HomeMy WebLinkAbout4760 Venturi Ln - Special Inspections/Combustion Safety - 02/28/2013Planning, Development & Transportation Services
City Of
�F®ort Collins
Replacement
✓" i.0 r i
Address: 4-17 (o tre,(Ac, ,'
Approved Agency:
Technician Name (print):
Technician Signature:
Appliance Tested: k.
Appliance Replaced: k
Worst Case Conditions:
Spillage Duration (in seconds):
Pass
(Failed test
Natural Conditions:
Spillage Duration (in seconds):
Pass �— F
(Failed test requires
Community Development & Neighborhood Services
281 North College Avenue
P.O. Box 580
Fort Collins, CO 80522.0580
970.416.2740
970.224.6134-fax
fcgov.com
tion Safety Test Compliance Form
'Natural Draft Appliances in Existing Houses
Permit Number--?
Company A (t e t, 5 cc L,'c-e—
Date
Carbon Monoxide (parts per million): re—`
Date Tested:
owner's signature acknowledging results.)
Carbon Monoxide (parts per million):
DateTested: 2--Z-9'(3
until test passes under Natural Conditions.)
Technician's recommendations I
o correct tested appliance failure:
- I certify that I am the legal owner
appliance has failed a Combustion
I have received a combustion appliance
Owner's Name (print)
Owner's Signature
of the above listed property and hereby acknowledge that my
Safety Test under worst -case conditions. I acknowledge that
safety information sheet.
Date