HomeMy WebLinkAbout3645 Little Dipper Dr - Disclosures/Mechanical - 09/24/2008cort Coigns Residentrel Energi/ Code the buiIdin9 & Lofting dep i of
MECHANICAL DISCLOSURE FORM Ccm la -it} Planni-ig and _m t-onmentai Se,vices
-, t N c- eg- t-%e c o Boa SaL, cur a of c b a
Vo�c y7J221 E763 -GY. 97u.:Z4 6 :;-
Jon Address
General iontracto� V(1-- L- , G E ('�—v mcVr�'
°etFaricai co-ltrac:or
iNSTRUCTIONS
T n s d ocicsa a -n is co be smile b ti o CuriirdGtOi or repre�er ative o' the gerB al ulttact0
Ptea-tr type o pn-L aX .ept U ; e �gna ure
F there are multiple s}sterns serva 9 any function make r u',iple elhddZ� to disc ibe them
t
One O�pY Of L� f0 - -ius be pto,ided t� tt'e 91iid nu d"it c-ioo Depa- +fen pfio J the C O
One -ory of t iu— r-as be -name available +c o igiral �orne biter
A Space heabng system
_oeatio� I Fut.
I
B Space coop, ig system
Lcca`ion �_rua
i
C Water heating system
i hp� capacity I Ene gy Str aye
Loca uan Fie _L n�f Tvae Maac u er I 9odei I k5 uh or KVJ Factor I OIL.-ne
k�i6�+�rvt' G [CJ1ET �Taa�-E ® eoa K
Certification
l'4'e certify thal 1'e ano ? t meted c Lrpmert (irt iud ng duL s ❑nC N ping) was instailed i i la b�itdil9 at aoO\,r IC-auo'1„
in cv to with the reyul a 1Ct S J1 t"s'Oti C shin'- Yes oei% al Ene,gj CO,Jic and jVt iidrifcat Ccdc a-lu fL.-tne ttla,
sa �- egwpmen was i-sta led in ac ordarlcc lAi h ma-U'ac u e , ins?rLello-S
person Gertrfyi-y Job r1�
r
SigratLre,/
Business P (_. P[ 4t�-(t$IA-<? ��vG
A8d r,s 109'95 0 PG FEbEYzh L /'}%
Phone 303-66-V -C/7 �
Fort Collins Residential Enei gy Code the building & zoning dept of
MECHANICAL DISCLOSURE FORM Community Planning and Environmental Services
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n hd s ')xls —7/10 98 281 h Coli-ne Ave P O Box 580 cur' Co16n CO 80522
Voice q70 221 30 FAX. 9'0 224 E131 t
Job Address � �. -1 S / /-/(c 0, e,
General contractor
Mechanical contractor r" re C s , v N 5 A
INSTRUCTIONS
T-iis disclosure form is ,o be sign, d by the mechanical contractor or rep esentative of the general contractor
Please type or print except for tl' signature
If there are multiple systems serving any function make multiple entries to describe them
One copy of this form must be p hided ,o the Build rio and Zoning Department prior to the C O
One copy of this fo — must be m ide available to Lhe original home buyer
A Space heating system
J Irp 1 -apacity AFUE or
Location Ft el _ T7pe Manufacturer 1 Model # I Btuh or M HSPF
—N-3cm cam, �- �'f $ 4 G i2 4 -7 n, c c� �
B Space cooling systerr,
Location I Fu
1
C Water heating system
Input capacity I Energy Storage
Location _ Fu, I I Type i Manufacturer Model # F B'uh or 1•VJf _ Factor volume
Certification
I'We ce"ify that the dbme listed e'tuioment (including oucts and piping) was installed in the builaing at the above locations
in confo malice with the rPawreme -its of the Fort Collins Residential Ene -y Code a -id Mechanical Code and further that
such equipment was i-istalied in ac ordance with manufacturers instructions
Person Certifying Jobi�.��
Signature Date 9Z
Business Firm re' (—, S G
Address Z 7 HC7 Alr e /c/
cli/Uvcf CCJ RU 1 / 0 Phone 303 9 / 0 S-'