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Pbrt Collins Residential Energy Code
INSULATION DISCLOSURE FORM
Job address- Z/
General contractor:
Insulation contractor:
the building St zoning dept. of
Community Planning and Environmental Services
281 N. College Ave., P.O. Box 580,Forl Collins, CO B0522
Voice: 970 2216760 FAX: 970 224 6134
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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 Informallon In the appropriate spaces provided
11 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.
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Location
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Materials
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Thickness
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. ...-..� .I .. ..1 ..................................... .... .... ........
Rated
R-value t
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Notesn
Plat or vaulted ceilings
with attics above
C011ingi with enclosed
rafter bavilles
Frame walls and rinVband
Joists — to exterior
Frame walls and rim1band
jolsis — to attic, garage
Fr&tn* floor - cantilever
Frame floor - over garage or
crawl space
Slab -on -grade (042.1
Cis space walls
•OLA")g
aw'-'C"
1
(2,
basement wells
—3 VA-
9 In confiormence %%41h the cLN��freciulre'ments*o'fft
www" w' u lo� W
its tnergy Code. I and that it w*s.InWA18dmln=ZZ=4 :InstAs n Guidelines" published by the City of Fort Collins.
Petsorl cartifyind Job:
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