HomeMy WebLinkAbout6227 CARMICHAEL ST - DISCLOSURES - 11/10/2005 (2)Fort Collins Residential Energy Code
MECHANICAL DISCLOSURE FORM
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the bui Idng & zoning dept. of
Community Planning and Environmental Services
281 N. College Ave., P.O. Bax 580, Fort Collins, CO 80522
Voice: 970 221 6760 FAX 9M 224 6134
Job Address: (ern
General contractor.
Mechanical contractor.
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
Location
Fuel
_Type
Manufacturer
`
Model #
Input capacity
kBtuh or kW
AFUE or
HSPF
S
✓
B. Space cooling system
Location
Fuel
•` ti
Type
Manufacturer
Model #
Input capacity
k8tuh or kW
SEER
C. Water heating system.
Location
I Fuel
I Type
Manufacturer
Model #
Input capacity I Energy
kBtuh or kW Factor
I storage
volume
Certification
VWe 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:
Signature: Date:
Business Firm: '!P�-4 kc.L�'t How�Os