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. ,. <br /> � .' May 15 0� 04:Q4p FiMERICIMM 95Z-4�5-�4�Z4 p.6 <br /> part �, n�P�tESS�ZA'I'�QN �ROTE�TION <br /> Cb�ek optiaa nsed: O�Fuel bunvaE eqoip�►ast(comp;taoe scl�ednke bslaw) O 1�to foet b�zroi�g equipm�nc <br /> � ��... ----- <br /> �,...,��... _ <br /> MSSRVC3t0�IS •�:T�AUST'/��-T.TP:A�SCSEDLTLE*..�. <br /> Sup 1. Carnpiete S�e CoAtbe�ttoa F.qutp,nenl Sdieehrla below. Qa}Y M��t �:Psibsosc dwi�s owr 300 Lfiai,< .::�.,- b� ,..�' . <br /> a�ich a Y(Yes)sn4y be selected under tl�e"Caas�ory 1"�lte�ate. N q c�s� <br /> Seep 2. Complrte Earl�uar/A�ake-crp�!b Scleedule oa the ri�tht if direa or peatr ,�:'�� <br /> vem�d ar solid fuel a4nospltecfc vsnt spaee beatieg equipes�emt ia teleaoed. •.e� <br /> • � � .i.��_r,� .•x^.f� _ :�Y��O�� �� �ii:��•`°�'�'nw�:w�.' `:�;', ^+•J.�;; •.' .r: ';�;�^: �:: <br /> _ �:if•�..:A.��•. ,�: •�' i� •:' G.�. 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'��.� � .eR� ;���i <br /> A3 DESIGNED,:��.�;� �uet �Iv � e6a• �e�tm : c5i►: �:� � . <br /> Sacement ef Complianee: 'fba piopoeed bnilding �e�Esa represenud ia tbese daume�m ;s ooasieeent witb t}ue buiidin$ pluss, <br /> spseifiatioas.aad oi}ies Weuluio�subrnitted�vith tbe permit aptflir:a6on. '�6e p:ogoeed bc.ildiag has beea des;geed !o msat tha <br /> nquirements of tlse Miai+eson Ener�y Code. <br /> lpplieant(priac name) � Sb°'aeNn Dace TeItp6one r,umba <br /> Part Cz. �1\��1'''���.1� (Submft Parr C'�npon completion of sy�stem�eri8cotlon fi) <br /> �<---�-=------------------------�___----------__----------_-____---------- <br /> Joh S9te Address: � Pers�it IJ�smbet <br /> F�a da ' �or loeaticn•� TOTALS <br /> • Iataka cfia ef� ' efm c� ��e8m <br /> PE1tFORi�A�tCE �� tust c� c dm• cfm ..c5u . <br /> � veotihtioa raot�st be masured aud vaified oi6e» perfoaaanee optsoa �ued in lien aP ps�qeriprivt aptioa for t6e seaiiat <br /> of joi�an tba i�uildim caaaditioned eavelape(firom Put A).. �� � � � . �!'•;:'':,'. <br /> Con�p{isnte State�ml: Instnlltd�enrilotion systeen is itf tompli�uce witb MV Famsr�y Code stxl is sized to provide Zhe desi�s aff flow. <br /> Appticant(print narne) Si6nawre Dita TeIephaoe nwnber <br /> 32 <br />