HomeMy WebLinkAbout4227 Applegate Ct - Special Inspections/Combustion Safety - 05/17/2016RED LINE Heating & Coolin
970-613-1406 P.1
—1 1
F® Clowns
Planning, Development & Transportatton Services
Community Development H Neighborhood Services
281 North College Avenue
P.O. Box 580
Fort Collins, CO 80522.0580
970.418.2740
970224.6134-fax
fegov.eom
Combustion Safety Test CoompHanEce�Fo Houses
Replacement of Natural, Draft Appliances
Permit Number
Address:
I
Approved Agency: Approved and have ptxformed the following
I hereby attest that I have been trained as an Agency Test Guide
Combustion Safety Test in accordance with Fort Collins Combustion Safety
Version 5, February 2012.
Technician Name (print):
Technician Signature:'
Company K9 e==
Date
Appliance Tested
5116
Appliance Replaced:
Worst Case Conditions:2'). �O
Spillage Duration (in seconds : Carbon Monoxide (parts p�
p� Fail Date Tested: S
Natural Conditions: Carbon Monoxide (parts per million):
Spillage Duration (in seconds :
Pass Fail Date Tested: 5 f - i 6
(Failed test requires corrections antil test passes under Natural Conditions.)
Technician's recommendations to correct tested appliance failure:
Failed Worst Case Conditions:
I certify that I am the legal owner of the above listed Property and hereby aelmowledge that my appliance
has failed a Combustion Safety Test under worst -case conditions. I aclmowledge that i have received a
combustion appliance safety informadon sheet.
.owner's Name (print)
Date
Owner's Signature
CST:replaceme°tJnaboal-draW4.25.12