Report Oregon Residential Specialty Code M1505.4
Balanced Mechanical Whole-House Ventilation System Installed
Permit No.: (ST�ef-co q Jurisdiction:
Site Address: 1/q 44 ? ? Alto 4r—
Subdivision/Lot#: eee-erus (..or ZZ..
and/or
Map and Tax Lot#:
By my signature below, I certify that the Mechanical Whole-House Ventilation System has been
installed at the address listed above per the requirements of the Oregon Residential Specialty
Code and Section M1505.4.
Signature: � z �'"— Date: /7 �� Z
Owner/General Contractor/Authorized Agent L
Print Name: , ePO �� �
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Oregon Residential Specialty Code R318.2
MOISTURE CONTENT ACKNOWLEDGEMENT FORM
1,
o gasaig.t...<4 , am the general contractor or the owner-builder
at the following address:
Site Address: 04/4 S 7Q TZ'
City: ----
Permit#: t"• ,1s T zou -co 6( 1 7
Subdivision/Lot#:
Ser en ccs L„ r ZZ
and/or
Map and Tax Lot#:
To conform with the 2017 Oregon Residential Specialty Code (ORSC), Section R318.2 and
OAR 918-480-0140, I am notifying the building official that I am aware of the moisture content
Requirement of ORSC Section R318.2 and have taken steps to meet this code requirement.
[Section R318.2 is provided for reference].
R318.2 Moisture Content: Prior to the installation of interior finishes, the building
official shall be notified in writing by the general contractor that all moisture-sensitive
wood framing members used in construction have a moisture content of not more than 19
percent by dry weight of dry framing members.
Signature: ___ Date: ��/ Z-Z
General Contractor or Owner-Builder
1:\Building\Form\RES-MoistureContentAcknowledgement_o22o 18
Oregon Residential Specialty Code R408.1
MOISTURE BARRIER ACKNOWLEDGEMENT FORM
I, cup 77-kiass r'•s„et e--t, , am the general contractor or the owner-builder
at the following address:
Site Address: f Lj`l 6 scci 7 9 r- svt
City: .•r- f/
(J!
Permit#: iv/Sr ze' a,—Gx7 q 9 ci
Subdivision/Lot#: (•T Z•Z..
Serie. %
and/or
Map and Tax Lot#:
To conform with the 2017 Oregon Residential Specialty Code (ORSC), Section R408.1
Ventilation. I am notifying the building official that I have installed the Moisture Barrier as per
Requirement in ORSC Section 408.1 and have taken the following steps to meet this code
requirement:
The ground surface of the under-floor space is covered by a Class I vapor retarder or
ork
other approved materials, with
k_Joints lapped 12 inches at seams and
Extending up the foundation walls 12 inches.
Signature: —. e_--- Date: �� Z
General Contractor or Owner-
Builder
1:\Bu i Iding\Fonn\RES-MoistureBarrierAcknowl edgement_022018
Oregon Residential Specialty Code N1107.2
HIGH-EFFICIENCY INTERIOR LIGHTING SYSTEMS
Permit No.: 64s r202" _00 if I Jurisdiction: T „rjr
Site Address: ry/_i/ ski 79 7
Subdivision/Lot#: �e- us 6_0 r-
and/or
Map and Tax Lot#:
By my signature below, I certify that all of the permanently installed lighting fixtures in the
above mentioned building contain high-efficacy lamps. Screw-in compact fluorescent and LED
lamps comply with this requirement. (Oregon Residential Specialty Code N1107.2)1
Signature: Date: `7�/ Z. Z
Owner/General Contractor/Authorized Agent
Print Name: £.
' ORSC Section N 1107.2.High-efficacy lamps. All permanently installed lighting fixtures shall contain high-
efficacy lamps. Screw-in compact fluorescent and LED lamps comply with this requirement.
The building official shall be notified in writing at the final inspection that the permanently installed lighting fixtures
have met this requirement.
Exception: Two permanently installed lighting fixtures are not required to have high-efficacy lamps.
I:\Building\Forms\RES-HighEfficiencyLightingAcknowledgement_022018
Ali Ill'
BACKFLOW EXISTING —REMOVED
PREVENTER REPORT NEW REPLACED
REPAIRED OLD SIN:
PROPERTY NAME DR Horton Serenus Lot 22 PHONE
CONTACT NAME PHONE
MAILING ADDRESS 14616 SW 79th Ave
CITY Tigard STATE OR ZIP 97224
PREVENTER ADDRESS 14616 SW 79th Ave Tigard, OR 97224
WATER SUPPLIER City of Tigard, Oregon SERIAL# HF 61560
LOCATION SW corner house
MAKE Febco MODEL, 850 SIZE 3/4"
TYPE n RP ❑ RPDA n RPDA-II (X DC n DCDA U DCDA-II Li PVB L. ] SVB I I AVB n AG
HAZARD PROTECTED n PREMISES ISOLATION M IRRIGATION CJ FIRE SYSTEM L__.] BOILER LJ OTHER
PNYtt(M.
APPROVED: IM ASSEMBLY '�, INSTALLATION IN ORIENTATION A1R(IAP PIPE SI'll? _ �in yrrnRATri1N in
REDUCED PRESSURE ASSEMBLY _ PVBA/SVBA INITIAL TEST
DOUBLE CHECK AIR INLET CHECK VALVE PASSED X
CHECK#1 CHECK#1 TYPE II Li OPENED AT: PRESS DROP:
PRESS TIGHT
DROP: X FAILED Li
INITIAL MIN s rs1D 1 .8
TEST RELIEF VALVE LEAKED n MIN I PSID MIN I PSID MIN I PSID DATE 07-10-22
RESULTS OPENED AT: OPENED
MIN a PSID CHECK#2 FULLY El FAILED SYSTEM PSI 10 5
RELIEF VALVE: TIGHT LA DID NOT [J DETECTOR METER
PASSED r-I FA.. 1 1 2.2 OWN n READING:
LEAKED ri MINI PSID
NOTES
REPAIRS
PARTS
REDUCED PRESSURE ASSEMBLY PV IA/SVBA TEST
CHECK#1 DOUBLE CHECK AFTER REPAIRS
PRESS CHECK#1
DROP: TYPE II I AIR INLET CHECK VALVE
REPAIR MIN 5 PSID TIGHT f-1 OPENED AT: PRESS DROP:
RESULTS RELIEF VALVE _ DATE
OPENED AT: CHECK#2 MINI PIMM) MIS I PSID MIN I PSID
RRMJRPVALVE MIN 2PSID TIGHT [1 P[A.i oplssLY I , PASSED
PASSED ri
PALED n Mi:I PSID
GAUGE S/N 04141250 MAKE/MODEL Mid-west Instruments 845 CALIBRATION DATE 11-12-2021
In completing and submitting this test report,the tester certifies that the assembly was tested and maintained in accordance with all applicable
rules,laws,codes and regulations of the state and water system usingapproved tcstiig_equipment and approved testing procedures.
INITIAL TEST TEST AFTER REPAIRS _
- --4, 066108
TESTER SIGNATCIRE TESTER SIGNATURE TESTER CURT#
Jordan A 503-849-0237
TESTER NAME(PRINTED) ilsSI ER NAME(PRINTED) PHONE#
2153 Molalla Rd Woodburn, OR 97071 Jordan@ablandscapes.net
TESTER ADDRESS TESTER ADDRESS EMAIL
Ashland Brothers Backflow Testing, Repair&Install
COMPANY NAME COMPANY NAME X WATER RESTORED?
REPORT RECEIVED EY(REPRESENTATIVE OF OWNER) REPORT RECEIVEDQU'.PRESRN4'ATIVIi UP OWNER}
BY FOUND OFF,LEFT OFF