RC-05-21-1140 IMPACT CERTENERGY, SOUND AND IMPACT CERTIFICATE
Building Permit No: Lr�
Project Name:
Job Address: -ICI KIW t o 9
STATEMENT OF COMPLIANCE
We, the undersigned, hereby certify that the ENERgL.�QIJNQ AND IMPACT INS LAT ON has been installed in the above
referenced project; in compliance with the latest edition of the ELQBTDA AUILQTNQ CODE the APPROVED ENERGY
CALCULATIONS and Plans and in accordance with good construction practice. The insulation fumished and installed has the
characteristics shown below: (check only applicable boxes).
1) Exterior CB5 Walls Insulation: fit- t4.2 (Min,): Material: �FDI L
Thickness: 3 inch (es): Density: ib/ft: Mfgr: _
2) Exterior Frame/Metal Stud Walls: R- (Min,): Material:
Thickness: inch (es): Density: Ib/ft: Mfgr:
3) Exterior solid c— gperete walls: R- 4*1 (Min.): Material: F-DI V
Thickness: 3 Li" inch (es): Density: lb/ft: Mfgr.
C` 4) Interior walls separating A/C from non A/C spaces insulation: R- (Min.)
Material: , Thickness: inch (es), Density:
'._ 5) MULTI -FAMILY RESiDF.NTIAL CONSTRi1CTION ONLY' The COMMON (Party) walls to two separate conditioned
tenancies shall be insulated to a minimum of R-I I for frame walls, and to R-3 on both sides of common masonry walls
See ENERGY CODE, 2007, paragraph 13-602. ABC. 1.1, on page 13.74, latest edition. These "minimum levels of
insulation"_ are not included in the Energy Calculations, but shall be installed in the field.
F6) Ceiling insulatiou R- 30 (Min.). Material. 81oLiti-in '-,r,er
Thickness' 10" inch (es): Density: Ib/ft: Mfgr:
1 oc) ss
C 7) Walls, partitions and floor/ceiling assemblies betwee*dwelling units or between dwelling units and adjacent public or service
areas such as halls, corridors, stairs, etc. mast have a sound transmission class (STC) of not less than 50 (penetrations must
maintain the required rating).
i"i 8) Floor/ceiling assemblies between dwelling units or between dwelling units and public or service areas such as halls, corridors,
stairs, etc, must have an impact insulation class (IIC) rating of not less darn 50,
Make photocopies of this sheet in your office, as required for future jobs.
Installed by: C'e t l r�5ytAn o! ) JA
Insulation Company Name Insul on Contractor Signature
Insulation Contractor CC# 0�5 C)C7 �� a Date Certi ed: 5� 1 5 aoci�
O.C./Builder:
Company Name
Building Contractor CC#:
G.C.Builder's Signature
Date Certified:
Note: For lightweight Insulating concrete, use appropriate forms, separate from this one.
Revised 02-26-2009