HomeMy WebLinkAbout6802 NIMITZ DR - DISCLOSURES - 10/8/2009 (2)1010812009 11:28 Smith and Willis HVAC
(FAX)3036881811 P.0011001
Fort Collins Residential Energy Code Neighborhood & Building Services
MECHANICAL DISCLOSURE FORM 281 N. College Ave., P.O. Box 590, Fort Collins, Co $0522
mchd1sc2.x19 —7No/99 Phone: 970 221 5750 FAX: 970 224 6134
Job Address:
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
Tyce
Manufacturer
Model #
Input capacity
k5tuh gr kW
AFLIE or
HSPF
Ise
m
-- III�-
B. Space cooling system
Location
Fuel
Type
Manufacturer
del 0
Input capacity
k8tuh or kW
SEER
410 A
D4PY
I INZ+Ab&&3
P
1
A 310 b
C. Water heating system
Location
Fuel
T e
alcturer
Model #
Input capacity
k9tuh or kW
Energy
Factor
storage
volume
Certlflcatlon
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.
Pemon Csrtlfying Job
Signature: Uv�VG�s Date:
Business Firm: s
Address:
Phone: 2)-l1/gk44q-�-.