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r Part B. DEPRESSURIZATION PROTECTION Check option used: ❑ Fuel burning equipment (complete schedules below) ❑ No fuel burning equipment Irrs�rxuc�noNs EXHAUST/MAKE-UP AIR SCHEDULE* Step 1. Complete the Combustion Equipment Schedule below. Only equipment Exhaust devices over 300 cfin Flow with a Y(Yes)may Ue selected under the"Category 1"alternate. �� Step 2. Complete ExhausdMake-up Air Schedule on the right if direct or power �� vented or solid fuel atmospheric vent space heating equipment is selected. �� COMBUSTION EQUIPMENT SCHEDULE � (check all es ro sed Space heating—nonsolid fuel (�Sealed combustion Y Hearth — nonsolid fuel Sealed combustion Y ❑ Direct or wer vented Y'� ❑ Direct or wer vented Y t�tmos hericall vented N tmos hericall vented N Water heating—nonsolid fuel �''�Sealed combustion Y S ace healin —solid fuel A�mos hericall vented Y* ❑ Direct or wer vented Y Water heatin —solid fuel ❑ Atmos hericall vented Y Atmos hericall vented N Hearth—solid fue( ❑ Atmos herica(1 vented Y * If atmospherically vented solid fuel or direct or power vented nonsolid fuel space heating is installed,then make-up air#o match flow is required for each individual exhaust device which exceeds 300 cubic feet r minute. Part C�. VENTILATIUN VENTILATION QUANTTTY (Mechanical ventilation must be provided per the lazger quantity calculated below) �� cubic feet x 0.00583/minute = � cfm ( � x 15 cfm/bedroom)+ 15 cfm= � cfm volume of habitable roc�ms number of bedrooms VENTILATION FAN SCHEDULE Check method(s)proposeti � ❑ E�chaust onl ❑ Balanced heat recove ventilator,air exchan er,etc. Fan descri tion or location -� TOTALS VENTILATION lntake cfm cfm cfm cfin cfm AS DESIGNED Exhaust cfm cfm cfrn cfm cfm Statement of Compliance: The proposed building design represented in these documents is consistent with the building plans,specifications, and other calculations submitted with the permit application. The groposed building has been designed to meet the requirements of the Minnesota Energy Code. Applicant(print name) Signature Date Telephone number Part C2. VENTILATION (Snbmit Part C2 upon completion of system verificationf) �G--------------------------------------------------------------- Job Site Address: Permit Number Fan descri tion or location TOTALS MEASURED Intake cfin cfin cfin cfm cfm PERFORMANCE�' Exhaust cfm cfm cfm cfm cfrn j' Ventilation rate must be measured and verified when the performance option is used in lieu of the prescriptive option for the seali�g of 'oints in the buildin conditioned envelo from Part A . Compliance Statement: Installed ventilation stem is in comptian �with MN Energy Code and is sized to provide the design air flow. �.�'�lfs �-� r�C�F� � � � `�' U.'(� '�j(�'�`3��7 Applicant(print name) /� Sigtrature � Da e Telephone number J��1- ��3 l Ir�ur�`� \_� / �----' 12