HomeMy WebLinkAbout2139 Clipper Way - Disclosures/Mechanical - 11/28/2005Fort Collins Residential Energy Code the building & zoning dept. of
MECHANICAL DISCLOSURE FORM Community Planning and Environmental Services
mchdisc'Z,xis 281 N. Coliege Ave., P.O. Box 580, Fort Collins, CO 80522
Voice: 970 2216760 FAX: 970 224 6134
Job Address:
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 G.O.
One copy of this form must be made available to the original home buyer.
A. Space heating system.
Location
Fuel
T
Manufacturer
Model #
Input capacity
kBtuh or It
AFUE or
HSPF
0
m
fJ m a%
B ` Space cooling system =
Location
Fuel
Type
Manufacturer
Model #
Input capacity
kl3tuh or kW
SEER
C.- Water hea#�ng sysitein'
Location
Fuel
I
Tvpj Manufacturer
Model 0
Input capacity
kl3tuh or kW
Energy
Factor
I storage
I volume
Celrtificatilin
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, tnat
such equipment was installed in accordance with manufacturers' instructions.
Person Certifying Job:
Signature: (/'iiir ,• Date: f f - 7,
Business Firm:r
Address d3 �% &mJ ewS
1-P:* e P%rGL% 6 6. �o slb Phone: 7 0 3 ?I, 7--14-1:?,