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Section 'l : Customer lnformation <br />Enrollment # <br />Applicant <br />Name: <br />I Pnone # <br />lnstallation <br />Address: <br />Contractor <br />Namer <br />Section 2: Existing Attic lnformation <br />Attic Square FootageExistinq Attic lnsulation R-Value <br />Upper <br />Lower <br />Amount of Attic <br />Ventilation Added <br />Existing Amount of Atlic <br />Venlilation <br />Section 3: lnstalled Attic lnsulation <br />QtvUnits <br />Square Foot <br />Detailslnstalled R-value <br />Square Foot <br />Knee Wal I Knee Wall (Frberglass Batls) <br />Section 4: Minor Home Repairs/Fees <br />Units QtvQtv <br />Each <br />Each <br />EachAddilional Servrce {Requrcs P rc - apprcv al) <br />Item <br />Venl Dormer <br />Ven! Eave Each <br />EachVent- Gable/[,,4ushroom <br />Venl Screen <br />Item <br />Atlic Access Cover <br />Each <br />Units <br />Each <br />Each <br />Per Joint <br />Attic Access New <br />Duct Repair <br />The itens/fees below can only be invoiced when a pernit has been obtained by the installation contractor <br />Qt)/Units <br />Each <br />UnitsItemQtvItem <br />Section 5: Additional lnformation <br />Section 6: Signatures <br />C <br />S <br />I Date <br />nature <br />Si naturePrint lD Bad e# <br />ustomet <br />lnstaller Program <br />Customer <br />Name (Print) <br />Energy Savings <br />r ffsempra Energv ,,r',ry <br />Assistance Program <br />White- So Cal 6as Yelbw- hplica-nl Pink- Contactor Revised-46/2016 <br />t)9-aA ntrl TrrA I <br />Climate Zone: <br />/cJn,!61to,J.-. t, \) -t ll l'\ ,lI <br />Existing Attic insulation Type: <br />Upperl gAIllpper: <br />aI <br />Lower:a <br />Required Amount of Attic <br />Ventilation <br />Lower: <br />e aw1Bra rd <br />3 l0l\,4ake:Itr "YC l6P\:30Attic: <br />EachExhaust Venl 0nly <br />IExhausl Vent- Cut opening <br />EachSmoke Alarm (',0 year batle,y)CO/Smoke Alarm Combo (10 yeat battery) <br />Permit Number;Perm t Fee Amountl <br />Date:\cI\e/t\f a, <br />lnstaller )3 ?\t)eb <br />Name <br />ff,ror,,n,,Attic lnsulation Work Order <br />Fonn+ ATTICSCG