HomeMy WebLinkAbout4123 VERBENA WAY - DISCLOSURES - 10/22/2008 (3)4 Fort Collins Residential Energy Code
MECHANICAL DISCLOSURE FORM
mchdisc2 xis—7/10/98
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 Budding 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
I Tvoe
I Manufacturer
I Model #
Input capacity
I kBtuh or kW
AFUEr
I HSPF
C44 ��
N �+�
i n�
n
X 0 X
d3 B
B Space cooling system
Location
I Fuel
I Tvpe
I Manufacturer
I Model #
Input
I kBtuh r kW
I SEER
Io
o
A-"
t -f- n
1"
1
aN x x
C Water heating system
Location
Fuel
Tvpe
I Manufacturer
Model #
Input capacity
kBtuh or kW
I Energy
Factor
I Storage
volume
/V,
M2XQSoy7-6Fn
&,-r N
y
Certification
I/We certify that the above listed equipment (including ducts and piping) was installed in the budding 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 tj 1."
Signature j ry�`� v�`1� Date 10 la -a /U,�--
Business Firm
Address :?(-rA n .1 A— t, -1—k 4— \ a
Phone 30 3 / &65 � /c) P-&?