HomeMy WebLinkAbout627 STONEHAM CT - MISCELLANEOUS - 2/1/2000 (2)E
llins Residential Energy Code the building & zoning dept. of
ANICAL DISCLOSURE FORM Community Planning and Environmental Services
mchdiscIxls—7/10198 281 N. College Ave., P.O. Box 580, Fort Collins, CO 80522
Voice: 970 221 6760 FAX: 970 224 6134
Job Address: �oPry
General contractor: H6�1_Q.Qj) /I-Fon rF T f�
Mechanical contractor: Hj kr- : y
INSTRUCTIONS
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 must be provided to the Building and Zoning Department prior to the C.O.
One copy of this form must be made available to the original home buyer.
A. Space heating system
Input capacity AFUE or
Location Fuel Type Manufacturer Model It kBtuh or kw HSPF
B. Space cooling system
Input capacity
Location Fuel Type I Manufacturer I Model # kBtuh or kW SEER
C. Water, heating system
Location
Fuel
Type
I Manufacturer
I Model #
Input capacity
kBtuh or kW
I Energy
Factor
I Storage
volume
ICA IrN
a
Certification
I/We certify that the above -listed equipment (including ducts and piping) was installed in the building at the above locations
in conformance with the requirements of the Fort Collins Residential Energy Code and Mechanical Code; and further, that
such equipment was installed in accordance with manufacturers' instructions.
Person Certifying Job: 7210RAJy
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Business Firm:
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Date: .;/- / -
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