HomeMy WebLinkAboutMiscellaneous Compliance Report 2013-6-4 (2) Jun 04 13 02:19p Corp 5417460194 p.2
.:a, ,,. SPRINGFIELD
j fi ;F 7.---=-=-*i guusuG GE7 ///EPARTM,ENT, LLC
Exterior Wall Envelope
Self-Certification Form
I, /14 I/4 ✓ie Sh, < ;,g'v'te
, am the general contractor or the
owner-builder at the following address:
65Y0 H7b H$'rs 6 . •
Street Address p•
City
2-e ii — 737c, Z
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.] .
ScAw,26,0s/37G
•
Print Name
I A/t (7de-1 i.. - . .
Signature
Date
Revised: 216/2010