HomeMy WebLinkAboutPermit Building 2010-09-30SCANNED
tffi GITY OF SPRINGFIELD
Building / Residentia! Permit
PERMIT NO: 811-SPR2010-00289
IVR Number: 811156576905
225 Fifth St
Springfield,OR 97477
Phone: 541-726-3753
lnspection Phone: 541 -7 26-37 69
Fax: 541 -726-3676
permitcenter@ci. springfield.or. uswww.ci.springf ield.or.us
PROJECT STATUS: lssued ISSUED:9/30/10 EXPIRES: 31291201'l
APPLIED:9/13/10 VALUE: $175,000.00
SITE ADDRESS: 539 48th S Springfield
ASSESOR'SPARCELNO: 1702324407200
SCOPE: Single Family Residence
WORK INVOLVED: New
TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: New single family dwelling - SAME AS 511 S. 48th St. - Lot 22 Westwinds
OWNER:
ADDRESS
HAYDEN ENTERPRISES INC
26225W GLACIER PL STE 1IO
REDMOND OR 97756
Phone Number:
CONTRACTOR IN FORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
STUTZMAN SERVICES INC PLU IVlBING PB7O1 0710112011 541-928-8942
TOP NOTCH ELECTRIC INC UU6 172366 0912912012 s41-317-1998
CCB 39237 0312s12012 541-672-9510
CCB 172366 0912912012 541-317-'1998
HAYDEN ENTERPRISES INC ULb 92208 07129t2011 541-923-6607
BUILDING INFORMATION
Occupancy Type
Construction Type
Occupancy Type
Construction Type
R-3
Type VB
U
Type VB
# of UniG
# of Bedrooms:
Sprinkled Building
Fire Alarms:
Energy Path:
Engineered Fill;
Fill Volume:
Flood Hazard Area:
Land Hazard Area:
Retaining Wall:
Soils Report Required:
I # of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Hazmat:
Forced Air Gas
Electric
Electric
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage:
Sq Ft Carport:
Sq Ft Other:
Occupancy Load
3
1408
24
Electrical Specialty Code Edition:
path 2A certiried n",t",,",fl!ii:XiJ:,
t{:::ff
::1"":;*,"",
Municipal / Development Code:
Plumbing Specialty Code Edition:
Residential Specialty Code Edition:
Structural Specialty Gode Edition :
Yes
ffiJi*u***5gi5ih$"H}*
iRY'\';i\-oi irntoo'
ATTENTION: Oregon law requires you to
lollow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth
ln OAR 952-001-0010through OAR 952-001'
0090. You may obtaln copies of the rules by
calling the center. (Note: thelelephone
ntmhel fgr,lh* Ore gbn Util ity N otif ication
Center is 1 -800€i)2'2344).
Site lnformation
Springfield Building Permit
No
No
Page 'l of 6
PACIFIC AIR COMFORT INC
Electrical Contractor TOP NOTCH ELECTRIC INC
kffi CITY OF SPRINGFIELD
Building / Residential Permit
PERMIT NO: 811-SPR2010-00289
IVR Number: 811166576905
225 Fifth St
Springfield,OR 97477
Phone: 541-726-3753
lnspection Phone: 541 -7 26-37 69
Fax:. 54'l -726-3676
permitcenter@ci. springfield. or. uswww.ci.springf ield.or.us
PROJECT STATUS: lssued
APPLIED:9/13/10 VALUE: $175,000.00
SITE ADDRESS: 539 48th S
ASSESOR'S PARCEL NO:
Springfield
1702324407200
SCOPE: Single Family Residence
WORK INVOLVED: New
TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: New single family dwelling - SAME AS 511 S. 48th St. - Lot 22 Westwinds
DEVELOPMENT INFORMATION
REQUIRED PARKING
Frontyard Setback:
lnterior Setback:
Sideyard Setback:
Rearyard Setback:
Solar Setback:
Overlay Dist:
# StreetTrees Reqd:
Paved Drive Reqd:
% of Lot Coverage:
Highest point on structure to
north property line:
15
13
54.79
121
0
3
Yes
17.3
Total:
Handicapped:
Compact:
2
18.5
PUBLIC IMPROVEMENTS
Street lmprovements:
Storm Sewer:
Storm Sewer Available:
Special lnstructon:
Subdivision Accepted:
Notes:
Description
Sidewalk Type:
DownspouUDrains:
Tvpe of Construction Unit Amount Unit Tvpe Unit Cost Value
Valuation Description
Springfield Building Permit 913012010 1:20:46PM Page 2 of 6
ffi CITY OF SPRINGFIELD
Building / Residential Permit
PERMIT NO: 811-SPR2010-00289
IVR Number: 811166576905
225 Fifth St
Springfield,OR 97477
Phone: 541-726-3753
lnspection Phone: 541 -7 26-37 69
Fax: 541 -726-3676
permitcenter@ci.springfield.or. usww.ci.springf ield.or.us
PROJECT STATUS: lssued ISSUED:9/30/10 EXPIRES: 3t29t2011
APPLIED: 9113110 VALUE: $175,000.00
SITE ADDRESS: 539 48th S Springfietd
ASSESOR'SPARCELNO: 1702324407200
SCOPE: Single Family Residence
WORK INVOLVED: New
TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: New single family dwelling - SAME AS 5'l l S. 48th St. - Lot 22 Westwinds
Description
SDC: Reimbursement Cost - M\M/IC Regional Wastewatr
SDC: Reimbursement Cost - Storm Drainage
SDC: lmprovement Cost - Storm Drainage
SDC: Total Transportation Administration Fee
SDC: Total Sewer Administration Fee
SDC: Administrative Fee - MWMC Regional Wastewater i
SDC: Compliance Cost - M!ryMC Regional Wastewater Sl
SDC: lmprovement Cost - MWMC Regional Wastewater {
SDC: lmprovement - Transportation SDC
SDC: Reimbursement - T SDC
SDC: lmprovement Cost - Local Wastewater
SDC: Reimbursement Cost - Local Wastewater
Multiple Permit Discount (Max 2)
Sidewalk up though 90 Feet
Curb CuUDriveway 1st Cut
Planning - ttlajor Review
Temp services 200 amps or less
Each added 500 sq. ft. or portion
Residence wiring 1,000 sq. ft. or less
First Appliance Fee
Heat pump
Single-duct exhaust (bathrooms, toilet compartments, utili
Range hood/other kitchen equipment
Furnace - up to 100,000 BTU
One or Two Family Dwelling with Two Bath
Same as Plan Review Submittal
Willamalane fees - Single family detached
Address Assignment, each new or change
Residential Fire (.05 Per Sq Foot)
Structural Building Permit Fee
Technology fee (5% of permit total)
Gas Piping up to 4 outlets
Admin fee (10% of aPPlicable fees)
State of Oregon Surcharge (12% of applicable fees)
Technology fee (5% of Permit
Amount Paid Date Paid
09/30/201 0
o9i3o/201 o
o9/30/201 o
09/30/2ol o
ost3ot2olo
09t30t2010
Receipt #
374446
374446
374446
$101 .97
$340.73
$Bi2.i o
$108.74
$258.88
$10.00
$-22.63
$1,333.57
$1,383.63
$356.96
374446
374446
374446
$13.00
$17.00
$374.00
$250.00
$3,468.00
$38.00
$91.60
$1 ,014.00
$7.30
$7.00
$9.16
$216.48
$92.1 0
$1 ,043.04
$1,937.76
$-30.00
$88.00
$88.00
$211.00
$63.00
$50.00
$134.00
09/30/201 0
o9/30/201 o
o9/30/2ol o
ogt3ot2o10
ogt3ot2o10
09t30t2010
ogl3ot2ol0
o9/30/201 o
o9/3oi2o1 o
ogt3ot2olo
o9/30/201 o
ogt3ot2olo
ogt30t2olo
o9/30/2ol o
374446
374446
374446
374446
374446
374446
374446
374446
374446
374446
374446
374446
374446
374446
374446
374446
374446
3,74446
374446
374446
374446
374446
374446
374446
$79.00
$17 00
$36.00
09/30/20'10
09/30/201 o
09130t2010
o9/30/201 o
o9/30/201 o
ogt30t2olo
09/30/201 o
o9i3o/2ol o
09/30/201 o
o9/3oi2ol o
o9/30/20'lo
o9/30/20'lo
o9/30/2ol o
o9/30/201 o
o9/30/20'10
374446
374446
374446
374446
374446
$14,053.65
Springfield Building Permit
Total Amount Paid
9/30/2010 1:20:46PM Page 3 of 6
ffiffi CIry OF SPRINGFIELD
Building / Residential Permit
PERMIT NO: 811-SPR2010-00289
IVR Number: 811 166576905
ISSUED:9/30/10
APPLIED: 9/13/10
225 Fifth St
Springfield,OR 97477
Phone: 54'l-726-3753
lnspection Phone: 541 -l 26-37 69
Fax: 541 -726-3676
permitcenter@ci. springfield.or. uswww.ci.springfield.or.us
PROJECT STATUS: lssued EXPIRES: 312912011
VALUE: $175,000.00
SITE ADDRESS: 539 48th S
ASSESOR'S PARCEL NO:
Springfield
1702324407200
SCOPE: Single Family Residence
WORK INVOLVED: New
TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: New single family dwelling - SAME AS 5'll S. 48th St. - Lot 22 Westwinds
Department
Planning Review
Public Works Review
Permit lssuance
Application Acceptance
lnitial Review
Structural Review
Due Date
0911312010
09t1312010
09t22t2010
09t1312010
09t13t20't0
09113t2010
Received
09121t2010
09t21t2010
09/30/201 0
09/1 3/201 0
09t't3t2010
09t22t2010
Complete
0911312010
09t13t2010
09t22t2010
09t13t2010
09t13t2010
09t13t2010
Result
Approved
Approved
lssued
Application Accepted
Approved
Approved
Reviewer
Deyette Kelly
Kaye Wilson
Chris Carpenter
Chris Carpenter
Chris Carpenter
Chris Carpenter
Comments
Front elevations are site sper
Storm water to streeUSubdivi
Items listed below (if any) ant
Springfield Building Permit 9/30/2010 1:20:46PM Page 4 of 6
ffi CITY OF SPRINGFIELD
Building / Residential Permit
PERMIT NO: 811-SPR2010-00289
IVR Number: 81 1 166576905
ISSUED: 9/30/10
APPLIED:9113110
225 Fifth St
Springfield,OR 97477
Phone: 541-726-3753
lnspection Phone: 541 -726-3769
Fax: 541 -726-3676
permitcenter@ci.springf ield.or. usww.ci.springfield.or.us
PROJECT STATUS: lssued EXPIRES: 312912011
VALUE: $175,000.00
SITE ADDRESS: 539 48th S
ASSESOR'S PARCEL NO:
Springfield
1702324407200
SCOPE: Single Family Residence
WORK INVOLVED: New
TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: New single family dwelling - SAME AS 511 S. 48th St. - Lot 22 Westwinds
INSPECTIONS REQUIRED
lnspections
'1020 Zoning/setbacks
1090 Street Trees
1 '1 10 Footing
1 120 Foundation
1160 UFER Ground
1 220 Underfloor framing
1260 Framing
1370 Masonry Veneer
141 0 Underfloor insulation
1420 lnsulation Vapor Barrier
1430 lnsulation Wall
1440 lnsulation Ceiling
1 520 lnterior Shearwall
1530 Exterior Shearwall
'l 540 Gypsum Board/Lath/Drywall
'1999 Final Building
2200 Underfloor Mechanical
2210 Underfloor Gas
2260 Gas Service
2300 Rough Mechanical
2995 Final Gas
2999 Final Mechanical
3'1 30 Footing/Foundation Drains
31 70 Underfloor Plumbing
3200 Sanitary Sewer
3315 Water Line
3400 Storm Sewer
Springfield Building Permit 9/30/2010 1:20:46PM Page 5 of 6
OiTEGON
www.ci. springf ield.or.us
PROJECT STATUS: lssued
CITY OF SPRINGFIELD
Building / Residential Permit
PERMIT NO: 811-SPR2010-00289
IVR Number: 81 1 166576905
225 Fifth St
Springfield,OR 97477
Phone: 541-726-3753
lnspection Phone: 541 -7 26-37 69
Fax: 54'l-726-3676
permitcenter@ci.springf ield.or.us
PRII{GFIELI)
*#
ISSUED: 9/30/10 EXPIRES: 3t2912011
APPLIED: 9l13l10 VALUE: $175,000.00
SITE ADDRESS: 539 48th S
ASSESOR'S PARCEL NO:
Springfield
1702324407200
SCOPE: Single Family Residence
WORK INVOLVED: New
TYPE OF STRUCTURE: Residential
PROJECT DESGRIPTION: New single family dwelling - SAME AS 51'l S. 48th St. - Lot 22 Westwinds
3500 Rough Plumbing
3999 Final Plumbing
4000 Temporary Power Service
4225 Service or Feeder
4500 Rough Electrical
4999 Final Electrical
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all
information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the
Ordinances of the City of Springfield and the Laws of the State or Oregon pertaining to the work described herein, and that NO
OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further
certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I further agree
to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the
permit card is located at the front of the property, and the approved set of plans will remain on the site at all times during
construction.
7- -* -/o
Owner or Contractor S re Date
Springfield Building Permit 9/30/2010 1:20:46PM Page 6 of 6
g**Q *9 {rt y' 4grn t?
Stl'tr( Pernrit APPlicat,-it DEPARTMENT USE ONLY
=PAINGFIELO
Pemtir no rfll)--f?
2l5FitlhSrreetrSE,ringield.ORgi'i77rPH(541)726-i71lrFl{\(5'il)726-1689
Date
This permit is issued under OAR 918-J60-0030. Pernrits expire if rvork is not started n'ithin I80 davs of issuance or if l'ork is
suspended for 180 da-vs.
FEE SCHEDULE
l. Valuation infornration
(a) Job description
Construction 1,pe. VO
Square feet:(a
Cost per square loot:
Othei information
Type of Heat: 1-* S
Energy Path: JA
EI new ! alteration I addition
(b) Foundation-only permit? D Yes f] lo
Total valuation:
(a) Pemiit fee (use valuation table):$
(b) lrrvestigative fee (equa! to [2a]):S
(c) Reinspection ($ per hour)
(number ofhours x fee per hour))
(d)Enter l2Tosurcharge (.12 x [2a+2b+2c]):S
(e) Subtotal of fees above (2a through 2d)
(a) Plan review (65o/o x permit fee [2a]):
$
.--..111-:.1'--
::'r-!a.i::j:: :.I .
s2sz-
(b) Fire and life safety (407o x permit fee [2a]):$
(c) Subtotal of fees above (3a and 3b)S
(a) Seismic fee, 1o/o (.01 x permit fee [2al)S
TOTAL fees and surcharges (2e+3c+4a)S
LOCAL GOVERNMENT APPROVAL
Date
This projecr has finai land-use approval
S i gnature:
Date
This project has DEQ aPProval
S i gnatu re
Zading approval i'erifi ed:EYes ENo
Properrl, is ''';ilhin flocd Plain ! Yes n i.io
D Corr,mercialI GovernmentB Residential
lob site address 5
Z|P.City:
Lot no.
Taxlot:
Su bd iv is ion
Reterence
ERPROPER TY
Name:
Address:
ZIPState: 6C
Fax
E-mail
me or a member of my immediate family, and is exempt from licensing
requirements under ORS 701 .01 0
This installation is being made on residential or larm properry owned by
Sign here:
Business name
Address:
State:
FaxPhone:711
E-mail
CCB license no
Prinl name
Phone NumberCCB License NumberNa me
-nJT0,6Electrical
317{1Plumbing
3q23'tIVI echa n ical
3g
Occupancy F/q
.3trPlat.:revi"ayi,fs'gs.; .i: ., 1r. . . ' .1' :, ,, ,- '. , ,',,',t.: l
CONSTRUCTION.CATEGORY
ANDJOB SITE
State: 6R- t.l
Fhone
Signature:
Electrical Permit A '' :ation DEPARTMENT USE ONLY
SPRINGFIELO . :.: ii
@, t",,,
225 Fifth Streettspringliel<1, oR 97.177rPH(541)726.37530Fr\X(541)726-]689
This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180
aays'of issuance or if work is suspended for 180 days'
Permit no..S/O-,27?
Date ?/rs
G
ESYvaverified?trtrapproZoning
STRUCTI NTEo
SITE DNA LOC
n Commercialn GovemmentflResidential
LJob site address: 531
ZIP:?State: a(city: Ul*^drJrl,-
Lot no.: 2zSubdivis
o
P
c"r
Name:
Address
ZIP '5".Slarc: alACiry:
Fax:Phone:
E-mail
oRlo
Signature
Business name:
Address
ZIPState:City:
BCD license no
Fax:
supervlsor 's license no.
Print name of lng
Signarure ofsigning suPervisor:
E-mail
CCB license no':
Phone:
\
{ov \)\artdahqff
{
$
0
Residential, per unit, service included:
s/?7I$134.001,000 sq. ft. or less (4)
s 25.00 $g2Each additional 500 sq. ft. or portion
thereof
$S 32.00Limited energy (2)
$s 63.00Each manufactured home or modular
dwelling seryice or feeder (2)
s 81.00 $200 amps or less (2)
$$ 9s.00201 to 400 amps (2)
$1 58.00 $401 to 600 amps (2)
$$205.00
$469.00 $Over 1,000 amps or volts (2)
$$ 63.00Reconnect only (2)
Temporary services or feerlers: inslallation, alteration, relocatiott
{3I$ 63.00200 amps or less (2)
s 87.00 $201 to 400 amps (2)
$s1 26.00401 to 600 amps (2)
Over 600 amps or 1,000 volts, see services or feeders section above
Branch circuits: new, alteration, extension per panel
a. Fee for branch circuits with purc:hase of a service or feeder fee:
$ 6.00 $Each branch circuit
b. Fee lor branch circuits without purchase ol a service or fecder fec
$s 55.00First branch circuit (2)
$ 6.00 $Each additional branch circuit
Miscellaneous fcest service orfeeder nol included
$$ 63.00Each pump or irrigation circle (2)
$ 63.00 $Each sign or outline lighting (2)
$$ 63.00Sienal circuit or a limited-energy pancl,
ali"eration, or extension (2)
(A) Enter subtotal ofabove lees
(Minimum Permit Fee $58.00)
trach additional insPection: (l)s58.00 $
E
W.ll(B) Enter l27o surcharge (.12 x [A])A.%c(C) TechnologY Fee (5% of [A])
I r/.Ac(TOTAL fces and surcharges (A through C):
D 6$(N
\qqD
Seivices or feeders: installation, alteration' relocation
601 to 1,000 amps (2)
M1P
440-2s84-J (9/08/coM)
willamalane
Park and Recreation District
Job. No.Sto-2s7
SYSTEM DEVELOPMENT CHARGE WORKSHEET
July {-December 31, 2010
NAME: ,(A /V PHON 22, G13r
LOCATION OF PROPOSED BUILDING SITE
Street Address ,?E S. qfr Pt
Plat Name Tax Lot Number:
1. DEVELOPMENT TYPE (Check appropriate dwelling(s). Dwelling type definitions are on the
back.)
A. Sinole-Familv Detached
NO. OF UNITS x $3,468 per unit = $3'(bt
B. Sinqle-Familv Attached
NO. OF UNITS X $3,538 per unit = $
C. Multi-Familv Apartment
NO. OF UNITS x$2 ,906 per unit = $
D. Sinqle Room Occupancv
NO. OF UNTTS X $1,453 Per unit = $
E. Accessorv Dwellinq Unit
NO. OF UNITS x $1,734 per unit =
WILI-AMALANE SDC
2. SDC CREDIT (lf applicable) SDc payer must fumish proof of
Willamalane Credit aPproval.)
3. TOTAL WILLAMALANE NET SDC ASSESSED
(if SDC reduced for Credit)
&--
\lsDec+AOlaA)
t
?1o8
$
$
$
$
?,ts,
Development Services Department
City of Springfield
Date
/a
5
eDoaessP?H 5 w {z*-,c 4trY FD muD SrArE:4!7te: ? 7 7J7
W TRANSACTION RECEIPT
81 1-SPR2010-00289
539 S 48th PL
CIry OF SPRINGFIELD
22s Fifth st
Springfield,OR 97477
541-726-3753
permitcenter@ci.sprin gfl eld.or. uswww.ci.springfi eld.or. us
RECEIPT NO: 2010000438 RECORD NO: 8l l-SPR20l0-00289 DATE:09/30/2010
SDC: Reimbursement Cost - MWMC Regional Wastewater SDC 444-00000448024 $101.97
SDC: Reimbursement Cost - Storm Drainage 441-00000448029 $340.73
SDC: lmprovement Cost - Storm Drainage 440-00000448028 $822.10
SDC: Total Transportation Administration Fee 71 9-00000426604 $108.74
SDC: Total Sewer Administration Fee 71 9-00000426604 $258.88
SDC: Administrative Fee - M\AAIC Regional Wastewater SDC 61 1-00000-426604 $10.00
SDC: Compliance Cost - M!\iMC Regional Wastewater SDC 444-0Q000426607 $22.63
SDC: lmprovement Cost - MWMC Regional Wastewater SDC 445-00000448025 $1,333.s7
SDC. lmprovement - Transportation SDC 447-00000448027 $1,383.63
SDC: Reimbursement - Transportation SDC 446-00000-448026 $356.96
SDC: lmprovement Cost - Local Wastewater 443-00000448025 $1,043.04
SDC: Reimbursement Cost - Local Wastewater 442-00000448024 $1,937.76
Multiple Permit Discount (Max 2)201-00000428060 $-30.00
Sidewalk up though 90 Feet 201-00000428060 $88.00
Curlc CuUDriveway 1st Cut 201 -00000-428060 $88.00
1 00-00000-425002 $211.00
services 200 am or less 224-00000426102
224-00000426102
$63.00
$50.00
Residence wiring 1,000 sq. ft. or less 224-00000426102 $134.00
First Appliance Fee 224-00000425604 $79.00
Heat pump 224-00000425604 $17.00
Single-duct exhaust (bathrooms, toilet compartments, utility rooms) 224-00000425604 $36.00
Range hood/other kitchen equipment 224-00000425604 $13.00
Furnace - up to 100,000 BTU 224-00000425604 $17.00
One or Two Family Dwelling with Two Bath 224-00000-425603 $374.00
Same as Plan Review Submittal 100-00000425602 $2s0.00
Wllamalane fees - Single family detached 821 -00000-21 s023 $3,468.00
each new or change 224-OOOOO425602 $38.00Address
Residential Fire (.05 Per Sq Foot)I 00-00000424005 $91.60
224-00000425602 $1,014.00Structural Building Permit Fee
100-00000425605 $7.30Technologyfee (5% of permit total)
224-00000425604 $7.00Gas Piping up to 4 outlets
224-00000426605 $9.16Admin fee (1 0% of applicable fees)
State of Oregon Surcharqe (2% ot aPPlicable fees)821-00000-21 5004 $216.48
100-00000425605 $92.10Technologyfee (5% of permit total)
TOTAL DUE:
Check
29230
$14,053.65HAYDEN ENTERPRISES INC
$14,053.65
Planning - Majol Review
Each added 500 sq. ft. or portion
PAYMENT TYPE CASHIER: CCARPENTER
^SCANNED
SPRINGFIELO
DEVELOPMENT SERVICES DEPARTMENT
HIGH-EFFICIENCY LIGHTING SYSTEMS
OREGON RESIDENTIAL SPECIALTY CODE (ORSC)
Permit No.:0-o Jurisdiction
Site Address:537 S qsth PL
h,225 FIFTH SIREET
SPR/NGF/EID, OR 97477
PHONE (541)726-s753
FAX (541)726_3689
www. ci. s pri ngfi e I d. o r. u s
L.,l LL -w.s* fuurlsSubdivision/Lot:
and/or
Map and Tax Lot:
By my signature below, I certify that a minimum of D fifty (50) percent, *S seventy-five (75) 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 N1 107 .2)1
* Check theT5Yobox if the additional measure selected to complywith ORSC Nl101.1 and Table
Nl10t.i(2) requiresT5o/o of lighting fixtures to have energy efficient lamps.
Signed:Z"Date: // /7 - /d
neral uthorized Agent---
Print
Name:
Contractor's CCB #t?,*t2.(Date: {- tL- tl
I ORSC Section Nl107.2. High-Efficiency Lighting Systems. A minimum of f,rfty (50) percent of the permanently installed
lighting fixtures, seventy-five (75%) percent, ifthe selected additional energy code measures in the Table N1 10i.1(2) requires
greater Iighting efficiency, shall be installed with compact or Iiuear fluorescent or alighting source that has a minimum efftcacy 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 the required percentage of the
permanently installed lighting fixtures are compact or linear fluorescent, or a minimum efficacy of 40 lumens per input watt.
C:\Hi gh-Effi ciency Inter.doc