HomeMy WebLinkAbout6127 CARMICHAEL ST - DISCLOSURES - 7/9/2004 (2)Fort Collins Residential Energy. Code
MECHANICAL DISCLOSURE FORM
MCr8dWC2_'& 7110M
Job Address:
General contractor.
Mechanical contractor
the building & zo rri ng dept. of
Community Planning and Ehviramnentai Services
281 N. CoUsgs Ave., P.O. Banc 580, Fart C0111M CO 80=
Vows: 970 221 6780 FAX: 970 2246134
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
Fuel
T
Manufacturer
Model #
Input capacity
k8tuh or kW
AFUE or
HSPF
B. Space cooling. system
Location
I Fuel
I Type
I Manufacturer
I Model #
Input
IkBtuh or WV
I SEER
C. Water heating system
Location
I Fuel
I Tvpe
I Manufacturer
I Model #
Input IkBtuh or kW
( Factor
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 withthe 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: L.y �hJ 10M
Business Firm:
Date: 7— i v
r.
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