HomeMy WebLinkAbout913 BELVEDERE CT - DISCLOSURES - 8/27/2001ort Collins Residential Energy Code
the building & zoning dept. of
JAIR SEALING DISCLOSURE FORM Community Planning and Environmental Service
aWdSC2.* - 7/16M 281 N. College Ave., P.O. Box 580, Fort Collins, CO 80522
(Not applicable to E-STAR or ENERGY SCORE rated homes) Voice: 970 2216760 FAX: 970 224 6134
Job address: 91 3 , e (-_#:, L
General contractor:
Air sealing contractor.
... ...... .... .. .. .. ....
Instructions �i*::�,*._*.*., ..... ...... .... ...... .... ... ....
Complete either Part A or Part B
Part A is to be signed by the air sealing contractor or representative of the general contractor.
Part B is to be signed by the blower door testing contractor or representative of the general contractor.
The "Blower Door Test Report" or equivalent documentation must be attached.
Please type or print, except for the signature.
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 C.'O.
One copy of this form must be provided to the original home buyer.
A. Prescriptive Oath (Air Sealing Checklist)
IAAfe certify that the air sealing requirements specified in the current City of Fort Collins Residential Energy Code
have been completed in this building, in accordance with the "Air Sealing Checklist" published by the City of Fort Collins.
Person Certifying Job:
Signature. Date:
Business Firm:
Address:
Phone:
B. Performance path 11316wer 000 T st .... ...
r e
INVe certify that this building has met the air leakage performance threshold specified in the current Fort Collins
Residential Energy Code, in accordance with the "Blower Door Test Procedures" published by the City of Fort Collins.
Testing contractor: �as i5na4v, lldoCtrL
Date of test: V/5/0 I U I
CFM50: 20 � 3 -t- 77a Air flow through the blower door at 50 Pascals pressure difference (cfm)
Volume: -3 3 & 0 0 Volume of home (cu. ft.)
ACH50: 3, Air change rate per hour at 50 Pascals pressure difference
ACH50 = (CFM50 x 60) / Volume
The performance threshold for code compliance is ACH50
not exceeding 5.0 ac/h
Person Certifying Job:
Signature: (rA1-Z.1< �2 � /244171-- Date: ZL2- 7 /0
U
Business Firm:A69 CAD� FVlnte S
Address:
Phone: 2- 7 3 (7-/