HomeMy WebLinkAbout802 BLONDEL ST - DISCLOSURES - 12/12/2007 (9)Dec.Q. 2007 12:07PM
No. 6565
Fort Collins Residential Energy Code
MECHANICAL DISCLOSURE FORM
inchdi3c2As -N10198
Job Address:
the building & zoning dept. of
Community Planning and Environmental Services
5s
251 N. College Ave., P.O. Box 580, Fort Collins, CO 80522
Voice: 970 2216760 FAX: 970 224 6134
General contractor:
Mechanical contractor:
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........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.
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Location
Fuel]
TVDe
Manufacturer
Model #
Input capacity
kBtuhorkW
AFUEor
HSPF
d,ODD
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Location
Fuel
TyRe
Manufacturer
Model #
Input capacity
k8tuh or kW
SEER
491�1
Am
1 440e6l
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hsystem.... .. ....... ..................... .. ... . ....
.:C: Wa
teri ....... ............... . . . . ..... . .
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Location
Fuel
TvbL%
Manufacturer
Model mn.1 fi
In capacity
pt,
Energy
Storage
ro-k
T2� i
D-OP3
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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 manufacturersinstructions.
Person Certifying Job: VItIl �///,
Si
Business Firm:
Date-