HomeMy WebLinkAbout5421 Rabbit Creek Rd - Disclosures - 12/15/2003 (2)E
ollins Residential Energy Code
ANICAL DISCLOSURE FORM
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Job Address:
General contractor:
Mechanical contractor. N0401-hern Colorado Air
the building & zoning dept. of
Community Planning and Environmental Services
281 N. Collepe Ave., P.O. Boot 5W, Fat Coffins, CO 80522
Voice: 970 2216780 FAX: 870 224 6134
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.
A. Space heating system
�l
-----------------------
-----
---------- -- ---
-------- - - ------------�PF
..,:
Input capacity
:.•
I AFUE or
&- -"- -- ---- ---------
-------- ----
---- -
M
B. Space cooling system
lion
Fuel
TWO
Manufacturer
Model #
Input capacity
kBtuh or kW
SEER
C. Water heating system
Location
-Fuel---
Manufacturer
Model #
Input capacity
kBtuh or kW
Energy
Factor
storage
volume
Certification
I/We certify that the above -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: Mark Shadowen
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Business Finn: rthern Colorado Air
Address: 812 Stockton Ave
Fort Collins, Co Phnna- 970-223-8873