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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 ................... ........................................ . ......... ...... ....................... .................. .. . . .......................................... ............................. 'INSTRUCTIO* ..................... NS' ........ .............. .... ................... ........................ .. = . ....... :..+.,.,.+.,+,..-.,.:.,.,.,:....:.......,.,.+.'.'.'.'.'..,:.,."..':..",.,.,.,.I..,.. : . ........................... ..... I ................ ......... ...... . . .............. ............... ............ ..... .. This disclosure form is to be signed by the mechanical contractor "o+r"representative'''"... ...*'''....* ... o"f' the he 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'...................... ............ . . .... ........... : ... ......... .................................................... . ............ . ......... ..... . ..... ....... ..... ...... . ..... . ....... ..... ........ .... .. . . ... ... ..... . .. ..... ..... "h............................. ............ ......... * ........... .. .... .. . * .. ...... ............... .. ...... ............. .... ::.:.::space................ ................. . ..... ­­ t .......................................... ........................................................... . ............. ... ...... ................................. Input A Location Fuel -A TvDe Manufacturer Model # capacity kBtuh or kW FUE or HSPF 6A CVq NA-�"r'a I I ILJ -1 OCD ...... . .. ........ ..................9......p....q...p.......,c.I.....o.....6... ..i.n.g.sysAem:.::.:,, -........... ..... ........... ............ .... ... .... ..... .... .. ....... ..............................-..... ................ ......... .... ........................................... : ...... . ........... ...................... .. .. .................................. ................ I .............. ... ............ Location Fuel Type I Manufacturer I Model # Input capacity I _kBtuh or kW I SEER 75.7'e No,., Vre of V C/Irtl'ell 3fC-1((_Q363qt _Sion .j .......... ..-. .............................'...................+. "..."..I................................................... ........... ..I .............................................................. ................................................................................... ....................................... ... ................. .............. .*.'.... ........... ....... ................... ........................ ....... ......... ... ....... . ........ .......... .. ........ ... .....Water ea. ngVs. .... .......... ...................................... Location Fuel Tvt)e Manufacturer Model # Input capacity kBtuh or W Energy Factor Storage volume .. . .................................................. .................... .................................. ................ ................. . . . . . ................ .................. ..................... ................................................................... ......... .................................................. ........... ......... . .......... 'dn ..................... .................. ....... ......... ....... .... I ........................................... ....... Qj6difido'ib . ...... : ... ........... ............................. .......................... . ...... . ........... ... * .......... ......... * .............. I ........ = ..................... I ................. .. ... .......... .... .......... ................................ ............. 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