Report Oregon Residential Specialty Code R408.1
MOISTURE BARRIER ACKNOWLEDGEMENT FORM
I, y l-o M o- , am the general contractor or the owner-builder
at the following address:
Site Address: 1 it 5 3 f d') 9JAt 94/A1/2-, &*�-T- )IT
City: `---rl H7
Permit#: 2_02-( - 002-14
Subdivision/Lot#: 1` k-- b f
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:
FP'"fhe ground surface of the under-floor space is covered by a Class I vapor retarder or
��/other approved materials, with
I "I Joints lapped 12 inches at seams and
Extending up the foundation walls 12 inches.
Signature: SC..t( Date: / /1.S-72 2--
eneral Contractor o wner-Bu'
1:\Building\Form\RES-MoistureBarrierAcknowledgement_022018
Oregon Residential Specialty Code N1107.2
HIGH-EFFICIENCY INTERIOR LIGHTING SYSTEMS
Permit No.: j( Z � �1I Lurisdiction:
Site Address: 1 5 c-� )/4 54/4L. 8 yrt5/ ,fl .
Subdivision/Lot#: I bOri-N.) L4;1— / ►lr,
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 NI 107.2)1
Signature: +�a9&l Date: / 2-5-
zZ
Owner/Gen 1 Contracto ri Agent
Print Name: (R / 8-gt
' 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, / ply Lot M,g12.1 / , am the general contractor or the owner-builder
at the following address:
Site Address: 1 u si/ A/Wide
City: ---r f 4,fr b
Permit#: 2_,' — 0 2—)
Subdivision/Lot#: t
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: (1)-- "'C�QL>` Date: ZS /ZL
General Contrac or or Owner-Buil r
I:\Building\Form\RES-MoistureContentAcknowledgement_022018
Form 640S 2017
Completion Certification—Site Inspection Ener Trust
New 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?. 'No
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 InceiNo
Site Information
Development. 4 LAS I PIDGI- 11 0l 1146 Axis ID. I 'REM/Rate®ID_
Address 16537 SW SUNSHINE COAST ST
Street Line 2 Multi-Family 'No City: TIGARD State: OR Zip. 97224
Total conditioned area(sq.ft.). 2,703 House Volume ' 25,635 Housing Type: Detached single family
Number of Stories. 12 Number of Bedrooms: 3 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- 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:
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#:
#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 'Partial %ducts inside [61$ lDuct Leakage(CFM)@ 50Pa: '147
Testing
Infiltration Air Changes per Hour(ACH)@ 50Pa: 2.24 I
Ventilation Ventilation Type HRV/ERV Model
Supply Side-Air Cycler Airflow measured or why untestable? I Roof Termination
Appliances
Refrigerator kWl/yr Model-
ENERGY STAR Diswasher kWh/yr Model. GDF510PSR3SS
Percent High Efficacy Interior Lighting(%) Thermostat
Showerhead 1.5 GPH I I Showerhead 1.6 GPH I 'Showerhead 1.75 GPH I
Notes: