HomeMy WebLinkAbout731 Parliament Ct - Miscellaneous - 09/14/2000Fort Collins Residential Energy Code
MECHANICAL DISCLOSURE FORM
mchd1se2As-7/10(98
Job Address:
General contractor:
Mechanical contractor:
� ? --/Os /0 S -,4 -/
the building & zoning dept. of
Community Planning and Environmental Service
281 N. College Ave., P.O. Box 580, Fort Collins, CO 80522
Voice: 970 2216760 FAX: 970 224 6134
INSTRUCTIONS
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This disclosure form is to be signed by the mechanical contractor or representative of the general contractor.
Please type or print, except for the signature.
If there are multiple systems serving any function, 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.
A Spaceheating system .. . . .... . ....
.....
Location
Fuel
Type
Manufacturer
Model #
Input capacity
kBtuh or kW
AFUEor
HSPF
,55e/ne.A)Tr
/,4
A ). r,
gre",h ) , r
I
A
Ir
0r
-
75"000
.B. Space cooling system
Location
Fuel
Tvpe
Manufacturer
I Model #
Input capacity
I kBtuh or kW
I SEER
4)e-!0-
Aj1)&jjKe_
kT4AI,-�� o I
— /S
7— -5, b10
±O A=A
C?�Zq- / e
I fold
C....W.ater heating system
Location
Fuel
Tvoe
Manufacturer
Model N
Input capacity
kBtuh or kW
I Energy
I Factor
Storage
volume
Allifflim-INE:
F_
.. .... .... - .... . .... . ..... . ...... .
Certification
IMe certify that the above -listed equipment (including ducts and piping) was installed in the building at the above locations
in conformance with the requirements of the Fort Collins Residential Energy Code and Mechanical Code; and further, that
such equipment was installed in accordance with manufacturers' instructions.
Person Certifying Job:
Signature: /(;, ACZDate: 4?_ 141
Business Firm:- ldyr;i(eA) _zW-111r6AeuTA1
Address:
Phone: