HomeMy WebLinkAbout6227 WESTCHASE RD - DISCLOSURES - 11/19/2003 (2)Fort Collins Residential Energy Code the building & zoning dept. of
MECHANICAL DISCLOSURE FORM Community Planning and Environmental Services
ffnWisc2.ws -7/1Q= 281 N. College Ave., P.O. Box 58q Fort Collins, CO 80522
Voice: 970 221 6760 FAX 970 224 6134
Job Address: �✓ Z Z lvr��y�.rs�- oaf
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
I Fuel
I Type
I Manufacturer
I Model #
Input rk
IkBtuh or kW
AFUE or
(HSPF
lInl�,
!Uct f
% c✓L� !
l' rY���
5%3 r
i 35"/L
i
f—A
B. Space cooling system
Location
I Fuel
I Type
I Manufacture
I Model #
Input
IkBtuh or kW
I SEER
C. Water heating system
Location
I Fuel
( Type
I Manufacturer
I Model #
InputEnergy
IB h or kw
I Factor
Storage
I volume
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:
S
Business Firm:
Date:
—d3
Address: /p s ,_ » , <� p le N . j" /e- /v u
�rrt,,,,,.� �.L U,//:-,c 6/eld i/I Phone: x0 -Yi'G - 5 e .