HomeMy WebLinkAbout5221 Mill Stone Way - Disclosures - 10/08/200303/12/2002 03:11 WRITER HOMES 4 6636071 NO,e44 D003
570 224 6134
Ji ,� ?0., CITY OF FT COLLINS i,
Fort Collins Residential Energy Code the building Zoning dept. of
MECHAN{CAL DISCLOSURE FORM Community Planning and Environmental Services
m•.naac2�s—�na>es - 28i N. College Avo.t f'_a. 60:4 580,.Fprt Colrms, C0.80522 .
Vnim- 970 221 6780 FAK: ,�70 224 613A
Job Address:
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General contractor
Mechanical contractor: - •.
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This disciosure 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 muFtiple systems serving any function, snake muliiple entries to describe them.
One copy of this form must be provided to the Buliding and Zoning Department prior to the CA.
One copy of this form must be made available to the onginai home buyer.
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Location
-Fuel
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Manufacturer
Model#
Input capacity
kBtuh or kW
EnergY
Factor
.Storage
volume
1NVe certify that tt eabove-fisted equipme t �ncludtng ducts and piping} was instAled in the building at the abbve locations
in conformance Wth the requirements of the Fort Collins Residential Energy Code and Mechanical Code; and further, that
such equipment was installed in -accordance. with manufnnturor5' instruct Ons_ ,
Person Certifying Jqb:
Business Firm: / i -jFf J^ C,l3Y1CL L 7
Address - c5g1t) ga",_ ZY. -�.