MOISTURE CONTENT ACKNOWLEDGEMENT FORM Sec R I, am the general contractor or the ownerbuilder at the following address: Street Address.

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1 MOISTURE CONTENT ACKNOWLEDGEMENT FORM Sec R318.2 I, am the general contractor or the ownerbuilder at the following address: Street City Permit # To conform with the 2011 Oregon Residential Specialty Code, Section R318.2, I am notifying the building official that I am aware of the moisture content requirement of ORSC Sec R318.2 and have taken steps to meet this code requirement. (Sec R318.2 is provided for reference) Section R318.2 Moisture Content. Prior to issuance of the insulation/vapor barrier approval required by R of this code: (A) All moisture-sensitive wood framing members used in construction shall have a moisture content of not more than 19% of the weight of dry wood framing members. (B) The general contractor or the owner who was issued the structural permit shall notify the building official on a division approved form that the contractor or the owenr who was issued the structural permit is aware of and has taken steps to meet the requirement in paragraph (A). Signature Date This form is required to be submitted to Building Codes Services prior to the insulation/vapor barrier approval.

2 CERTIFICATE OF CONTRACTOR LICENSING OAR I certify that the following is a list of contractors used on this job: General Contractor name HVAC Contractor name Plumbing Contractor name Electrical Contractor name General Contractor/Owner Signature: If more than one of any type of contractor worked on the job, please mark and submit additional form(s) as necessary. This form is required to be submitted to Building Codes Services prior to issuance of the Certificate of Occupancy.

3 CERTIFICATE OF LIGHTING FIXTURES Sec N _ Mark one as appropriate: I certify that a minimum of 50% of the permanently installed lighting fixtures are compact or linear fluorescent, or a minimum efficacy of 40 lumens per input watt; Or, I have selected item #2 of Table N1101.1(2), including an additional 15% of the permanently installed lighting fixtures to be high efficiency lamps; Or, I have selected item #D or E of Table N1101.1(2), including a minimum 75% of permanently installed lighting fixtures as CFL or linear fluorescent or a min efficacy of 0 lumens per watt as specified in Sec N I certify that the lighting has been provided as required. General Contractor/Owner Signature This form is required to be submitted to Building Codes Services prior to issuance of the Certificate of Occupancy.

4 ENERGY ADDITIONAL MEASURE SELECTION New One and Two Family Dwellings and Large Additions (40% or more of the existing heated floor area or 600 sf in area, whichever is less) Sec N & N This measure selection is required for all new one and two family dwellings and additions that are equal to or more than 40% of the existing building heated floor area or 600 sf in area, whichever is less. From the list attached (ORSC Table N1101.1(2), I am required to select two of these measures for additional energy conservation, one from each portion of the table, in addition to the standard requirements specified in Table N1101.1(1). I select measure # (circle appropriate measure) and letter A B C D E F G (circle appropriate measure). Within the measures selected, identify the optional items to be selected. Only the requirements of the two measures selected will be applicable. NOTE: The tables are available in our office at 1113 Kelly St., The Dalles or on BCD s website and may be accessed through our website at scroll to Building Codes, then to FAQ s, then Effective Codes, then click on the link to the 2011 Oregon Residential Specialty Code, then Chapter 11, page 11-3 Contractor/Owner Signature This form is required to be submitted to Building Codes Services prior to plan review and permit issuance. If not submitted along with the original permit application, the file will be placed on hold pending receipt of this information.

5 ENERGY ADDITIONAL MEASURE SELECTION Small Additions (less than 40% of the existing building heated floor area or less than 600 sf in area, whichever is less) NOT required if less than 15% or 200 sf, whichever is less Sec N This measure selection is required for all additions that are less than 40% of the existing building heated floor area or less than 600 sf in area, whichever is less, but greater than 15% of the heated area and greater than 200 sf. (not required if less than 15% or 200 sf, whichever is less) From the list attached (ORSC Table N1101.1(2), I am required to select one of these measures for additional energy conservation, Item # ; OR comply with one measure from Table N (below). Item #. Only the requirements of the one measure selected from either table will be applicable. Contractor/Owner Signature Table N (select one OR select only one from either portion of Table N1101.1(2)) 1 Increase the ceiling insulation of the existing portion of the home as specified in Table N Replace all existing single-pane wood or aluminum windows to the U-value as specified in Table N Inulate the floor system as specified in Table N and install 50% of permanently installed lighting fixtures as CFL or linear fluorescent or a min efficacy of 40 lumens per watt as specified in Sec N Test the entire dwelling with a blower door and exhibit no more than 7.0 air changes per 50 Pascals 5 Seal and performance test the duct system 6 Replace existing 78% AFUE or less gas furnace with a 92% AFUE or greater system 7 Replace existing electric radiant space heaters with a ductless mini split system with a minimum HSPF of Replace existing electric forced air furnace with an air source heat pump with a minimum HSPF of Replace existing water heater for a natural gas/propane water heater with a minimum EF of Installa solar water heating system with a minimum of 40 sf of gross collector area. This form is required to be submitted to Building Codes Services prior to plan review and permit issuance. If not submitted along with the original permit application, the file will be placed on hold pending receipt of this information

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