HomeMy WebLinkAbout1418 TARRYTON DR - SPECIAL INSPECTIONS - 3/25/2015Mar26 1507:32a Swan Heating and Air
97M13-0826 p.1
Fort `Collins
Combustion Sal
Replacement of Natural
Address: Li 1 ( � 1 ae-,\ f
Approved Agency:
I hereby attest that I have been trained as in
---Combustion Safety
Test -in -accordance -Version
Technician Name (pri
Technician
Appliance Tested:
Appliance Replaced:
Worst Case Conditions:
Spillage Duration (in seconds):
`
Pass 1� Fail ]
Natural Conditions:
Spillage Duration (in seconds):
Pass Fail
(Failed test requires corrections
Technician's recommendations to correct
Failed Worst Case Conditions:
Planning, Development & Transportation 6ervices
Community Development 8 Neighborhood Services
251 North College Avenue
P.D. Box 580
Fort Collins. CO 80522.0580
970.416.2740
970.224.6134- fax
fcgov.com
est Compliance Form
Appliances in Existing Houses
Permit Number: 6 \ 5_0 0 65—j
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Agency and have performed the following
,olfims Combustion Safely Test Guide
✓ 2012.
LCompany �ak:&)6 l
Date
on Monoxide (parts per million):
Tested: 'c)
Monoxide (parts per mullion):
Tested:
test passes under Natural Conditions.)
appliance failure:
I certify that I am the legal owner of the above listelroperty and hereby acknowledge that my appliance
has failed a Combustion Safety Test under worst-ca conditions. I acknowledge that I have received a
combustion appliance safety information sheet
Owner's Name (print)
Owner's Signature
CST:replacement/natural-draft/4.25.12
Date