HomeMy WebLinkAbout2648 Avocet Rd - Special Inspections/Combustion Safety - 12/02/2016Planning, Development & Transportation Services
City of Community Development & Neighborhood services
281 Nmth College Avenue
FOtj ` ` COI l i n s P.O. 5R0
97Coollilli ns, 0 80522 0580
0 1 970 224.6134- fax
Icgov.com
Combustion Safety Test Compliances`
Replacement of Natural Draft Appliances in Existing blouses }
Home Owners Name: JOE MUSA Permit Number: PA t&U,-ii
Address:2648 AVOCET RD
Tele: 970-204-0297
Licensed Contractor:
I hereby attest that I have performed the following Combustion Safety Test in accordance with Fort
Collins Combustion Safety Test Guide Version 5, February 2012.
Company Name: NORTHERN COLORADO AIR, INC.
Technician Name (print): MARCUS ORTEGA
Technician Signature:
Appliance Tested: WATER HEATER
Appliance Replaced: FURNACE
License Number: H-837
Date: 12/02/2016
Tele: 970-223-8873
u 00MU
Model #: EL195UH07OXE36B
STEP 1: Worst Case Conditions Test
Spillage/Back raft Duration (in seconds): � Carbon Monoxide (parts per million):
Pass ` Fail (Technician must test under Natural Conditions if "Failed")
Technician's recommendations to correct tested appliance failure:
STEP 2: Natural Conditions Test
Spillage/Backdraft Duration (in seconds): Carbon Monoxide (pans per million):
Pass Fail
(Failed test requires corrections until test passes under Natural Conditions.)
STEP 3: Nome Owner Signature
I certify that I am the legal owner of the above listed property.
Owner's Name (print)
Owner's Signature
Date
In the event that my appliance has failed a Combustion Safety Test under worst -case
conditions, I hereby acknowledge that I have received a combustion appliance safety
information sheet. (initial)
Further information can be obtained at www.fcgov.com/buiIdiiig/greenclasses.php