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, i <br /> ' S�4C��d1te of In�n1eH.,.. <br /> ��l• Addre�e of Rp;de Se 1, 2. Nam�� Addttet of Iotul�don Contre;to r <br /> �"�`c� L — � � Y} <br /> a �j��/G✓�7�'i�'/v <br /> � � ���/ � /Ssf/ �r,•f�i��G.s liv� <br /> ?. Dute otlmtwllaHon ''��i � F/�/ C�/�q 9��� <br /> 1. C no�d�acoor Pbone <br /> 3�- E�'/ -��� —. <br /> �TTIC <br /> i [stimated R•Velue of&gianing lasu�eaon I,ovel <br /> : R•Va���e Added (Depth Bt Type of Ituulndon) _ _ �a� <br /> ' F��! R•Value of irvulation � <br /> � � <br /> ° Totnl Area(Sq. Ft.of Spnce Insuleted) /,..,_�„ '� , 1/ `�`�,�� <br /> s '�'umber of Recessod Ll�htt Tltwed ��` ��— �U/�J <br /> 5 ti'urnber of Bath feas Vented Out -"- -- <br /> , •�wnber o!Kitchcn Fens Veated Ouf �---- - <br /> B Numba of 3ize of Roof Jocici Added !�l_ �� ��� S <br /> y Knob & Tube Report Needed(yey or No) ` — <br /> i(Yes—•Electriciaa Name dt Licenve k - <br /> ,.�ttPch copy of Kaob I�C 7Lbe Repon lf needed.) ------ <br /> ��'nLLS <br /> � R Value Added (Well Depth�£Typo of Wulation) — � <br /> 2 Total Ivee (Sq. Ft, of Space Inaulnted) �j�,, ��� <br /> ��k�a-���z_�--_ --- <br /> ' .4rta� Nol In�ulated (Yei o� <br /> lf Yes, Which area� sad rwon ---- <br /> ------ -- - <br /> 4 Knob & Tube Repon Needed(Yq ot No) <br /> I I(Yes--Elactrician Neme & License N <br /> ;4 ruch copy of Knob& 'Ilibe Rcport lf needed,) — <br /> �� �� �avc� � h�-d � <br /> U�S���,`, ia� o �K �w��- <br />