HomeMy WebLinkAbout2605 Orchard Pl - Special Inspections/Combustion Safety - 01/16/2016RED LINE Heating & Coolin
970-613-1406 p.1
FFbift %.OPWI
v
Planning, Deve€opngent & TranepectfflOn 9er%li�tis
Community Dsveloprnent & t4eighborhOOd Services
281 No[th College Avenue
M.O. eox 684
Fort Collins, CO 805- 0580
970'416.2740
970.224.8134- fax
tcgov.com
Combustion Safety Test ComplMP-e Form
Replacement of Natural Draft Appliances in Existing Houses
U� .L
Permit Number. (31
Address: i)
Approved Agency: as an Approved Agency and have Performed the following
I hereby attest that I have been trained Test Guide
Combustion Safety Test in accordance with Fort Collins Combustion Safety
_ Version 5, February _
�8m � C,rxnpany 1
Technic �_ -- Date l e {
Technician Signatuxe:
Appliance Tested: ,
Appliance Replaced:.
Worst Case Conditions:
Spillage Duration (in seconds '
Carbon Monoxide (parts per million):
Pass Fail Date Tested.
Natural Conditions: are million}:
Spillage Duration (in secan�. �. C�� Mano�de (p Per
„ Date Tested:
Pass Fail
(Fabled test requires correctdons untdl test passes wader Natural Conditions.)
Technician's recommendations to correct tested appliance failure:
Failed Worst Case Conditions: appliance
that 1 am the legal owner of the above HAM property and hereby ado owl Mgt I have° ved a
I certify don Safety Test under worst -case conditions. I aclmowledge
has faileri a Combos
combustion appliance safety information sheet.
Owner's
Owner's
CSTx4fteMa l0atllM -dtaV4•25.12