HomeMy WebLinkAbout4244 ROLLING GATE RD - MISCELLANEOUS - 11/28/200011/28/2000 09:33 9702238164 MARK TWAIN HOMES INC PAGE 04/05
Fort Collins residential energy code 7/96
Mechanical s stems disclosure form
Job address:
General contractor:
Mechanical contractor:
Space l Gatlin'
gsystem ;
Location
Fuel
an faeturer
Model #
Input capacity
Btu or W
AFUE or
1-181155
BASEMW
GAS
P A
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input capacirty
aver h6at1ng;system.:
Input capacity Energy Storage
Location T Manufacturer Modal 0 ke —Factor volume
Certiflcatlon
IIWe certiy that the above•flsted equipmentwas Installed in the budding atthe above locations in conformance with the
current requirements of the City of Fort Collins Residential Energy Code and Mechanical Code, and that it was Installed In
accordance with manufacturers Instructions. VWe certify that any ductwork has been installed In conformance with
the current requirements of the City of Fort Collins Residential Energy Code and Mechanical Code,
Certified by: ROBEST R .MILLER Phone: (970) 223-8873
Business flrm:t,DkgHUM ggjQBLD0 AIR, 1W.Date:
Address:1823 E HARb]CUY RD Signature;
Instriictlons .
type print Pt g
This disclosure form is to be signed b the mechanical contractor or re 9 Y presentative of the general contractor.
Please a or rin except for the signature.
If there are mOOG systems serving any function, make multiple entries to describe them.
One copy of this form shad be provided to the Building and Zoning Oepertrnent at final inspection.
One copy of this form shad be provided to the homebuyer.e suaca_c,Nor