HomeMy WebLinkAbout7338 Matheson Dr - Disclosures - 10/20/2003 (3)Fort Collins Residential Energy Code
MECHANICAL DISCLOSURE FORM
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Job Address:
General contractor:
Mechanical contractor:
the building & zoning dept. of
Community Planning and Environmental Services
281 N. College Ave., P.O. Box 580, Fort Collins, CO 80522
Voice: 970 221 6760 FAX: 970 224 6134
INSTFtt1CTIONS ..
.
This disclosure form is to be signed by the mechanical contractor or representative of t11e 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.
pat; heating system .:
13i Space cooling system
G Wader heating system
location Fuel T e
Manufacturer
Model #
Input capacity
kl3tuh or kW
Energy Storage
Factor I volume
F --T
::......:::.....::•.::::.....:::::: •::::: •:::: :.....:::::: ::......................... ...
Certifc:atio :•::::...;:...::•::••::::..
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UWe certify that the above -listed equipment includin 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 manufacturer' instructions.
Person Certifying' Job:
Signature:
Business Firm:
Address:
Date: %ZA9 ZAGI,'3
Phone: 3d3-LKI%_--�I,
Port Collins Residential Energy Code
MtbHANICAL DISCLOSURE FORM
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Job Address:' 7,138 MA4Ae--
General contractor: y
the building & zoning dept. of
Cornrrrunity Planning and Environmental Services
281 N. College Ave., P.O. Box 580, Fort Collins, CO 80522
Voice: 970 2216760 FAX: 970 224 6134
Dr.
Location
Fuel
— Type
Manufacturer
Model #
Input capacity
k13tuh or kW
AFUE or
HSPF
ac::coo In s stem
g ..
LInput capacity
Location Fuel T e Manufacturer Model # Btuh or kW SEER
:D:.::.. a er`�ieatin�syseh..:3:.....
Location
Fuel
T e
Manufacturer
Model #
Input capacity
kBtuh or kW
Energy
Factor I
Storage
volume
FI
40
:::::::.::........................................................... .
.................................................................................:::::.:.................G-,M-
:�i�t% . c:.:.:............................................................................ .......................
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NVd t:siti )i Mat the above -listed equipment (including ducts and piping) was installed in the building at the above locations
1r1 cohfbfm:flhce with the requirements of the Fort Collins Residential Energy Code and Mechanical Code; and further, that
such etlil10MOM was installed In accordance with manufacturerg' instructions.
06t'8bti CLhtifylhg Job:
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Date: 10
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