HomeMy WebLinkAbout732 Maple St - Disclosures/Mechanical - 06/17/2010Fort Collins Residential Energy Code
MECHANICAL DISCLOSURE FORM
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Job Address
Neighborhood & Building Services
281 N College Ave P O Box 580 Fort Collins CO 80522
Phone 970 221 6760 FAX 970 224 6134
General contractor j�, ale ,,,/
Mechanical contractor ^�T
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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
M
Location
Type
Manufacturer
Model #
Input capacity
kBtuh or kW
I AFUE or
HSPF
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rFuel
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LG77
B Space cooling system
Location
Fuel
Type
Manufacturer
Model #
Input capacity
kBtuh or kW
I SEER
C Water heating system
Location
I Fuel
I Type
I Manufacturer
I Model #
Input capacity
I kBtuh or kW
I Energy
I Factor
Storage
volume
Certification e I I t
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
re Date
Business Firm /�f // /`�,, 1
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