HomeMy WebLinkAbout2163 Chandler St - Disclosures - 04/13/2004 (2)cannsRsta al 'code the building d zoning dept. of
INSULATION DISCLOSURE FORM Community Planning and Environmental Services
281 N. C 11age Ave., P.O. Banc 580, Fort Collins, CO 80M
mWWc2Aw-7MQW Voice: 9M 221 8780 FAX 970 224 6134
Job address:
General contractor.
Insulation contractor
2163 "rrd Ir, :�/'
INSTRUCTIONS
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.
1110U ""Wag
Location
Material(s)
Thickness
Rated
R-value
Location
grit / ext) Notes
Flat or vaulted ceilings
with attics above
t k rL
Ceilings with enclosed
rafter cavities
Frame walls and rirnrband45
joists -to exterior
RG��
AA
Frame walls and rim/band
joists - to attic, garage
✓ .C. �t
r
Frame floor -cantilever
Frame floor - over garage or
crawl space
e y
Slab -on -grade (0-12")
Crawl space walls
Basement walls
i, % tie- Llnj
Certification
1/we certify that the above -listed insulation was installed in the building at the above locations in conformance with the current requirements or 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: ke G✓i t a . f
Address: �la,I )f 4*rAbo1 o )� Ay-e /Od
GYr'r i4 Lye " t- V1 / e ' . 'J !'o/)) Phone: 30 9 -