HomeMy WebLinkAbout3633 Galileo Dr - Disclosures/Mechanical - 04/25/2012Fort Collins Residential Energy Code
MECHANICAL DISCLOSURE FORM
mchdisc2.xls—7I10198
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Neighborhood & Building Services
281 N. College Ave., P.O. Box 580, Fort Collins, CO 80522
Phone: 970 221 6760 FAX: 970 224 6134
Job Address: 3633 �IIG Ll- .
General contractor: TD x1Dtj CAM /1'I"t.)N Inr—__� -
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 "syste0h i � , ,, ,
Location
Fuel
T e
Manufacturer
Model #
Input capacity
kBtuh or kW
AFUE or
HSPF
St�l3'1 _ t
N
B =,Space cooling
Location
Fuel
Type
Manufacturer
Model #
Input capacity
kBtuh or kW
SEER
t F I ' °'..'.a
C. Wat@r hpating. Syste►n
Location
Fuel
TvDe
Manufacturer
Model #
Input capacity
I kBtuh or kW
Energy
Factor
Storage
I volume
&M at�-
I LOS
I 7
2r
de, rGficatton'ti
IANe 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 J96. �j�� 144Q_\ t4a-J
Signature: Date: `7 12 -
Business Firm:
Address: (I•y'(Q
Y (D 223 Phone: