HomeMy WebLinkAbout1907 Etton Dr - Special Inspections/Combustion Safety - 12/06/2017Dec 07'17, 04 38p
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Planning, Development & Transportation Services
I i f of Community Dmmkn meat& M&%#vhoihood 5ecrices
261 MOM Cafte Avenue
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r-ers cam, co eo522 05M
970AIa.zr40
9M 224 6134- fax
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Combustion Sa&tyy Test Compha ce Foram,
Replacemwt of Nadtral Draft Apptiainces in Ezisfing Rouses
Address ° Q 7_ 7� �t �� � r,� ', 60 Permit Number- L�-
Approved Agency:
I hereby attest that I have been bumed as an A m,ed Agmey aad ban performed the followW
Combustion Safety Test in accordance with Fort Collins Combustion Safety Test Guide
varsion S, I;cbruaty Z 12. - --- - - - -
Technician Dame (per)- Y'i rvi o V any PSOMS'T MAMIMIG, LLC
Technician Signature. Date 12 ff2l-Z_
Appliance Tested- _ c L n l
Appliance Replaced
Worst Case Conditions:
Spillage Duration (in sPnnnek): L Carbon Monoxide (parts per million): J7
Pass Fail Date Ter..sted: 1211,b/-il z
Natural Conditions:
Spillage Duration (in seconds): U — Cari`ioL bdonoxide (parts per million):
Pass _ Fail iDaU T ed: Vf 1 Z
(Failed rest relatives cm7ecdo sa arrli,4'Amtpmxts mader Nawml Cowan&)
Technician's recon2mendanons to correct tested appliance failure
Failed Worst Case Conditions:
1 ccrtlfy that I am the legal owner of the above listed ;µn.,p , andhereby arlmowledge *at my ambnee
has failed a Combustion Safety Test underworst-case conditim, g I acknowledge that I have received a
combustion appLancc setiv info.�mation sheet.
Ovmer's Name (prom)
Owner's Sigrawe
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Date I Zl4/aa/}