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Oregon Residential Specialty Code R408.1
MOISTURE BARRIER ACKNOWLEDGEMENT FORM
L
o t I v ,,
(�L 1D , am the general contractor or the owner-builder
at the following address:
Site Address: 114 1 01 0 5-1ti
City: ,y/1' J
Permit#: ILA Sri" 2-02-I - &&13 I
Subdivision/Lot#: R V L L /_or l
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
[19-ro-ints lapped 12" at seams and
xtending up the foundation walls 12".
Signature: Date:
/,e z
General Contractor weer-Builder
I:\Building\Form1RES-MoistureBarrier.doc 09/13/2016
1 (ti `I
•
Form 6405 2017 .
Completion Certification—Site Inspection E er,.g yT..ust
New Homes Program-Single Family
of Oregon
To be completed by Verifier
CLEAResu/t/s a Program Management Contractor for Energy Trust of Oregon,Inc.
Payment Information
Incentive Payee Company Name. IPo fygon Northwest-WA Its this payment redirected?: INo
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 Inct{No
She Informallon
Development: RT 4 EASTRIDGE II MED ILoI 1167 Ass ID: I 'REM/Rate-6 ID:
Address: 44190 SW 165TH AVE
Street Line 2 Mirk-Family INo City: TIGARD State: OREGON Zip: 97224
Total conditioned area(sq.ft.): 2,929 House Volume: I 29.581 Housing Type: Detached single family
Number of Stones: 11 Number of Bedrooms: 4 Foundation Type: Crawlapace
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 A#Wml Model Equipment Details&Notes
Slab Perimeter Insulation R- B0 Slab Under Insulation R-
Framed Floor R- 30.0 Secondary Framed Roar 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:10.3 Total window area: 1510
Cooling Air Conditioning SEER: 0 Model le ML14XC1S042-230A06
Primary Heating System Details AFUE: 95 Brand Lennox
Type: Gas Furnace HSPF: Model re ML196UH090XE48C-51
Heating Fuel: Gas SEER:
Primary Heat Comment: COP:
Source
Location: Conditioned A Outdoor Unit(for heat pumps)
ECM: No Model#: I
AHRI Certificate:4805339 #of Systems 11
Gallons: I Brand: AOSmith
Water Healer Type Heat Pump EF: I Model 4: HPTU-80N 130
Water Heating Fuel Electric Location: 'Garage or op=
Ducts and Duct Location 'Partial %ducts inside: jaiVi Duct Leakage(CFM)@ 50Pa: 1S3
Testing ,
Infiltration Air Changes per Hour(ACH)@ 50Pa: 3.17 I
Ventilation Ventilation Type HRVIERV Modal:
Supply Side-Air Cycler Airflow measured or why untestable? I Roof Termination
Appliances
Refrigerator kWVyr 613 Model: GYE22GYNFFS
ENERGY STAR Diswasher cWNyr Model: GDF510PSR3SS
Percent High Efficacy Interior Lighting(%) Thermostat
Showerhead 1.5 GPH I Showerward 1.5 GPH I Showerhead 1.6 GPH I IShowerhead 1.75 GPH I
Notes: 1
Oregon Residential Specialty Code N1107.2
HIGH-EFFICIENCY INTERIOR LIGHTING SYSTEMS
Permit No.: ZoZI - D O 13 I Jurisdiction: TIN 1�
Site Address: ( c4. 10 I �Q S
Subdivision/Lot#: uis+t+ �
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
3 / 1 8/
Signature: Date:
er/General Contractoq.utbol Agent
Print Name: (Ye 0 7/- L (G 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.
1:1BuildinglFornu\RES-HighEfficiencyLighting.doc 07/01/08
Oregon Residential Specialty Code R318.2
MOISTURE CONTENT ACKNOWLEDGEMENT FORM
I, 14-'/L_ I I i21 , am the general contractor or the owner-builder
at the following address:
Site Address: ( c..j_ 14l 0 I ( S 7:11 �i
City:
Pennit#: 2O Z ( — 00 f 2
Subdivision/Lot#: Z 0 a G,L (10 7' I (�
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: r%"�'e-- i Date: / �� / 2-2—
General Contractor or Owner-Builder
I.1Building\Form\RES-MoistureSensitiveWood.doc 09/25/08