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Fort Collins Residential Energy Code Neighborhood & Building Services
INSULATION DISCLOSURE FORM 281 N. College Ave., P.O. Box 580, Fort Collins. CO 80522
k1&CR"' ft - 7nasa Phone: 970 2216760 FAX 970 224 6134
Job address:
Genera) contractor:
Insulation contractor.
L&L insulation, LLU
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.
Insulation
Location f
Materials
Thickness
Rated
R-value
Location
Int/ext)
Notes
Flat or vaulted ceilings
with attics above
Loose FillFiberglass
_
Ceilings with enclosed
rafter cavities
Fiberglass Bgtts
M InI
Big
' SeA ll
9
Frame walls and rimtband
joists - to exterior
Fibercilass Batts
Closed Cell Foam
�"
F
Blow -In -Blanket
a
Frame walls and rimlband
Joists -to attic, garage
Fiberglass Batts
Closed Cell Foam
"
Blow -In -Blanket
Frame floor - cantilever
Fibe( lass Batts
Blow -in -Blanket
Frame Floor - over garage or
crawl space
Fiberalass Batts
Blow -In -Blanket
k't
Slab -on -grade (0-1r)
Crawl space walls
Fiberglass Batts
Vinyl Wrap
Basement walls
Fiberglass Batts
\
Vinyl Wrap
_
Certiftcatlon
Wye certify that the above -listed 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: Kevin Miller
Business Firm: L&L Insulation LLC
Address: 401 North Link Lane Fort Collins CO 80524
Phone: 970-221-3180