Cf 6R Env 01 Form – Fill Out and Use This PDF

INSTALLATION CERTIFICATE		CF-6R-ENV-01
Envelope – Insulation; Roofing; Fenestration		(Page 1 of 3)
Site Address:	Enforcement Agency:	Permit Number:

If more than one person has responsibility for installation of the items on this certificate, each person shall prepare and sign a certificate applicable to the portion of construction for which they are responsible; alternatively, the person with chief responsibility for construction shall prepare and sign this certificate for the entire construction. All applicable Mandatory Measures with check boxes require to be checked to ensure the mandatory measures have been met.

Description of Insulation
1. RAISED FLOOR
Material:__________________________________	Brand Name:_______________________________
Thickness (inches):_________________________	Thermal Resistance (R-Value):_________________

†§150(d): Minimum R-13 insulation in raised wood-frame floor or equivalent U-factor.

2. SLAB FLOOR/PERIMETER
Material:__________________________________	Brand Name:_______________________________
Thickness (inches):_________________________	Thermal Resistance (R-Value):_________________
Perimeter Insulation Depth (inches): ____________

†§150(l): Water absorption rate for the insulation material alone without facings is no greater than 0.3%; water vapor permeance rate is no greater than 2.0 perm/inch and shall be protected from physical damage and UV light deterioration.

3. EXTERIOR WALL

a. Insulation Type (e.x. Batt, Loose Fill, Spray Foam)

________________

b. . Insulation Type (e.x. Batt, Loose Fill, Spray Foam)

________________

Brand: ___________________________________

Spray/Loose fill) Installed Actual Thickness (inches):_____________

Manufacturer’s installed weight per square foot to achieve Thermal Resistance (R-Value)

†§150(c): Minimum R-13 insulation in wood-frame wall or equivalent U-factor.

Exterior Foam Sheathing (rigid Insulation)
Material:________________________________		Brand Name:_______________________________
Thickness (inches) :_______________________		Thermal Resistance (R-Value) :________________
4.	FOUNDATION WALL
Material:________________________________		Brand Name:______________________________
Thickness (inches):_______________________		Thermal Resistance (R-Value):________________
5.	CEILING
Batt or Blanket Type: _______________________		Brand Name: _____________________________
Loose Fill Type: ___________________________		Thermal Resistance (R-Value): _______________
Spray Foam Type: _________________________		Brand Name: _____________________________
Installed Actual Thickness (inches):____________		Contractor’s min installed weight/ft² _______lb

Manufacturer’s installed weight per square foot to achieve Thermal Resistance (R-Value):

†§150(a): Minimum R-19 insulation in wood-frame ceiling or equivalent U-factor.

6. ATTIC ROOF INSULATION AND/OR ATTIC RADIANT BARRIER

Material: _________________________________	Brand Name: ______________________________
Material: _________________________________	Brand Name: ______________________________
Thickness (inches): ________________________	Thermal Resistance (R-Value): ________________

†§118(a): Insulation installed meets Standards for Insulating Material.

†§150(g): Mandatory Vapor barrier installed in Climate Zones 14 or 16.

2008 Residential Compliance Forms

August 2009

INSTALLATION CERTIFICATE

CF-6R-ENV-01

Envelope – Insulation; Roofing; Fenestration

(Page 2 of 3)

Site Address:

Enforcement Agency:

Permit Number:

Description of Roofing Products

CRRC Product ID

Manufacturer

Product

Roof

Roof

Product

Initial Solar

Aged Solar

Thermal

Number1

Information

Brand/Model

Type

Area

Slope

Weight 2

Reflectance

Reflectance4

Emittance

†3

†3

†3

1.

The CRRC Product ID Number can be obtained from the Cool Roof Rating Council’s Rated Product Directory at

ww.coolroofs.org/products/search.php

2.

The weight in lbs per square feet of the roofing product being installed.

3.

Check box if the Aged Reflectance is a calculated value using the equation below, footnote 4.

4.

If the aged reflectance is not available in the Cool Roof Rating Council’s Rated Product Directory then use the initial reflectance value from the

directory and use the equation (0.2+0.7(ρinitial – 0.2) to obtain a calculated aged value.

†CHECK APPLICABLE BOX BELOW IF EXEMPT FROM THE ROOFING PRODUCT “COOL ROOF” REQUIREMENT:

†The roof area covered by building integrated photovoltaic panels and building integrated solar thermal panels are exempt from the above Cool Roof criteria.

†Roof constructions that have thermal mass over the roof membrane with a weight of at least 25 lb/ft2 is exempted from the above Cool Roof criteria.

To apply Liquid Field Applied Coatings, the coating must be applied with a minimum dry mil thickness of 20 mils across the entire roof surface and meet minimum performance requirements listed in §118(i)3 and Table 118-C. Select the applicable coating

† Aluminum-Pigmented Asphalt Roof Coating	† Cement-Based Roof Coating	† Other ___________________________
† CRRC-1 Label Attached to CF-6R

(Note if no CRRC-1 label is available, this compliance method cannot be used and another method is required to meet compliance).

FENESTRATION/GLAZING

		Product		#		Total Quantity		Add. Exterior	Comments/
		U-	Product	of	NFRC	of Like Product	Area	Shading Dev.
	Manufacturer/Brand Name								Location/ Special
Item	(GROUP LIKE RODUCTS)	factor1	SHGC1	Panes	Certified1, 2	(Optional)	ft2	or Overhang	Features
1
2
3
4
5
6
7.

8.

1.Use values from a fenestration product’s NFRC Certified Label. For fenestration products without an NFRC label, use the default values from Section 116, Table 116-A and 116-B of the 2008 Energy Efficiency Standards.

2.NFRC Label Certificates shall not be removed until the building inspector has verified the efficiency. Enter Yes or No.

†§116(a)1: Doors and windows between conditioned and unconditioned spaces designed to limit air leakage.

†§116(a)2 and 3: Actual fenestration products installed are equivalent to or have a lower U-factor and/or a lower SHGC than that specified on the Certificate of Compliance (Form CF-1R).

†§116(a)4: Fenestration products (except field-fabricated windows) have a label listing the certified U-Factor, certified Solar Heat Gain Coefficient (SHGC), and infiltration that meets the requirements of §10-111(a)

†§117: Exterior doors and windows weather-stripped; all joints and penetrations caulked and sealed.

2008 Residential Compliance Forms

August 2009

INSTALLATION CERTIFICATE		CF-6R-ENV-01
Envelope – Insulation; Roofing; Fenestration		(Page 3 of 3)
Site Address:	Enforcement Agency:	Permit Number:

DECLARATION STATEMENT

•I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct.

•I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person).

•I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency.

•I reviewed a copy of the Certificate of Compliance (CF-1R) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF-1R that apply to the installation have been met.

•I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy.

Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)

2008 Residential Compliance Forms

August 2009