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} S INITT()NST\TE ; I\ I lrl <br /> .y) j} /q t <br /> insulation`Certificate for Residential New Construction <br /> Permit#: v /ice✓ <br /> House address or lot number: 'A 1 N% CVC"S.N &*k ' Ck ..O3 <br /> Wa Blown or Sprayed Fiberglass or Cellulose-Walls <br /> ype of insulation: R-Value per Inch: <br /> >, Manufacturer: /-X".\63,..) Coverage Area: <br /> r, R-Value: Bag Count: <br /> 1J <br /> Floor Blown or Sprays Fiberglass or Cellulose -Ceiling <br /> Type of insulation: ~ R-Value per Inch: <br /> Manufacturer: Coverage Area: <br /> R-Value: Bag Count: -D-k-)3 Str <br /> Flat Ceiling/Attic Sprayed Polyurethane Foam (SPF) <br /> Type of insulation: - ` Density: <br /> Manufacturer: Installed Thickness: <br /> R-Value: '�--'.R R-Value of Installed Thickness <br /> Building Component Installed: walls floor ceiling <br /> Single Rafter Joist Vaulted Ceiling <br /> Type of insulation: <br /> Manufacturer: <br /> R-Value: <br /> Insulation Installer: <br /> • <br /> Company Name: ' '!,"1 l , , fkxt it Installer: PNik -"\ "` <br /> '( <br /> Installer Signature: CI, V1--/ `~ Date: t - , -d <br /> Phone Number: <br /> Washington State Energy Code Reference h#tp:tiwww.arier v wsu.i du/documentsf2042°Io20Res° 20Eneruv.pdt: <br /> R303.1 Identification.Materials,systems and equipment shall be identified in a manner that will allow a determination of compliance with the applicable <br /> provisions of this code. <br /> R303.1.1 Building thermal envelope insulation.An R-value identification mark shall be applied by the manufacturer to each piece of building thermal <br /> envelope insulation 12 inches(305 mm)or greater in width.Alternately,the insulation installers shall provide a certification listing the <br /> type,manufacturer and R-value of insulation installed in each element of the building thermal envelope.For blown or sprayed <br /> insulation(fiberglass and cellulose),the initial installed thickness,settled thickness,settled R-value,installed density,coverage area <br /> and number of bags installed shall be listed on the certification.For sprayed polyurethane foam(SPE)insulation,the installed <br /> thickness of the areas covered and R-value of installed thickness shall be listed on the certification.The insulation installer shall <br /> sign,date and post the certification in a conspicuous location on the job site. <br />