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Fort Collins residential energy code 7196 ,:,•
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Mechanical systems disclosure form
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t, :iT�a;>J6b address:
�03 ,l.) c,k �R � 501S
x General contractor:
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echanical`contractor: '
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...............:......
::............... :a� e:
ace::�ieatt 9.....y...................................................
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.................................
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Input capacity
AFUE or
Location
Fuel
Type
Manufacturer
Model #
ketuh or kW
HSPF
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SlrM
5f 's.
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t •a COO
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Water h atln 9 Y e :: ........
........... .... ....... ... .::....:....:.....:......:.. .....:.......: ..::.:::.::...:.:.......:....:.:.......::..............
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Inputcapaclty Energy
Storage
...';!.:;�.,+..Lc
Location
Fuel
Type
Manufacturer Model # kBtuh or kW Factor
,
volume
.O.
:...................................
4` 4UWi"cerUfy that.the above -listed equipment was installed in the building at the above locations in conformance with the
', 66d6nt requirements of the City of Fort Collins Residential Energy Code and Mechanical Code, and that it was installed in
.:accordance with manufacturers instructions. I/We certify that any ductwork has been installed in conformance with£a
r..ifie-•current requirements of the City of Fort Collins Residential Energy Code and Mechanical Code.
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`Certified by: Phone: LCX 21�(Q
Business firm: Date:
Address: gnature:
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'0°This,disctosbre form is to be signed by the mechanical contractor or representative of the general contractor.;
��please type or print, except for the signature.
V1 lfttiere are muttiple systems serving any function, make multiple entries to describe them.
0 oneycopy of this form shall be provided to the Building and Zoning Department at final inspection.
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= 'iOne copy of this form shall be provided to the homebuyer. �,dd.o.We�rssn eauee
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Fort Collins residential energy code 7/gt3
Insulation disclosure form
Job address: Ca!CA_ wiel O CaLLW5 C
General contractor: lvvt _0 ('�, f '__FV.
Insulation contractor:
In ulat'o'............
.............................. : ........................................................
............... ... ... . . . ... .......... . .................................. I ............................ .... . ............................................
Location
....
Material(s)
........ I .................................*......
Thickness
Rated
R-value
.. . .. ................ .....................
Location
Ont I ext Notes
Flat or vaulted ceilings
with attics above
'V%Vm<_ Am4vl U jP
Ceilings with enclosed
rafter cavities
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-A
Frame walls and rim/band
joists - to exterior
�AIAS (AN" V ILI 1
_4171
Frame walls and rim/band
joists - to attic, garage
Mik-r-jilul-
z
Frame floor -cantilever
Mu"'ViViLIT
Frame floor - over garage or
crawl space
S� M(StjV1LL(_.
Slab -on -grade (0-12")
Crawl space walls
Basement walls
...... .......... . ........ I ..............................................................
................. ............
........................................ .... .......... ....•.......... .... : .......... ............
: ....... ............
............................ ..... Certification . ...... ......
................... * ...... . ..... ... * .......... ........................
[AAfe certify that the above -listed Insulation was Installed In the building at the above locations In conformance with the .........................
current requirements of the City of Fort Collins Residential Energy Code, and that It was Installed In accordance with
the applicable "Insulation Installation Guidelines" published by the City of Fort Collins.
Certified by: l Phone: _64cf-h_
Business firm: Date:. 99
Address: i EL41Z Signature:
................................
........................
......................................... ..........
.................. ........... I ...... ................... ..........
nstftidtjdjj*!§':' ................... ............. ..................
.................... ...... ...................... .............. I .............. *.* .............
..... ... . ................................
disclosureThis ...''-torn is to be signed ,*b'*y' the Insulation contractor or representative of the general contrac' Ito" r ..........
Please type or print, except for the signature.
If components vary, make multiple entries to describe them.
One copy of this form shall be provided to the Building and Zoning Department at final Inspection.
One copy of this form shall be provided to the homebuyer.
Fort Collins residential energy code.719p,
Air sealing dis*closure form
'Job address:
..�,;General contractor.
Airsealing contractor.
I/We certify that the air searing requirements specified In the current City of Fort Collins Residential Energy Code
have been completed In this building, In accordance with the "Air Sealing Checklist' published by the City of Fort Collins.
Certified by:Rl rtt's.
Business I :�
Address: I lo:31 ggempg, I/
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1-% . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .;..
fjtji that this building has met the air leakage performance threshold specified In the current
ott Collins Residential Energy Code, In accordance with the "Blower Door Test Procedures," published
,Ity Of Fort Collins.
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Air flow through the blower door at 50 Pascals pressure diffe
Volume of home (cu. ft.)
Air change rate per hour at 50 Pascals pressure difference.
ACH50 = (CFM50 x 60) 1 Volume
The performance threshold for code compliance Is ACHPO
not exceeding 5.0 ac/h
to by: Phone:
i firm: Date:
cress: Signature:
part El.
ie air sealing contractor or representative of the contractor..:
general
ie blows i.door testing contractor or representative of the general contractor.,:,,
poiC' or equivalent dociumentatioh must be attached.
the
t for tignatur'e.
multiple entries to descdbe' them.
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I be provided to the Building and Zoning Department at final inspection.
I be provided to the homebuyer.
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Fort Collins residential energy cede 7196
Mechanical systems disclosure form
Job address: (o03 aEbG,t..�lc.kDR _ ��l_�1*�S._._..__g'd5a5 --
General contractor: �y t,pla 1 V 5—tt` B. r.
Mechanical contractor: j�is,� _I <.!N ^,,►r_a�- ____._._____._ __
;.... •::•::::.:
h...a.. .. 9 .. Y ..... ...:..
uel
...................................................................................
S ace coolln system*:
9 Y
ocaaon 1 Fuel
Input capacity AFUE or
Model # I kl3tuh or kW I ISPF
Jype
Manufacturer I
Model #
Input capacity
I kl3tuh or kW
l SEER
Wat r heattn s stem. :.:..........:.: :.:..•:::::.:
9 Y
Location I Fuel I T
Model #
Input capacity I Energy I Storage
S��nicn! i'" --r3 a nrrP Tam h o v�N'T-rt I rc=;mo I 'ell), oy) 7111- '1"oA A C-
........ ... ......... ..
:Certificaiiorr.�•:
Certified by: / Phone: (-� _(, _p?.'f�
Business firm: Date: _
Address/-jpi3j//)Signature:
..................................5�.....
:,;,'rr:..... . ...... ......::::: 1i?rir:iiiir?:>:;>.; _ __ _
This disclosure form is to be signed by the mechanical contractor or representative of the general contractor.
Please type or print, except for the signature.
If there are multiple systems serving any function, make multiple entries to describe them.
One copy of this form shall be provided to the Building and Zoning Department at final inspection.
One copy of this form shall be provided to the homebuyer. , ti,,c,.e,rssn_WOO