HomeMy WebLinkAbout4703 DUSTY SAGE DR - DISCLOSURES - 3/29/2005LFo�,c:iin; Rosidential EnergyCode
HANICAL DISCLOSURE FORM
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General contractor:
Moch,an,'cal contractor:
the building & zoring dept. of
Community Planning and Environmen'tat Services
?A' N CCfle;,e Ave.
vCi_-g' -70 22. f.75-
INSTRUCTIONS
71is dis_,:�sJ"e torrr. is to Le signed by the 7ech3rlczI cmtractcr or re5er,
r@RtaGv- ' ` ti e
PIe93e ty:;e cr ornt, 'except for the sigratcre. �ensre, cent actor.
if t�;rn t: 4irJl eystems s'S:-ling jr•y .. dKc T :a•.pi� 3 ifISS t0 cSC.'
iC
Cne ce_y t'-is `o-m rrust be provided to `�e S ;ilding and Zcnino Departmeit p, c C r�
Ore copy c' ;^.is form rrus' be maQe availabis to the orgina; Home b;yer, v
A..._ Spaoe heating systprn
e. Space cooling system
0. Water heatin
g system
j
Lecation Fuel T�'pe Manufacturer Model # k3tuh or kW I Input capacity Energy I Storage
` Fnetor vniump
Certificaton
l;We -.. a above -listed equipment (n uding ducts and plp(ng) was insta;leo :r 'he building at the abovc locations
it conforrns.nce with tic requirements of the For. CoIT-Is Rasldentlal Enercy Cede anc !ectianical ode: an:' further, that
such aquipmart was irstallad in accordance w,th manufacturers' instructions.
Person Certifying JobD P�' Tzll�//"
'—
Signature:
Business Firm: �- r�` ; ✓
Address: 2—
I �c -- __
'7 Phone'
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