HomeMy WebLinkAbout2221 Chandler St - Disclosures - 03/09/2004'`'rM fide building do ionin delit. of
Fort Coltlns Residential' 9 9 p
MECHANICAL DISCLOSURE FORM Cornmunity Planning and Environmental Services
rtct+di�e'tbs-tntvae 251 N. College Ave., P.O. Soot 580, Fort Collins, CO 80522
'VoK= 970 221 8780 FAX: 970 224 6134
Job address- Z filiorer/rr s
General contractor:
Mechanical contractor: P-1-z 1 s 1 o'n S1,re t lV r- la l
INSTRUCTIONS
This disclosure form is to be signed by the mechanical contractor or representative of the general contractor.
Please type or prirrt, 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
Location
I Fuel I
Type
I Manufacturer
I Model #
Input capacity
I Btuh or kW
AFUEr
I HSPF
r�'rtlrt >Z
/L/d f
% crlc' l
l / rYIrr
B. Space cooling system
Location
I Fuel
I Type I
Manufacturer
I Model #
Input capacity
IBtuh or kW
I SEER
C. Water heating system
Location
I Fuel
I Type
( Manufacturer
I Model #
Input
o
IBtu r kW
Energy
I Factor
[
r 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: /7
Signature: Date: 3--9-o'l
Business Firm:
Address: nrrt/v
Phone: