Permit CITY OF TIGARD MASTER PERMIT
11, .
COMMUNITY DEVELOPMENT .1 Permit#: MST2012-00233
1 Date Issued: 04/22/2013
T fGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 WM Parcel: 2S109DA19100
�(� ir��- Jurisdiction: Tigard
Site address: 12613 SW CANYONRIDGE CT
Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 120
Project: Arlington Heights No.3, Lot 120
Project Description: New SF. 6/4/13, reprinted to finish basement. 11/13/13:Reprinted permit to include NC. A/C
unit must comply with manufacturer's clearance requirements.
r
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 4 First: 1335 sf Basement: 1000 sf Left: 5 Parking Spaces: 0
Height: 31.5 Bathrooms: 4 Second: 1717 sf Garage: 743 sf Front: 15 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 4052 sf Value: $455,357.20 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 4 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 5 Dishwashers: 1 Floor Drains. 0 Sewer Lines. 100 SF Rain Storm Sewer: 100
Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: Y Vent Fans: 6 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Fum<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Fum>=100K: 1
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'I 500 sf: 8 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
asin Y
Other: N Other Description: Ecom p 9
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 4052
Owner: Contractor:
STONE BRIDGE HOMES STONE BRIDGE HOMES NW LLC Required Items and Reports(Conditions)
4230 GALEWOOD ST,SUITE 100 16869 SW 65TH AVE#505 1 Ersn Cntrl 503-639-4175
LAKE OSWEGO,OR 97035 LAKE OSWEGO,OR 97035 2 geo tech report required prior
to footing inspection
PHONE: 503-387-7577 PHONE: 503-387-7577
FAX: 503-387-7615
Total Fees: $23,453.58
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. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You ma ob a' ..:,, • •-- les or direct questions to OUNC by calling 503. 2.1987 or 1.800.332.2344.
Issued By.40/11°111111.17:-_i — ' -- Permittee Signature:
111 by 7:00 a.m.for the next available Inspection date.
This permit card shall be kept in a conspicuous place on the Job site until completion of the project.
Approved plans are required on the Job site at the time of each inspection.
Mechanical Permit Application `r.b y ) ' i i FOR OFFICE USE ONLY
4"-, //received
14 . City of Tigard o to tt.: Permit No.: ,_-f>�33
13125 SW Hall Blvd.,Tigard,OR 97223 S i3 d d '1012 y ® - �-2 � �� pO
Phone: 503.639.4171 Fax: 503.598.1960 L Plan Review �KJK OIO/�--.ci jl0 O
DatciBy, Other Permit:
T I G A R D Inspection Line: 503.639.4175 } Date ReadyRty: Jude: ® See Page 2 for
Internet: ww%.tigard-or.gov t), 1' t.r:- 1-;saMilt a Nutilied/Method: Supplemental Information
.1'pi t11Fjir-.:(,,/a/14.aj1y�
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
®New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑ Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
CATEGORY OF CONSTRUCTION Value:S
® I-and 2-family dwelling RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
y g ❑Commercial/industrial ❑Accessory building
For special information use c•hecklici.
❑ Multi-family ❑Master builder ❑Other: Description I Qty. 1 Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: I�13 SIv cAY4"2 l �l ( 'T• Air conditioning
(requires site plan showin t_placcmcnO ` 46.75 Lit,.7r
City/State/ZIP:Tigard,OR Furnace 1(8),000 Bl'l I(duet(duets/ye 46.75
Furnace 100,000+BTU(duets/vents) 1 54.91
Suite/bldg./apt.no.: Project name:Arlington Heigh °I
Heat pump 61.06
Cross street/directions to job site: iff/3 /3 e.,/ 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:Arlington Heights I Lot no.: I W Flue/vent for any of above 23.32
Other: 23.3_
'Fax map/parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater , 23.32
Gas fireplace ( 33.39
p� New,Single Family Residential Flue vent for water heater or gas
ep aG`®D•I A/C 0313 fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
0 PROPERTY OWNER 1 ❑ TENANT Chimney/liner(Oue/vent 23.32
Other: 23.32
Name:Stone Bridge Homes NW,LLC Environmental exhaust and ventilation
Address: 16869 SW 651°Avenue#505 Range hood/other kitchen !
equipment I 33.39
City/State/ZIP: Lake Oswego,OR 97035 Clothes dryer exhaust 1 _ 33.39
Single-duct exhaust(bathrooms,
Phone:(503)387-7577 Fax:(503)387-7616 toilet compartments,utility rooms) 5- 23.32
❑ APPLICANT ❑ CONTACT PERSON Atttcicrawlspace funs 23.32
Other: _ 23.31
Business name:same as above Fuel PiP t m
g
Contact name: Deirdre Britt $14.15 for first four;54.03 for each additional
Address: Furnace,etc. _
Gas heat pump _
City/State/ZIP: Wall/suspended/unit heater
Phone:( ) Fax::( ) Water heater r
Fireplace j1
E-mail: dbritt @stonebridgehomesnw.com Range G
CONTRACTOR _Barbecue
Clothes dryer(gas)
Business name:Comfort Zone -
Other:
Address: 1032 NW Corporate Drive MECHANICAL PERMIT FEES*
City/State/ZIP:Troutdale,OR 97060 Subtotal 4(6,'75
Minimum permit fee($90.00)
Phone:(503)667-5595 Fax:(503)491-8252 Plan review(25%of permit fee)
CCB tic.: 110091 State surcharge(12%of permit fee) S, 62/
TOTAL PERMIT FEE cc)...36 7 "4/C
Authorized signature: This permit application expires if a permit is not obtained within ISO ////t/)
days after it has been accepted as complete. J
Print name:David Heldstab l Date: • Fee methodology set by Tn-County Building Industry Service Board 7: •
I:,aaitdind/PennitsMEC•Pen„itApp.doc Iaro1AW 1811-461rr+I I•O2JCOM'WEB! ' ■
CITY OF TIGARD I MASTER PERMIT
I li l: • COMMUNITY DEVELOPMENT IM® Permit #: MST2012 -00233
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/22/2013
Parcel: 2S109DA19100
Jurisdiction: Tigard
Site address: 12613 SW CANYONRIDGE CT
Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 120
Project: Arlington Heights No. 3, Lot 120
Project Description: New SF. 6/4/13, reprinted to finish basement
BUILDING
Floor Areas Required Setbacks Required
Stories 3 Bedrooms' 4 First 1335 sf Basement: 1000 sf Left 5 Parking Spaces 0
Height 315 Bathrooms 4 Second 1717 sf Garage: 743 sf Front. 15 Smoke
Dwelling Units 1 Third. 0 sf Right: 5
Detectors Yes
Total 4052 sf Value. $455,357 20 Rear. 15
PLUMBING
Sinks* 1 Water Closets: 4 Washing Mach: 1 Laundry Trays' 1 Rain Drain 1 Urinals 0
Lavatones 5 Dishwashers' 1 Floor Drains: 0 Sewer Lines. 100 SF Rain Storm Sewer 100
Tubs/Showers 4 Garbage Disp: 1 Water Heaters 1 Water Lines 100 Drains 0 Catch Basins: 0
Bckflw Prevntr. 0
Footing Drain 0 Ice Maker 1 Hose Bib: 2 Backwater Value' 1
Drywell -Trench Drain: 0 Other Fixtures 0
Other Fixture Units
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 6 Clothes Dryers. 1
Natural Gas Heat Pump: N Hoods: 1 Other Units. 0
Furn<100K. 0 Vents 0 Woodstoves' 0 Gas Outlets: 4
Fum > =100K: 1
' ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less 1 0-200 amp: 0 0-200 amp' 0 W/ Svc or Fdr 0
Ea add! 500 sf 8 201 -400 amp' 0 201 -400 amp: 0 W/O SvclFdr 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 Secunty 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 4052
Owner: Contractor:
STONE BRIDGE HOMES STONE BRIDGE HOMES NW LLC Required Items and Reports (Conditions)
4230 GALEWOOD ST, SUITE 100 18869 SW 65TH AVE # 505 1 Ersn Cntrl 503 - 639 -4175
LAKE OSWEGO, OR 97035 LAKE OSWEGO, OR 97035 2 geo tech report required prior '
to footing inspection
PHONE' 503 - 387 -7577 PHONE' 503 - 387 -7577
FAX: 503- 387 -7615
Total Fees: $23,401 22
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 nce 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 ENTION: on law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952 -001 010 through OAR 52- -0090. You may obtain a copy of the rules or direct questions to OUNC by calla • : 03.232 1987 or 1.800.312.2344.
Issued B Permittee Signature. _ _ A C
Call 503.639.4175 by 7:00 a.m. for the next available Inspection date. 0
This permit card shall be kept In a conspicuous place on the Job site until comple • n of the project.
Approved plans are required on the Job site at the time of each Inspection.
FOR OFFICE USE ONLY — SITE ADDRESS: /� /3 SGc2 C--4A/y0/1/1.6(c-C--
This form is recognized by most building departments in the Tri -County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Transmittal Letter
T I G A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard- or.gov
TO: .LTh /9 DATE RECEIVED:
DEPT: BUILDING DIVISION RECEIV
MAY 2 3 2013
FROM: ,-9- 77/- 9S CITY OF TIGARD
COMPANY: C4-2“ Dr 1 l _ 1.4 ..,-, ,v i 4_1_6. BUILDING DIVISi rt;
PHONE: C.S 76 — 3 — S 191 By.
RE: /a 6 /3 s C'9wyo.v /2./ AG-g MSTda/a - 2 Oa 33
(Site Address) (Permit Number)
'9 Z-1/1/61 /C/ / ic/0. 3 Le) / / _0
(Project name or subdivision name and lot number)
ATTACHED ARE THE FOLLOWING ITEMS:
Copies: I Description: I Copies: Description:
Additional set(s) of plans. i� Revisions: 75 A;.1/7,5y 6
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:
FOR OFFICE USE ONLY •
Routed to Permi chnician: Date:t°3e'.) k k.' Initial
Fees Due: es ❑ No Fee Description: Amount Due:
Ql) T $
$
$
re $ ,2,X53,
Special
Instructions:
Re I rint Permit s er ' ►i Yes ❑ No ❑ Done
• pp scant otified: V l ate: 4/03 /3 v'F1 40•Nr/ Initial .
1:\ Building \Forms \TransmatalLetter - Revisions doc 05/25/2012 .
CITY OF TIGARD MASTER PERMIT
*= COMMUNITY DEVELOPMENT Permit #: MST2012 -00233
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/22/2013
Parcel: 2S109DA19100
Jurisdiction: Tigard
Site address: 12613 SW CANYONRIDGE CT
Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 120
Project: Arlington Heights No. 3, Lot 120
Project Description: New SF
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 3 First: 1335 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 31.5 Bathrooms: 3 Second: 1717 sf Garage: 743 sf Front: 15 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 3052 sf Value: $351,437.20 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Drains: 0
Tubs /Showers: 3 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: 5 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Furn > =100K: 1
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'I 500 sf: 5 201 -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 3052
Owner: Contractor:
STONE BRIDGE HOMES STONE BRIDGE HOMES NW LLC Required Items and Reports (Conditions)
4230 GALEWOOD ST, SUITE 100 16869 SW 65TH AVE # 505 1 Ersn Cntrl 503 - 639 -4175
LAKE OSWEGO, OR 97035 LAKE OSWEGO, OR 97035 2 geo tech report required prior
to footing inspection
PHONE: 503- 387 -7577 PHONE: 503 - 387 -7577
FAX: 503 - 387 -7615
Total Fees: $21,147.76
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. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 - 0010 th h OAR 952 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800. .2344.
Issued By: 4# i/ Permittee Signature: !'
Call 503.639.4175 by 7:00 a.m. for the next available inspectioate.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
1 •
Building Permit Applicationw
Residential FOR OFFICE USE ONLI
l of Ti a S P 12 2012 Received 9 H 3c442_47 3
DateB 7 Permit No.: J
1 3125 SW Hall Blv Tigard, OR 97 23 Plan Revs
Er
hone: 503.639.4171 Fax: 503.5 A pn Date/I3 : /ro j1, A Other Per,nit�; �� �`
T I GARD I "spection Line: 503.639.41 BUILD t1tt1J Da te Rea : : CH �� L i Juris: ® See Page 2 for
Internet: www.tigard- or.gov I NGDNISION Notified/Method `r► '1 Supplemental Information
L.,‘,i
TYPE OF WORK RE UIRED DATA: 1- AND 2- FAMILY DWELLING
® New construction ❑ Demolition Permit fees' are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
❑ Addition /alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
® I- and 2- family dwelling ❑ Commercial /industrial Valuation,07-2t0
❑ Accessory building El Multi-family Number of bedrooms: 3
❑ Master builder ❑ Other: Number of bathrooms: 2 ,r
JOB SITE INFORMATION AND LOCATION Total number of floors: 2
Job site address: I2/il 3 SM/ya4 16 tE GT • New dwelling area: 3052 square feet
City/State/ZIP: Tigard, OR 97223 Garage /carport area: 143 square feet
Suite/bldg./apt. no.: Project name: Arlington Heights Covered porch area: 6,5 square feet of 7
Cross street/directions to job site: Deck area: 107 square feet 133
Other structure are 27.45 square feet 3( ,5
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Arlington Heights Lot no.: Ito Permit fees' are based on the value of the work performed.
Tax map /parcel no.: 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.
New, Single Family Residential Valuation: $
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name: Stone Bridge Homes Type of construction:
Address: 4230 Galewood St, Suite 100 Occupancy groups:
City /State/ZIP: Lake Oswego, OR 97035 Existing:
Phone: (503)387 - 7577 Fax: (503)387 -7616 New:
❑ APPLICANT ❑ CONTACT PERSON
NOTICE
Business name: SEE ABOVE All contractors and subcontractors are required to be
Contact name: Deirdre Britt licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
City / State/ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) Fax :: ( )
E -mail: dbrittnstonebridgehomesnw.com
CONTRACTOR
Business name: SEE ABOVE BUILDING PERMIT FEES'
Address: (Please refer to fee schedule)
City /State/ZIP:
Structural plan review fee (or deposit):
Phone: FLS plan review fee (if applicable):
( ) Fax:( )
CCB lic.: 173318 Total fees due upon application:
of
• Amount received:
Authorized signature: 7
This permit application expires if a permi is not obtained
T �'n Db � � O � � •'Z within 180 days after it has been accepted as complete.
Print name: V „ IE Date: • Fee methodology set by Tri -County Building Industry
Service Board.
1: \Building\Permits\BUP -RES PermitApp.doc 10/01/09 440 -4613T(I1 /02 /COM/WEB)
P I u m bins Permit Applicati
Buildin g Fixtures ".JCi V t FOR OFFICE l SE ONE%
City of Tigard SEP 1 2 2012 Received t % /01. ( k „ Permit No.. •462� _ � _ .253
I I I 13125 SW W Hall Blvd., Tigard, OR 97223 _ Plan Review ' tt, OG
= Phone: 503.639.4171 Fax: 503.5 i ' L 0' tf : Date/B : Other Permit No.: / ,,�_
Inspection Line: 503.639.4175 w t T tt� � !� Date Ready/By: Iuns: See Page 2 for
TIGARD Internet: www.tigard - or.gov `- JtIO B ® _I nft? .l i ;l)Cj Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
® New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑ Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
® 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
SFR (3) bath ( 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 LOCATION Site utilities:
Job site address: r L I3 gN (, j , r i c , j Ripte cr. Catch basin or area drain I 18.76
City/State /ZIP: Tigard, OR 97223 Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: _) Page 2
Suite/bldg. /apt. no.: I Project name: Arlington Heights Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no. linear ft.: _) Page 2
Water service (no. linear ft.: _) Page 2
Subdivision: Arlington Heights I Lot no.: `O Fixture or item:
Tax map /parcel no.: Backtlow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
New, Single Family Residential Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Stone Bridge Homes Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 4230 Galewood Street, Suite 100
Garbage disposal 25.02
City/State /ZIP: Lake Oswego, OR 97035 Hose bib 25.02
Phone: (503)387 -7577 Fax: (503)387 -7615 Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: SEE ABOVE Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: Deirdre Britt Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: dbrittnstonebridgehomesnw.com Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: Max Plumbing Water piping/DWV 56.29
Address: PO Box 5597 Other: 25.02
City/State /ZIP: Beaverton, OR Subtotal
Phone: (971)275 -0198 Fax: ( ) Minimum permit fee: $72.50
Plan review (25% of permit fee)
CCB Lie.: 194644 Plumbing Lic. no.: PB1083 State surcharge (12% of permit fee)
Authorized signature: r ems/ r. l TOTAL PERMIT FEE
Print name: Jason rner /�'� � Date: This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
I: \ Building \Pennits\PLMU- PermitApp.doc 10/01/09 440- 4616T(10 /02/COM/WEB)
Mechanical Permit Application '7, I ht)IZ OFFICE USE ONLY
City of Tigard ' " � . 'received Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 S E P 12 2012 Date/By: '7' _� 1 oa.2 33
tl —
Phone: 503.639.4171 Fax: 503.598.1960 Plan Review .r n n !a ^60loir
> Other Permit: OHO O
Date /By:
TIGARD Inspection Line: 503.639 CFI( DateReady /By: Juris: ® See Page 2for
Internet: www.tigard tiJ11 t gov � o ri O Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
® New construction ❑ Addition/alteration /replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
® I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi family ❑ Master builder ❑ Other:
Description I Qty. .I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 1 SW CANNIa4 k Vbe Cr. Air conditioning g p )
(requires p
uires site plan showing lacement 46.75
City/State /ZIP: Tigard, OR Furnace 100,000 BTU (ducts /vents) 46.75
Furnace 100,000+ BTU (ducts /vents) 1 54.91
Suite /bldg. /apt. no.: Project name: Arlington Heights Heat pump 61.06
Cross street/directions to job site: 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
Flue /vent for any of above 23.32
Subdivision: Arlington Heights Lot no.: IZv
Other: 23.32
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater ( 23.32
Gas fireplace ( 33.39
New, Single Family Residential Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
® PROPERTY OWNER Chimney /liner /flue /vent 23.32
❑ TENANT Other: 23.32
Name: Stone Bridge Homes NW, LLC Environmental exhaust and ventilation
Address: 16869 SW 65 Avenue #505 Range hood/other kitchen
equipment 33.39
City/State /ZIP: Lake Oswego, OR 97035 Clothes dryer exhaust ( 33.39
Single -duct exhaust (bathrooms,
Phone: (503)387 -7577 Fax: (503)387 -7616 toilet compartments, utility rooms) 23.32
El APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Other: 23.32
Business name: same as above
Fuel piping
Contact name: Deirdre Britt $14.15 for first four; $4.03 for each additional
Address:
Furnace, etc. I
Gas heat pump
City/State /ZIP: Wall /suspended /unit heater
t
h
Water heater
ea f
Phone: ( ) Fax::( ) Wa f
Fireplace
E -mail: dbritt @stonebridgehomesnw.com Range
CONTRACTOR Barbecue
Business name: Comfort Zone Clothes dryer (gas)
Other:
Address: 1032 NW Corporate Drive MECHANICAL PERMIT FEES*
City/State /ZIP: Troutdale, OR 97060 Subtotal
Minimum permit fee ($90.00)
Phone: (503) 667 -5595 Fax: (503) 491 -8252 Plan review (25% of permit fee)
CCB lie.: 110091 State surcharge (12% of permit fee)
TOTAL PERMIT
Authorized signature: This permit application expires if a permit is not t obtained within 180
days after it has been accepted as complete.
Print name: David Heldstab I Date: • Fee methodology set by Tri -County Building Industry Service Board
1:\ Building 1 Permits \MEC- PermitApp.doc 10/01/09 440 -4617T (I I /02 /COM'WEB)
Electrical Permit Applicailo� FOR OFFICE USE ON I V
of Tigard • ' , ' Received p, Permit No.: ,
I II City O g �i;� "� Date/By: / /� //d .4......„k249 �T6tolz — ooa3
13125 SW Hall Blvd., Tigard, It 97223 �01' Plan Review
• Plan Re : Other Permit: n ^�
Phone: 503.639.4171 Fax: 503 � 1 9 � 1 a /C DtJ�a �o�gg
I I (, \ r. . I , Inspection Line: 503.639.4175 ! Date Ready/By: lurk: ® See Page 2 for
Internet: www.tigard or.gov ..,; ,, ;iL * + Notified/Method: Supplemental Information
TYPE, i VrEKkh. - " PLAN REVIEW
® New construction ❑Addition /alteration /replacement
Please check all that apply (submit 2 sets of plans w /items 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
® 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION
El Emergency system. larger separately derived system. A
❑ Addition of new motor load of ❑ "A ", "E ", "I - ", "1 - ",
Job no.: 14411 Job site address: 124 swCA Nya1 P.1 DI* t'T. I OOHPormore. occupancy.
❑
0 Six or more residential units. Recreational vehicle parks.
❑ Health - care facilities. ❑ Supply voltage for more than
City /State /ZIP: Tigard, OR 97223 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Arlington Heights ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Arlington Heights I .ot no.: 12 0 1.000 sq. ft. or less f 168.54 4
Ea. add'I 500 sq. ft. or portion '5 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) \ 757 2
Limited energy, multi - family 67.84 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
® PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
Name: Stone Bridge Homes 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: 16869 SW 65th Avenue #505 Over 1,000 amps or volts 552.26 2
City/State /ZIP: Lake Oswego, OR 97035 Temporary services or feeders installation, alteration, and /or
relocation
Phone: (503)387 -7577 Fax: (503)387 -7615 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 _ 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date:
A. Fee for branch circuits with
® APPLICANT I ❑ CONTACT PERSON above service or feeder fee,
7.42 2
each branch circuit
Business name: SEE ABOVE B. Fee for branch circuits
Contact name: without service or feeder fee, 56.18 2
Deirdre Britt first branch circuit
Address: Each add'l branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E -mail: dbritt( stonebridgehomesnw.com Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: City Electric Signal circuit(s) or limited-
energy panel, alteration, or
Address: 55568 SW Schaltenbrand Lane extension. Describe: Page 2 2
City/State /ZIP: Sherwood, OR 97140 Each additional inspection over allowable in an of the above
Per inspection 66.25
Phone: (971) 404 -1714 Fax: (503) 625 - 3052 Investigation per hour ( hr min) 66.25
CCB Lie.: 42422 Electrical Lie.: 26 -289C Suprv. Lie.: 35925 Industrial plant per hour _ 78.18
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
Print name: Chuck Friesen Date: Plan review (25% of permit fee):
State surcharge (12% of permit fee):
Authorized signature: 2 ) TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\ BuildingPennits \ELC- PermitApp.doc 10/01/09 4 0- 4615T111/05/COM/WEB
1 Building Division
Development Code Provision Review
fz D Residential Projects
Building Permit No.: H a--% c9 P-6O' 3 - 3
Site Address: (A G l ? c C_Jcl-∎3 vo a-1 D a e -
Project Name & Lot No.: -l.t 4.) 6T x) 1-1-ttiTS ] L-o-r (?
CWS Service Provider Letter
Required: Yes ❑ No
Received: Yes ❑ No
Routed Plans:
Original Plan Submittal Date: / I (9, /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 (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 onl if approved.
Planning Review (contact at 503 -718a or @tigard- or.gov)
Lad Use Case No. ‘3 ug,, 2a. - ZYll('7 /
El Zoning . 7
❑ Setbacks: -
Front 1 5 Rear I Side E5 Street Side it) 1 Garage 0
Er Maximum Building Height Actual Building Height 2 j) , 5'
Er Visual Clearance
E' Easements
E Sensitive Lands Type: Nn Gf 1
Notes:
Original Plan: Approved T( Not Approved ❑ Date: l7 f
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)
J Actual Slope: 7 1' %
Notes:
Original Plan: Approved ,lir Not Approved ❑ Date: I I
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
(Review Continues on Page 2)
Page 1 of 2
City As borist Review (contact Todd Prager at 503- 718 -27 00 or t d @ tigard- or.gov)
Street Trees L9 Protected Trees
Notes:
Original Plan: Approved V Not Approved ❑ Date: ! 7 Zi
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albeit @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 Permit: Yes No ❑ �
Date Routed to Building.
Page 2 of 2
FOUNDATION CERTIFICATION
LOT 120 OF "ARLINGTON HEIGHTS"
CITY OF TIGARD, WASHINGTON COUNTY, OREGON , r.
.4,
,o
PREPARED FOR fr\ °
STONE BRIDGE HOMES NW �°
988- 0-0 518800
7
16869 SW 65TH AVE #505
LAKE OSWEGO, OR 97086
----••(14111g) in
N
N
/ D6
10' Imo-- N
l t!3 S� C/4NYo�/1!- E CT .4� 10 SSE
�I,, °b
l'v, Srpfa _0o A � `O GOB 1 9.50 '
c
z
SSE = PUBLIC SANITARY SEWER EASEMENT uo
SDE = PUBLIC STORM DRAINAGE EASEMENT TRACT M -0-
5.50' 15.00' " LOT 23 "
BELLA VISTA"
120
,\ b o
co Li"
SCALE 1" = 30 FEET 4 4 4
1111 4° 0 , 6 4.0 10.0'
0 0 � ° c'' 3.00 0.50' c.i
r 18'35 "E
7 � 12.00'
I, ROBERT RETTIG, A REGIS I LRED N01'00'58 ° E 56.68' 15 `�
PROFESSIONAL LAND SURVEYOR IN THE 5
STATE OF OREGON, HEREBY CERTIFY �� .
THAT I HAVE ACCURATELY STAKED THE N56'00'16 "E 12.43' \ LOT 21
FOUNDATION FOR LOT 120 OF LOT 119 i "BELLA VISTA"
"ARLINGTON HEIGHTS" WITH HUBS AND
TACKS AS SHOWN. N00'18'35 "E 13.00'
c>4 -25- 13 v
REGISTERED GRANDVIEW ESTATES HOUSE ENGINEERING • PLANNING • LANDSCAPE ARCHITECTURE
PROFESSIONAL JOB NAME: STAKING - LENNAR FORESTRY • SURVEIING
LA A ti SUR OR LICENSED IN OR & WA
117 JOB NUMBER: 2643
13910 SW GALBREATH
DRAWN BY: BDT
DRIVE, SUITE 100
OREGON SHERWOOD, OR 97140
JANUARY 11, 2005
ROBERT D. RETTIG CHECKED BY: RDR iy,, / 0 ,4 � 4,4 , 2r;,I, � PH ONE: (503) 925 -8799
60124LS FAX: (503) 925 -8969
RENEWS: 12/31/14 DWG NO.: 2643CSTK OFRCES LOCATED IN SALEM, OR & VANCOUVER, WA
RECEIVED
SEP 12 2012
CITY OF FI AARO
31IILD'N(
1
I •SB STONE BRIDGE OBE: 1491
• • HOMES NW
LOT: 120
DATE: 8/16/12
4230 GALEWOOD ST. SUITE ioo PROPERTY: ARLINGTON
LAKE OSWEGO, OR seo HEIGHTS
(5 3
'1,9 lip : CITY: TIGARD
'' S SCALE: 1 " =20'
PLAN No.: 244
U �� PRAIRIE ELEVATION
LU 6 6 �4:
1
Z 2 1 310
7j 4
1 44 6 � i
i!1 ... 14'8'
)... \ i
3052 so
m' Fs. j ,,, FFE -312 `
22'1.- • ..`
U
N. " . '� 4' �. 8 . 1'10
u3k7•\r . �.. ;3121: ` '�
C ' . 'S ' 4 . ll '
_ 316 ..; : .. ;• ' .• , i. I •'•'�' I 143 = • FT aD a `��.. • _4
•' i' � ; 0 3 CAR G.GAR. �`-
ti) ',� •.. ��';• c..:.:,1:,':::.:: i FF - 312' . vERED_
t!1 1. _ v 497,
-1° , : -. i ! ,,.,�
CII I V II' •l10 12'6' I - - - - -- `
29' -i®' - 0 300 - 1® 68E
vo 4
(NI E O / \ \ 21425' 0
11— EL. ■316' 1 :ea
4 312 310 308 306 304 302 300
LOT COVERAG LEGEND
LOT AREA: 9,311 SQ. FT. ^
BUILDING AREA 2,362 SQ. FT. — STREET TREES:
PERCENTAGE: 25 %1 PARKWAY MAPLE
NOTES: Z
ALL GRADE AND PROPERTY LINES ARE ESTIMATES OF CURRENT LOCATIONS. k
ALL DIMENSIONS AND SQUARE FOOTAGE ARE APPROXIMATE FIGURES.
ALL RETAINING WALL HEIGHTS AND LOCATIONS ARE ESTIMATES. ,
THEY MAY VARY AND BE SUBJECT TO CHANGE. LOT 0 120
DRIVEWAY MAY DIFFER DUE TO LOCATION OF UTILITY BOXES, 9,311 sq. ft. A
STREETLIGHTS, AND OTHER SITE CONDITIONS.
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12613 SW CANYONRIDGE CT, TIGARD, OR,
97224
Residential - Master Permit
199 Electrical final
2013-11-07 00:00:00
MST2012-00233
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
12613 SW CANYONRIDGE CT, TIGARD, OR,
97224
Residential - Master Permit
210 Foundation walls
05/03/2013 09:00
MST2012-00233
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
12613 SW CANYONRIDGE CT, TIGARD, OR,
97224
Residential - Master Permit
330 Water service
05/06/2013 00:00
MST2012-00233
PART
1. Leave trench open from meter box back 3' to inspect for 24" depth and hook-up to
meter. Call when ready.
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
12613 SW CANYONRIDGE CT, TIGARD, OR,
97224
Residential - Master Permit
225 Post/beam structural
06/12/2013 00:00
MST2012-00233
PART
Front left section of crawl to come, left side garage floor, to come, center and right side
garage floor, ok
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
12613 SW CANYONRIDGE CT, TIGARD, OR,
97224
Residential - Master Permit
330 Water service
05/06/2013 00:00
MST2012-00233
PART
1. Leave trench open from meter box back 3' to inspect for 24" depth and hook-up to
meter. Call when ready.
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
12613 SW CANYONRIDGE CT, TIGARD, OR,
97224
Residential - Master Permit
310 Crawl drain
05/06/2013 00:00
MST2012-00233
PART
1. Provide approved rip rap at crawl drain discharge location.
Call when completed
Violation Summary:
Inspector Contractor
:gym STREET TREE
,{SS�i hSui I
Skyy{ry..','1(. �yE
4I3P,GAR®:
CERTIFICATISN 0 N
Si
I, ha, V-�(cL--✓'� , owner!agent for i "a .fir% ti�
(PLEASE PRINT) (PERMIT HOLDER) C L C=
do hereby cert5 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.: ,ST -La/Z C
SITE ADDRESS: / a 6/ 3 Si,,/ r -yam- /-1e2e c_r-
`
SUBDIVISION: tUkfio , y1--71.1 LOT#: / ?o
SIGNATURE: DA 1 E: /0-5'/-/ ?
( R/AGENT)
RECEIVED &
VERIFIED BY t DALE: 1///60
(C F TIGARD
❑ Tree location verified per approved site plan.
I:\Building\Forms\StreetTreeCertificate 05/30/2012
Oregon Residential Specialty Code R318.2
MOISTURE CONTENT ACKNOWLEDGEMENT FORM
•
I, 1)cz,1/4. ✓e ( , am the general contractor or the owner-builder
at the following address: •
Site Address: 12_ 6 13 Sw C�.�y C �I,dy `_City:
Permit#: Z O I Z cD04.3 3
• Subdivision/Lot #: 4P- L.- ,;, � [7-1-e- 5 5
and/or
Map and Tax Lot#: / - C)
To conform with the ?008 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 feference].
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:
General Conn-actor or Owner-Buil -
1:\Building\Form\RES-MoislurcSensstiveWood,doc 09/25/08
Oregon Residential Specialty Code N1107.2
HIGH-EFFICIENCY INTERIOR LIGHTING SYSTEMS
Permit No.: Jurisdiction: ,1
20 12, 0O 3) I , 5 G--r-a
Site Address: _
/2 6/3 S(,) C --yob �-i c(9,1 G i
Subdivision/Lot :
PA r
and/or
Map and Tax ' o 74: / 7_0
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 N11072)1
?( ')
Signature: _ Late: IQ �l
--Owner/General Contractor/Au •.rized Agent /•
Print Name: V? < - 561
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.
I:\Buildin\Forms\R S-)liehr:fficiencyLighting.doc 07/01/08
This mark certifies that this home was built in strict accordance with
• Earth Advantage®green building guidelines and has passed
Energy rust New Homes EBW performance tests and two onsite building inspections.
Certified Residential Air Duct System
ENERGY „� •
EnergyTrust l Z6 j ?� vv ��1`t ci�N I T)CL C-T
�f Oregon.:nc. S 0 Q
Compa Information T 1 G + -" �I r/ Z F
Company ne / :s �(�-e- g'D • ( '7 I c,F4,
Technician` I' Rj 4 t(1_, Date "
Combustion Appliance Zone(CAZ)Test
Main Zone Zone 2.if applies
CAZ WRT Outside Pa Pa Passed By: /L/, Date:(D// /13
Baseline(WRT Outside,fans off) Pa Pa im ktrkC c,.,,f C tctle;Zt1 (+7,--,,Cum
NET CAZ Pressure(subtract
�r'r ,(iat,'r�';['ir -011 .,.rte,. O_ Civiaa-ticru_•baseline from CAZ WRT outside) Pa Pa C-.Criril 1 ,;;( -°- ri;1L.(.-74,1-4.,:-.,7•;clZi.5;r"c.
-
Duct Leakage fill out one sticker per duct system)
Description of Area System Serves eaf�lhome`
certification
_Cond. Floor Area System Serves(ft2) """11 05
R34es tcno Air Handler in conditioned space? This home has been certified as an Earth Advantage®New Home.All Earth
yes❑ no Air Handler present during Advantage homes are built with the same attributes as other high quality
1 homes but they also include a comprehensive package of energy efficiency
If"yes"for either,then maximum CFM is 75 CFM @50 Pa or and environmental features you will not find anywhere else.
floor area a 0.06 '/.3./ .CFM@50 Pa,whichever is greater.
Since this house was performance tested for quality.you can be assured it
If"no"for both•then maximum CFM is 50 CFM @SO Pa or has passed the rigorous design and construction criteria of the Earth
floor area x 0.04 = CFM @50 Pa,whichever is Sreater. Advantage program-a recognized regional leader in green building science
Test VIe[hOd: A and implementation.
❑ Leakage to Outside or Total Leakage
[- � �
Test Result Your Earth Advantage certified home was built with sustainable materials.
CFI co�OPa
G 1
[ techniques and systems that reduce pollutant sources and improve your
Fan Pressure/1 Pa Gauge type: ❑ DG-3 or -DG-70o indoor air quality,ensuring a healthier home.It was designed to be energy
efficient. cutting your energy consumption and utility costs. The Earth
Ring(circle one) Open I l t� t�i / Advantage New Homes program also guarantees superior environmental
Duct Blaster Location /�v®2 p�,�-� �� responsibility and resource efficiency in home construction through the
�A ! use of recycled and/or renewable materials that decrease waste and
Pressure Tap Location I ,nom/ Q/��j� increase the durability of your home.
ru891•9 31V1dW31 pfueny asj e earth
EuloL:ad lua,ed f(,5OJoUy3a1 N, )Ol2ana www.earthadvantage.org -3,::.a , '
i
•
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