Building Shell-Walls Wall Type 1 Wall Type: Balloon Platform Masonry Block Other Stud Size: 2x2 2x3 2x4 2x6 2x8 Exterior Type: Wood Metal/Vinyl Stucco Brick/Stone Other Exposed to: Outside Buffered Existing Existing Insul: Cell Blown FG Blown Rockwool FG Polystyrene Other Wall Codes & Area (break out 1st and 2nd fl): Added Insulation: Blown cellulose Cellulose-interior Cellulose-wood Cellulose-slate/vinyl Cellulose-steel/alum Cellulose-stucco Additional Costs (i.e. LSWP): North East South West Comments: Wall Type 2 Wall Type: Balloon Platform Masonry Other Stud Size: 2x2 2x3 2x4 2x6 2x8 Exterior Type: Wood Metal/Vinyl Stucco Brick/Stone Other Exposed to: Outside Buffered Existing Existing Cell Blown FG Blown Rockwool Batts FG Polystyrene Other Wall Codes & Area (break out 1st and 2nd fl): Added North East
Cellulose-steel/alum Cellulose-stucco Additional (i.e. LSWP): South West Comments: Building Attic 1 Attic Code: Joist Spacing: 16in 24in Area (sq ft): Type: Floored Unfloored Cathedral or Flat Outer Ceiling Joist Collar Beam Kneewall Roof Rafter Existing Insulation: Cellulose FG Blown Rockwool Batts FG Other: Existing Depth (in): Comments: (include information on bypasses, notable features, etc.) Added Insulation cellulose Below Floor-Cellulose Slants-Side Attic Method FG Batt R22 Other: Additional Costs Access fee-Interior Access fee-Roof Bypass sealing: # hours ____ Flue Shielding Vent Chutes: # chutes_____ Hatch-horizontal Hatch-vertical Hatch-WS ONLY Knob & Tube Other:
Attic 2 Code: Joist Spacing: 16in 24in Area (sq ft): Attic Type: Floored Unfloored Cathedral or Flat Outer Ceiling Joist Collar Beam Kneewall Roof Rafter Existing Insulation: Cellulose Blown FG Blown Rockwool Batts FG Other: Existing Depth (in): Comments: (include information on bypasses, notable features, etc.) Added Insulation Blown cellulose Below Floor-Cellulose Slants-Side Attic Method Slants-Drill/Blow/Patch FG Batt R22 Other: Additional Costs Access fee-Interior Access fee-Roof Bypass sealing: # ____ Flue Shielding Vent Chutes: # chutes_____ Hatch-horizontal Hatch-WS ONLY Knob & Tube Other:
Attic 4 Attic Code: Joist Spacing: 16in 24in Area (sq ft): Attic Type: Floored Unfloored Cathedral or Flat Ceiling Joist Collar Beam Kneewall Roof Rafter Existing Insulation: Cellulose Blown FG Blown Rockwool Batts FG Other: Existing (in): Comments: (include information on bypasses, notable features, etc.) Added Insulation Blown cellulose Below Floor-Cellulose Slants-Side Method Slants-Drill/Blow/Patch FG Batt R22 Other: Additional Costs Access fee-Interior Access fee-Roof Bypass sealing: # hours ____ Flue Shielding Vent Chutes: # chutes_____ Hatch-vertical Hatch-WS ONLY Knob & Tube Other:
Building Shell-Foundation Foundation 1 Foundation Code: Type: Conditioned Non Conditioned Vented Non Conditioned Unintentionally Conditioned Slab Uninsulated Insulated Slab Floor Area: Joist size (in): 4 6 8 10 12 Wall Height: Total Perimeter: Height Exposed: Existing R-Value (walls): Add Sill Insulation 2 Part Foam Rigid Board Perimeter to Insulate: Add Wall Insulation 2 Part Foam Rigid Board sq ft: Vapor Barrier Needed sq ft (include walls): Seal in crawlspace Comments: Foundation 2 Foundation Code: Type: Conditioned Non Conditioned Vented Non Conditioned Unintentionally Conditioned Slab Uninsulated Insulated Slab Floor Area: Joist size (in): 4 6 8 10 12 Wall Height: Total Perimeter: Height Exposed: Existing R-Value (walls):
Vapor Barrier Needed Total sq ft (include walls): Seal ducts in crawlspace Comments: Heating Heating System 1 General Information Heating Code: Equipment Type: Gravity Furnace Forced Air Furnace Hot Water Boiler Fixed Electric Resistance Vented Heater Other Fuel: Natural Gas Oil Electricity Other _____________ Location: Heated Unconditioned Space Unintentionally Heated Heat Supplied: 100% Other _____________ Manufacturer: #: Input: Output: AFUE: Age: Condition: Good Fair Poor (but working) Programmable T-Stat: Yes Automatic Vent Damper: Present Pilot Light/IID: IID Pilot On in summer Power Burner: Yes Replacement System: Evaluate Replacement Tune-up Mandatory Replace w/High Efficiency Replace w/Standard Cabinet size: Install EC motor upgrade New Slot New Cover Additional Costs: Cond. Pump-New Cond. Pump-Replace Line Seal Ductwork HVAC contractor WX contractor Combustion Air: New Remove from return J trap only Remove humidifier Other: Comments: Damper Type: None Found Electric Thermal Barometric Damper Condition: Good Fair Poor (working) Broken Chimney Type: Masonry-Lined Masonry-Unlined Metal None Chimney Condition: Good Fair Poor (working) Broken
None-Recommended Broken-Replace N/A Other None N/A Flue Type: Metal-Single Wall Wall PVC Other Flue Condition: Good Fair Poor (working) Broken N/A Flue Diameter (in): Combustion System: Sealed Unsealed Combustion Air: Adequate Present-Inadequate None Inspections: Cracked heat exchanger Insufficient Clearance Gas Leak Present Fuel Shutoff MISSING Drip Leg MISSING Any Other Problems Elec. Service Switch: Good Fair Poor (working) Broken None N/A Thermostat: Thermostat Type: Bimetal Mercury Bulb Elec-(no setback) Elec-Setback Powerpile Daytime Setting: Nighttime Setting: Anticipator Setting: Relocate Adjustment Needed Furnace Components: Adjustable Control Settings Fan On: | Fan Off: |High Limit: | Limit not working Burner Type: Ribbon Upshot Flame Retention Burner Condition: Good Fair Poor (working) Broken None N/A Type: On in Summer Off in Summer Hot Surface IID Other Blower Type: Direct Belt Blower Condition Clean Dirty Plugged Belt Condition: Good Fair Poor (working) Broken None N/A Humidifier: Good Fair Poor (working) Broken None Elect Air Cleaner Good Fair Poor (working) Broken None AC Coil: Good Fair Poor (working) Broken None Filter Size: Filter Condition: Fair Dirty Plugged None Boiler Components: ASBESTOS PRESENT REMOVAL REQUIRED System Type: Gravity Pump Pump Location: Supply Return Xtank Condition: Good Fair Poor (working) Broken Drain Valve Condition: Good Fair Poor (working) Broken General Condition: Good Fair Poor (working) Broken T/P Valve Present Pressure Reading: Convector Type: Radiator Zone Type/Model:
Refrigerator General Information Replace -- Other funding source Replace – Evaluate w/DOE Manufacturer: Size (cu ft): 14 15 16 17 18 21 Other: Location: Heated Space Unconditioned Space Unintentionally Heated Style: Top Freezer Bottom Freezer Side by Side Single Door Single Door w/ Freezer Other Defrost: Auto Manual Age: < 5 5-9 10-15 >15 Door Seal: Good Fair Poor Comments: Health and Safety Alarms ALARM CO ALARM Location Working < 5 years Install New Location Working < 5 years Install New SMOKE/CO ALARM Total Smoke to Install: CO to Install: Total COMBO Smoke/CO: Comments:
Equipment Wood Stove/Fireplace is present Improper venting Combustion air is inadequate Clothes Dryer improper venting Exhaust Fans Bathroom Missing Not Operational Improper Vent Kitchen Missing Not Operational Improper Vent Air-to-Air Exchanger Exists Fan measurements on "Blower Door Testing Form" Venting VENT ONLY Venting HOOD ONLY Dryer Venting VENT AND HOOD Clean/Tune Oven Stove Top Burners Repair Gas Leak At Cook Stove Install Exhaust Fan(s) Location: Motion Switch Low Profile w/Light Range Hood (standard) Range Hood (Venmar) Accessible Attic Above? Yes No N/A Possible Venting Locations: Gable Roof Other: Additional Instructions: Revent Existing Fan(s) Location(s): Service Existing Fan Location(s): Install 2nd Fan (list instructions in “Comments”) Other: CO Measurement Oven: LF Burner 1: LR Burner 2: RF Burner 3: RR Burner 4: Gas Leak Present Comments: Attic Recessed Lights Present Chimney/Flue Shielding Wiring Problems Ventilation Inadequate Water Leaks Present Moisture/Mold Evident Vermiculite Present Other Problems: Walls Wiring Problems Water Leaks Present Moisture/Mold Evident Lead Base is Likely Asbestos in Siding is Likely Other Problems: Basement/Crawlspace Vapor Barrier Needed Wiring Problems Leaks Present Plumbing Leaks Present Moisture/Mold Evident Other Problems: Comments: Building Shell-Windows