HomeMy WebLinkAbout4702 DUSTY SAGE DR - DISCLOSURES - 2/5/2003Fort Collins Residential Energy Code the building & zoning dept. of
MECHANICAL DISCLOSURE FORM Community Planning and Environmental Services
mchdisc21ds —7/1 W98 281 N. College Ave., P.O. Box 580, Fort Collins, CO 80522
Vo e: 970 2216760 FAX 970 224 6134
Job Address: Ll 702 574a, S3
General contractor Ri/'T-T- Co,,54-rw
Mechanical contractor tnu AX
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This disclosure form is to be signed by the mechanical contractor "o+r"representative'''"... ...*'''....* ... o"f' the he general ....''... . . contractor.
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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.
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Location
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Model #
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Fuel
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Manufacturer
Model #
Input capacity
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Energy
Factor
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IMe 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 CertifyinaJob:
Business Firm: YN-16&
Address: 9L4n r-+',
Date: -.Z - � -
Phone: 170 - 927 - 23_1 7