HomeMy WebLinkAboutMiscellaneous Compliance Report 2013-3- IIIf'111 �
SPRINGFIELD f l'�1"I'E
'BUILDING
BEUsGENE
�o�o� :DEPARTMENT, LLC
Exterior Wall Envelope
t� Self-Certification Form
I, li 'CUCc U ■ e e 4 CQS-Eun, } rr,es , am the general contractor orthe
owner-builder at the following address:
X590 17 fL •
Street Address
City J
(3
- go
Permit#
To conform to the 2011 Oregon Residential Specialty Code (ORSC), Section
R703.1.1, I am notifying the building official that I am aware of the exterior wall
envelope requirements of R703.1.1, and hereby certify that the components of
the exterior wall envelope have been installed in accordance with the code
requirements. [Section R703.1.1 is provided for reference on the reverse side of
this form.]
/A./-. •
Signature
3 - 1g - 13
•
Date
•
Shared on'spifs02S\dsd'T:\Building Forms\2011 Exterior Wall Envelope.docx Revised 10/1/2011