☐ ☐ - Yes No Gas or oil detected Locations: __________________________________________ ☐ ☐ ☐ - Yes No Inoperable CO Monitor Locations: ______________________________________ ☐ ☐ ☐ Yes No Inoperable Detectors - Locations: ___________________________________ ☐ ☐ Yes No Heating/DHW sys venting issues - Description: ___________________________________ Locations with signs of moisture or durability issues: ☐ ☐ ☐ Windows Soffits Attic ☐ ☐ ☐ Crawl/Basement Interior: Walls ☐ ☐ ☐ Roof Sill plate Other: _________________ Improperly vented, non-operable, or needs ventilation: ☐ ☐ ☐ Master bath Dryer Whole-house ☐ ☐ ☐ 2nd bath Range hood _______________ ☐ ☐ 3rd bath Crawlspace Recommended Measures: Higher Cost Measures: These changes will likely require a contractor Buy new Energy Star appliance(s) Refrigerator, washer, dishwasher Contractor air sealing See attached checklist Contractor duct sealing See attached checklist Add attic insulation Blow additional R-20 fiberglass or cellulose Insulate the space floor Use R-19 unfaced batts. Support with tension wires every 2-feet. Install ground poly Cover all exposed soil Create a closed crawl space See attached checklist Install air IC rated can lights Install storm window Install new 2-pane, low-E windows Install new Energy Star heat pump 12 SEER Install new Energy Star Furnace 90% plus efficiency and include sealed combustion Install a solar hot water heater Installation qualifies for 40% NC tax credit up to $1,400 Adding renewable sources of energy like solar or wind to your home can Renewable Energy reduce your monthly energy bill Low Cost Measures:
☐ Yes ☐ No Gas or oil detected - Locations: __________________________________________ ☐ Yes ☐ No ☐ Inoperable CO Monitor - Locations: ______________________________________ ☐ Yes ☐ No ☐ Inoperable Detectors - Locations: ___________________________________ ☐ Yes ☐ No Heating/DHW sys venting issues - Description: ___________________________________ Locations with signs of moisture or durability issues: ☐ Windows ☐ Crawl/Basement ☐ Roof ☐ Soffits ☐ Interior: ☐ Sill plate ☐ Attic ☐ Walls ☐ Other: _________________ Improperly vented, non-operable, or needs ventilation: ☐ Master bath ☐ 2nd bath ☐ 3rd bath ☐ Dryer ☐ Range hood ☐ Crawlspace ☐ Whole-house ☐ _______________ Recommended Measures: Higher Cost Measures: These changes will likely require a contractor Buy new Energy Star appliance(s) Refrigerator, washer, dishwasher Contractor air sealing See attached checklist Contractor duct sealing See attached checklist Add attic insulation Blow additional R-20 fiberglass or cellulose Insulate the space floor Use R-19 unfaced batts. Support with tension wires every 2-feet. Install ground poly Cover all exposed soil Create a closed crawl space See attached checklist Install air IC rated can lights Install storm window Install new 2-pane, low-E windows Install new Energy Star heat pump 12 SEER Install new Energy Star Furnace 90% plus efficiency and include sealed combustion Install a solar hot water heater Installation qualifies for 40% NC tax credit up to $1,400 Renewable Energy Adding renewable sources of energy like solar or wind to your home can reduce your monthly energy bill Low Cost Measures:
V-Home-Performance-Assessment-Report-Revised.docx