Report Oregon Residential Specialty Code R318.2
MOISTURE CONTENT ACKNOWLEDGEMENT FORM
WIL2,4V---1106,4s , am the general contractor or the owner-builder
at the following address:
Site Address: I t T?L1 ( & ,
City:
Permit#: i,1Lts r 9-0($—OOP-7F
Subdivision/Lot#: 4 Jt.r ra A"3
and/or /`1
Map and Tax Lot#: 15-3
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.
Signature: 1 R'Vi` Date: /^
General Contractor or Owner-Builder
I:\Building\Form\RES-MoistureSensitiveWood.doc 09/25/08
41101..
Oregon Residential Specialty Code R408.1
MOISTURE BARRIER ACKNOWLEDGEMENT FORM
I, I2-O\,I*- , am the general contractor or the owner-builder
at the following address:
Site Address: —71/ C 040 S-lj' Ad&
City: 1 ` L
Permit#: VUS-1— 01 ' Q D v?-
Subdivision/Lot#:
and/or
Map and Tax Lot#: tot ( S3
To conform with the 2014 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:
171 The ground surface of the under-floor space is covered with 6-mil black polyethylene
sheeting with
I ` I Joints lapped 12"at seams and
Extending up the foundation walls 12".
Signature: i ' ) — Date: , —+g61
General Contractor or Owner-Builder
I:tBuilding\Form\RES-MoistureBarrier.doc 09/13/2016
Oregon Residential Specialty Code N1107.2
HIGH-EFFICIENCY INTERIOR LIGHTING SYSTEMS
Permit No.: r-i 5-1-9 0 I O, 6 0 r F Jurisdiction: -�
Site Address: 0,9.7c( c ,J (( A-Oe
Subdivision/Lot#: 1043.
and/or
Map and Tax Lot#: (Of ( S�
By my signature below, I certify that a minimum of fifty(50)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 N1107.2)1
Signature: f �' Date: 1 � 2.();J
Owner/General Contractor/Authorized Agent
Print Name: 120\6-F-r±- 4 V' -
1 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\Forms\RES-HighEfficiencyLighting.doc 07/01/08
Form 640S 2017
Completion Certification—Site Inspection
New Homes Program--Single Family �a, Trust
of Oregon
To be completed by Verifier
CLEAResult is a Program Management Contractor for Energy Trust of Oregon,Inc.
Payment Information
Incentive Payee Company Name. !Polygon Northwest-WA Its this payment redirected?. !No
Builder or Company Polygon Northwest-WA Redirect to Name:
Verifier Payee Company Name. Performance Insulation and Energy Redirect Payee Com
Affordable Housing No
Solar Ready Builder Incentive No (Solar ReadyVerifier IncE No
Site Information
Development. NE River Area 3.Larye Lot 153 Axes ID. I !REM/Rate®ID.
Address 12974 SW 165th Ave
Street Line 2 Multi-Family INo City: Sherwood State: OR Zip. 97140
Total conditioned area(sq.ft.). 2,594 House Volume. 29,500 Housing Type. Detached single family
Number of Stories. 11 Number of Bedrooms 4 Foundation Type Crawispace
Electric Provider. Portland General Electric Gas Provider. NW Natural Gas
Solar installed None Solar Installer Name/Company:
Blue shaded fields are required for EPS sheet
Verification Type Actual Model Equipment Details&Notes
Slab Perimeter Insulation R- 0.0 Slab Under Insulation R-
Framed Floor R- 30.0 Secondary Framed Floor R- 59.0
Insulation
Above Grade Wall Insulation R- 23.0 Below Grade Wall Insulation R-
Flat Ceiling Insulation R- 49.0 Vaulted Ceiling Insulation R-
Windows Windows U- 0.3 SHGC.f 0.3 Total window area. 1314
Cooling Air Conditioning SEER Model It MXZ-8C48NA2
Primary Heating System Details AFUE. Brand Mitsubishi
Type: Electric Heat Pump-Air Source Ducted HSPF: 13.5 Model#: PEAD-A36AA7 MX
Heating Fuel: Electric SEER 30.5
Primary Heat
Comment: COP.
Source
Location: Attic Outdoor Unit(for heat pumps)
ECM: No Model it IMUZ-FH09NA
AHRI Certificate. #of Systems 11
Gallons. 166 Brand: AOSmith
Water Heater Type Heat Pump EF. 13.17 Model#: HPTU-66N 130
Water Heating Fuel Electric Location. !Garage or ope AHRI Certificate:
Ducts and Duct Location !Unconditioned %ducts inside 0 „74 ,]Duct Leakage(CFM)@ 50Pa. 1814
Testing
Infiltration Air Changes per Hour(ACH)@ 50Pa: 3.49
Ventilation Type HRVIERV Model:
Ventilation —
Supply Side-Air Cycler Airflow measured or why untestable? !Roof Termination
Appliances
Refrigerator kWh/yr Model.
ENERGY STAR Diswasher kWh/yr 268 Model. FGID2466"`A
Percent High Efficacy Interior Lighting(%) 100% Thermostat
Showerhead 1.5 GPH I Showerwand 1.5 GPH ! Showerhead 1 6 GPH I IShowerhead 1.75 GPH I
Notes: