HomeMy WebLinkAbout4123 VERBENA WAY - DISCLOSURES - 10/22/2008it Fort Collins Residential Energy Code the building & zoning dept of
AIR SEALING DISCLOSURE FORM Community Planning and Environmental Service
wrd=2x.-711ass 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 61-14
Job address &r 6eftA
General contractor 7--ry� r-7 b it
Air sealing contractor 14el- r) , 5Ku f )rj- -)LjU-77ell lin r-
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 Prescriptive path (Air Sealing Checklist)
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
nature
Business Firm
Date
Address -3OU FV a c4-3
Phone �D3
B. Performance path (Blower Door Test)
I/We 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
Date of test
CFM50 A Air flow through the blower door at 50 Pascals pressure difference (cfm)
Volume I Volume of home (cu ft)
ACH50 I I Air change rate per hour at 50 Pascals pressure difference
ACH50 = (CFM50 x 60) / Volume
I The performance threshold for code compliance is ACH50
not exceeding 5 0 ac/h
Person Certifying Job
Signature Date
Business Firm
Address
Phone