HomeMy WebLinkAbout2739 Pleasant Valley Rd - Miscellaneous - 04/23/19985-20-1 998 6 : a5Ai1 FROtt AIR COP 1FORT 6359076 p I
Fort Collins residential energy code 7/96
Mechanical systems di: -closure form
Job address:
General contractor:
Mechanical contractor:
Space heating system
Location
SI fir'Gfn1
Fuel
, •ro.?
T e
i
A1ccr.r:.i
Manufacturer
Y
Model #
!'�A �
Input capacity
kt3tuh or kW
DSO :i.1• ,-
AFUE or
I HSPF
�f., c�;
Space cooling system
Input capacity
Location Fuel . Type Manufacturer Model # kEltuh or kW I SEER
Water heating system
Location
Fuel
--Type
Manufacturer
Model #
Inputcapacity
kBtuh-or-klN
Energy
Factor
Storage
volume
Certification
UWe certify that the above -listed equipment was installed in the building at the above locations in conformance v✓ith the
current requirements of the City of Fort Collins Residential Energy Code and Mechanical Code, and that it was installed in
accordance with manufacturer's instru,:tions. I/We Certify that any ductwork ha':: been installed in conformance with
the current requirements of the City of Forl Collins Residental Energy Code and Mechanical Code
Certifiedby; Phone:_970 - 5' /ys�
Business firm: >� / jf . ptC Date; y au-9�
Address: �i1mn;Pl<P L)/ _/ Signature:
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 shall be provided to the Building and Zoning Department 3t final inspection.
One Copy of this -form shall be provided to the homebuyer_
05/19/1998 20:43 669-0839
Job address -
General contractor:
Insulation contractor:
lrasuEatiti� '
Flat or vaulted oelllnpa
with atUcs above
Ceilings with enclosed
rafter cavities
Frame walls and r(m'band
Joists — to exterior
Frame walls and rim'band
Joists — to attic, garage
Frame floor - cantilever
Frame floor - over garage of
crawl space
Slabon-grade (0-12.1
Crawl space walls
Basement walls
P
DONS INSUL:+TING PGGE 01
energy
Ratwd e......
hlekness R-valve ll`......ntl9xt1
Certification
IANe cert fy that the above IlsteJ nsulation was installed In the building at the above billions In conforrna=0 wtth the
eso current requirements of the City of Fort Collins Residential Energy Code, and that It was installed in accordance with
the aDorinhle 9nadm:,.., i.,.. _��. _.:__ - - _
Job address:
General contractor:
Air sealing contractor:
A. Prescriptive path
INVe certify that the air sealing requirements specified in the current City of Fort Collins Residential Energy Code
have been completed in this building, in accordance with the "Air Sealing Checklist' published by the City of Fort Collins.
Certified by: �a 1r ,�V e��c
Business firm: j:0
Address:
B. Performance path
Phone: _G G �— 9 7 3 l
Date:
Signature:
INVe certify that this building has met the air leakage performance threshold specified in the current
City of Fort Collins Residential Energy Code, in accordance with the "Blower Door Test Procedures,,,
by the City of Fort Collins. published
Testing contractor:
Date of test:
CFM50:
Volume:
ACH50:
Certified by:
Business firm:
Address:
Air flow through the blower door at 50 Pascals pressure difference (cfm)
Volume of home (cu. ft.)
Air change rate per hour at 50 Pascals pressure difference
ACH50 = (CFM50 x 60) / Volume
The performance threshold for code compliance is ACH50
not exceeding 5.0 ac/h
Phone:
Date:
Signature:
Instructions
Complete either Part A or Part B.
Part A is to be signed by the air sealing contractor or representative of the general contractor.
Part B is to be signed by the blower door testing contractor or representative of the general contractor.
The "Blower Door Test Report" or equivalent documentation must be attached.
Please type or print, except for the signature.
If components vary, make multiple entries to describe them.
One copy of this form shall be provided to the Building and Zoning Department at final inspection.
One copy of this form shall be provided to the homebuyer.
asdiscr itl/s523 — E24/35