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Date_ I�1� Y_
<br /> APPlicatioNpermit f_
<br /> �Wt1Ef_�L.L'.��_��Y`�__ '•., l 0 W R I�E R E S I 0 E N T I A L ;'�:
<br /> SReAddras__��_L.Lg%1__�r`�L��1Ql.0 �..1�� 1 � � ' ' � I
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<br /> • Sfte Addras ....1�.�,......... � 1 AY 1 i'�Q.. V1G� �f
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<br /> � Owner'sAddress..�OZ;O......�.{..�.�........ •.S\� ; �B 2
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<br /> y� ........ Ciry....�:Q!�f .. .........rp..iS��.l..Phone....`..7.'1.�,�-��I
<br /> Builder.....l./ � r� —
<br /> ................. ......
<br /> W�?:.......�.:.�.........................Addresa.......�SY.l��...........................................................................................
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<br /> . Cdy.................................................................................................Tip........................._.........Phone.....Sa.`::^:�.................................
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<br /> • P,R�ECTUESCRIFTION: O��/111 �r
<br /> ; �INew O Additfon '�Ro� • (�
<br /> ,�1 r, Z S+n/le-Fairtiy Co�n•�u�c.aC/ot Stories...1r...:...........
<br /> � O Remodel ��Sq.R....C��..fT.it O Muhi•Fami
<br /> • N �ai Jnits.........................
<br /> FUEL SOURCE HEATING SYSTEM TYPE
<br /> � O'�lectric O Basebaard O Heat pump HSPF ..............................
<br /> � O Oil �9Vall heater O Other......................................... .. .
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<br /> • Gae O Furnace ARJE................... O Total insqlled watts ar 8TU's..�(�O
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<br /> � � � � � � � � � � � � � � � � � / �� � v � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �
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<br /> ' �i � • � �• i COMPONENT �p
<br /> Flat Ceilinp R,�.p,
<br /> CMdc anr of the Compi�np Opypo gaces pdaw,lisert tAe vdues inlo box number�.Belon complNinq Ihis Vaulted Ceilinp R. .
<br /> uNan tehr ro tlr Imhuctlo�xan b�cic al torm. Wall R.,�
<br /> EluUie-Norfhwnt En�rpy Cod�, O��r �_. Below Grade Wall:
<br /> ChtptK 6 n ��� interior R..�..
<br /> O Well Ineulated Floor Q S tema Analysia, rceeriptrve Approach,
<br /> ya exterior R..../.......
<br /> � �D�� Ctwpter 4 Chapter 6 Floor R..l...
<br /> O Well Ineulated Wall O Component Performance, ormance Siab on Grade R.
<br /> Optkn Chapter 5 Approach,Chapter 4 Daon 6 Frsme U.! . „..
<br /> O Paasive Salar Option O Cemponem point System, O Systems Analysia, Glazinp U.
<br /> O Heat Pump Option Chapter 7 Chapier 5 N,Glazinq .,�.
<br /> SolarAllovranee ..........!/,
<br /> Air Leakape O STD O ADV
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<br /> FOR DEPARTMENT USE ONLY: � • � . • , , � � �
<br /> Amou�RolPaymeirtS .......:. ._..,,_,,,;,,.,, ����W�dietlanhlxUicutllirywilm�laaWym mttoeiMerlhebuild�rorownarforn�weNetriraly
<br /> � . . . hmted rcsidences.Pormil must M issuM by 17/31N1 ond constnictlon fin�bdryy 6/30/02 in ordrr ta
<br /> Vu�liry Iw p�yment.To hciliub paymen4 IM lollowin inlortn�Gai must be filled ou[canpktely.
<br /> Daze PermA iasued ._..._.:: ..._...._..:„. 0�Qa or AuMoriu�q��nL• II� � y� ��.-,
<br /> .. -?A,Y.Y.I.C?.11....!.._,lS:1C.1:1��I........... ....;W,,,1 4�. .�A.�...!..��.L1.1,11,,,,,,,
<br /> DatePermRFinabd.........:._...„...._.....:...._:_... PnntNune Sipn�Wm
<br /> I herc6y artily tlut Ihe slNclud pu�ek will meet the NWEC Fortn�kehyde repuinmenb•either Iha
<br /> I Aereby certity that thia dWelfinp was bciR in. HUD snnduds ormarked'e:tedor or'ezposum 1'
<br /> compliance wrth tha NWEC. Mtll chuk to:(pkue prjnp /�
<br /> _......_......�................_......_......._............ w. n
<br /> Name..�1'��0.�..��C. ed.Tax I or SS�.......C..Z,..�.J..J.��.�'�.!.5.��....
<br /> BuiklnQOffid�lorAuthor¢MAQent .. Address .�.�ll....�.Q:�.......... ........��............................�,j..Q..........................._...
<br /> 0�4............._..............._.:__..�_._.`......_.......... Ciry......��V.:�L1.t�. ................... tp.....••1.0 w�,�.................
<br /> _ 1 Noh:M ias hrm�099 M�a t�n�u aN Ma or er yur.
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