HomeMy WebLinkAbout2132 Clipper Way - Disclosures/Mechanical - 03/15/2005[Fort`G6l1r1ins Residential Energy Code
ECHANICAL DISCLOSURE FORM
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Job Address:
General Contractor:
Mechanical Contractor
the building & zoning dept. of.
Community Planning and Environmental services
281 N Cortege Ave., P.O. Box 580, Ft. Coins, CO 80522
Voice: 970 221-6760 FAX: 970-224-6134
This disclosure form is to be signed by the mechanical contractor or representative of Please type or print, except for the signature. the general contractor.
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 Departments prior to the C.O.
One copy of this form must be made available to the original home buyer.
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Location ( Fuel input capacity AFUE or
Type Manufacturer Model # kl3tuh or kW NSPF
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Location 1 I Input capact
Fuel Type Manufacturer t Model # �Rfi .�. � . �
....w.. v� null!I SEER
Location I Fuel Tvoe. Input capacity
NlanuEnergy
factt�n:r Model # kBtuhor kW
Factor
Storage
volume
INYe certify that the above -fisted equipment (including ducts and i in
in conformance with the requirements of the Ft_ COW Resides#ialfner9�e Code
P P g? yvas installed in the'building at the above 1
such equipment was installed in -accordance with , . and anipl Cx�de, °cations
manufacturers instructions. and further, that
'erson .Certifying ,lob:
Signature:
3usiness Firm:
Iddress: 9111
le
f6
Ve
Date:
Phone:
303=48- 9492