Energy Envelope And Roof Covering Certification
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1PRINCE WILLIAM COUNTY
Department of Development Services – Building Development Division
ENERGY ENVELOPE AND ROOF COVERING CERTIFICATION
Version 2009-04-12
BUILDER DATA
SITE DATA
NAME: _____________________________________
MODEL#: ________________________________
ADDRESS: __________________________________
PERMIT#:________________________________
__________________________________
ADDRESS: _______________________________
PHONE #: ___________________________________
_______________________________
LICENSE #: _________________________________
SUBDIVISION:____________________________
CLASS: _____________________________________
LOT#:____________________________________
ITEM
DATE
TYPE INSULATION/GLASS
R-VALUE/STC RATING
SLAB
CRAWL SPACE
FLOOR
WALLS
CEILING
WINDOWS
DOORS (GLASS)
STC
INSULATION CONTRACTOR: _____________________________________________________________
CONTRACTOR LIC. #: ____________________________________________________________________
HVAC CONTRACTOR: ____________________________________________________________________
CONTRACTOR LIC. #: ____________________________________________________________________
I certify that the above items are in conformance with the Certified Load Calculation Sheet submitted for
the listed model and meet or exceed the energy envelope requirements of the applicable addition of the
International Residential Code (e.g., sections pertaining to air leakage are complied with by caulking,
gasketing, weather stripping or other materials in an approved manner).
I certify that the roof has been constructed to comply with the requirements of the applicable addition of
the International Residential Code, which includes the provisions to protect from roof ice buildup/ice
damming.
JOB SUPERINTENDENT: ________________________________________ DATE _________________
(Signature)
Staff Use Only
RECEIVED BY (PWC Inspector): __________________________________ DATE _________________
Page 1 of 1
Building Development Division. 5 County Complex Court, Prince William, VA, 22192. 703-792-6930.
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