HomeMy WebLinkAbout215 Pascal St - Disclosures/Mechanical - 01/08/200811�l
Fort Collins Residential Energy Code the building & zoning dept. Of
MECHANICAL DISCLOSURE FORM Community Planning and Environmental Services
mchdisc2.xls—7/10/98 281 N. College Ave., P.O. Box 580, Fort Collins, CO 80522
Voice: 970 221 6760 FAX 970 224 6134
Job Address: 21 S �� R•Z �.�
General contractor:
Mechanical contractorp
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
I Fuel
I Type
I Manufacturer
( Model #
nput capacity
I I kBtuh or kW
I AFUE HSPF r
r�u a
n S
T. Ccz55
ZS-I Z
I` 1
wn�-iz i r=
_ >Tv+3;jtp % ,_„
B. Space cooling system
Location
Fuel
Type
Manufacturer
Model #
Input capacity
kBtuh or kW
SEER
C. Water heating system
Location
Fuel
TvDe
I Manufacturer
I Model #
Input
( kBtuh capacity or kW
Energy.
I Factor
Storage
I volume
PutEAw� L '1Zo
GhS
14.ris174A
rnt T*
Z{•3Z
lB"'S lL
2
1i ti
Certification
I/We 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:
Date:
NMMI
Address:
Phone: *7 20 y-3 4 3 0