HomeMy WebLinkAbout609 JANSEN DR - DISCLOSURES - 1/9/2002 (3)0
Fort Collins Residential Energy Code the bui Idi n
g &zoning dept. of
MECHANICAL DISCLOSURE FORM Community Planning and Environmental Services
mchdiscZxis -7n 0198 281 N. College Ave., P.O. Box 580, Fort Collins, CO 80522
Voice: 970 221 6760 FAX: 970 224 6134
Job Address:
LcInl
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
B. Space cooling system
C. ` Water heating system
n I Fuel TYpe I I Input capacity I Energy Storage
Manufacturer Model # kBtuh or kW Factor I vniijm.
Certification
[/We certify thg
at 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:
Business Firm:
Address:
Date
Phone: 3a 3_ e,11 / „