HomeMy WebLinkAbout602 KEENESBURG CT - DISCLOSURES - 1/9/2004 (4)Fort Collins Residential Energy Code
MECHANICAL DISCLOSURE FORM
mchdisc2xls—7/10/98
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: e-.�[A—
I,NST`RUCTIONS .. _ .
_.
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 5 arc hettn `s stem
p..::. .... �.. Y
...
Location
Fuel j___Tj2e
Manufacturer
Model #
Input capacity
kBtuh or kW
AFUE or
HSPF
T
31c)ANVoM
1/0
to 05-oft
16
B Space cooling system
G Waterheating system .. .....
Input capacity Energy Storage
Location Fuel T e Manufacturer Model # kBtuh or kW Factor volume-4-
. .... . ...... . ---------------------------------------
Certtfica ........';'.:......
. . . . .
.... . .. ................. ........ ... ....
:.::.
...............
1/We certify that the above -listed a ui ment includin ducts andpiping)was installed in the building at the above locations
.... . • •::: ::::
q P �' 9 ..
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: iJ K&L�_
Signature:
Business Firm:
Address:
Date: 'I �ppcf
Phone:_