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

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Energy Compliance Residential Certificate Form (City of South Bend)

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The Energy Compliance Residential Certificate Form (City of South Bend) form is 1 page long and contains:

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Country of origin: US
File type: PDF

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

BROWSE CITY OF SOUTH BEND (IN) FORMS

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ENERGY COMPLIANCE CERTIFICATE
RESIDENTIAL
COMPLIANCE METHOD
Check (√) method
Prescriptive (Table 1102.1)
RESCHECK (http://www.energycodes.gov/rescheck)
Performance (675 IAC 14-4.3 – 139.1)
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 10/2ft.
/
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 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 Residential Certificate Form (City of South Bend)

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Completed 16 July 2020

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