City of Bismarck
Community Development Department
Building Inspections Division
Phone: 701-355-1465 * FAX: 701-258-2073 * TDD: 711
PO Box 5503 * Bismarck, ND 58506-5503
buildinginspections@bismarcknd.gov
Last Revised 4/20/2017
RESIDENTIAL
ENERGY EFFICIENCY
CERTIFICATE OF
COMPLIANCE
PROJECT INFORMATION:
Property Address:
Company:
Contact Person:
Phone Number:
Email:
Project Type (check box that applies):
New Construction
Addition
Select the design method you have chosen to use for compliance with the 2015 International Residential Code (IRC) or the
2015 International Energy Conservation Code (IECC). Documentation in addition to this form must be submitted for the total
UA alternative path and the simulated performance path.
Prescriptive Path (values in Section 2 must meet or exceed the minimum values in the IRC or IECC)
Total UA Alternative Path (submit REScheck report and Compliance Certificate)
Simulated Performance Path (submit energy compliance documents in accordance with IECC Section 405)
BUILDING THERMAL ENVELOPE:
Building Component
Notes
Fenestration U-Factor
Skylight U-Factor
Ceiling R-Factor
Specify with or without attic space
Wood Frame Wall R-Value
Specify if the R-value is continuous insulation (CI) or framing
cavity insulation (FCI)
Mass Wall R-Value
Floor R-Value
Basement Wall R-Value
Specify if the R-value is continuous insulation (CI) or framing
cavity insulation (FCI)
Slab R-Value & Depth
Specify if insulation depth will be vertical insulation or a
combination of vertical insulation, insulation extending under
the slab or insulation extending out from the building. Also
specify if slab is heated
Crawl Space Wall R-Value
Specify if the R-value is continuous insulation (CI) or framing
cavity insulation (FCI)
Ducts located outside of the
building thermal envelope
EQUIPMENT PERFORMANCE:
SYSTEM
TYPE
EFFICIENCY
Heating
Cooling
Water Heater
The following have been installed (check all that apply):
Electric Furnace
Gas-fire unvented room heater
Baseboard electric heater
I certify that all information and statements provided on this application and all other documents submitted along with this
application are true and correct. I further certify that all work will be done in compliance will all applicable law, codes,
and ordinances of the City of Bismarck.
Signature
Date
click to sign
signature
click to edit
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