Report Oregon Residential Specialty Code R408.1
MOISTURE BARRIER ACKNOWLEDGEMENT FORM
I, �r.}y/to( M of KA yOki , am the general contractor or the owner-builder
at the following address:
Site Address: I Le 555. A42,( J/ Lo o
City:
Permit#: M 2 )2, s °o 30
Subdivision/Lot#: iZfo L p 1 Z I I
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
xtending up the foundation walls 12".
Signature. (� Date: 67/ &/zz_
General ontract or Owner- er
I:\Building\Form\RES-MoistureBarrier.doc 09/13/2016
Oregon Residential Specialty Code R318.2
MOISTURE CONTENT ACKNOWLEDGEMENT FORM
I, i LI LAC t t 0 Lf , am the general contractor or the owner-builder
at the following address:
Site Address: l (€ 553— gin.) c A,P.44)`&( P
City: &1 010
Permit#: � —�� � _ 0 0 3 0 o
Subdivision/Lot#: D r Z I 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.
2/7 i6Z
Signature: Date:
�e �4 /iZ-
eneral Contract r or Owner-Builder
I:\Buitdmg\Form\RES-MoistureSensitiveWood.doc 09/25/08
Oregon Residential Specialty Code N1107.2
HIGH-EFFICIENCY INTERIOR LIGHTING SYSTEMS
Permit No.: M 5' 2 of I _ 00 3D( Jurisdiction: .1-,
Site Address: ( it(J s s. 004,0 `�A ,t)/A J LOD P
Subdivision/Lot#: 541 Lb 1--
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)l
/ Le / 4/zz
Signature: CG/ Date: /
Owner/Gener Contrac orized Agent
Print Name: to JYT L/L7zc/B�ie4
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
2 ( (
Form 6405 2017
Completion Certification—Site Inspection
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.
ii Payment information
Incentive Payee Company Name: ( Is h :
Builder or Company: Polygon Northwest-WPolygonA Northwest-WA
Redirect to Name
is payment redirected? INo
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 LASTRIDGE II MED ,Lot 1211 ^Axis ID. I (REM/Rate®ID.
Address: 16555 SW DARWIN LOOP
a
Street Line 2 Multi-Family (No City: TIGARD State: OREGON Zip: 97224
;Fi Total conditioned area(sq.ft.): 3,150 House Volume: I 31,500 Housing Type: Detached single family
Number of Stories: 13 Number of Bedrooms: 5 Foundation Type: Crawispace
Electric Provider: Portland General Electric Gas Provider: NW Natural Gas
f''. 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-
, FramedFloor R- 38.0 Seconds Framed Floor R-
Insulation Secondary
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:I0.3 Total window area: I
Cooling Air Conditioning SEER: 0 Model#: 13ACXN042-230-23
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 #of Systems 11
Gallons: 166 Brand: AOSmith
Water Heater Type Heat Pump EF: 13.17 Model#: HPTU-66N 130
Water Heating Fuel Electric Location:1Garage or ope AHRI Certificate:
i Duets and Duct Location Partial %ducts inside fA' Duct Leakage(CFM)Q 50Pa: EomtattkattitIKCv
t Testing
t Infiltration Air Changes per Hour(ACH)@ 50Pa: 4_87 I
Ventilation Ventilation Type HRV/ERV Model:
Supply Side-Air Cycler Airflow measured or why untestable? I Roof Termination
Appliances ,'
Refrigerator kWtoyr 664 Model: GZS22DSJPFSS
ENERGY STAR Diswasher kWlvyr Model: GDF510PSR3SS
Percent High Efficacy interior Lighting(%) Thermostat
Showerhead 1.5 GPH I Showerwand 1.5 GPH I Showerhead 1.6 GPH I IShowerhead 1.75 GPH I
Notes: