HomeMy WebLinkAbout5209 Country Squire Ln - Disclosures/Mechanical - 01/20/2006[Fort Collins Residential Energy Code
ECHANICAL DISCLOSURE FORM
meWhic2mr —7n0AS
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 C.O.
One copy of this form must be made available to the original home buyer,
the building dt zoning dept. of
Community Planning and Environmental Services
281 N. Collage Ave., P.O. am 58o, Fort Collins, CO 60522
Voi0e; 970 2216760 FAX: 970 224 0134
A... Space heating system
ocagon
Fuel
T e
Manufacturer
Model p
Input capacity
kBtuh or kW
AFUE or.
HSPF
1fiS S
-4
62a
B: 'Spaca b oling syste'rn
Location
Fuel
T e
- Manufacturer
Input capacity
Model if kBtuh or MN
SEER
3
C. W r -h4erlting system: ^'
on
Fuel
TVDG
Manufacturer
Model S
Input capacity
kBtuh or kW
Energy .
Factor
storage
volume
Certifi6tion
IIWe cerdfi that th"e obove-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:
Signature: Date:
Business Firm: r,�-,
Address: ��p d "' " 7��1F'. I R A -fin
WiP F.!T,r0a �f amI_ I