HomeMy WebLinkAbout1157 Picard Ln - Disclosures/Mechanical - 01/25/2005port Collins Residential Energy Code the building & zoning dept. of
MECHANICAL DISCLOSURE FORM Community Planning and Environmental Services
mchdise2ids-7110/98 281 N. College Ave., P.O. Box 580, Fort Collins, CO 80522
Voice: 970 2216760 FAX: 970 224 6134
Job Address:
General contractor: �QrY Q.�,'�� �•-���.
Mechanical contractor:�S �aG._-tee-•
....-. ...............................................::.:::..........::.....:.:........: :...............
UCTI :._:.:..: :;::: :;:: ;
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 S ace heatm s stem.....
p.:.c 9 ..Y.:....
....... ........... .:... :
Location
Fuel
T e
Manufacturer
Model #
l9quLZapacity
kBtuh kW
AFU r
SPF
E
N GAS
WCA 1-0
Vw
B.. S.pace cooling systern:.. .
Location
Fuel
Tvpe
Manufacturer
Model #
In capacity
Btu or kW
SEER
A
OloOLOD\
C Water hea. in : ;::
s stern .. _:.
.....:.
g.....Y... ...
Location
I Fuel I
Type
I Manufacturer
I Model #
Input capacity
kBtuh or kW
Energy
Factor
Storage
volume
i:::` of Cat�011r :::.: �` :.' ?: ' >=:......................:':: ":. ':k:':' :-r} :' : 1 . 4: ( >: ?:: '> 4 '''.. ? sF............
Ce.r..............................................................................................................
............................................................................................-::::..........::......::.......................................................:....:............:.:....................................
[Me 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 Certifvina Job:
Sianature:
Date: k I V5
Business Firm: • CWTN, .�. _ N G
Address: 6?-.% ��c..g► �a^rc �t.- �� .y.at'- -Pc
�a� Vr..s'rt,.ars Phone: S 32 - O 123