Certificate of Occupancy CITY OF TIGARD CERTIFICATE OF OCCUPANCY
S Permit #: MST2012 -00217
COMMUNITY DEVELOPMENT Permit Issued: 09/13/2012
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S102DC06400
Jurisdiction: TIGARD
Site address: 13878 SW 90TH AVE
Subdivision: GERTZ HOMES AT EDGEWOOD NO.2 Lot: 13
Project Description: New SF. DEMO CREDITS FROM BUP2011 -00156 APPLIED TO THIS PERMIT.
Class of Work: NEW
Type of Use: SF
Type of Constr: VB
Occupancy Group: R -3
Occupancy Load:
Fire Sprinkler Required:
Project Name: Gertz Homes at Edgewood No. 2, Lot 13
Owner: GERTZ CONSTRUCTION CO INC
19200 SW 46TH AVE
TUALATIN, OR 97062
Phone: 503 - 692 -3390
Contractor: GERTZ CONSTRUCTION CO INC
19200 SW 46TH AVE
TUALATIN, OR 97062
Phone: 503 - 692 -3390
Fax: 503 - 692 -5433
This Certificate issued 3/7/2013 grants occupancy of the above referenced building or portion thereof and
confirms that the building has been inspected for compliance with the 2011 State of Oregon Specialty
Codes for the group, occupancy, and use under which the referenced permit was issued.
Mark VanDomelen
Building Official
City of Tigard
POST IN CONSPICUOUS PLACE
Oregon Residential Specialty Code N1107.2
HIGH - EFFICIENCY INTERIOR LIGHTING SYSTEMS
Permit No.: Jurisdiction: / .
Site Address: 3r A (54) r
Subdivision/Lot #: n
0
and/or
Map and Tax Lot #:
By my signature below, I certify that a minimum of fifty 50
installed lighting fixtures in the above mentioned building have percent
ve beeninstall d with compact or
linear fluorescent, or a lighting source that has l a minimum efficacy of 40 lumens per input watt.
(Oregon Residential Specialty Code N1107.2)
Signature:
gnature:
• wner /General Con : -tor /Authorized Agent Date: 7/ 13
Print Name: )Z 14D l vt
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:\ Building\ ForrnARES- HighEfficiencyLighting.doc 07/01/08
Oregon Residential Specialty Code 8318.2
MOISTURE CONTENT ACKNOWLEDGEMENT FORM
I, � kJ' ii
� r�,' le-- , am the general contractor or the owner- builder
at the following address:
Site Address: /3 c l 7 ft
City: /
Permit #: 20 /Z — 0 0 2% 7
Subdivision/Lot #: • ;� 9 / , /3
and/or
Map and Tax Lot #: /3
To conform with the 2008 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.
�j
Signature: � '` Date: 2 � 3
G nera Contractor or Ow er- Builder
I: \Building\Form\RES- MoistureSensitiveWood.doc 09/25/08
11 ° STREET TREE
TIGARD CERTIFICATION
I, 4440 )i_ , owner/ agent for 6ftT2 -
(PLEASE PRINT) (PERMIT HOLDER)
do hereby certj 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.: 00 /Z- CO 2-1
SI'1 E ADDRESS: 13 Pe? ,..5(A.) Ili 7/4- �
SUBDIVISION: LOT #: l3
SIGNATURE: DA1 E: /7 /y
(OWNER /AGENT)
RE CEIVED d�
VERIFIED BY DALE:
(CITY OF TIGARD)
❑ Tree location verified per approved site plan.
I: \Building \Forms \StreetTreeCertificate 05/30/2012
Tim Aufenthie - T &R Backflow Services 1 fl 432
(503) 318 -6313 FAX (503) 682 -4466
CCB# 116054 email: TRbackflowservices @msn.com ®'NEW
❑ EXISTING
BACKFLOW ASSEMBLY TEST REPORT n
0 MOVE REPLACEMENT
PROPERTY
OWNER: G e, 7 i f v 1M e PHONE:
MAILING
ADDRESS:
CITY
STATE ZIP
�I
ASSEMBLY -- (6-1 IAI • U "1
ADDRESS: STREET
❑ R.P.B.A. itli D.C.V.A. ❑ R.P.D.A. ❑ D.C.D.A. ❑ P.V.B.A. ❑ S.V.B.A. ❑ A.V.B. ❑ AIR GAP
1 tit I L �(/ N 5 MODEL: S U
SIZE: I I r 1-1���t MAKE:
WAGER
SERIAL
PURVEYOR: 1 v A?) NUMBER: TA1_2_01-----_
ASSEMBLY lt' 7 l�2
LOCATION: &)
REDUCED PRESSURE ASSEMBLY P.V.B.A. I S.V.B.A. INITIAL TEST
DOUBLE CHECK AIR CHECK PASSED
PRESS CHECK S DR OP (A) CHECK INLET I FAILED
PRESS DR # ,
INITIAL RELIEF VALVE OPENED AT: PRESS DROP DATE: /
OPENED AI. (B) TIGHT
M IN 2 PSID PSID ' �'
TEST LEAKED ❑
RESULTS BUFFER PSID PSID
A_B= CHECK I(2
MIN 3 PSI TIGHT C
PSID DID NOT FAILED SYSTEM
RELIEF VALVE LEAKED OPEN ❑ ❑ PSI
PASS ❑ FAIL ❑
COMMENTS
REPAIRS
AND /OR
PARTS
REDUCED PRESSURE ASSEMBLY AFTER REPAIRS
P.V.B.A./ S.V.B.A.
NL CHECK D.C•V•A DATE:
RELIE F �'
TEST PRESS DROP (A) CHECK #1 OPENED AT PRESS DROP / /
RELIEF AFTER OPENED (B) TIGHT ❑ PSID
REPAIRS "I` 2 1h112
BUFFER • CHECK #2 PASSED 11:1 A " B = TIGHT El PSID PSID PSID
NIA I RI
IN COMPLETING AND SUBMITTING THIS TEST REPORT. THE TESTER CERTIFIES THAT THE
ASSEMBLY HAS BEEN TESTED AND MAINTAINED IN ACCORDANCE WITH ALL APPLICABLE
RULES AND REGULATIONS OF THE WATER SYSTEM. AND STATE REGULATIONS.
GAUGE CALIBRATION DATE / I ; v/ / DETECTOR METER READING
3466
CERT N
TESTER SIGNATURE TIM A. AUFENTHIE 20061
GAUGEM
TESTERS NAME PRINTED 8660 Rogue Lane, Wilsonville, OR 97070 (503) 318 -6313
• PHONE p
TESTERS ADDRESS T & R Backflow Services
COMPANY NAME ' . - __:i , I Li [ SERVICE RESTORED
REPORT RECEIVED BY: MEW SENTATIVE OF ON NERI +\
WHITE - Nater S,tam Copy PINK - Customer Copy YELLOW - Tesler Copy