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� .; Ctty of Ml�neapolia <br /> _ Homeowner Heat Loss and Equipment Identification Form � �` <br /> � � <br /> �tl� Servic� <br /> xomeow�er At-las 1-�or�CS tN G c3�as co�actor �rt'a-I'Lw I�e� G as <br /> Job addr�15.'t4 M iY111 t. Contr Phone Gl.� " •?C� -�3!?.�. <br /> comr Phone (o(� "9 I g •Q53�S <br /> City of Mim�eapolu requiros d�is�haat l�form For furnaoea and boilais inetalkd in single tamily homes or ' <br /> duplaocee be leJ1�dke fob ahs. ' <br /> Do 0ot aubmit tl�hee�g loed c�lwtations with your permit applicacion. <br /> (Noa:I'ou cor une the,�re.yrnr are�lY usln�as lon{g Jx�t!t ha�s aU tha l�'a�atbn c�or�winadon the Clty,�'vrrn). <br /> Meaw ementa sutd calculatlons: <br /> 1. sq.Ft e�paea w.11s above grad��sq8 x"u"•o �x s8 de�ee dasi�n�anpaatwr � 13 , y 9� <br /> (Note:A typka!2x��U w3di 1x1 wnoal fiwinbg wUlaut fns�latlo»ha� � <br /> a U vrrlua oj 1.AB and a w�all with 3�."of tntu/ation has a "U"vabie of 0.063.) <br /> 2. Sq.Ft of tfie oeilio� �� � sq8 x"U"y O�i.�x 88 - 3 ! 5� � <br /> (Note:A ryptcal 2x�fi�mning wtth S"oJt�sulatton haa a U vahre <br /> oJO.OS,wllh 9"of tnswlaHon has a U vdwe oj0.032.) <br /> 3. 3q.ft of bas�flo�aroa below iS�„sqft x 3 Btu's/Sq Ft � �� <br /> 4.Sq.R.of well arai bebw �sqft x 6 Bw's/Sq.Ft - �'i�� <br /> s.L�a.�of����:�;.�. �ao x c.s>x�.os x se -S�0-3 <br /> , <br /> 6.Lin.Ft of infilus�ion f�dours- 3� x(1.25)X(1.08)x 88 s ��7 � <br /> 7.Lin.Ft of in5ldation for sliding �_x(.75)X(1.08)x 88 = 1?� <br /> 8.Allowanoa for eachaust f�s:600�u's per kitdnn fan 200 Btu's per Bath�: - I� �1� <br /> 9.Allowamoe for firaplace�: 1,500 Btu's each = /Jr d�C� <br /> 19.Tohl�a loss�r a0 abuve kema-- - - = 3 S ,y 6 � <br /> 11.A�Fa camb�tio�n air(0.001)x net l�ss above x(12.5)x(0.075)x 8& = 3 � 7 <br /> 1�.Tanl lisea 10 a�d ii a de�he reac laa(Or sNba�xts beat lara j�rr otl ie� � ��i�?7 <br /> 13.ssae�►be��-M.nlp�ie.�b..by�.�o bu�e�a�e.aa&�a�dlow�. - `1 S • SS�1 <br /> (Thia l�d�e alme f�nace y�u aho�u/d u�e 1n th/s atructure. Ths codc dvss allow y+nu to ase the nart ahe a�rllabk prov�ling <br /> thr�die appruprlate oq�t Ls not�odJty aNaf/able.Fqulp�ad whase capxfry exeeeds the deslgn/oad may be�ted�J' <br /> � the overall arua�a!ane�►catls ane not lr�d) <br /> The t�signed,as applic�nt for a 1�Permit.ha�abY affirms the above infortnation hes ban prepaned by a for <br /> himlhaceel�a w�da�his/hx diroction;turaby sdQawl�the infortnation to be ooRect and ma�cate. <br /> Proposed futnace/boiler siz�: e►e Btu's. Proposed furnace/boiler make:�ooGQMQ � <br /> Proposed . C� O �1 <br /> Si -� Date• $ '' �.5 " l 3 <br /> Fotm can be fanid online at www.minneanoli�n.�v/www/arouas/uublicJC�vioes/doaio�/weboonoait/convart 280467.p�f <br />