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J\ <br />FORM INSTRUCTION3: � pl��i� n�d D�fon compl�tlnp form <br />FIII In all shaded Inlormatbn boxee thal apply to your projed. fln.aol place marke in ihF two lelt slde <br />columna labeled' COMPLIANCE REOUIRED' and 'INSPECTtON APPROVED•. Since this torm <br />wlll be evalueted for corrpleleneee, you can avold unecestary parmtt tlelaye by carelully providinp all <br />required IMormatbn. You may dierepard ir�ormatbn requeMes that don't addreas your part�ular <br />bul101rq or equpmeM. <br />StaH mambers will help wRh peneral questbns about Illllnp out this form. However, fl is your <br />reporroibilfly to provide epec8k Infortnation for heatinp syatema, plezirp, insulatbn, and other <br />bulldirp speclllcatWns. For specHk requiremenls, refer to the NOAhweet Enerpy Code, 7987 Editbn. <br />Thle lorm will uRlmalely ba the basie lor all NWEC tield Inspedions. You can evoid problems by <br />eeekirp approvel for any subetltutions belore incorporetinp them IMo Ihe pro�ed. The building official <br />may requlre ihet you substwMlate complience clalms ebout bulldinp products ar techniques by <br />provldirp documentetion irom approved testinp apancles or code euthoritles auch as ICBO. <br />When your permfl Is Issued, you will receive a copy ot this torm. Boxes wlll be checked under <br />'COMPLIANCE RE�UIRED" Indicatlnp NWEC requlremems that must be incorporated Into ihis <br />proJed. Eech chedced requirement wlll be eveluated by the buliding Insper.tor and , when deemed <br />acceptebte, marked approved In the 'INSPECTION APPROVED' column. <br />NAMF R S. Q�SH�YtE BUILDING ADDRESS z� ��'��� �' �OT I_ <br />BUILDING TYPE: ���,,,(((��_ COMPLIANCE PATH: <br />❑ New Resldenlial: �hsinple Fam. �Chapter 6(< 5000 F12) <br />�Remodel ❑ Multl Fam. omponent PeAormance Ch#5 <br />tldltion ❑# Storles_ (s 3) Systems Analysis Chp 4 <br />� Polnls System Chq7 <br />Heetinp System Type: NOTE: an non•oismnc.��y nearad <br />Ela tric: tlw�lllnpa musf comply wlth the <br />�ase board �Forced alr lumace 188B Wath/npfon Staf� Enarpy <br />OHeat pump OZone heaters Cotl� �nd ot��r ordlnenc�s o! thls <br />�Other ��� <br />wEc� �reu �o <br />NWEC plan /evleW: (Depanment use only) <br />Approved by. Dats p�p� t of � <br />