HomeMy WebLinkAbout2309 Chandler St - Disclosures - 03/17/2004 (2)fy.
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Fort Collins Resaldentia! �• Coin, uilding ioni •ng dept. of
MECHANICAL }DISCLOSURE FORM Community Planning and Environmental Services
ems _71101" 281 N. College Ave., P.O. Box 580, Fort COMM CO 80522
Vokw 970 221 9M FAX: SIM 224 6134
Job address:
General contractors %L.a 1o4 fir►;, �s
Mechanical contractor: P/ ° Cts/m _SAerf" Iy%e
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
Location
Fuel
Manufacturer
Model #
Input capacity
kBtuh or kW
AFUE or
HSPF
l�►tl�if
Allaf
% c.Cr
lir✓�ir
YS%
/1/
�
G-� s
Alf
B. Space cooling system
Location
Fuel
iym
Manufacturer
Model #
Input capacity
kBtuh or kW
I SEER
C. Water heating system
Location
I Fuel
I Tvpe
I Manufacturer
I Model #
Input
I kBtuh or kW
I Factor
Storage
f 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: , n v/s -i I --el f7
Signature: Date: 3-/7-oy
Business Firm:
Address: 5 /-' �-. . ;,i� rr -z j
Phone: