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� HPR. 2.201�1 ��2��48f'h - �-� <br /> h10.E1�7� F.c:•c <br /> ; ' �'art �. �F�'1�E�S R��ATIQ►�I" �ROT�C�I�� � -� <br /> �. ��eek apti�a�hed: ❑ Fuel bu�n{ag pmeat (complttr schedules helow) a No fue!buruing eq,,dpment <br /> �.,,_. <br /> , ` � �NS UCT[ NS _�— <br /> 1'�?;� ' � E.�►UST I yi,a.i�-irP�iR SC�:UL�* <br /> ' �i��ttg 1. Camplete the Combr�srio�E� uipme t Schedule bclatv. Oniy cquipmeat E:cbausr devi ec s over 300 eFm �lo�v <br /> !: ;� ' with a Y(Yes)may be ul�e uad the"Category 1"attemat�. ___ �� <br /> � itep 2. Camplete ExhausdMake-up ir Sch dule on th�rigfit if direct or pon•er �� <br /> ' �� vcuteci ar selid fuel amaasph� c v �pace heating equip�,eac is salected, -- �� <br /> �. ;� <br /> ' Ov�LBUS'I'ZUN EQLT�'N�,(7'g�g�DL�.E <br /> � � (chccfc�1 cypcs proposed) <br /> � • <br /> ;ipace heatizig-naasoHd fuel • S led busridn Y Hearth , nonsolid fuel p S�aled combusuon�� X <br /> '� 0 D�rect or ower veated '�" ! Dsect or power veated Y <br /> A osphkric.�illy vented� N A�o�hericalIy vence3 r� <br /> ��i ater hea�n3-nousc�lid fuel � S led a bustinn Y � Space hearing-solid fuel Q AQaasphericaIly veateci Y" <br /> C] Dueet ar nwer ventad Y Wa�er he3ti.ng-solid fue; � Amospt�e:ically vented Y <br /> � A osFh ric.�ily vented \ H�..rr1:-sulid fuel ❑ A�nosp�er.cali.; vence:a Y <br /> " If atmo.spkericaLly ventad solid fnkl ar ' eet or pdwer ventrd noesoIid fueI space �zatiag is ;nsr�Ilea, [IICII QL1kC-�� azr co m�tc� <br /> �ow is required for ezsch individua��.�cha t device wfaich exce�ds 30b�Lbic fzec per minµce. <br /> —.---.� <br /> �w <br /> Par� �x. 'V��'+l�'IILA. � ��Y (Co�xx�ru�tion lA.ir�'eop�e ��r) <br /> . 1 � ���tiTIY.ATIOIti QC�.Y?ITY '.......— <br /> (vitehaaiea�ventil�ti�n m�ssc be pr���ed per che !ar3e-quaneie�calc��:sr�d bel���v i <br /> �' 0 3� cubic teet r U.OpS�" � " _ � . �y � <br /> 3 ...,m�nl�ce /77 cfm � � ;3� x 13 cfrrvbedroom) � � =�fn, = �Q j cfn� <br /> ; ';;alume of ha itable cooms ��I � ( ms::�er of beeroums <br />;-,'� I VENTILATION F:�.�SCHEDCZ.E �— <br /> ,:� <br /> -i�'heck meihad(s)proposed 3 ❑ E.�cha t onlv • Balanced (t�ear cecove:v veurilator, sir exchang�r,ec:.) <br />;,,;�• , .. <br /> a',;�an descri cion oc lncaaon � Uey, .•�',( �.o TOT_�LS <br /> 'ENTII.ATZON ititake cfm cfrl cfrn c.5-n a� c� <br /> ta <br /> ;�.5 DfiSIG�fED E.�chaust c�n ctin � c5n c� ac�o cf:a <br />� ;� � <br />' �'�tacement af Co�plia�nce: 'Ihe p�a osed uildiu�; e�csi� ccprese[�ted in L':�se e�or.une�cs is consis�en� wic� the bui!dic,g placs, <br /> `��ecifiCatiotis, and ather eaIeutadons �bmitt d wic,�: the per.nit app!icar.oR. T1;- pcoFosed buildir:g has been desirned co ;,ieec ct:e <br />;� ��quirement3 of t�te i1�tinaesota�nargy�odr. <br /> ,�L�p� ,�,.� -�. ,B�-� ��1�� ssa-9 y�c�ai� <br /> ;pplicant(princ name) Si atvse pa•� ' - <br /> : <br /> • Te?ephone r.ur.�ec <br /> � <br /> �?�r� `�-,►z• V ��\ .l. ,� �1�11� (Sub�nit P�rt C2 upaa comp[etion of syste� verifir.atioa�) <br /> 'C -------------------i___ --_�-- ------- ------ ----- -------- ----- ---, ------ <br /> ;�b Site Addt:ss;��e// , C�✓�"'o P.:mu N�rr:r_: <br /> , ------- <br />; ��►n d�scripaon or tocaaon � ( 70't'ALS <br /> ,":.E.�SU'R.ED Intaicc � ' cfm � cirn ' cfm cf�: c�rh <br /> 'i�12F4R.�L��iCEfi E:ch�ust cfm � c;r-: c�rr, c�:n i cfm <br /> �—..__.^ <br /> ' Vtntitation race mus�be maasured�nc ve:r�tird �.�'EteR tfl� pe;ie.�a^c:opt:ur. is u5ed in l�eu of ch� prescripriv: cp���.,; for :t;: s::�licg <br /> oPjoitits in the buildir.g condirionc� �:r:velc�p= (fror.: Par..�). <br /> ,�mp(isnce Statement: Ins�ulfe�vrnt�:acion ��;tcro s ir.<.ompl:an�e �.�•::'^. �C� �r.z:��v Co�e 1r.� is sizcd to pr�v;�r. ;hc d_�tg� �ii t?o��. <br /> `'`1 — -� — "� — — ------� <br /> �p 1 n[(prtr.[name} , Si;; aNrc Ca�, _ ,..i. � <br /> T...,. .or.z r.�.r�:�r- <br />