Report Oregon Residential Specialty Code R408.1
MOISTURE BARRIER ACKNOWLEDGEMENT FORM
I, L,pTf"/Iet , am the general contractor or the owner-builder
at the following address: /
Site Address: l6/6,i/D S� 78'
City: • -"
Permit#: Z p U—4c29 y�o
Subdivision/Lot#: tbP...
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:
jkThe ground surface of the under-floor space is covered by a Class I vapor retarder or
other approved materials, with
O/ Joints lapped 12 inches at seams and
r'1 Extending up the foundation walls 12 inches.
Signature: Date:
c i zz
General Contractor or Owner-Builder
I:\Building\Form\RES-M oistureBarrierAcknowledgement_022018
Oregon Residential Specialty Code N1107.2
HIGH-EFFICIENCY INTERIOR LIGHTING SYSTEMS
Permit No.: P de r2.02/ _00 Imo Jurisdiction:
T�
Site Address: / Y 6 c/o $6/ 78 rfv�--
Subdivision/Lot#: Ser-e4/7 ccs 1 f l
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 Nl 107.2)1
Signature: Date: �-z-
Owner/General Contractor/Authorized Agent
Print Name: ..c.® l�f�loSS
ORSC Section N1107.2.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.
1:\Building\Forms\RES-HighEfficiencyLightingAcknowledgement_022018
Oregon Residential Specialty Code R318.2
MOISTURE CONTENT ACKNOWLEDGEMENT FORM
I,
® oSS.Ss�,�`, , am the general contractor or the owner-builder
at the following address:
Site Address: 144 ao se.ti78 d�v�
City:
!9a(-'0/7
Permit#:
NLS T- wit - 'a Y 5 o
Subdivision/Lot#:
Se -evs u c of l3
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
C\Bui(ding\Form\RES-MoistureContentAcknowledgement_022018
Oregon Residential Specialty Code M1505.4
Balanced Mechanical Whole-House Ventilation System Installed
Permit No.: sT z/� 110 Jurisdiction:
Site Address: /y 6 e/O s.,� 7,7 4 _
Subdivision/Lot#: GC r l3
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: / Z Z
Owner/General Contractor/Authorized Agent
Print Name:
w__1.
sok
$AC +'I,Q` / EXISTING —
REMOVED
PREVENTER REPORT NEW REPLACED
REPAIRED OLD SIN:
PROPERTY NAME DR Horton Serenus Lot 13 PHONE
CONTACT NAME PHONE
MAILING ADDRESS 14640 SW 78th Ave
CITY Tigard STATE OR 'ZIP 97224
PREVENTER ADDRESS 14640 SW 78th Ave Tigard, OR 97224
WATER SUPPLIER City of Tigard, Oregon SERIAL# HF 61562
LOCATION Front lawn, NW corner
MAKE Febco MODEL 850 sizE 3/4"
TYPE rl RP I 1 RPDA Ili RPDA-II rx] DC I I DCDA LiDCDA-It Li PVB I__j SV13 AVE rl AG
HAZARD PROTECTED r-1 PREMISES ISOLATION FA IRRIGATION �.... FIRE SYSTEM r_ ] BOILER L. OTHER
(� PHYSICAL
APPROVED: I2( ASSEMBLY I�1 INSTALLATION IM ORIENTATION AIRGAP PIPESI'ZR _ in smourron in
REDUCED PRESSURE ASSEMBLY PVBA/SVBA INITIAL TEST
DOUBLE CHECK AIR INLET CHECK VALVE PASSED X
CHECK#1 CHECK#1 TYPE II I 1 OPENED AT: PRESS DROP:
PRESS TIGHT t^1 FAILED LI
DROP:
INITIAL mix srs1D 2.2
TEST RELIEF VALVE LEAKED ri MIN I rSID suN I PSID MIN I PSID DATE 08-29-22
RESULTS OPENED rcr. 4 OPENED
MIN 2ESE) CHECK#2 SILLY I 1 FAILED SYSTEM PSI 105
RELIEF VALVE: TIGHTLA DID NOT
I I DETECTOR METER
PASSEL) FAILED 2.2 OPEN [ , READING:
LEAKED I-1 MIN 1 PSID
NOTES
REPAIRS
PARTS
REDUCED PRESSURE ASSEMBLY TEST
CHECK#1 DOUBLE CHECK PVBA/SVBA AF1'ER REPAIRS
PRESS
DROP. CHECK#1 TYPE II I I AIR INLET CI IECK VALVE
REPAIR MIN S MD TIGHT I ] OPENED AT: PRESS DROP:
RESULTS RELIEF VALVE _ _ _ _ DATE
OPENED AT: CHECK#2 MIN I P511/ YMIN I PSID MIN I P51D
RELIEF VALVN MIN 2 PSID TIGHT n III Ii Y PASSED
PASSED [] PAWED I I MINI PM
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 approved testing equipment and approved testing procedures.
INITIAL TEST TEST AFTER REPAIRS
066108
TESTER.SIGNATURE TESTER SIGNATURE TESTER CERT#
Jordan A 503-849-0237
TESTER NAME(PRINTED) TESTER 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 XI
WATER RESTORED?
FOUND OFF,LEFT OFF
REPORT RECEIVED AY(REPRESENTATIVE OF OWNER) REPORT RPI'EW ED IIY(REPRESENTATIVE OP OWNER)