Spray Foam Insulation Form (Print)

10 Johnston County Inspections Department 309 E Market St Smithfield , NC 27577 Phone 919 989 - 5060 Fax 919 989 - 5431 Spray Foam Insulation For review and approval prior to obtaining a permit Check ONE of the following four options consult insulation contractor prior to choosing Preliminary report will need to be provided at Plan review and final report before Final CO can be issued Contractor Homeowners assumes all risk responsibilities if report does not pass at Final UA Compliance Report Simulated Performance Alternative must be performed by a NC Design Professional Energy Rating Index Score must be less than or equal to 65 and performed by a NC Design Professional or HERS Rater Prescriptive Method Not practical with whole house systems State R - Value and depth required to meet Prescriptive Code fill in only ones that apply Wall _________ _________ Ceiling ________ ________ Floor ________ _ _______ Items that need to be readily available for the Inspector at Insulation Inspection ? Current ICC ES Report within last 12 months ? Manufacturers Specifications and Installation Instructions ? Vapor Ignition barrier requirements Answer the following Questions ? Locations where an ignition barrier is required __ Attic __ Other ________________________ ? Locations where a thermal barrier is required _________________________________________ ? Is the crawl space going to be sealed __ Yes __ No Describe_ ___________ ? Is the attic going to be sealed __ Yes __No Describe_ ___________ ? Is a vapor barrier required at any locations __ Yes __No Describe_ ___________ General Contractor Homeowner Signature Date ___________________________ _____ ___________ All Spray Foam Insulation must meet the 2018 NCRC , 2018 NCECC , and all Manufacturers Installation Instructions No work is to be covered until insulation has approval by Johnston County Inspections Page