2014, 08-28 BLD-2014-1431 Insulation CertificatePART 1 Residence Address
1—Y=0-1 t
LOOSE -FILL
INSULATION CERTIFICATE
Date Installed
SPECIALIZED .)
INSULATION/NC.
RESIDENTIAL • COMMERCIAL
509.489.35 f
S94 E. COZZA DRIVE
SPOKANE. WA 99208
CONT. Lic. # SPEC111999D7
PART 2 Ceiling Areas Insulated (Loose Fill) :,.i
Square
1 1
ExistinR-Value Added/
R-Value�
�7 ,
Bags
Lbs. Bag
• 3
Total Depth
1e.0 If
CombinedR-Value
Insulation
Type
, /
2.
3.I
PART 3 CI Wall Area Insulated (loose Fill) ❑ Floo Areas Insulated
Square Feet
1.
Existing
R -Value
Added R -Value
No. Bags
Lbs. Bag
Total Depth
•
Combined
R -Value
.9hsulation
<'=-7. Type
2.
This certified that he above residence identified in Part 1 was insulated as specified in Part 2, or 3 and the installation was
conducted in conformance to applicable codes, standards and regulations at the time of installation.
WHITE COPY TO CUSTOMER • YELLOW COPY TO CONTRACTOR HARD COPY TO ATTIC
(AUTHORIZED SIGNATURE)