HomeMy WebLinkAbout1302 Nassau Way - Disclosures - 12/03/20021=ort Coilins Residential Energy Code
iNSULATION DISCLOSURE FORM
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Job address:
the building & zoning dept_ of
Community Planning and Environmental Services
281 N. College Ave., P.O- Box 580, Fort Collins, CO 80522
Voice: 970 221 6760 FAX: 970 224 6134
General contractorr
AN H MES
Insulation contractor. R _ (� _ InGn l at ion Co
.......... .... ... ................. .....:........................
:.:...:STR.U'CTiONS * ::::::::;::•:;:::;:::::::::::..:::.:.::.:-:::::::::::::::::--:
This disclosure form is to be signed by the insulation contractor or representative of the general contractor.
Please type or print, except for the signature. Complete the information in the appropriate spaces provided.
If components vary, make multiple entries to describe them.
One copy of this form must be provided to the Building and Zoning Department prior to the C.O.
One copy of this form must be made available to the original home buyer_
....Blida. lOtl........ _................
Location
Flat or vaulted ceilings
with attics above
Ceilings with enclosed
rafter cavities
Frame walls and rim/band
joists —to exterior
Frame walls and rmfband
joists — to attic, garage
Frame floor - cantilever
Frame floor - over garage or
XXXXXAM
Slab -on -grade (0-12")
Crawl space walls
Basement walls
Rated Location
Materiai(s) �j Thickness R-value I (Int f ext)
� rr
tr—„14-
,.
m
ID
m
Notes
Ce rtefi c a tl o n ::: : ;:: ::::::::::::::.....::::•::::::::•::::::::::.-:::::. _ .. ...... ........................................:.............................:.:.: ...::::..................... ......................._...
UWe certify that the ..............- insulation was installed in the building at the above locations in conformance with the current requirements of the
Fort Collins Residential Energy Code, and that it was installed in accordance with the 'insulation Guidelines" published by the City of Fort Collins.
Person Certifying Job:
Signature:
avid M Van Buskirk
Date: /
Business Firm:
Address: 74th Ay
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