HomeMy WebLinkAbout3833 Celtic Ln - Disclosures - 11/15/2001Fort Collins Residential Energy Code the building & zoning dept. of
MECHANICAL DISCLOSURE FORM Community Planning and Environmental Services
mchdisclAs-7/10/98 281 N. College Ave., P.O. Box 580, Fort Collins, CO 80522
Voice: 970 2216760 FAX: 970 224 6134
Job Address: 3g33 (�e'�ic GVI .
General contractor: K8 fume -
Mechanical contractor:
.INSTRUCTIONS
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. space heating system.
Location
Fuel
GiaS
Tvpe
tj C,
Manufacturer
C" t- t 1
Model #
?DO �qy7S
Input capacity
kBtuh or kW
000
AFUE or
HSPF
M76
B. Space cooling system
Location Fuel I Type Manufacturer Input capacity
Model # kBtuh or kW SEER
...............................
C. Water heating system
Input capacity Energy Storage
Location Fuel Type I Manufacturer L Model # I kBtuh or kW I Factor _ -I volume
Certification I/We certify that the above -listed equipment (including ducts and i g1.
in 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: ACA S
Business Firm: 4
Address: R I -A 44,
Date -
NUM
Phone: