HomeMy WebLinkAbout419 W MOUNTAIN AVE - DISCLOSURES - 2/25/2004 (2)Fort Collins Residential Energy Code
MECHANICAL DISCLOSURE FORM
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Job Address:
General contractor:
Mechanical 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
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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
L l._
S. Space cooling system
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Manufacturer
Xell
Model #
1 kBdih or kWty AFUE ] HSPF r
rJeD
rer
L Model
LjInput ce
1tu orr kW
I SEER
EET777
C. , Water heating system
Location I Fuel I I I I Input capacity I Energy I Storage
TVDe Manuachirar fu..�_� y
RYA,
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:
oinature: OV 1_
Date:
Business Firm:
Address.