Report Oregon Residential Specialty Code R408.1
MOISTURE BARRIER ACKNOWLEDGEMENT FORM
I, �/4 y/L44 . m 61t424 saki , am the general contractor or the owner-builder
at the following address:
Site Address: l (d(g l.E,Z 5.vAl /d‘ 7—
City: l4
Permit#: Yv15 - Zp 2 I — to l S2
Subdivision/Lot#: 5131
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 with
Joints lapped 12"at seams and
xtending up the foundation walls 12".
Signature: 1
Date: CZ/ /3 /al
General Contract or Owner-Builder
I:1Building\FormmRES-MoistureBarrier.doo 09/13/2016
Oregon Residential Specialty Code N1107.2
HIGH-EFFICIENCY INTERIOR LIGHTING SYSTEMS
Permit No.: M e� 24)Z I ` op is Jurisdiction:
Site Address: 62 L 2 14/ L. � _ 91_
Subdivision/Lot#: l 5-0
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 N1107.2)1
Signature: � Date: /1/13/II
Owner/General ntractor/ orized Agent
Print Name: Yet."?' Ll L-J ,
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.
1:\Building\Forms\RES-HighEfficiencyLighting.doc 07/01/08
Oregon Residential Specialty Code R318.2
MOISTURE CONTENT ACKNOWLEDGEMENT FORM
I, - ayt C16 d / , am the general contractor or the owner-builder
at the following address:
Site Address: r g(Q l.( yvu d 6711-7 ,T
City: 4)
Permit#: M W- Loll e O 6Z
Subdivision/Lot#: 15 0
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: L Date: /Z/13/2 /
General Contrac or Owner-Buil1t
I:\Building\Form\RES-MoistureSensitiveWood.doc 09/25/08
) j r S T E r
�) L L
Cr1_ I. ) - 0 0 c
Form 640S 2017
Completion Certification—Site Inspection y
New Homes Program-Single Family 8 �f� i ,
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 I Is this payment redirected?: "No
Builder or Company: Polygon Northwest-WA Redirect to Name:
Verifier Payee Company Name: Performance Insulation and Energy Redirect Payee Comi
Affordable Housing No
Solar Ready Builder Incentive: No ]Solar ReadyVerifier IncelNo
alto Information
Development: 4 EASTRIDGE (Lot I'ISO " ..,.°' . Axis ID: I (REM/Rated ID:
Address: 18642 SW SUNSHINE CpAST ST
Street Line 2 Multi-Family INo City: TIGARD State. OR Zip: 97224
Total conditioned area(sq.ft.): 2,703 House Volume: I 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 8 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-
,
FlatCeiling Insulation R- 49.0 Vaulted Ceiling Insulation R-
Windows Windows U- 0.3 SHGC-10.3 Total window area: I
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#: I
#of Systems 11
Gallons: I Brand: AOSmith
Water Heater Type Heat Pump EF:, Model it: HPTU-66CTA 130
Water Heating Fuel Electric Location' 'Garage or ope
Ducts and Duct Location 'Partial %ducts inside: ISO% ' ;'Duct Leakage(CFM)@ 50Pa:
Testing
Infiltration Air Changes per Hour(ACH)@ 50Pa. 1.65 I
Ventilation Ventilation Type HRV/ERV Model.
Supply Side-Air Cycler Airflow measured or why untestable? 'Roof Termination
Appliances
Refrigerator kWldyr Model:
ENERGY STAR Diswasher kWldyr Model: GDT645SSN3SS
Percent High Efficacy Interior Lighting(%) Thermostat
Showerhead 1.5 GPH I I Showerhead 1.6 GPH I IShowerhead 1.75 GPH
Notes: