HomeMy WebLinkAbout2726 Sunstone Dr - Special Inspections/Combustion Safety - 03/18/2016,,.art CollBns
Replacement
Address: 1:7 2,,4
Approved Agency:
Technician Name (print):
Technician Signature:
Appliance Tested:
Appliance Replaced:
Worst Case Conditions:
Spillage Duration (in seconds):
Pass e� F
(Failed test
Natural Conditions:
Planning, Development & Transportation Services
Community Development & Neighborhood Services
281 North College Avenue
P.O. Sox 580
Fort Collins, CO 60522.0580
970.416.2740
970.224.6134- fax
tcgov,com
Lion Safety Test Compliance Form
'Natural Draft Appliances in Existing Houses
*`N�—�/PermitNumber: t5l�015-31
_ Carbon Monoxide (parts per million):
Date Tested: 3 — ► ` - — I? (f
owner's signature acknowledging results.)
Spillage Duration (in seconds): CP Carbon Monoxide (parts per million):_
Pass e Fa d Date Tested: 73 — (<c;-
(Failed test requires c rrections until test passes under Natural Conditions.)
Technician's recommendations o correct tested appliance failure:
I certify that I am the legal own r of the above listed property and hereby acknowledge that my
appliance has failed a Combusti tliance
n Safety Test under worst case conditions. I acknowledge that
I have received a combustion ap safety information sheet.
Owner's Name (print)
Owner's Signature _
Date