HomeMy WebLinkAbout1920 Corvid Way - Disclosures/Mechanical - 02/27/2012Fort Collins Residential Energy Code Neighborhood & Building Services
MECHANICAL DISCLOSURE FORM 281 N. College Ave., P.O. Box 580, Fort Collins, CO80522
inrhdisc2.xis—7/10198 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. i
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 Zonirig Department prior to the C.O.
One copy of this form must be made available to the original homie buyer.
A. Space heating system
Location
Fuel
Tv
Manufacturer
..:
Model #
':Input capacity'l
kBtuh or kW
AFUE or
HSPF
. ��
-IN . ' 04•
.:Go.000
92. /
o42q...
B. Space cooling system
Location
I Fuel
I Tvae
I Manufacturer I
Model #
Input capacity
kBtu or kW
SEER
i
C. Water heating system
Location
Fuel
Type
Manufacturer
Model #
Input capacity
kBtuh`or kW
Energy.
Factor
I Storage
I 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: iQ GJ
Signature: �1Aer .. .. I - ....Date:.- ...a-22�./2
Business Firm: r7/Fi`i•D• et o�rrtCr-/ (Aim
Address: 27,r,?
POS",2 6 Phone: 4!?-/O 6/9f 0.rO�