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�I E=ENt4 er cH:rn„_
Exterior Wall Envelope
Self•Certification Form
I, ' '1 . . <yt SM`'fib ,am the general contractor or the
owner-builder at the following address:
570 9 PetceeL c4 .
Street Address
city '
517, — I1 (rs
Permit*
To conform to the 2011 Oregon Residential Specialty Code(ORSC),Section
8703.1.1,I am notifying the building official that tam 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.)
(:—.1-4-4-- .
Signature '`
Cade S I /LT .
•
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