HomeMy WebLinkAbout6714 ANTIGUA DR - DISCLOSURES - 6/14/1999 (5)01/18/1999 14:31 9702299983 NCA
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Fort Collins residential energy code 7196
Mechanical systems disclosure form
Job address: 6-7 W At1T jC3y A 09 - � �Z
General contractor: FAMES _ GoNST(Z.Jc j tON 0-
Mechanical contractor: NOgOM COXCRADO AIR,
ILW-
Space heating system
Locmw-n
Fuel
Twe
Manufacturer
Model N
Input capacity
k8tuh or kW
AFUE or
HSPF
BASEMENT
GAS
F A
l
Space cooling system
Location
Fuel
Tvoe
Manufacturer
Model B
Input capacity
k tuh or kW
BEER
GAS
F/A
Water heating system
Location
Fuel
rim
Manufacturer
Model N
Input capacity
k9tuh or kW
Energy
Factor
Storage
volume
Certification
I/We certify that the above -dated equipment was installed in the budding st the above locations in conformance with the
current requirements of the City of Fort Collins Residential Energy Code and Mechanical Code, and that it was installed in
accordance with manufacturer's instructions. IIW* car* that any dutxwork has been installed In conformance with
the current requirements of the City of Fort Collins Residential Energy Code and Mechanical Code.
Certified by: ROB= R ML LER Phone: (970) 223-8873
Business flrm l CO OgAM AIR, U C-Date'. - I A
Address:1823 E HAidM FO Signature:
Instructions
This disclosure form is to be signed by the mechanical contractor or representative of the general contractor.
Piesse type or print, except for the signature.
If there are multiple systems serving any funttlon, make multiple entries to descrlbe them.
One copy of this form shall be provided to the Budging and Zoning OepeNnent at final inspection.
One copy of this form shall be provided to the homebuyer.