (1 hr min) 66.25/ br �� Investigation (1 hr min) 66.25/ hr City / State/ZIP: k/d4/3 $C • • _ ' 7(9 if Industrial plant (1 hr min) 78.18 / hr Phone: j ) j S ' ' p j 6 lge? Fax: ( 1'7) -I, � - `2. Inspections for which no fee is 90.00/ hr specifically listed (h hr min) _ CCB Lic.: 6 b et ( 2. Electrical Lic.: 2e. 499 Suprv. Lic.:=V s ELECTRICAL PERMIT FEES Subtotal: Suprv. Electrician signature, required: Plan review (25% of permit fee): Print name: f Q ' P,I ' Date: •3 s f .' State surcharge (12% of permit fee): i TOTAL PERMIT FEE: Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: = Number of inspections allowed per permit. I: 1Building\Permits\ELC- PermitApp.doc 07/01/10 440 - 46157(1105 /COM/WEB r . . /la 60e � l a �w . �, ) v 94/ , - 3 IN Building Division d 1 Development Code Provision Review Residential Projects Building Permit No: 1 6T-0 1?- —to 0 1 7 0 CWS Service Provider Letter Received: Yes ❑ No ❑ N/A Routed Plans: // Original Plan Submittal Date: C 2- 1st Revision Submittal Date: 1. Y ❑ Site Plan Only 2nd Revision Submittal Date: 141 ❑ 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 (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 if approved. . Planning Review (contact " 47 at 503 -718- 2 ` (3 Y or @tigard - or.gov) Land Use Case No. 5i..'13 'ib Name W a t 13' Zoning - 1 2_ E Setbacks: , _ t, Front I Rear / S )Side Street Side d' Garage zc D Maximum Building Height 3 - 5 -- Actual Building Height 3e? .0 Visual Clearance O Easements �r O Sensitive Lands Type: y' Notes: , y, S e �, l3 .f5 � c i I. .!L'7V�ffill C 'u' " o - 1/M1/ /l'.pNCI. , Original Plan: Approve. ' Not Approved 8 Date: - 2 - Z Revision 1: Approved z Not Approved ❑ Date: q ----12. fine Revision 2: Approved ❑ Not Approved ❑ Date: 1 Engineering Review (contact Mike White at 503- 718 -2464 or MikeW @ tigard - or.gov) J2 Actual Slope: 5 Notes: Original Plan: Approved -Er Not Approved ❑ Date: 7 / Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: (Review Continues on Page 2) Page 1 of 2 City Review (contact Todd Prager at 503- 718 -2700 or todd @ tigard - or.gov) treet Trees Protect d Trees J I // 1 I _� d 1 Notes: ie /i3e C4tie7 �nC TPU'q 6J Lc lu��; ' I/ a11 J 4,4 +e n l o-� ie' - �J( >uGm 91 -' %, 1 Original Plan: Approved LEFT Not Approved LN Date: — 1- ,1 b - Av /a. Revision 1: Approved Not Approved ❑ Date: 9 f S / .z.-- 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: Yei, o )0 �� /11."4------- Date Routed to Building. S i 1 1 1111111/ r Page 2 of 2 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 III = Transmittal Letter T I G A R [) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard- or.gov C TO: DATE RECEIVED: DEPT: BUI G DIVISION RECEIVED FROM: • ( Ii CITY (}FTIGARD COMPA BUILDINIGD PHONE: By. # RE: )1b� o .t.J ad_t - t ?c (Site Address ` ermit Numbe 3 (Project name or subdivision name 0,. of u 1 '�l 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: —at • l , ° of" C) . FOR OFFICE USE ONLY Routed to Permit Technician: Date: c-((-7 (Z Initials• it i Fees Due: ❑ Yes To Fee Description: Amoun r 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: /4 gui 6,4.� L 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 11114 ■ r Transmittal Letter I , , „ I, Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard- or.gov TO: D E to DEPT: BUILDING DIVISION JUL 2 4 2012 ,., /' C +T OF TIG ARD FROM: ••: / �� 1 � u B G �O �IOt COMPA ,_c__,,,,,N.Q t,".o ,-� PHONE: _ RE: H to -L1i L7d (Site Address) 6 , I / 2 (Permit umber) . rodect name or su 1 lvrslon name ' • it num 9 er ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: I Copies: I 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: �.)--e_ O cI1 +S U FOR OFFIcE USE ONLY Routed to Permit Technician: Date: 1 Z ? [ Z Initials• Fees Due: El Yes [a'lvo Fee Description: Amour ue: $ • $ $ $ Special Instructions: Reprint Permit (per PE): ❑ Yes ❑ No ❑ Done Applicant Notified: Date: Initials: I \ Building\Forms \TransmittalLetter- Revisions.doc 05/25/2012 • SI r�QD��/(N��ua7111a 7 "'I JOIUID Z "10Z0C 9Ad .. _ I O l = MARK STEWART U / 101_0 \ v ,{ �( I�/J\II / ��I _� II HOYBDESIGN m _ � �} �} SLR l m ''"; ,r 1 0 E.E. 0.0' - _ - 69.58 _ _ _ - - E. 0.0 � � - Y ,� 44.0' — — 341 N.111 9tH r — ` •�4i :.A:9:4. �i4 P ORTLAND, OR AVE. VE. •'• — ��i�i : i i i : i : i i i i i (503) 88515311 P • • \0� � x5000,0 �.50 ..•�•����� (503) 519.4132 F I L •wuu,markeiwart.com - 225 SQ. T. 2 . 5 ;�i�i�i�i�i�i�i� I � GARAGE �-, - ~ 2,08 , FT. I I �� PLAN WHITE OAK - 0 1 U R I — — — � VILLAGE LOT *3 p cv o o i aD O - \ / I Q ,�� \ I PA .E. I lir 1 C... / CABLE v — — _ . PHONE 4 : %.�. - .�' _ �L GAS ,, _/ N.B. .."•-,N W i - \ it iii .. = E.E. 0.0' 69. e7 ' E.E. 0.0 � = Stock Nome Plane T ^ ((� I _ II Guetom Dealgn v� / Bulldar Marketing P.U.E. (') / 101 _ / 1 4 _ 11 0 / 1 _ ' / Interior Deelgn SL/ 10 / fL/ 1 a n since 1992 LOT INFORi IMPERVIOUS AREA'S- . ; LOT AREA 1,815 SQ. FT. 63 SQ. FT. DRIVEWAY L D T 3 IMPERVIOUS COVERAGE 1,241 SQ. FT. 25 SQ. FT. PORCH # Moons* nesse � BUILDING COVERAGE 66% 40 SQ. FT. WALK BUILDING 1-IEIGHT APPROX - 29' -9' 12 SQ. FT. PATIO w..�....1...... 154 SQ. FT. OVERHANGS SCALE: 1/8"= 1 - - �-� - 581 SQ. FT. BUILDING COVERAGE ... � r ,.r..,.r.. ,1....a. . ...wrll.r ow/ R Is • Aei.0 . 1 ,241 TOTAL SQ. FT. IMPERVIOUS AREAS r2 r,.. � livIe � .. ruy w • . m n vMwr .r it I. oo..'tlP I . w. � ` Yr 1.� —I wwM.l.11.� .. . M. = STREET TREE .d..« ...... ...., = WOODEN CURB RAMP ,,,,,,....,.�,,,..,,, ,,,,,,,,,,. 2' PYRUS CALLERYANA CAMBRIDGE taboo NO llw for the --c• w- b.ti..e.o..rya.e., - = CATCH BASIN PROTECTION ,-- =WORK STAGING/ MATERIAL STORAGE CUM WESTLAND HOMES j/ = CONSTRUCTION ENTRANCE • ;: . COVERED STOCKPILES P+•.xrra OAK VILLAGE '• - -�•t +I LOT #3 =SEDIMENT FENCE N I = COVER ALL AREAS OF BARE SOIL UNTIL �"° . � - � . PERMANENT LANDSCAPE IS IN PLACE PAM SITE • • 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 11040 SW LEGACY OAK WAY, TIGARD, OR, 97223 Residential - Master Permit 199 Electrical final 04/30/2013 00:00 MST2012-00170 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 11040 SW LEGACY OAK WAY, TIGARD, OR, 97223 Residential - Master Permit 199 Electrical final 04/30/2013 00:00 MST2012-00170 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 11040 SW LEGACY OAK WAY, TIGARD, OR, 97223 Residential - Master Permit 699 Mechanical final 04/30/2013 00:00 MST2012-00170 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 11040 SW LEGACY OAK WAY, TIGARD, OR, 97223 Residential - Master Permit 199 Electrical final 04/30/2013 00:00 MST2012-00170 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 11040 SW LEGACY OAK WAY, TIGARD, OR, 97223 Residential - Master Permit 299 Final inspection 04/30/2013 00:00 MST2012-00170 PASS - C of O Final Inspection requires: Erosion approval Moisture Content Acknowledgement Form High-Efficiency Interior Lighting System Form Street Tree Compliance Form Blower door test for Radon requirements Violation Summary: Inspector Contractor Oregon Residential Specialty Code R318.2 MOISTURE CONTENT ACKNOWLEDGEMENT FORM I, Roo �ivD /Q/V , am the general contractor or the owner- builder at the following address: Site Address: /, 0 y � 1.674'f /' -k h 4-f City: --7767472.61 Permit #: is /7 0 Subdivision/Lot #: /,� GLAd-e 4,7-- 3 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: ``� �/�■ 4,0 Date: -/ 3o 7/ 3 G Contractor or Owner - Builder 1:\ Building\ Form \RES- MoisturesensitiveWood.doc 09/25/08 Oregon Residential Specialty Code N1107. HIGH - EFFICIENCY INTERIOR LIGHTING SYSTEMS Permit No.: 2D / _ Q� / 20 Jurisdiction: 7 Site Address: 040 560 Z g U t DAB ably 1h Subdivision/Lot #: / /��G A-446-6, and/or � G- Map and Tax Lot #: By my signature below, I certify that a minimum of fifty (50) percent of the permanently installed lighting fixtures in the above mentioned building have been installed with compact or linear fluorescent, or a lighting source that has a minimum efficacy of 40 lumens per input watt. (Oregon Residential Specialty Code N1107.2) Signature: ��� Date: t /3 O r eneral Contractor /Authorized Agent Print Name: /0/ 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 .71 STREET TREE TIGARD CERTIFICATION I, A6 4,vOg eSo.c.i 5 owner/ agent o ifiesr a s 57 / a r g f (PLEASE PRINT) (PERMIT HOLDER) do hereby certi,6 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.: /157' 0 HIE ADDRESS: 000 5 1 Gy a e S" SUBDIVISION: `(/ tre LOT #: 3 SIGNATURE: DA4 E: `-f -30- / 3 (OWNER /AGENT) RECEIVED & VERIFIED BY DA1 E: (CITY OF TIGARD) • ❑ Tree location verified per approved site plan. I: 'Building \Forms \StreetTreeCertificate 05/30/2012 Program Use Only \ Form 640S FastTrack ID '` Completion Certification —Site Inspection EnergyTrust New Homes Program — Single Family Data check by of Oregon (initials) To be completed by verifier Portland Energy Conservation, Inc. (PECI) is a Program Management Contractor for Energy Trust of Oregon. First Inspection Second Inspection Date: 1/1/13 Verifier Name: preston kuckuck Date: 4/8/13 Verifier Name: preston kuckuck Incentive Payee Company Name: Builder or Company: Westland industries Contact Name: Performance Testing Company: Fireside Home Solution Technician Name: pak Site Information Development Lot Number: REM/Rate SCO Project ID: Name: white oak 3 File #: pro ectis ENERGY STAR') Site Address:1 1040 legacy oak way City: TigarI State OR Zip: Jnattached ❑ Attached Number of Stories: 3 Total Building Square Footage: Number of Bedrooms 3 218:, Basement ❑ None ❑ Full Basement ❑ Half Basement XXJ Crawlspace Type ❑ Garage/basement combo ❑ Slab on grade ❑ Other Electric Provider PGE ❑ PAC ❑ Other: Gas Provider j NWN ❑ CNG ❑ Other: Electric Meter Number: 22236926 Gas Meter Number: 42413078 (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) M Path 1 EPS Best Practices ❑ Path 2 ENERGY STAR ❑ Envelope Upgrade ❑ Ducts & HVAC Equipment Inside ❑ Equipment Upgrade ❑ Path 3 ENERGY STAR with ducts inside ❑ Path 4 Performance Plus with ducts inside ❑ Path 5 Advanced Performance ❑ Zonal Electric Efficient ❑ Advanced Electric Resistance ❑ Solar Electric (PV) ❑ Solar Water Heating (SWH) ❑ Small Wind Renewable ❑ Solar Ready Electric (SRPV) ❑ Solar Ready Water Heating (SRWH) Energy ❑ Qualifies for Solar Ready Incentive (must attach checklist) Solar Installer: Name: Company: Low Income ❑ Yes ® No Does this project qualify as Low Income? (must provide documentation from builder) Accessory ❑ Yes IN No Is this home an ADU? Dwelling Unit ❑ Yes No Is the ADU separately metered? If so, provide meter numbers above Other ❑ Earth Advantage — Certification Level: Certifications ❑ LEED -H - Certification Level: 0 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@en ergytrust. org Ali Form 640S ii\ Completion Certification —Site Inspection EnergyTrust New Homes Program — Single Family of Oregon To be completed by verifier Portland Energy Conservation, Inc. (PECI) is a Program Management Contractor for Energy Trust of Oregon. Verification Type Actual Value Equipment Details & Notes Category Insulation Flat Ceiling R- 49 Insulation Type: bib Framing Type: Vaulted Ceiling R- 38 Insulation Type: bait - Standard Scissor Truss R- Insulation Type: Intermediate Above Grade Walls R- Insulation Type: bib ❑ Advanced 23 Framing Below Grade Walls R- Insulation Type: 30 Size: Floor Over Unheated Space R- Insulation Type: bait Floor Over Garage R- Insulation Type: Slab Floor (unheated) R- ❑ Full Slab ❑ Perimeter Doors Door R- Windows Windows U- .30 SHGC: 30 Window Frame Material: vinyl Skylights U- SHGC: Window Area (Glazing) % Total window area: Lighting Indoor and Outdoor # fixtures: 37 81 % # of ENERGY STAR fixtures or CFLs: 30 Appliances ENERGY STAR Dishwasher 14 Yes ❑ No EF Cooling Air Conditioning SEER: No Btu /Hr: Primary Heat l Fireplace AFUE: 95.5 Brand: fraser johnston Outdoor Unit (for heat Source Gas Furnace pumps) ❑ Electric HSPF: Model #: TG9S060A I OMP 11 A ❑Boiler Model #: a Gas Heat Pumps: SEER: Serial #: W 1 }- 12143783 ❑ Other: Serial #: ❑ Air Source (ducted) COP: Btu /Hr: 60,000 ❑ Mini Split (ductless) ❑ Ground Source Location: ECM: ❑ Yest No Heat pump commissioning ❑ Radiant Floor Heat d No P ❑Cadets cond Electronic Air Cleaner: ❑ Yes L� No report attached or confirmation for ground ❑ Zonal Backup fuel: ❑ Electric ❑ Gas ❑ Other source heat pumps that ❑ Other: space X manufacturer's start up procedure was performed 0 Additional notes on primary heating: Notes on secondary heating: Water Heater ❑ Storage Gallons: Brand: Rlnnal ❑ Electric ( aTankless 7121 Gas EF: 82 Model #: R1751 Location: Serial #: DK.CA- 095332 cond space Btu /Hr: 1 80,000 Form 640S v10 120101 Page 2 of 3 Return completed form to: Energy Trust New Homes Program—Single Family 100 SW Main Street, #1600 ♦ Portland, Oregon 97204 1.877.283.0698 ♦ Fax 1.855.575.4315 newhomes@energytrust.org \r. Forni 640S 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 3Yes ❑ No ]xhaust & Supply Cycler ❑ Heat Recovery ERV /HRV Model #: Ducts ❑ Ducts Inside % ducts inside: Ducts in Conditioned Space If 1 iming incentives for ducts inside, check one of the following: Lf6ucts Tested ❑ Visual Inspection per RTF specs Duct Insulation R- Duct Location 50 attic 50 cond space Duct Sealing w /Mastic Paste JYes ❑ 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. y Duct Cubic Feet Per Minute Duct Leakage Air Handler In )n Yes Air Handler Present lOr Yes Leakage: (CFM) © 50Pa: 97 N Pass ❑ Fail Conditioned Space ❑ No During Test ❑ No Fan Pressure ❑ DG3 Fan Ring Type ❑ 0 ❑ 2 Leakage Test If Total Leakage Gauge ®(DG700 Pressure: -235 (check one) ❑ 1 3 Method ❑ Leakage to Outside Duct Blaster Location: Main return Pressure Tap Location: Bath Area Tested: 1 Whole House Air Changes per Hour Envelope Tightness Cubic Feet Per Minute Leakage: (ACH) @ 50Pa: 3.8 [XPass ❑ Fail (CFM) @ 50Pa: 1210 House Volume: 1 8750 g2I5t Practices Requirements PT requirements Gime an - g co Energy Performance Score) • Thermal Enclosure Checklist Complete Pass ❑ Fail Thermal Enclosure Checklist attached? ❑ Yes • Insulation Quality Inspection Performed 1'I 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 C ressure: Pa If not applicable, please explain: All dv (required) Forced air system operation must not depressurize Combustion Appliance Zone (CAZ) by more than 3 Pascals (Pa.) *All shaded sections are required for Best Practices. Applications will not be processed without these sections completed. Technical Compliance Options (please list all that apply) If any values on this form do not meet Builder Option Package (BOP) requirements, please indicate which Technical Compliance Option(s) allow the variance and explain which component was traded. TCO #: Explanation: Additional Notes: Signature By my signature below, I certify that I have performed the tests as described, that the form is complete, and that all information on the form is accurate. Verifier Verifier Signature: Preston Kuckuck Name: Preston Kuckuck Date: 4/8/13 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