HomeMy WebLinkAbout6327 Golden Willow Dr - Disclosures/Mechanical - 07/11/2005i
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Fort Collins Residential Energy Code the building & zoning dept. of
MECHANICAL DISCLOSURE FORM ' Community Planning and Environmental Services
maxrool)b -7/1 OJ98 281 K College Ave., P.O. Box 5W, Fort Collins, CO 80522
Voice: 970 221 6780 FAX: 870 224 6134
Job Address:
General contractor:
Mechanical contractor:
INSTRUCYIONS
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. ,
Locadon
Fuel
a
Manufacturer
Model #
Input capacity
kBtuh or kW
AFUE or
H8PF
_
.rrnrt�x
aLegIPD'ff/419
6 70
70 -000
i3 Space:cooling system
Location
Fuel
Type
Manufacturer
Model #
Input capacity
kStuh or kW
SEER
i
C Water heating system '` 3 u ti a :� a
Location
Fuel
Type
I
I Manufacturer
Model #
input capacity
kStuh 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: C#?rbA
Signature: 4, t%-W Date:
Business Firm: i Id _
Address:
�� 6 ! rl kS ,go'
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�' L tc� `. Va b Phone: J� 7 Z'%