HomeMy WebLinkAbout5220 Southern Cross Ln - Disclosures/Mechanical - 12/21/2007i I
Fort Collins Residential Energy Code the building At Zoning dept. Of
MECHANICAL DISCLOSURE FORM Community Planning and Environmental Services
fw*e=2X1s 7h We 251 N. College Ave., P.O. Box 5W, Fort CoHna, CO W522
Voice: 970 221 6760 .FAX: 970 224 8134
Job Address,
i General contractor:
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,
Input capacity I AFUE or
tu kBh or kW HSPF
B. Space cooling system
Location
-
Fuel
T
Manufacturer
Model a
Input -capacity
k5tuh or kW '
SEER _
-----
�13,90�rA v30
C. Water heating system
Fuel'Location
Model #
Input capacity'
kBtuh or kW
Energy .
' Factor
Storage
volume
Certification' -
I/We certify that the above41rted 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'.j! �' i�i/�✓4�7
i•
Fort Collins Residential Energy Code the buildin_q & zonin_q dept. of
MECHANICAL DISCLOSUREFORM Community Planning and Environmental Services
m-hdi=2Yh —7110,188 28! N. College Ave., P.O- Box 580, For. Collins, CO 80522
Voice: 970 2216760 FAX: 970 224 6134
Job Address:,
General contractor.
Mechanical contractor
A'-.',*-.'.S - -- ----- -- - - ........ ---1—..-m-.-
....... ;Space wsyste
Location
Fuel
Type
Manufacturer
Model 4
I input capacity
1 kBtuh or kW
AFUE or
HSPF
. .... ..... -
... ......
st-- .....
Location
Fuel
Tvr)e
Manufacturer
Model# .1
Input capacity
kBtuhorkW
I SEER
I --T
F—
....... ............ ..
.G a er... ea In
.......... . .. ..
.... ...... .. . . ---
......... . - g-.§.y -prn ......... ... -r -, -- - ---- - ...... . .... . ....... .. ..... ......
.............. ........... ........
Location
Fisel
Tvne
MRnnfnrhirer
Input capacity
AAo,4e1 U kBtuh or kW
Energy
Fac or
I Storage
volume
067
M �Yrw q �MAM
I/We certify that the above -listed equipment clncludirgr 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 CertifyirygVob:
Date:
Business Firm:
Address: