HomeMy WebLinkAbout802 BLONDEL ST - DISCLOSURES - 12/12/2007 (3)FFort Collins Residential Energy Code the building & zoning dept. of
AIR SEALING DISCLOSURE FORM Community Planning and Environmental Service
aWirsxa-mass 281 N. College Ave., P.O. Box 580, Fort Collins, CO 80522
(Not applicable to E-STAR or ENERGY SCORE rated homes) Voice: 970 221 6760 FAX 970 224 6134
Job address: 002 ?)�Vr,(Je\ IL ,� 204
General contractor: M i11 hciKS T;,�
Air sealing contractor. S)CA\ A"CWC,;
INSTRUCTIONS
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 Pres;666 tue path (Air Sealing C;heckf; st}
I/We 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:
Business Firm: qe..1 --klr cV\
Address:-
k3^-1-,A) r (0 OS,S a Phone: 17a 2 i 4 - jgi D
r