HomeMy WebLinkAbout6127 CARMICHAEL ST - DISCLOSURES - 7/9/2004Fort Collins Residential Energy Code
INSULATION DISCLOSURE FORM
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the building & zoning dept. of
Community Planning and Environmental Services
281 N. College Ave., P.O. Box 580, Fort Collins, CO 80522
Voice: 070 221 6780 FAX: 970 224 6134
Job address: ( P i Z e-A j,*"/ t 4 F e St•
General contractor: Q �.vrry►'1P S
Insulation contractor: %MG /07 Tn to /,f -�7-^m
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.
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Location
Materials
Thickness
Rated
R value
Location
ant I exq Notes
Fiat or vaulted ceilings
with attics above
i%
Ceilings with enclosed
rafter cavities
Frame walls and rim/band
joists — to exterior
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Its
Frame walls and rim/band
joists — to attic, garage
77 =7
Frame floor - cantilever
Frame floor - over garage or
crawl space
7 '
Slab -on -grade (0-12")
Crawl space walls
Basement walls
11,1,41
It
i
Certification
Me 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.
Pennon Certifying Job:
re:
Business Firm:
Date:
Address: 'f- 10 o ,G = M a n /a- •.-v d W-
G'1'tr a ka fl ek dd&!e s/do Sod' Phone: -Fd 3 q'f & - SD 0 0 -