|
. ,.
<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.�. ' �" i�'1 +r r�� �� p"� �i�":•�y�, �'S';,�'.,•. :-•:`.C,�L,�ti�1'�r�.i'
<br /> >:i � `�.,�^i:J�,',t� yy�.�:i.i�%!s_�:y��',•'`.n'�•4�����Gs.-�:-•.: �,�L��N �� ;y::.��.Y;..��i!9 a�'y6A'�T.��.�.:.'�.�7(�'�+•.s..iA^iE' ..t.[._Tq.�;l•r� �
<br /> 1'!ti.tirYjY'�,� ::wr���i$�••:3�', .!; .�� .`cYaulia�a•.. _..l��t+'� ��Ya.S•n. �:.r'?.��:,. i. ."�y�,.�
<br /> .S e he� ��aemolfd el.. Saaled cambustion :Y:.' ee�th';-?aat�sol�d t,iei,;:;7 Q Salsd combn:d� .:;y::
<br /> P� , ;,� - '��°� th �� :�y+.;••,�
<br /> ,, ,, :�,;;�;..� ,��. .;;r,;':.',";'`�w ❑ Direaear v J=Y*-' �;'.,+�':�::::.�=��;' ��>;:�.a,�''•�`��� iacea wvavented ;'�,Y.,
<br /> ��a p a,�} •��. .
<br /> �i,3Lx''Sp1x.'�1.�:75 j�.i�.:Li��"s�'i,� • f '��6'�.:i�:,•<iy,.:�;'..•'�!�'>�7".°:f.:' � �•.
<br /> •:�z-:w=;.,s���;4i;:z•::.'��:.t�sr� ��: "ealt veated•: .,, ,z �;�:,.,� ,;,,, �ar-. t•�.�::�t ::.�A�" �cfm4lv.vea�ed�. N�;•.
<br /> ;:��tes' e� � '. �noaso]idfi�d- Sealed coonb+�stioa :: �r �ee .,,sotifl.. . Atmoipb�ically venced
<br /> tes ���
<br /> �.��,,�..'�;�.: �. .r-,.•�� •,
<br /> .�. .��t_.f�'....a. �`"., f�k'','t�;:EY..� {�!'GIQ� V!lDZRd �' �� ��0� .}�1C:. /�LT1106�lACl�1}�WAHQ 'i� :.�;
<br /> ' !'n.,� '�:���4ar}.x�,w '�i� . � •.;ry,:.;...� .�':,.
<br /> �,:, �fi' ..;hc;. .:- �,� ,•Atmo el !',,.;.� ` y veated y�;,.
<br /> *'..�If attnospti�icp�it,y,v�ed.soli .oir�� ,v=.ad,wer• t ,.ap�ce tx' .� ...: .., .._ . ��p_;aa:te�1i
<br /> _� ,. �..: ','• . r . .,;,..�,..,��.,: .. :��.;�:. � , ..::
<br /> �Qow�ae IIea.fa�eaalis�di�idua]�e�c�r','e�eahicbdioeeds`s��;c�icfset '�riat�:•��i�:.'�°�:�:�:=�:�,'��,.r:�'.;':.,,..1c� �"���;�;-:
<br /> P�rt C�. V.�N��ATIOl� _
<br /> �� 'k��',:,���►• .:t� ��'�' .._. .L!'i;� ,"• i. �i;-"�41':'..�`7� � •.►•.. �.:..,.- .:�i�'°�'�Sd�..���«.,.F.;: ..
<br /> '+ ' �.` , ��s'��:;•��j•.y::�j�, ,� ,� ' 'i+ �' ,� .c��l:a;t�. ;y,l•,�, r.,..,�:
<br /> ���'•C'.,�Mi' �•�r�.t}4;ti rr`i�^�j%:�1`'� t yp �tt .w�i,�"�y.,L��`�'�'��.� .T��l:...� oi`�� .� +• '��e '�„ �&���y�.-A.'F.� '�1J
<br /> .�.. :'{�f�•',i:� � � �t�; E�V� ��plD�'7�. ���� C7�C17�!� . '�'r{r �:}.SG'u�� y..
<br /> ` -' .'•'!$�:'�"t:�a;��. �. r.� .A�rp.:S.-t- .�-;..
<br /> `;�.?�`'��. l •�i. �r••i o�• a�. .�•.+�.� - 1:' ..,:r
<br /> ... i F '. ',. ,J. .. /,,�.,��.�.r��..��. : �7yy�� �x.. • 1.y,��'p�i`,�^.�y� .(!i.��},,..q�.y.a µY�;�.�:..':�7.' q.�!~•:{`w
<br /> ..
<br /> ..ZS�aG+ ��IC���j�'x �.W�I�wuu�}n•'�� �5O a:ll7O� !1' ,�+ .� .�A7'c!a1�l���d�V1ft�;:fS���CLID��r:�• yS• ���.:
<br /> .. � .
<br /> '": :.w,��':4t" " � �.:�LTh�.0 :' f'� �r!�F 1.''i: ���;:���`rY,�rt
<br /> ..+ .
<br /> v
<br /> ' .. . . '• ..,�'
<br /> , . ... {.. . , .... . . r ..•:• .•...� • '
<br /> , . . n
<br /> , ..
<br /> volians of bl�tboma:�••� . �... ,, .,,. . .,s:,�;;.;, . , �o � :..�:5..�?:.:�: ;kry�'�.'.•�.^;Y,:z;. - ,�:�..
<br /> .�,
<br /> :,: ,-�;,,
<br /> �,.�:"•b�..�'k,c�;�'�:ki'�'�i'•'� . .`;�:�: '��;• j;�;;.,:.,,+,�••:;'; :'i.1�•.r:,At::.
<br /> .�. , , . , •�na,�.�zon� . - ,.� . „ , ,.. ..
<br /> .. .�,�...Y�,':.•. .:�...,���� �.;..�:':�.'��'.' �. : . ,y . ^..�� •: •.: :S•','.• . :�._� '.':�tri�!.: :.�•.�'�� ...�;R":.%'��d
<br /> C:hecta�v�d(e)'pivposcd':?!�� O•Exha�ust� e nad aet rtca •veatilat�r,�ir exclr�ga,atc.) :;;���.s�:�
<br /> }. ,A
<br /> Fea ti�aa O�leCttion':i 70TALS;:::•.,
<br /> ON�.;�� '.•ahL�e /�o .'c� e '�. '��.� � .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 />
|