HomeMy WebLinkAbout508 KIM DR - DISCLOSURES - 9/16/2002 (3)r
Fort Collins Residential Energy Code
MECHANICAL DISCLOSURE FORM
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Job Address:
General contractor:
the building & zoning dept. of
Community Planning and Environmental Services
281 N. College Ave., P.O. Box 580, Fort Collins, CO 80522
Voice: 970 221 6760 FAX: 970 224 6134
Mechanical contractor: HIJI&C 'LEY iP1 j6d IA(
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 T e Input capacity AFUE or
Manufacturer Model # kBtuh or kW HSPF
B. Space cooling system
Location Input capacity
Fuel Type Manufacturer Model # kBtuh or kW SEER
C. ` Water heating system
Input capacity I Energy I Storage
Certification
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.
Person Certifying Job:
Business
Address: Vf
Date:
ne: 363-4//-/.. -