Report Oregon Residential Specialty Code N1107.2
HIGH-EFFICIENCY INTERIOR LIGHTING SYSTEMS
Permit No.: 64 s r .c'Z/ _005-00 Jurisdiction:
"06-
Site Address: (y` yy SG / ?9 �✓
Subdivision/Lot#: —Ces"Ge1 u S to7 23
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 NI 107.2)1
Signature: Date: // Z L
Owner/General Contractor/Authorized Agent
Print Name: £G.O ,1�'`OSS�•. '`
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-H ighEfficiencyLightingAcknowledgement_02201 8
Oregon Residential Specialty Code R408.1
MOISTURE BARRIER ACKNOWLEDGEMENT FORM
I, ce-49 Z /4 c ,rie i..z , am the general contractor or the owner-builder
at the following address:
Site Address: /qr y/� Sw 7 / / /I a.
City: �f�
Js v
Permit#: gsr Zit? u_00 SAD
Subdivision/Lot#: 5 �.T,
e - % �s
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:
it The ground surface of the under-floor space is covered by a Class 1 vapor retarder or
other approved materials, with
Joints lapped 12 inches at seams and
DZI_Extending up the foundation walls 12 inches.
Signature: Date: /!/ Z Z,
General Contractor or Owner-Builder
I:\Building\Form\RES-MoistureBarrierAcknowledgement_022018
Oregon Residential Specialty Code R318.2
MOISTURE CONTENT ACKNOWLEDGEMENT FORM
I, , am the�•- e� � gossit-t-eg.c-i general contractor or the owner-builder
at the following address:
Site Address: (y 6 qv sc.) 7? l h ,rly`
City: I�t
Permit#: ks r wat
-co Soa
Subdivision/Lot#:
Seen res �•T Z3
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: 7( !/L
General Contractor or Owner-Builder
I:\Building\Form\RES-MoistureContentAcknowledgement_o22o 18
Oregon Residential Specialty Code M1505.4
Balanced Mechanical Whole-House Ventilation System Installed
Permit No.: ZO Jurisdiction: D
Site Address:
COL ye/ SW 79/
Subdivision/Lot#: e Gt S LOT
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: Date: 74 2.Z,
Owner/General Contractor/Authorized Agent
Print Name: S 'tT
_ .
A Ilw
Mb
BACK.FLOW EXISTING REMOVED
PREVENTER REPORT NEW REPLACED
REPAIRED OLD S/N:
PROPERTY NAME DR Horton Serenus Lot 23 PHONE
CONTACT NAME PHONE
MAILING ADDRESS 14644 SW 79th Ave
CITY Tigard STATE OR ZIP 97224
PREVENTER ADDRESS 14644 SW 79th Ave Tigard, OR 97224
WATER SUPPLIER City of Tigard, Oregon SERIAL# HF 57018 _
LOCATION NW corner house
MAKE Febco MODEL 850 SIZE 3/4"
TYPE n RP ri RPI)A n RPDA-II [X1 DC n DCDA I 1 DCDA-II Li PVB [ I SVB AVB n AG
HAZARD PROTECTED ri PREMISES ISOLATION LJ IRRIGATION Ci FIRE SYSTEM L_ , BOILER Li OTHER
APPROVED: rllvsu�n�.
APPROVED: LX ASSEMBLY kvA INSTALLATION ICI ORIENTATIONri A1ROAP PIPE Si'l..1? in :ARArxIN in
REDUCED PRESSURE ASSEMBLY PVBA/SVBA INITIAL TEST
r DOUBLE CHECK AIR INLET CHECK VALVE PASSED X
CHECK#1 CHECK#1 TYPE 11 I OPENnu AT: PRESS DROP:
muss TIGHT [ FAILED n
DRIP:
INITIAL MIN sPSID 1 .6
TEST RELIEF VALVE LEAKED n MIN I Pam) MIN I PSID MINI PSID DATE 07-10-22
RESULTS OPENED AT: OPENIED
MIN 2 PSID CHECK#2 FULLY 1..1 FAILED SYSTEM PSI 1 05
RELIEF VALVE: TIGHT LA DID NOT L DETECTOR METER
PASSED ri FARM I 1 - 2.0 OPEN L 1 READING:
LEAKI?I) LI MIS I PRO
NOTES
REPAIRS
PARTS
REDUCED PRESSURE ASSEMBLY TEST
PVBA/SVBA
CHECK#1 DOUBLE CHECK AFTER REPAIRS
PRESS CHECK#1
DROP: TYPE IT 1 AIR INLET CHECK VALVE
REPAIR MIN S PSID TIGHT f-.1 OPENED AT: PRESS DROP:
RESULTS RELIEF VALVE DATE
OPENED AT: CHECK#2 MI MIN I MD MIN I PSID MIN I PSI!)RRirRRVALVY, MIN]PSID TIGHT n ° D I PASSED r-
FULLY
PASSED ri PALED LI MIN 1 P5)I)
GAUGE S/N 04141250 MAKE/MODEL Mid-west Instruments 845 CALIBRATION DATE 1 1-12-2021
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 slate and water system using_appcoved testing equipment and approved testing procedures.
INITIAL TEST TEST AFTER REPAIRS
7.17,;`- 066108
TESTER SIGNATURE TESTER SIGNATURE TESTER CERT#
Jordan A 503-849-0237
TESTER NAME(PRINTED) tits 1 ER NAME(PRINTED) PHONE#
2153 Molalla Rd Woodburn, OR 97071 lordan@ablandscapes.net
TESTER ADDRESS TESTER ADDRESS EMAIL
Ashland Brothers Backflow Testing, Repair&Install
COMPANY NAME COMPANY NAME 1 X WATER RESTORED?
FOUND OFF,LEFT OFF
REPORT RECEIVED BY(REPRESENTATIVE OF OWNER) REPORT RECEIVED BY(REPRESENTATIVE OP OWNER)