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Date~ •.._ .[ t_�_.�.._.__...__.._. _ <br />7 - 9 / ,-, <br />._...... . __. <br />_. <br />Applicationp/Permit /..........__......._._._._._...---_.._------.- <br />Owner ...... 1�Q �.. . ... %�/�.�-/ S_ . <br />_.. _ _ _.. _...... .. ... <br />SiteAddrtat____.._._.._.....�°y.—_—. PL. ,SE <br />_ . . ... ----- <br />Asscssor's_Property Tax_Account No. <br />• <br />. <br />• <br />• <br />• <br />. <br />. <br />� <br />• <br />• <br />• <br />•. <br />02U0 <br />oweisc nceio�w <br />t'•��.1 D' �^:••:i'"' <br />,;,. <br />Sile Addreea ................................��� _' P�.. .SE . <br />q.. ............... .... q..�.................................................................................................................................... <br />Owner'eAddreae......�../..OS...........�C�S......IL::....SFC (i �. O 2 V <br />. iry .............'��%��......... Zip..'%.�.../...... Phone ...�t��.-...�3CI.8 <br />...... . <br />Builder . ........ .. .�.......� � G L / .5 .................. Addreae ......................__ <br />Clry <br />� <br />�nnR <br />Ph o n e .. ......................... ........... <br />PRpJECT DESCRIPTION: <br />{�'�sW O AdCitlon u�, �Qf Sinple FamiH / of Stories ..........:........... <br />O Remodel G CondNfoned Sq. Ft. .. ��. �" Q Mufli•Famiy / of Un(Is ......................... <br />� FUEL 80URCE: HEATIHG SYSTEM TYPE: , <br />�Eleciric O Basebwrd <br />O 0(I O Heal pump HSPF .............................. <br />O Wall heater O Olher ................................................ <br />O Gae � Furnace AFUE ................... Q Total Inatalled watls ar BTU9 ,.,..,.,,,,, <br />� <br />•.�.�...�..�������.C���.��.���.�.�.�.�.�..�..�...���� <br />Check one ol Ihe ComplWnu OpUon Boxee below. IrisM tl�e wlues In�o boM number 1. &lo�e complelinp Ihis <br />sectlon reler lo Ihe InsirucBons on 6�ck ol lorm. <br />EI�elrie - Norlhwnl En�rqy Cod�, Olh�r Fuel Source� • <br />Ch�plu 6 W�ihlnqton Sl�te Enerp� Cad� <br />O WeII In�ulated Floor Q Syetemt Anaye(s, Q Pteaciiptive Approach, <br />�P��o� Chapler 4 Chapter 6 <br />O Well Ineulated Wall �j Component Perormance, O Component PeAormance <br />Option Chapter S Approach, Chapter 4 <br />O Peaeivr S;;ar Opllon O Cempener.t pofnt Syalem, p Systeme Analynls, <br />O Hmt Pump Opt(on Chapler 7 Chapter 5 <br />FOR DEPARTMENT USE ONIY: <br />Amoum ol Paymenl 5 ...................................... <br />Date Permit leeued <br />Dale Permit Fnaled .................... <br />I here�y certily Iha� Ihi� dwellinp wae 6uiA in <br />complunce wAh the NWEC. <br />.................._...................... ....................._........... <br />BuiMinp Oflkul or Aul�onted Apenl <br />...................................................._._..__....�_...... <br />D��e <br />CDMPOHENT� <br />Fiat Ceilinq <br />Vaulled Ceilinp <br />Watt <br />Below Grade Wall: <br />interior <br />exterior <br />R............ <br />R.. <br />Floor R.�.�. <br />Slab on GraAe R......... . <br />Doae b f�ame 11/Y �.� <br />Glazinp U <br />7CGIazinO /, ...',� <br />SolarAllowance ..........% <br />Aif Lealwpe TD OADV <br />••••.••.•• <br />I hereby utliy ih�� �he sWcmrv pmeLs wi�l mec� ttK NWEC Formaldehydt rcQuiremtnh • eilher Ihe <br />MqD sl+ndads or ma hed'ntennf or'e.posure I' <br />�ar u�rlt ��J �� <br />..... 6 . ! ......................... . .... .... ��y��...'....... <br />D nl Nune �pn�Wre <br />TM lonl wAsdicUon/elxlrk uuliry wiu m�ke � paymenl to eilher the buiWei ar owner lor newelxlrfulYy <br />halM residenus. Permil must be Issued by 1T17IN1 and construcoon fln�kd Dy NJ092 in order to <br />qwlily lor p�ymenl. To I�cili�le p�ymmt, Ihe IollovAnp inlorm�tlon mus� he Alkd out compMlely. <br />— — — — — — — — — — — — — — — — — — — — — — — — — � <br />Millche�o:�pk�scpnnt) ADDITIONS/RIiMODfiLS NOT f:LIG111I,f:) <br />�v // <br />Name ..7� .G..� O,/,Za. ..aS....... Fed,,Iau ID or gSl.d'.�.,.�.`.�. .t.�SZ�ir ............. <br />� � <br />Addreae �'� Q , „ _,.,�� , /� �C. <br />. .................................... <br />�M. � ..........,1% .� .. .... .... ..... . .... . <br />... ... . ............... . . - .✓./�.................. Iip.....�"�1.��.. ......... <br />