HomeMy WebLinkAbout421 S GRANT ST - DISCLOSURES - 3/3/2011Planning, Development & Transportation
e� City Of Community Development & Neighborhood Services
Flirt Collins
oll' n C For N College Ave. P.O. Box 580
/ = ■_ VI 1 1.7 Fort Collins, CO 80522
Phone r2740 Fax 970 224fi134 wv.co
Residential Energy Code Mechanical Disclosure Form
tt (not applicable to E-Star or Energy Score rated homes)
Job Site Address: l S ' C,V rq ay.'' Permit # B n q06 2 qs
General Contractor: vs
Mechanical Contractor'. 5,6fuG
Instructions:
This disclosure form is to be signed by the mechanical contractor or representative of the general contractor. Please type of print
legibly, 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 Department prior to C.O.
One copy of this form must be provided to the original home buyer.
A. Space Heating System
Location
Fuel
Type
Manufacturer
Model #
Input Capacity
KBtuh
AFUE or
HSPF
ba���h
��
/
6!!i!e_
L L
MbtmAkPx
Me-..li20
' �ior.TKW / w
'�v�vG� /lj�l
0' '
B. Space Cooling System
Location
Fuel
Type
Manufacturer
Model #
Input Capacity
KBtuh or KW
SEER
C. Water Heating System
Location
Fuel
Type
Manufacturer
Model #
Input Capacity
KBtuh or KW
SEER
-Tar, e35
Certification
I/We certify that the above -listed equipment (including ducts & piping) was installed in the building at the above locations in
conformance with the requirements of Fort Collins Residential Energy Code and Mechanical Code; and further, that such
equipment was installed in accordance with manufacturers' instructions.
Person Certifying Job: h K
Business Firm:
Phone:5403 726 '- % 2 -:?L 1
Address: 4?) 3 2 1,hf rt -- 9 v F/-- �_e.v/ ;h, <f 2 4(
Signature: Date: 3 -3 J