Report Oregon Residential Specialty Code N1107.2
HIGH-EFFICIENCY INTERIOR LIGHTING SYSTEMS
Permit No.: tittS ( 2-0,2-O ' 0 0 7/ 5 Jurisdiction:
ICI
Site Address: (to i 70
Subdivision/Lot#: S((�
and/or
Map and Tax Lot#: ( f (1?-
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: 6 O
Date: 0 r
wner/General Contractor/Authorized Agent
Print Name: ((2c, �` 1 (-1-0
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
Oregon Residential Specialty Code R408.1
MOISTURE BARRIER ACKNOWLEDGEMENT FORM
PiLl 1-0'^'l�-�✓~ , am the general contractor or the owner-builder
at the following address:
Site Address: ( 61 70 suJ („)
City: T� Q
Permit#: 0)..p 9-O 00
Subdivision/Lot#: S k,
and/or
Map and Tax Lot#:191 'l
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:
The ground surface of the under-floor space is covered with 6-mil black polyethylene
sheeting with
[i Joints lapped 12"at seams and
[J° Extending up the foundation walls 12".
Signature: /`)' ----�" Date: (� )7 ��a/
General Contractor or Owner-Builder
I:\Building\Form1RES-MoistureBarrier.doc 09/13/2016
Oregon Residential Specialty Code R318.2
MOISTURE CONTENT ACKNOWLEDGEMENT FORM
am the general contractor or the owner-builder
at the following address:
� I� �. I
Site Address: 1 ( I7O (,�'A(.�lG�h �I r Y
\;
City
Permit#: 1°"'
'�-
iM31 goaO_ �o ��
Subdivision/Lot#:
and/or
Map and Tax Lot#: s\v/Ac_
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: Date: v
Ge eral Contractor or Owner-Builder
I:\Building\Form\RES-MoistureSensitiveWood.doc 09/25/08
4
Form 640S 2017
Completion Certification—Site Inspection �" a� "�""
New Homes Program—Single Family rust
:.7
of Oregon
To be completed by Verifier
CLEAResult is a Program Management Contractor for Energy Trust of Oregon,Inc.
Payment information
IIncentive Payee Company Name [Polygon Northwest-WA I Is this payment redirected?: [No
Builder or Company: Polygon Northwest-WA Redirect to Name:
li Verifier Payee Company Name. Performance Insulation and Energy Redirect Payee Corn
Affordable Housing No
Solar Ready Builder Incentive: No [Solar ReadyVerifier Inc4No
Site Information
Development: RI 4 EAS I RIDGE!I MED Lut 1242 Axis ID. I [REM/Rate®ID'
Address: 16970 SW ROCKHAMPTON LN
Street Line 2 M-a/i Family [No City: TIGARD State: OREGON Zip: 97224
Total conditioned area(sq.ft.). 3,248 House Volume: 1 29.029 Housing Type: Detached single family
Number of Stories: 12 Nuni ber of Bedrooms: 5 Foundation Type: Crawlspace
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.[0.3 Total window area: [510
Cooling Air Conditioning SEER. 0 Model#: 13ACXN042-230-22
Primary Heating System Details AFUE: 95 Brand Lennox
Type: Gas Furnace HSPF: Model#: ML196UH090XE48C-51
Heating Fuel: Gas SEER.
Primary Heat
Source Comment' COP:
Location: Attic Outdoor Unit(for heat pumps)
ECM: No Model#. I
AHRI Certificate:4805339 It of Systems 11
Gallons. I Brand: AOSmith
Water Heater Type Heat Pump EF I Model#: HPTU-80N 130
Water Heating Fuel Electric Location: [Garage or ope
Ducts and Duct Location [Partial %ducts inside [50% [Duct Leakage(CFM)@ 50Pa [ r :, .. ,
Testing
Infiltration Air Changes per Hour(ACH)@ 50Pa. 2,21 I
Ventilation Ventilation Type I/RV/ERV Model:
Supply Side-Air Cycler Airflow measured or why untestable? [Roof Termination
Appliances
Refrigerator kWh/yr Model:
ENERGY STAR Diswasher kWh/yr Model: GDF510PSM4SS
Percent High Efficacy Interior Lighting(%) _Thermostat
Showerhead 1.5 GPH I Showerwand 1.5 GPH I Showerhead 1.6 GPH [ IShowerhead 1.75 GPH I
Notes: