HomeMy WebLinkAbout1926 Corvid Way - Disclosures/Mechanical - 11/18/2011F
linsResidential Energy Code Neighborhood &Building Services
ANICAL DISCLOSURE FORM 281 N. College Ave., P.O. Box 580, Fort Collins, CO 80522
mchdm2.xls—7/10/98 Phone: 970 221 6760 FAX: 970 224 6134
Job Address:
General contractor:
Mechanical contractor:
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
Type
Manufacturer
Model #
Input capacity
kBtuh or kW
AFUE or
HSPF
yn7D.-'t
B. Space cooling system
Location
I Fuel
I Type
I Manufacturer
I Model #
Input
IkBtuh or kW
I SEER
C. Water heating system
Location
Fuel
Tvpe
I Manufacturer
Model #
Input capacity
kBtuh or kW
I Energy
Factor
I Storage
volume
Certification
I/We certify that the above4isted 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: PVQ �/n ,r 9 ) C Ae Ile r/
�iBnacure: Date:
Business Firm:LLC—
Address: `PO T d 277 6 7 2— k of 2 7
Phene- y X/ — //GC '7 Cl