HomeMy WebLinkAbout613 Flagler Rd - Disclosures/Insulation - 02/20/2009Job address:
General contractor:
Insulation contractor:
...................................................
nsulation: ::.. . I
Location
Flat or vaulted ceilings
with attics above
Ceilings with enclosed
rafter cavities
Frame walls and rim/band
joists — to exterior
Frame walls and rim/band
joists — to attic, garage
Frame floor - cantilever
Frame floor - over garage or
crawlspace
Slab -on -grade (0-12")
Crawl space walls
Basement walls
Fort Collins residential energy code 7196
Insulation disclosure form
............ I.. ....
.
Rated
R-value
Location
(Int 1 extl
II _ ln4t-& M+ti11�U-F 1 --ST7 1 V-1zq --
t...:: Ce :: :.::::::::::::::::::...,,.. •.:::: •.:::.:..:.:::.:.::::: •:::.::: I Ica ton"::. .. ........................... .................. ...
:::........::.•.::•:::::::::::..............*......... ................................. .... ... ........ ..............................................................................................................
. ................
Me certify that the above -listed insulation was Installed in the building at the above locations in conformance with the
current requirements of the City of Fort Collins Residential Energy Code, and that it was Installed In accordance with
the applicable "Insulation Installation Guidelines" published by the City of Fort Collins.
Certified by: JE;ff C, g:-r�l� ,� Phone:
Business firm: /7%kuo -f Date:
Address: itt� l '-� t`w�nl Jl.�. 114.1jSt„nLLq ,?$ignature:
c+ �
,......::::::::::::::::. ....I.::::...... ::: .� .::::.0....::.....:::::::::::::::::::::::::......:•::•:.::..................................:................:..................................................................
st O
................ .
. ......n.................................................................................:::::::::::::.::::::::::::::::::::::.:::::::::::::::::::::::
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.
If components vary, make multiple entries to describe them. r.e...w�asn-aa.Ae
One copy of this form shall be provided to the Building and Zoning Department at final Inspection.
One copy of this form shall be provided to the homebuyer.
0