HomeMy WebLinkAbout4123 VERBENA WAY - DISCLOSURES - 10/22/2008 (2)Fort Collins Residential Energy Code
INSULATION DISCLOSURE FORM
m 4se2 xis — 7/10/98
the building & zoning dept of
Community Planning and Environmental Services
281 N College Ave P O Box 580 Fort Collins CO 80522
Voice 970 2216760 FAX 970 224 6134
Job address
General contractor
Insulation contractor
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
Insulation
Location
Material(s)
Thickness
Rated
R value
Location
(Int / ext)
Notes
Fiat or vaulted ceilings
with attics above
I^
4,1A
�"
�> n
� k ¢ a
r �
A
Ceilings with enclosed
ratter cavities
,
Frame walls and nm/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 12")
Crawl space walls
Basement walls
Certification
I/We certify that the above4isted 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 d was installed in accordance with the Insulation Guidelines published by the City of Fort Collins
Person Certifying Job
Date / 0/ .2 .}-/,? ,
Business Firm