HomeMy WebLinkAbout421 PEYTON DR - DISCLOSURES - 6/16/2003 (3)Fort Collins Residential Energy Code
AIR SEALING DISCLOSURE FORM
and.c2-0s — 7N0W
(Not applicable to E-STAR or ENERGY SCORE rated homes)
Job address:
General contractor:
Aq
the building & zoning dept. of
Community Planning and Environmental Service
281 N. College Ave., P.O. Box 580, Fort Collins, CO 80522
Voice: 970 221 6760 FAX: 970 224 6134
Air sealing contractor: At LiCQ �( F��i tlTtGw
Instt`uctions .::.:
..._ . .. _........ _ .:.- .
Complete either Part A or Part B . s
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` Plrescrlptive ath �41r Sealn Checklist
.. p ... . g
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:
Signature: Date: CD - 11e - r)
Business Firm: i
Date of test:
CFM50: Air flow through the blower door at 50 Pascals pressure difference (cfm)
Volume: /V Volume of home (cu. ft.)
ACH50: Al 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: Date:
Business Firm: /V �}
Address:
Phone: