HomeMy WebLinkAbout6802 NIMITZ DR - DISCLOSURES - 8/19/20090811912009 12:35 Smith and Wi1Gs HVAC
(FAlt)3036881811 P-0011004
AUG/16/2009/TUE 11:10 AM Development Review
port Collins Residential Energy Code
MEgHANICAL DISCLOSURE FORM
mchdlrc2414 —7/10W
Job Address:
General contractor:
Mechanical contractor, c,Ul I1V 1�
FAX No, 970-224-6134 P. 002
the building A zoning dept, of
Community Planning and Environmental Services
281 N. College Ave,, P,O, Box no, Fort Collins, CO 80572
Voice: 970 2216760 FAX: 970 224 G134
t� # 10.1
INSTRUCTIONS . "
Thle disclosure farm is to be signed by the mechanical contractor or representative of the general contractor.
Please type or print, ®xCopt for VV signature.
If there are multiple systems serving any function, make multiple entrlea to dmscribe them.
On* Copy of thlir form must be provided to the Building and Zoning Department prior to the C,O,
one copy at this form must be made available to the original home buyer.
A. ,Space heating system
IS, Space cooling system
l.oaatlan
t7
Fuel
Manufacturer
Model S
Input capacity
kEltuh or kW
ko
8159R
l
C " p
C. Water heating system
Location Input capacity Energy Storage
Fuel a Manutgoturer Model ° WHO or kW Factor volume
Certification
WV® 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 wets Installed In accordance with manufacturers' Insiructlons.
Person Certifying Job;d
Blgnature: ®tats:
Address: iZ') 40 I A n (ld I k Vi ► i I , 4-h i -i n/\ S2fl 11 �
P