Loading...
HomeMy WebLinkAboutBLD19486 SFR - BLD Permit / Conditions - 10/22/1986 TYPE RESIDENCE Permit No. 19486 No. Floors 2 Sq Ftg 1536 Owner SEELEY, Ralph Tel 377-3711 Date 10-22-86 Address Box 483 Bremerton Zip Contractor Reuben Caldwell Address 134 Gold Cr. Rd. W Bremerton Zip Legal Description Tr 11, NE 11-23-2 Direction to project site NE 6630 Elfendahl Pass Rd Belfair Plumbing x Mechanical x Sewer Wood Stove x Fireplace Deck 252 Garage Carport Basement Loft Other 2 bdrm Shorelines: /y/k Plumbing VJ Setback: Mechanic Special Interior: Conditions: FINAL: Mobile Home: Smoke Detector: Remarks: Footing: 2g � Setback: Foundation , Walls: k-lt) '1 1 L Framing: s' a - J t�� PERMIT Fireplace: NULL & VO+D BY EXPIRAI i"?N1 Wood Stove: ATE 1 8Y I EXHIBIT 'A' TRACT 11 OF SURVEY RECORDED IN VOLUME 4 OF SURVEYS, PAGE 19-22 UNDER AUDITOR'S FILE NO. 345571 AND BEING A PORTION OF THE NORTHEAST QUARTER OF SECTION 11, TOWNSHIP 23 NORTH, RANGE 2 WEST W.M., IN MASON COUNTY, WASHINGTON. TOGETHER WITH AND SUBJECT TO A 60 FOOT WIDE EASEKNT FOR INGRESS, EGRESS, DRAINAGE AND UTILITY PURPOSES OVER, UPON, UNDER All) ACROSS THE NORTH ONE-HALF OF SECTION 11, TOWNSHIP 23 NORTH, RAKE 2 WEST, M.M., IN MASON COUNTY, WASHINGTON, LYING EASTERLY OF THE TAHUYA RIVER, AS SET FORTH IN INSTRUMENT RECORDED JUNE 5, 1978 UNDER AUDITOR'S FILE NO. 344111. y i COUNll tar........................... On this day M%onrdN arlwared before me On this....._.Jay of.............................� Nancy R. Ro ..............._....._.......19......... b Sert Emit Weishaar before me.the urd—igned.a Notary PuhBc in and fM the State d�s..AirlFrra•dal! ...................................................... commiawioned and sworn.M%onalk aryean:d..........................._........... ........ to me known to he the indiaidual dcscrthed In and who necutcd the within yr1d forr><oing Instrument. and .............................................................................................................. ac\mlalnlRed that ...i•ney...._ signed the same as and........................................................................................................ thea.r...._._.._.._...free and%vthmur,act and deed.for the uses and PurMsKs Ihcrmin mentarted. far me ln to he the......................Pr"ident and......................secretary. r"ftntiamly.of......................................................................................... uv N under my hard and official Kal Ih� the cmN-F3tkm Ihal"mated the foreroinl insrument,and ackm"k*cd the said in- day of.... A8 strument to be the free and voluntary act and deed of said corn—atkwt.few the uses 16 Juiy.... .. 19....... ••"•••' � Y�':"':'""- 'and PurMta"therein mentioned,and rwt nth atatrJ that •�iJ� ' awhnrirnl to nccmed the acid iMlramMl and that the KAI Affianf K the CtnMt0le .......... �•r� ..• .•.G•..G'!..i.:'.}.�...• weal of said—,mrnm— Notary Public to and IFrLtftOt?�aaahinFlnn. tiding at ...........................f...................... R'itrt"s my hand and official Kal berets affiaed the day atl war first aMwe ply commission expires: May 15, 1987ritten. ............................................................................................................. Noun Public in and few the State of A'3ahinrks4 residingat.............................................. taw Ir+ • MASON COUNTY P.O. BOX 186 Sheltpn,Washington 98584 PLUMBING PERMIT APPLICATION IMPORTANT—Complete ALL items. Mark boxes where applicable. Name Mailing address—Number,street,city,and State Zip code Tel.No. ,. IQ41-PI-I V 63 Al /O 377 37(/ Owner 0-.91U 37Z-Z72e 2. ,QF U�iG��!_L /S L�L1� C�c'L�,e jz 3i Z �'`�7 Contractor The owner of this building and the undersigned agree to conform to all applicable laws of Mason County and State of Washington Signature of applicants Address Application date LEGA DESCRIPTION Location Of Building NO. PLUMBING FIXTURES FEE WATER CLOSETS 2 ;41/1 zv BASINS BATH TUBS SHOWERS /t WATER HEATERS AUTO.WASHERS QQ SINKS i FLOOR DRAINS DRINKING FOUNTAINS LAUNDRY TRAYS Connect to City Sewer DISH WASHER DISPOSAL URINAL (Show Street Names & Property Lines) INDICATE LOCATION OF MAIN SHUTOFF VALVE FOR WATER. PERMIT 3 C SKETCH IN SEPTIC TANK & DRAIN FIELD LOCATION OR SUBMIT ON OTHER SKETCH. DO NOT WRITE IN THIS SPACE — FOR OFFICE USE Approved by Permit fee Date pemit issued Permit number Receipt No. CHRISTMASTOWN PRINTING T I ..eAss.�. 3 c►Z .q-7 Z I 0 L9 Az 0 r - � r O ` ^ T VOCET SOLJND POWER & LIGHT CO. HEkf.L0SS Ir:FOP.MATION SMI.R. ARy (For Central Heating Systems (electric forced air, hydronxc, etc.) NA'LE C.o < - 12ra( ADDRESS TELEPHONE: HOiLE ?(j_ `1 4 e� 4;0RK Style of house (check one) : One-story rambler Multiple story , Split level Other (specify) -�� Type of electric heating system planned SOURCE OF HF-AT LOSS Sq. Footage Insulation Puget Recommei MALL S (type-inches Cross exterior framed wall or R-value) Windows (single) Zdindows (insulated) �y Z Doors _ Insulated Net exterior frame wall -�� h'et concrete/ walls (above grade) 3�" ( ll) CEILING With vented attic above OOP Open bean type construction '� )-Olt (R-30) �•o" EI7-3o) FLOORS Over vented crawl space Over unvented, unheated area 61' (R-19) Concrete, including below-grade walls 6" (R-19) (indicate-lineal feet) 2" (R-7) V0 IA.II?:1 Infiltration (1 air change per hour) Floor square foo[age x ceiling height cubic feet DUCT LOSS - Percentage of ducts in unheated area Lpp Insulation wrap (in inches) � C01-ZIEUTS: / S, 8-o t� (.vim, a 3q.13 cs- Uc _L' 40t- F-"T-ft� Please fill out and re-turn to: Puget Sound Power & Light Co. P.O. Box 379 *Ie I3re.Lerton, 1.71 9833.0 Sure to indicate lineal fEet Attic: Marketing I)c-pt. **. If below grade walls are insulated c - Tel. 37 7-3 J.i.l- TICOR TITLE .r.'.rar•w.. INSURANCE sae.cF«worn rna nrrownr ausr A,5.98U �V Filed for Record at Request of REEL34-I_ AFTER RECORDING MAIL TO: u JUL 29 P I : 10 ,�,n 4Ak, 1 ,L1 CjIr,, REOUEST OF HOFAE TITLE COMPANY 10U58 P.O.Box Z-Shelton 426 1626 FORM L-Sa(aa+) Statutory Warranty Deed THE GRANTOR NANCY R. WEISHAAR, FORMERLY NANCY R. NEHL AND ROBERT E. WEISHAAR, HER ONLY HUSBAND SINCE MAY 26, 1978 for and in consideration of TEN AND NO-100 DOLLARS AND OTHER GOOD AND VALUABLE CONSIDERATION in hand paid,conveys and warrants to C. SUSAN CROWELL, A SINGLE WOMAN the following described real estate,situated in the County of MASON ,State of Washington: SEE EXHIBIT 'A' ON ATTACHED RIDER WHICH BY THIS REFERENCE IS MADE A PART HEREOF. SUBJECT TO: EASEMENT RECORDED APRIL 19, 1979 UNDER AUDITOR'S FILE NO. 343098; EASEMENT RECORDED MAY 9, 1978 UNDER AUDITOR'S FILE NO. 344111 FOR INGRESS, EGRESS AND UTILITIES; RIGHTS, RESTRICTIONS AND RESERVATIONS CONTAINED IN PROTECTIVE COVENANTS RECORDED 4-24-78 UNDER AUDITOR'S FILE NO. 343246; RIGHTS;-RESTRICTIONS AND RESERVATIONS SHOWN WITHIN SAID PLAT; PROVISIONS CONTAIKED IN THE ARTICLES OF INCORPORATION AND BYLAWS OF TOONERVILLE ACREAGE TRACTS ROAD MAINTENtNCE FUND. wM Rvyy�Sv��rr •AIDrt1��" Dated this 16TH dayof JULY, 1986 JUL 2 9 1986 I DURLNL RA c C• C 1•T1C't.:�'e-'t .. :......4: -.Svr?.� F:�.rBc ...,...L.r�/ .1tf� <'-C....d............. ...vnC..... By NANCY R. WE"HAAR ROBERT EMIL WEISHAAR By .................................................................... By ................................................................................. STATE.OF WASHINGTON STATE OI 1144SHIN1711CIN j COl'NTY OF.......Kl tSa.p.._.._.. } ss COUNT\OF.................................. On this dac rersonally appeared Wore me On tt.........day of................................................... 19........, Nancy R. 6 RoSert Emil Wei shaar before re.the undersigned,a Notary pwhPe in and for the Crate of\\ashinelon.dub - ........................................................................ comml cw.wd and sworn,rtcramall)aprw•arcJ........................... ................... to ma•kntwcn to tY the imh%idual dewrihed in and whu noted the within qqJ foregoing m%itument. and .............................................................................................................. acknowledged that ._L.n.ey...... signed the same as and....................................................................................................... their.......-----.free and cnluntarr act and deed,for the uses and purpose there..mentioned. to me kth+n to he the......................President and....................scv,etan, resrw•ct„r',.of............................................................_........................ GI\'FN under in, hand and official teal t� the eor"ism that inectued the tmevoinr in.trument,and a:kmw.lcdecd die said in. JOY ^B6 ttrumrnt to to the free and cnluniar act and deeJ o1 sa,J cnrN•a irm,fill the nse' ..16.day or r.. - ... .....Y..... i.......19.:...... .../ Y '• - •anJ purpc^a therein mrntinneJ,and nil oath an1N that........-d,%..a c........it, .. �� ....� .i,..(f:)s.r r.L:.... ' atuhorra:",necuted the said in,trumem and that the.rat aft-c:d n the acrrwwate .. ........•r'�`� teal of a tJ cornorarion. Ne'laty 1'uFhc in at for th St nr ka%htngton, reciting at �rt br �.....d............ Mltrwrc my hand and official teal hrrcut affised the Jac mra)rnr lira ahmr ........... ........ My commission expires: May 15, 1989i11c" Notary Public in and in the state If Nach itr!I teidineal ........................................ ... c.a w.to EXHIBIT 'A' TRACT 11 SURVEY R IN VOLUME 4 19-22 OF S E RECORDED E OF SURVEYS PAGE UNDER AUDITOR'S FILE NO. 345571 AND BEING A PORTION OF THE NORTHEAST QUARTER OF SECTION 11 TOWNSHIP 23 NORTH, RANGE 2 WEST M.M., IN MASON COUNTY, WASHINGTON. TOGETHER WITH AND SUBJECT TO A 60 FOOT WIDE EASEMENT FOR INGRESS, EGRESS, DRAINAGE AND UTILITY PURPOSES OVER, UPON, UNDER Ala ACROSS THE NORTH ONE-HALF OF SECTION 11, TOWNSHIP 23 NORTH, RANGE 2 WEST, W.M., IN MASON COUNTY, WASHINGTON, LYING EASTERLY OF THE TAHUYA RIVER, AS SET FORTH IN INSTRUMENT RECORDED JUNE 5, 1978 UTAER AUDITOR'S FILE NO. 344111. T COUNr1(11 ---'.................:........... . (,n rhia day reramnatic aPKared Wort me on to......_day of.............................................................19......... Nancy R. b RoSert Emil Meishaar before me the und—igned,a Nmary Puhlic in and for the Stare of N'eahinFrmn,dul• ....................................................................... cnmmia..vrcd and axarcn,perannally appeareJ............................................... to me Anman to tv the indnidual dcsctdcd in and whu e,otined the xiihin geld foterninF murumem, and .............................................................................................................. ac\nt•xledged that ....flQy...... signed the same as and........................................................................................................ Iree and anluntan act and deed.for the to me(noxn to he the......................President and...................... ae [reretan, usc•and purpns therein mentioned. G1\'r N tinder my hand and official seal Chia/ the eo,r—t on that esecuted dte loregrnnr imtrumem.and acknowledged the said in- ^B6/ s(rumaet to he the Iree and avlumarp an and deed of said.mr—arit•n,for the uacs day of�..y'......yJU�.Y.... 1/9/•=.... ,and Pur(xxes therein mcmioned.urd on math gated that............................... awh mr onml in taecwed the said imuumcnl and thin Ihr seal affiwJ i.the rmp<nare .e....a. ...e...G.cr.s ..*:.... atal of saal apnmllllll. NMar>Puhlia•in atdO�,rLthOPCllaf ngtnn, residing at ............................................... Maness my hand and official seal hereto affiscd the das and Vicar first shine My commission expires: May 15. 1987ri'1Pn ............................................................................... .....................Nolan Puhlk in and for the Stale of N'aahinpun, residingat................................................... i I � • Or �, • _. _ _ j 23 _.��. s� r� � -% tit' tir � _• � -- / / V• ry�N M �• 1�,,�.% `1• /B. , r .tee• ` /. `. -40 '!(/ �4 / y� �mac 5 •',�•20 _ r -'� /'V pGj /ry 7 y u o.^'� •.' 7v 5.0 pctiES ,9�xplgl o lL.� Vr F •V I ` ` 0 0 y c a �• c i� '+ irr.' C �. ji. r SurvC �/ r 44 Of N _ - t��r4 'LE.i •_.'•j.-�S�> �i a •\ � .,. vU Q� � _ �j e J 2 �v ,'p y,,�t:f�'. Z", sac";-+wa+ �s � 87'�� E �• x ;,. ram.".•r y �; ,'��: -� � ,:y' � a r..�� N � `�::•i'�'1,�,.Y� �1• S.a nrc+E' Nor• Ct 's'•b......�"`_ +, ! � ^r.r.•��..�'-,.r •����;�. 1 - •• O ioformallon supplied harem 13 from company recorua us,! and Is supplied for k4wmatlonaf purposes only at your re a,eet.No liability Is eaaumed for any errors and or on le. dory and all"u"do not purport to stow all roads and L QP p mAcrW M. NTY INC j�.` �,cyL1•,.,' r wawnents affecting said property, "¢ `. -;� r ;, ; ; y_ _��.;� w; :•t_� Howe TITLE CO.or MASON COUNTY 6�r W.COT -P.O.pOX 2•S+''.1TON,WA 9e4f.4 iti:-:.'• 'r y+1.ra�.�jA..,%= i 426.16211 Scam 3T7d017 (MC)426-i&M BfRELIEn^TOtJ;' )97 i•,;u,7 SHELTON Lake: 0; '4�r —= — ------� ' 427-9061 :z �` zs A / I 428 W BIRCH ~. p co i v 1�1 COLLIER CLINIC #10 �\4 ImnEW° �� V LACEY Gumm,ngs 491-1611 Y pant so z r / #5 SOUTH SOUND CENTER, LACE - �'�'� I✓off' ' - � �. r . I c•� /, C '4 '' �� COUNTY 'A✓Orsfeo rK 1 T S A P -- -�. yr Pon to •1 .�` c n ITpe' 6 oaf 4 kso `o �Osens AyoC► I �/ I -�LOkf 1 \• P`J6� . L ,n ake PafMelbourne - ifflocklmith Loke to41C �' i ^ e I Lake 71 J ook t �'" �� GomP Q , c Lake I p 0 d PO / p .ti is 17 1 R I6 ,1e a I• to Ik I�,J�1 spider1k is l / 17 i� co 1• 1 c ` -•; O I r' .1 P( Lake _[ £ Sul'kI/I I Y 'r r�.nwlcn«I 'a f. Y -r` .r(\ �a Pond f aF I �� kr//r�o ���IbwouO �O cJ !, --- I I '�a Patch Gp Fotis r ` Bl�nLok O sO Lok.�j I Lake 22 �y i ii ' 1e 22 �6t ��1 zk 3 i � 2S ; "''Is 20 a 4 16 Lake 3 11111woup ��� —� Woolenit( Corso Rahn 1 I nis Cr ` Loi- Ha✓en - - T- I soy of Lake ,� w ,2S, 01 26 1 23, \ 2e _27 of I Dewaffo o snee 6 Belfalr 1 I �.'' Loke Maven/VaY YI 3.4 I Long - -"�I Po�nf Erdm- - /RQ 1M Sava-q°' —�� ad Ta1wTa Rd sS n 1 I I ,ss Sk _321I — S I �a a 8elfal► E„a 300 � to -- —J IAfdricA 1 / o//ins IS.P. Loke _Coke Ikwauo Rd ,P,00 I- Howell ° �0°6 I I Y I a' �v roe --fpsII A -121 ke Cody Lake 1 'Jel k —6RDbr Lo cokeLIkI 3 Lone Rea I/I Rose 0 6 LfeeM �Or I 106 y � 10 S"sel Beoc� Derrreou.e ., I e Rd v' toy�� LOke wooa Cote Moppre �� �d/' 1 p 302 I 1 1 -I Ie ee�,,e D, 3 1 le(16- 16 Q 16 5 B ;� 1 Musouen W1ia Be\rlry1 -07— aho'sHdi AV Po,nr toLok0 _ Lake II tN nR N r- i I------ 36 I l.k. Allyn 01 I I o 0 20 21 TOhuyO 23 ( O y i b ( I r , O 16 O d e R ` • 2 oyrlt �! =1n y.d �� TS _ O 1 Pr!I 1 I V,Cforl - — r--- — r t fe ' I! - —__--- FUI ON COUNTARTMENT of GENERAL SERVICES , Courthouse Annex I N. Fourth & W. Cedar P.O. Box 186 Shelton Washin ton 98584 (206) 426-5593 _ f building environmental health maintenance parks&recreation planning sewer&water May 1986 TO: ALL BUILDING PERMIT APPLICANTS Q� SUBJECT: 1985 UNIFORM BUIDLING CODE REQUIREMENTS AND ENERGY CODE REQUIREMENTS �I ca4 This Department adopted the 1985 Uniform Building Code and Energy Code Requirements on April 1 , 1986 . In addition to the requirements mentioned on the attached memorandum, the following information will be needed with your application for building permit. Heat Loss Calculationsod Thermo Number of Windows (D4- Water Tank Model Number - ��l'Y1 A � ro�� Source of Heat and BTU Output 7S To help you with the required heat loss calculations, the following sources are available to *you: Harold Dahlke & Assc. 203 W Railroad 426-2550 Grant Foster & Assc. 717 W Railroad 426-0511 Before your building permit can be processed, we need the above mentioned heat loss calculation. We will begin to process the permit but the issuance will be held up until the calculation is received. — . • ::::::..;..::.:. ;'NORTH:: :...:. ....::,:::;: i & MANY MORE I T ♦ S %J 2 IHre'ad •HEARING EVALUATION-HOME OR OFFi ` �,I � I � I •% of •EXPERT FITTING ``r`--� _ _--� o •REPAIRS-BATTERIES-SERVICE ! •UNION PLANS&INSURANCE ACCEPTEE I / •CERTIFIED HEARING AID AUDIOLOGIST 9 I u LOke 12 1 --Aimstcony a Hdem°er ofNationalSSociety Member of id Soc r � Hearing Ago Souely Hearing Aid SocP� t / EVENINGS 3 SATURDAYS I i 101 /� BY APPOINTMENT 16 .♦',. SHELTON 427-9061 428 W BIRCH 22 G 23 %. P h wt COLLIER CLINIC #10 Eldon 1�1 LACEY Lonnw on Cummings 491-1611 Font ?#5 SOUTH SOUND CENTER, LA zr c c, <33 43' � COUNTY ' sled r- �K I T S A y a 4 T yer I ♦ � + 3 2 o y LOMe r ckson owes Ayock Y -Loke Pomf �— !�' a •. 9 LOk! C • Oak �+ r C� Comp r I I LOkf ap Pan is 17 16 / 1g nRtl ; F / °C fo ♦ ar s��f%/ Soide� .+" I fsj� �Qo 1• 17 i J° 1• c r , Sucke// sn H,rcna.r i Pond `-ds �� ( 0'♦F 0 ,� --- ° BenLaken'///111 I IAok Polch //' Lake ,p z2 Lake° ° , 2♦ 3 1 Y I 22 I 27 � ; '-'i! 2a z f ` Woolf ( I eb C MCM.yn1 1 �Q __.—. LOISo Rd 4 Have 11 a'- ��� ♦ Lake I or I 01 i I 'LOkf d ♦ 2 al — Rd 26 1 23 29 J27 26 6 ,d Belialr I Shoo o �� Loke \ l HdvM 4 Erdman leek- A� .— OAF a o ,��nnuy.Rd. I I 1 a ]♦ I 1q �a �s ellair E d 300 I to I I AldrichIS.9 P. o) Aldrich o/Bns roc Lake Rd Late -- ed ! - — De«a1w °iOO� Howell dA 1 I I Tee !21 D , ,w R Loke Cady LOke 2 ' 3 I s © Lows I 1 e ♦ '' I + Lone Duck ,I I .._._. Rose a _._. Pond -. _.. �. n .-- -- I C I od..• —P G t fM J 1 I i ,IU I\ 'e► o�ap I Beccn. 106 o 7 /I Devereou� Loke - - ---- H.,,S ` N P_ .. Lake I �? ew, r:o� 302 I 1 Wood Lake Moyyre T 1 �.1• Be.♦.nDr V • L -�,,,_ - -- - 16 Q fs 5 13 >> I 1 > _ N I Wr/d Berry 1 Ti99s Snore Hill A\1 --:--- a 0 Gar_ L o_ k�_ L oke ¢+ ec Rd N _ - Z ` 36 1 coon aake I Allyn a 12----- sl 12 o 23 21 Tcnuya 1 I a I v r i I o I I victor — ---I Pncke/I o LOke � 1 28 31 -- +uJk! 106 2! 27 26 I YS:'! Pond -4 TWANOH --- STATE PARK — V hru�ad t------- 122 r _ I sisters P°1nt °s c v _ W e Dr k, _ O 1. 1 Q :,If U t " 1 i _ / •..\}-J Allyn Is e 3 .. n,/ HLA I LUZJ LALL;ULA I IU(V TION ' PHONE NO. ��—4'LOCA k Ctr � 4Qj Acr®A/IF/R (BASED ON INSULATION VALUES LISTED) DESIGN TEMPERATURE DIFFERENCE DEGREE DAYS PLAN OR MODEL NO. DATED HEATED SQUARE FEET ADDED INSULATION HEATED SPACE - R-VALUE WATT Spp,CU. Spp CU SQ.,CU. SQ.,CU. SQ.,CU. Spp� Cu_ MATERIAL SOURCE OF TABLE LOSS OR LIN. WATT OR��LIN. WATT Q IIU- WATT Q LIN. WATT Q L U WATT oR LIN. WATT ONLY HEAT LOSS NO. FACTOR FEET LOSS FEET LOSS FEET LOSS LOSS LOSS FEET FEET FEET LO.:S GROSS WALLS EXTERIOR LESS WINDOWS 1 (SINGLE) LESS WINDOWS (DOUBLE LESS DOORS 1 NET WALLS- FRAME 2 or 12 NET WALLS- CONCRETE 3 or 13 ABOVE GRADE CEILING- VENTED ATTIC ABOVE 4 Ov r CEILING- OPEN BEAM 5 or 13 CONSTRUCTION FLOOR. OVER VENTED i c CRAWL SPACE 6 or 13 FLOOR- OVER UNVENTED 7 UNHEATED AREA FLOOR- SLAB INCLUDING BELOW 8 ^•RADEWALLS INDICATE LINEAL FEET COMMON WALLS 9 (MULTIPLE UNITS) COMMON CEILING 9 (MULTIPLE UNITS) COMMON FLOOR 9 (MULTIPLE UNITS) INFILTRATION (CU.FT.) 10 (- AIR CHANGE/HOUR) t INFILTRATION (CU.FT.) 10 SUNKEN BASEMENT':AIR CHANGE/HOUR TYPE OF HEAT WATT LOSS PER ROOM INSTALLED WATTAGE 84945 3-79 1.STRUCTURE HEAT LOSS(SHL)..............................I0Qlo_L WATTS 5. ESTIMATED DUCT HEAT LOSS- SHL(1) x DHLM (3)xFRACTION(4)-, f93 WATTS. 2. DUCT OR PIPING INSULATION(INCHES OR APPROX. R-VALUE) 6. TOTAL HEAT LOSS(ADD LINE 1 TO LINE 5)=................ L3l,51 WATTS. 3. DUCT HEAT LOSS MULTIPLIER(TABLE 11)DHLM= .................. - s Q 7. TOTAL INSTALLED WATTS PIZ4,Din rrv4v,#lca......../_!ZDD_L_'WATTS. 4. FRACTION OF DUCTWORK IN UNHEATED SPACE. WORKED� DATE u / r� PLAN OR MODEL NO. DATED GENERAL CONTRACTOR - CONSTRUCTED FOR ELECTRICAL CONTRACTOR JOB LOCATION NEW CONSTRUCTION ❑ CONVERSION ❑ hereby (name of General Contractor, Financing Institution or Owner) certify that the insulation R-Values listed below (insulation material only) will be installed and warrant that such installation will actually be made at the location listed above. INSULATION R Exterior frame walls R Exterior Concrete Walls above grade R Ceiling with vented attic above R Ceiling open beam construction R Floor over vented crawl space R Floor over unvented unheated area R Floor - concrete slab (Perimeter) R Concrete walls below grade R `Duct Insulation R MULTIPLE OCCUPANCY STRUCTURES (Exterior Exposures See Above) Common walls separating adjoining R living units Common ceiling separating adjoining R living units Common floors separating adjoining R living units Indicate insulation to be installed on ductwork or piping located in vented attics, crawl spaces, unheated garages and unheated basements when central electric systems are to be installed. SIGNED (General Contractor, Financing Institution or Owner) BY ITS DATE SIGNED (Individual) DATE .