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3601-A Crossroads Parkway
Fort Pierce, FL 34945 INSULATION INSTALLATION CERTIFICATE
_______________________
Gale Insulation
BUILDER: ___________________________ SUBDIVISION:______________________________
JOB ADDRESS:________________________CITY:_____________________________________
PERMIT#:____________________________LOT/BLOCK:_______________________________
The undersigned hereby certifies that insulation has been installed in the above property as follows:
1. Exterior CBS walls have been insulated with ______________ to thickness of _______ inches, which
according to ___________________ will yield an “R” value of __________.
2. Ceiling Area (flat) has been insulated with _______________to a thickness of __________inches, which
according to ____________________ will yield an “R” value of ____________.
3. Ceiling Area (vaulted) has been insulated with _________________ to a thickness of _____ inches, which
according to ___________________ will yield an “R” value of ___________.
4. Interior knee walls have been insulated with ________________ to a thickness of _______ inches, which
according to ___________________ will yield an “R” value of __________.
5. Garage common walls adjacent to conditioned living space have been insulated with __________________
to a thickness of _____ inches, which according to __________________ will yield an “R” value of ________.
_____________________________ _______________________________
General Contractor/Builder Insulation Contractors Signature
______________________________ License # CGC1512179
Signature
THE AFFIANT, __________________ IS PERSONALLY KNOWN TO ME. Sworn to and subscribed before me this ______
day of ____________ 20__.
Notary Public, State of Florida ______________________________________