Report Oregon Residential Specialty Code R408.1
MOISTURE BARRIER ACKNOWLEDGEMENT FORM
I, - 14\/V,-4 N tr , am the general contractor or the owner-builder
at the following address:
Site Address: I ulkk 9, 8 51,0&) st),J 4, xi &tiff "
City: --r14
Permit#: r-(�"� ?mot? I ob®5
Subdivision/Lot#: (1061.tri--€4.- ( 5- q
and/or
Map and Tax Lot#:
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 wi
Joints lapped 12"at seams and
Extending up the foundation walls 12".
Signature: 62/ / D / Z"" /
2!.��'
Date:
eneral Contra or -
I:Building\Form\RES-MoistureBarrier.doc 09/13/2016
Oregon Residential Specialty Code R318.2
MOISTURE CONTENT ACKNOWLEDGEMENT FORM
I,-1-r41/LO( ► _` U'0.42A , am the general contractor or the owner-builder
at the following address:
(Site Address: r �O' b A(sitibtIL deb-
City: L 1411€--4)
Pennit#: Nt ST 2,02I -8c7d,3
Subdivision/Lot#: AIAL l �.
and/or
Map and Tax Lot#:
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: C� ,_.�- } Date:
General Contrac or Owner-Btffder
I:\Building\Form\RES-MoistureSensitiveWood.doc 09/25/08
Oregon Residential Specialty Code N1107.2
HIGH-EFFICIENCY INTERIOR LIGHTING SYSTEMS
Permit No.: M 5-7-2,02„1 _°Dp ss Jurisdiction: ---nD
Site Address: /ix LP g ggvu SV/—44 0
Subdivision/Lot#: 12 a ( 15-4
and/or
Map and Tax Lot#:
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 Ni 107.2)1
Signature: L Z�"( Date: /o 1 Z Z 02 f
Owner/Gen- A Conbaetz horized Agent
Print Name: Stt 7T I-/ ix=-4 8--&-e�j
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\Fonms\RES-HighEfficiencyLighting.doc 07/01/08
Form 640S 2017 ,
Completion Certification—Site Inspection E - ,'4r""" ,u
stNew Homes Program--Single Family °
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 !Is this payment redirected'? INo
Builder or Company: Polygon Northwest-WA Redirect to Name:
Verifier Payee Company Name Performance Insulation and Energy Redirect Payee Corn
Affordable Housing No
Solar Ready Builder Incentive: No Solar ReadyVerifier InceNo
Site Information
Development 4 EAS1 RIDGE It of 1154 Axis ID: I !REM/Rate®ID.
Address 16690 SW SUNSHINE COAST ST
Street Line 2 Multi-Family INo City: TIGARD State: OR Zip. 97224
Total conditioned area(sq.ft.): 2,703 House Volume: 1 25,635 Housing Type: Detached single family
Number of Stories 12 Number of Bedrooms 4 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 S.Notes
Slab Perimeter Insulation R- Slab Under Insulation R-
Framed Floor R- 30.0 Secondary Framed Floor R-
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 10.3 Total window area. 1
Cooling Air Conditioning SEER. 0 Model#:
Primary Heating System Details AFUE. Brand Lennox
Type: Gas Furnace HSPF: Model#: ML196UH070XE36B-52
Heating Fuel: Gas SEER.
Primary Heat
Source Comment COP:
Location. Attic Outdoor Unit(for heat pumps)
ECM: Model#: 1
#of Systems 11
Gallons 166 Brand: AOSmith
Water Heater Type Heat Pump EF: 13.17 Model#: HPTU-BOCTA 130
Water Heating Fuel Electric Location' !Garage or ope AHRI Certificate'
Ducts and Duct Location !Partial %ducts inside [r'r"* s71Duct Leakage(CFM)@ 50Pa: 1185
Testing
Infiltration Air Changes per Hour(ACH)@ 50Pa. 2.33 I
Ventilation Ventilation Type HRV/ERV Model:
Supply Side-Air Cycler Airflow measured or why untestable? (Roof Termination
Appliances
Refrigerator kwh/yr Model
ENERGY STAR Diswasher kWlvyr Model: GE
Percent High Efficacy Interior Lighting(%) Thermostat
Showerhead 1.5 GPH 1 I Showerhead 1.6 GPH I IShowerhead 1.75 GPH I
Notes: