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DAWSON COUNTY COMMUNITY DEVELOPMENT BUILDING INSPECTIONS INSULATION AFFIDAVIT THIS FORM MUST BE COMPLETED AND RETURNED TO THE BUILDING INSPECTIONS/ PERMIT OFFICE AFTER THE INSULATION IS INSTALLED AND THREE(3) BUSINESS DAYS PRIOR TO THE REQUEST FOR A FINAL INSPECTION. BUILDING PERMIT # ADDRESS PARCEL # LOT # BUILDER (COMPANY NAME): INSULATION CONTRACTOR (COMPANY NAME): TYPE BATTS FOIL LOOSE FOAM R-Value THICK CEILING WALL FLOOR INSULATION CONTRACTOR-PRINT NAME: SIGNATURE: BUILDER SIGNATURE: By signature above the insulation contractor certifies that they are in compliance with the requirements of the 2015 International Energy Conservation Code with Georgia Amendments for buildings. Anyone willfully violating the Energy Code or misrepresenting information on this form is in violation of state and local law subject to citation, reporting to the state for investigation, and revocation of permit. COMMUNITY DEVELOPMENT 25 Justice Way I Dawsonville, GA 30534 I dawsoncountyga.gov 2.11.2025 SIGN SIGN