Fillable Energy Compliance Proposal Residential Form (City of South Bend)

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Energy Compliance Proposal Residential Form (City of South Bend)

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U.S.A. forms for City of South Bend

BROWSE CITY OF SOUTH BEND (IN) FORMS

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ENERGY COMPLIANCE PROPOSAL
RESIDENTIAL
COMPLIANCE METHOD
R-Values from Table
1102.1
Check (√) method
Prescriptive (Table 1102.1)
RESCHECK (http://www.energycodes.gov/rescheck)
Performance (IECC Chapter 4 2009 Edition)
SQUARE FOOTAGE
Total square feet of conditioned space
INSULATION RATINGS
(list R-value of predominant area of component)
ENTER R-VALUE or
N/A (does not apply)
Ceiling/Roof (including access hatch)
38
Walls
20 OR 13+5
Basement __ Ext. Continuous / __ Interior
10/13
/
Floor *over unconditioned space
30/19
/
Slab R value/Depth
10/2 ft.
/
Crawl space __ Ext. Continuous / __ Interior
10/13
/
HEATING EQUIPMENT
EFFICIENCY
(BTU’S/RATING)
Electric
Gas
COOLING EQUIPMENT
EFFICIENCY (BTU’S/SEER)
/
FENESTRATION
ENTER U-VALUE
Predominant U-factor of windows
Property Address: ___________________________________________
I hereby attest that I am the Builder or Design Professional of the above-referenced property
and attest to the proposed compliance of this structure with Rule 4.3 2005 Indiana Residential
code or any subsequent amended version of the same regarding energy efficiency. I declare
that the above statement is true and accurate to the best of my knowledge.
_______________________________ _____________
Builder/Registered Design Professional Date
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Energy Compliance Proposal Residential Form (City of South Bend)

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Completed 16 July 2020

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