HomeMy WebLinkAbout1133 SAINT CROIX PL - DISCLOSURES - 8/7/2003Fort Collins Residential Energy Code the building & zoning dept. of
INSULATION DISCLOSURE FORM Community Planning and Environmental Services
msalscZ=- 7110M 281 N. College Ave., P.O. Box 580, Fort Collins, CO ao522
n Voice: 970 2216760 FAX: 970 224 6134
Job address: i,l 3.5 '�Y+- C f6i
General contractor. C Mi�-JW
Insulation contractor: A) )�'ed 7A1 Sv 10. ��`D✓1
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This disclosure form is to be signed by the insulation contractor or representative of the.generaI •cont; actor.
Please type or print, except for the signature. Complete the information in the apprcoriate 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.
j :n s u :•::
la ff
Location
Flat or vaulted ceilings
with attics above
Ceilings with enc!osed
rafter cavities
Frame walls and rim/band
joists — to exterior
Frame walls and rim/band
joists — to attic, garage
Frame floor -cantilever
Frame floor - over garage or
crawl space
Slab -on -grade (0-121*)
Crawl space walls
Basement walls
M aterial(s
a
::::::Rated:.`,:: ((::::::Location
Thickness I R-value .I (Int / ext)
�WIE
U" I RII irsv
Notes
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��Ttvppa ion.
I/We 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 Fcrt Collins.
Person Certifying Job: -VV1a
Signature:
Business Firm: Al Gel
Address:
so OA,
Date: " / / in
Phone: 94 9,6/