The URL can be used to link to this page

Home My WebLink About4255 Pierce Streeti CITY OF WHEAT RIDGE Building Inspection Division (303) 235-2855 Office INSPECTION NOTICE Inspection Type: 2-i i (, rk [�,) �C-.- C U_�_ Job Address: 4,2 1� J g2e_, F- Permit Number: 7�?_;1) i ❑ No one available for inspection: Time% j2-2- AM/ � `ter Re -Inspection required: Yes �c_No When corrections have been made, schedule for re -inspection online at: h ttp://www. ci. whea tridge. co. us4nspection Date: I _ - . I T Inspector: DO NOT REMOVE THIS NOTICE i CITY OF WHEAT RIDGE Building Inspection Division (303) 235-2855 Office INSPECTION NOTICE Inspection Type: 2-i i (, rk [�,) �C-.- C U_�_ Job Address: 4,2 1� J g2e_, F- Permit Number: 7�?_;1) i ❑ No one available for inspection: Time% j2-2- AM/ � `ter Re -Inspection required: Yes �c_No When corrections have been made, schedule for re -inspection online at: h ttp://www. ci. whea tridge. co. us4nspection Date: I _ - . I T Inspector: DO NOT REMOVE THIS NOTICE City of Wheat Ridge Residential Mechanical PERMIT - 201902037 PERMIT NO: 201902037 ISSUED: 09/26/2019 JOB ADDRESS: 4255 Pierce St EXPIRES: 09/25/2020 JOB DESCRIPTION: Residential mechanical set and venting a free standing wood stove in the living room out of the roof. Manufacturer specs are included. *** CONTACTS *** OWNER (720)612-9226 DEBACA JASON MARTIN JR SUB (303)887-4727 JASON BRENDLINGER & ANDREA LAU 060165 FIREPLACE & GRILL EXPERTS *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 2405 / BARTHS, COULEHAN GRANGE, WHEAT BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 1,200.00 FEES Total Valuation 0.00 Use Tax 25.20 Permit Fee 50.30 ** TOTAL ** 75.50 *** COMMENTS *** *** CONDITIONS *** Work shall comply with 2012 IRC & 2017 NEC. Per IRC Sec. R314, smoke detectors are required to be installed in every sleeping room, in hallways outside of sleeping rooms, and on every level of the structure. I, byy myy s' nat re, do hereby attest that the work to be performed shall comply with all accompanying approved plans and specifications, ap'p icm%l u' ing codes, and all a licable municipal code polif s and pro edures, and that I am the legal owner or have been authorized by the I al ner of the grope an am uthorized to obtain thisrmit an perform the work described and approved in conjunction with this pe it. further attest that am I all authorized to inclu antities amed within this document as parties to the work to be perto a nd that all wo aper o ed is disclosed in this oment d/or its' accompanying approved plans and specifications. A 17 Si OWNER or CO CTOR (Circle one) ate 1,h' permit was issued based on the information provided in the permit application and accompanying plans and specifications and is subj to the compliance with those documents, and all applicable statutes, ordinances, regulations, policies and procedures. 2. This permit shall expire 365 days after the date of issuance regardless of activity. Requests for extension must be made in writing and received prior to the date of expiration. An extension of no more than 180 days made be granted at the discretion of the Chief Building Official and may be subject to a fee equal to one-half of the original ermit fee. 3. If this permit expires, a new permit may be required to be obtained. Issuance of a new permit shall be subject to the standard requirements, fees androcedures for approval of any new permit. Re -issuance or extension of expired permits is at the sole discretion of Official Chief Building Ocial and is not guaranteed. 4. No work of any manner shall be performed that shall results in a changeof the natural flow of water without prior and specific approval. 5. The permit holder shall notify the Building and Inspection Services Division in accordance with established policy of all required inspections and shall not proceed or conceal work without written approval of such work from the Building and Inspection Services Division. 6. T issuance or g ting of a permit shall not be construed to be a permit for, or an approval of, any violation of any provision of any pp;acable code o . y ordinance or regulation of this jurisdiction. Approval of work is subject to field inspection. Signature of Chief Building Official Date REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. City of � r Wheatedge COMMUNITY DEVELOPMENT Building & Inspection Services 7500 W. 291' Ave., Wheat Ridge, CO 80033 Office: 303-235-2855 * Fax: 303-237-8929 Inspection Line: 303-234-5933 Email: permits(a_ci.wheatridge.co.us I FOR OFFICE USE ONLY I Date: qlg / Plan/Permit # I �':: 9 0��3 Plan Review Fee: Building Permit Application *** Complete all applicable highlighted areas on both sides of this form. Incomplete applications may not be processed. *** Property Address: 'f.25 S Pr' c r e c S t e e t Property Owner (please print): C')7.^,-5 c De b uc,,,- Phone: 720-612 - `/126 Property Owner Email: C%r:s e pleb uca. P !am'a.'/' cc Tenant Name (Commercial Projects Only) Property Owner Mailing Address: (if different than property address) Address: Citv, State, Zi =I— Architect/Engineer - Architect/Engineer E-mail: Phone: Contractor Name: F`r <A/uc C City of Wheat Ridge License #: 060 %(,o.S Phone: 303- 0 0 7- `A717 Contractor E-mail Address: i n �dG z`he c,�s ore>, ccs -en For Plan Review Questions & Comments (please print): CONTACT NAME (please print): 111 c WulcaPhone: 3aT-957-1717 CONTACT EMAIL(please print): 1 r foa CC? the 00.5 Orr . c vM Sub Contractors (Must provide Wheat Ridge License No & Signed Subcontractor Authorization form): Electrical: Plumbing: Mechanical: W.R. City License # W.R. City License # W.R. City License # Other City Licensed Sub: Other City Licensed Sub: City License # City License # Complete all highlighted fields. ❑COMMERCIAL D4RESIDENTIAL Provide description of work: For ALL projects, provide a detailed description of work to be performed, including current use of areas, proposed uses, square footage, existing condition and proposed new condition, appliance size and efficiency, type and amount of materials to be used, etc. jet T Vent 4 r7ew tirC StG�t�.`• vVuaU'�tvv� i1 &/,e �i �,..� r004" Sq. FULF Amps Squares BTUs Gallons For Solar: KIN # of Panels Requires Structural For Commercial Projects Only: Occupancy Type: Construction Type: Occupancy Load: Square Footage: Project Value: (Contract value or the cost of all materials and labor included in the entire project) om s 126V OWNER/CONTRACTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT I hereby certify that the setback distances proposed by this permit application are accurate and do not violate applicable ordinances, rules or regulations of the City of Wheat Ridge or covenants, easements or restrictions of record; that all measurements shown and allegations made are accurate; that I have read and agree to abide by all conditions printed on this application and that I assume full responsibility for compliance with applicable City of Wheat Ridge codes and ordinances for work under any permit issued based on this application; that I am the legal owner or have been authorized by the legal owner of the property to perform the described work and am also authorized by the legal owner of any entity included on this application to list that entity on this application. I, the applicant for this building permit application, warrant the truthfulness of the information provided on the application. CIRCLE ONE: (OWNER (OC' NTRACTOR or (AUTHORIZED REPRESENTATIVE) of (OWNER) (CONTRACTOR) Signature (first and last name): DATE: Printed Name: ZONING COMMMENTS: Reviewer: BUILDING DEPARTMENT COMMENTS: Reviewer: PUBLIC WORKS COMMENTS: Reviewer: DEPARTMENT USE ONLY OCCUPANCY CLASSIFICATION: CONSTRUCTION TYPE: Building Division Valuation: Fireplace And Grill Experts Inc. <information@thegaspro.com> 7/19/2019 3:10 PM Bebaca To Fireplace & Grill Experts Inc. <info@thegaspro.com> Copy Andrea Lauricella <brendlinge@comcast.net> alPnt Cv'� �� Best Regards, Jason Brendlinger Fireplace & Grill Experts Inc. 30 Potomac Street tC-L .6Ovc Ce VAv NV: &c) �` ndlw5 Oct.etnJ\ Installation and Operating Instructions MorsO 2110 For use in North America MORSO JERNSTOBERI A/S . DK-79oo NYKOBING MORS E -Mail: stoves@morsoe.com • Website: www.morsoe.com Optional Accessories A wide range of accessories (such as handling gloves, fireside tools, glass cleaner and heat- proof paint) are available for use with your Morso stove. They help with day-to-day running and maintenance. Contact your Morso dealer for more information. The MorsO 2110 meets the U.S. Environmental Protection Agency's emission limits for wood heaters sold on or after July 1, iggo �mpot4AL We suggest that our woodburning hearth FIREPLACE INS -MUTE products be installed and serviced by professionals who are certified in the U.S. by the National Fireplace Institute' INFO as NFI Woodburning Specialists or who are ` certified in Canada by CERTIFIED `urnnxmfiearifad,w9 Wood Energy Technical - ww My recfenreor rrui�np Training (WM). The Morso 2110 are listed by OMNI -Test Laboratories, Inc. The test standards are ANSI/UL- 1482 for the United States and ULC S627 for Canada. The stove is listed for burning wood only. Do not burn other fuels. Under specific test conditions this heater has been shown to deliver heat at rates ranging from 81600 to 42,ioo Btu's. Cast iron Cast iron is a live material. There are no two ovens that are identical. This is partly due to the tolerances of the casting process, partly because the ovens are a work of craftsmanship. Minor unevennesses may also occur in the cast iron surface. City of ?C(, m r t Wh6a , , Ldge OM.MuNn DEVELOPMENT Building & Inspection Services 'Division 7500 W. 29 Ave., Wheat Ridge, CO 80033 Office; 303 - 235 -2855 * Fax: 303- 237 -8929 lnscectian line. 303 - 234 -5033 Building Permit Application piete all highlighted a s on boW s ides of this fwm. IncortIplie epgi' o Pi p 4255 St W h ea t R CO 80033 DeBaca, Christine pho (720) 612-9300 # •, O (p lea se Mailing dress; (if different than property address) d re s: Sal e as above i lat,i R Architec ngin r E-mail: Phone q Contractors City Uce #: 1 10035 035 Ph . 919 -622 -37 Contractor E-mail Address: tmorrisi@solarcity.com Sub Contra Electrical: Plumbing; Mechanica W.R. City license W,k City license # W,k City License Complete all information on BOTH sides of this form C L I PSE- ENG6NE ERI NG COM Budiding Department ement of R En-MEM • Building Jurisdiction: • Applicable Codes, • Ground Snow Load: • Roof Snow Load: • Basic Wind Speed: • Solar Modules: Wheat Ridge, Colorado 2009 International Building Code, ASCE 7-05 30 psf 30 psf (per building dept.) 100 mph, Exposure C Sincerely, APPROVED Eclipse Engineering, Inc. Subject to Field 33039 Wheat f`Wc e Bjjqcf Scoff Rafterman, EIT Date Y Project Engineer NN A Si g ried:, '-- / k± 1 ---'-,' -- Enclosed: Supporting Calculations P";" n 113 Wesl Mir, $* R Wsoh, MT 6W M 82W Ave, S* E, Weft, M1 M7 421 Vft 421 SPOAM, WA 9M 376 SW Ed Ds", sum 8, ow, OR 9 rM2 PWW (406) 721-6733 • FaX (406) MA M Phm (W) 862-3716 - Far 40rrM-3718 Phow (W) 921.7731. Fax 4 WO) 921-6704 PhWW (541) 3W0669 - Fax (TAI) 312vo9 Uum E C L I P S E- E G I N E E R 1 N G C O O +t 923 M4%, SUMS, S, f . W 5W 1005WffAveSWeE,WhWM,W5W 821 si $An- 422 rte WA 1. 376 SW Rd Drie, Sub E, BW, OR 87702 Phow ( ( 721.5733 w Fax ( ( 721 Q: ( ) N"716. Far -3728 Mm OW 9217731 • Fax 001 W1 : (91) MWO = F (641) 322.8708 0 " ECLI PS E Solar City 611812014 Calculations Sly E N G I N E E R I N G Project DeBaca Residence Client: Solar City EEI Proj. #: 14-06-196 Solar City Prof. #: 8004992 Date: 6/18/2014 Roof Angle: 14 deg Wind X: 121 Wind Exposure: C Building Dept: Wheat Ridge Ground Snow: 30 psf Wind Speed: 100 mph - 3 sec gust ROOF-LOADINIUSTIMATU DL Roof - DL (psf) Comp. Shingles M M @ 24" o.c. 11 5/8" Plywood Shtg 18 Misc 1.5 Total: 6,9 psf Use: 7 psf Dt. Solar Panel - Panel Length 65.0 in Panel Width 39.0 in Hardware Weight 6.668 lbs Panel Weight 45.2 lbs Panel CL 2.95 psf Total* M psf Use: 2.9 psf �� ECLI PSE Calculations E N G I N E E R I N G ROOF SNOW LOAD - Per The -Current IBC Section:1608 Roof Design Criteria Roof Pitch a 14 deg Ground Snow Load - P 30 psf Exposure Factor - C" = 1 Per ASCE Table 7-2 Thermal Factor - C = 11 Per ASCE Table 7-3 Importance Factor - I = 1 Per ASCE Table 7-4 CAT It Slope Factor - Co. = 1 Per ASCE Figure 7-2 Non-Slippery Flat Roof Snow Load - P = 23.1 psf Pr r = 0 7 * C * C I * I * P Minimum Flat Roof Load - P „ = 30 psf Per Bldg Dept Pft.j. = 30psf I Flat Roof Design Snow Load - P = 30 psf Sloped Roof Design Snow Load - Psi = 3H psf Psi, = CS1 * Pf New Roof Snow Load - Per ASCE 7, Section 7 New Thermal Factor - q = 1.2 Per ASCE Table 7-3 New Slope Factor - C, = 1.00 Per Bldg Dept Flat Roof Snow Load - P = 251 psf Pf,2 = 0,7 * C, Ct2 * I g Minimum Flat Roof Load - P = 30 psf Per Bldg Dept P 30psf I Flat Roof Design Snow Load - PQ = 30 psf Sloped Roof Design Snow Load - P, = X0 psf P52 = CS2 * Pf Estimated weight of Solar Panels W 2.9 psf Not Increase in Load on Roof W 32,9 psf Wt = PS 2 + WS % Increase in Load on Roof vvt * 100 F11 - NOTE: The increase in load on the roof from the addition of the solar panels is greater than the 5% allowed by the IBC; therefore, reference the attached roof structure capacity calculation, M 8004992 - DEBACA sectiGn M J =byDate SIVIR 6)18/20:14 Job Ref, 14-06-196 Sheet no.ftev. ApWdby Dte CRECK EXISTMfWTB,.--.MK STRUMMOMI) REAMANALYSIS-0 OJEWRINDS) In accordance with the ANSUAFSPA NDS-2012 using the ASD method Beam loads Dead full UDL 14 IbIft Snow full UDL 60 Wit PANELS Dead partlat UDL 6 IbIft from 42.00 in to 114,00 in Analysis results MIUM Dressed breadth b = 1.5 in Dressed depth d = 5.5 in Breadth of member b =1.5 in TEDDS calculation version 1.6,00 1 TTMT E N G I N E E R I N G Edipse Engineering 421 W, Riverside Ave., STE 421 Spokane, WA 99201 M R= caic, by Date Chk'd by I Date Date SMR, 811812014 Job Rot, 14-WI96 App'd by M. searing porpendicutar to gn - cl.3.10.2 Adjusted compression F,_, 505 1br1n Strength in bending - cl.3-3.1 Design bending stress F =1 lb/in' Vrength in shear parallel to grain Design shear stress F,'= 155 Win' Applied compression f, , = 179 lblin 2 PASS - Design compressive stress exceeds applied compressive stress at bearing Actual bending stress f =1487 Iblin' PASS - Design bending stress exceeds actual bending stress Actual shear stress f, = 73 Win' PASS - Design shear stress exceeds actual shear stress Deflection - cl.3.6.1 Allowable deflection ad , = 0.362 in Total deflection 0.305 in PASS - Design deflection is less than total deflection EXISTING 2X6 SPACED @ 24 O.C. IS ADEQUATE TO SUPPORT ADDITIONAL PANELLOAD i! Eclipse 421 W, Riverside Ave., STE 421 Spokane, WA 99201 Im 8004992 DEBAi A Section Cain. bi Date : 0 try Date SINR 61181201.,4 ;iau Rat..;. 14-06 -19 Sheet no.trev. "d by Date STRUCTURAL WQQDBEAIAANALY-Sl$,-6 In actordante with the ANSUAFSPA NDS-2011 using the ASD method Applied loading Beam loads PANELS Dead partial UDL 6 lblff from 20.00 in to 132.00 in Analysis results Design moment Nf = 482,9 lb_ft Design shear F = 376.1 lb Total load on member W = 112 7.1 lb Reaction at support A Rk m ,,, = 0 lb RA_nn = 0 lb Unfactored dead load reaction at support A R A _ De = 0 lb Unfactored snow load reaction at support A RAs. = 0 l Reaction at support B Rp ,, = 410 lb Rs. ill = 410 its Unfactored dead load reaction at support B Rs „,d = 94 lb Unfactored snow load reaction at support B R snow = 319 lb Reaction at support D R _ = 657 ib RC "6,, = 957 lb Unfactored dead load reaction at support D R Dead =157 lb Unfactored snow load reaction at support D R = SW lb Reaction at support D Rer,, = 60 lb R D _p, i , = 60 lb Unfactored dead load reaction at support D Ru_'Dead = 6 lb Unfactored snow load reaction at support D R o.'sw = 56 lb Sawn lumber section details Nominal breadth o r ,, = 2 in Dressed breadth b =1,5 in Nominal depth d, = 6 in Dressed depth d = 5.5 in Number of sections N=1 Breadth of member b =1.5 in Lumber grading No.2 Spruce- Fine -Fir Member details Service condition Dry Length of bearing L = 2 in 00 6/18/2014 :�: EC Ll PS E Calculations StR E N G I N E E R I N G SOLAR ARRAY CONNECTION TO EXISTING ROOF Wired Zone 1 Wind 'o DX•r 3 Second Wind Gust V = 100 mph 391 Ibs Importance Factor I = 1 L6; Net Design Wind Pressure - Figure 6 - 3 p,t3o = 16.5 psf 10 SQ FT Velocity Pressure Expo Coefficient - Figure 6 - 3 X = 1.21 p = Up to 15ft above grade Withdrawl Capacity T = 738 Ibs C Topo graphic Factor 6,5.. & Figure 6.4 K, 1 (1 K 2 * K& K1=0, K .v; td z = 718:9 Ibs Velocity Pressure - 6.5.10 p. = 20.0 psf A * K * ! * Pnet3o Length of Solar Panel LIP = 3 in flax load is half of two panels Spacing of Rase Supports S = 72 in Height of Solar Flack H = 4 in Worst case Area of Solar Panel a support A„ = 16.5 L * S,, Worst Case for Offset Panel Uplift per Bracket T _ 389 Ibs � * n Shear Force per Bracket V 40 lbs Pnet * h * S Number of Screws per Bracket N, = ' 1' Component Load on Screw 4 = 391 Ibs Duration Factor C - L6; Shear S Withdrawl ® 5116" Lag Z = 208 Ibs 130 Cd Withdrawl Capacity per Inch W : 206 Ibs /in Depth of Screw p = 2.26 in Withdrawl Capacity T = 738 Ibs C T Capacity of (1) Lag Screws z = 718:9 Ibs T * COS 2 +L am " sin 02 Capacity of SolarCity Base - ZEP Sleeklmount Z = 637 Ibs M Z > T Z > Z, OKI OKI 00 V1812014 ::� ECLI PSE Calculations SIR E N G I N E E R I N G SOLAR ARRAY CONNECTION TO EXISTING ROOF Wind Zone 2 3 Second Wind Gust V = 100 mph Importance Factor 1= 1 Net Design Wind Pressure - Figure 6. 3 p,asaa — 281 psf 10 Std FT Velocity Pressure Exp„ Coefficient - Figure 6.3 n. = 1.21 U p to 151t above grade Topographic Factor 6.5.7.2 S Figure 6 - 4 K 1i 1 + K * K * K3) K = tit K2 = 0, K = fl Velocity Pressure - 6.5.16 ".s = 341 p f A * K * 1 * P et30 Length of Solar Panel l 86 in flax load is half of two panels Spacing of Base Supports S 66 in flax trio is half of spacing + cantilever Height of Solar Rack H = ' 4 in Worst case Area of Solar Panel @ support A 16.25 g' L, * S Worst Case for Offset Panel Uplift per Bracket T 564 Ibs Pnet * A Shear Force per Bracket Vb= 58 Ibs Pnez * h * S Number of Screws per Bracket N = 1 Tension per Screw T, = 564 Ibs 7i L Shear per Screw V, = 58 Ibs �V Angle of Component loading 0 = 84.1 deg tan V, Component load on Screw F �z: 567 Ibs I + v 2 Duration Factor C = < 16' Shear & Withdrawl - 5116" Lag Z = 268 Ibs 130 * C" Wit Capacity per Inch W = 206 Ibslin Depth of Screw p = 2.25 in Withdrawl Capacity T = 738 Ins Cd * P * � 1 ECLI PS E Calculations E N G I N E E R I N G VITIUNWAITIl. 100 mph 1 42.4 p 10 Std FT 1.21 Topographic Factor 6.5.7.2 & Figure 6 - 4 K = 1 K, =0, K2 = 0, K3 =t) Velocity Pressure - 6.6.10 p,, = 51.3 psf zn_.MERM�� L 20 in S = 60 in H = 4 in A = 8.3333 ft (1 + K, Max load is half of one panel M F ----- Tb 428 lbs -- I p,,et * A V 86 lbs p net * h * S N, = 1 T, = 428 lbs Lb N, V, = 86 lbs ph " s !rd ( 1 tl9 a� s c >.� d XT9 - d9S 1OS NVIOVNVO ( W33dSM 3W 10 3S 2 0 Id 1.M S.9 Q Ot End OMV ltd M 9N IS d ld � � � W llvw WN AI I +'# OJ WDA lJori N IS 6 ti t` NI1SINH VDV83 s x3 j 3 } Z � -- 9 r s 3 } 4Gi G .GTJ j{ �� Ap1eEtJydlrtaky —gg00 N p j p § /{g} ° Yz VYP90/v y�yz aRTle juawn , p sigl ul nleu is Aw 03HSVO Sl iN3VidlnO3 80183IN[ �` �y ju woo l l st Ail pou4sp w �� j sLUJ I04101 l :u s 038 38V SiN3A JNl 11oodd IV3H � � 'lam AOA= . `Li, 00 - lAO4 -N`3 *Nth °jusla@�c� 80183INI Nth Nnd l.lnGNl13 c �� '� urn alp` pau ts Allepr3jo dl ?1d3iX3'NCB Nn8 ilnONO .�..,� ••• *'' SNl3ll t}1 3 GNVIS 8313A V43LSAS ltd 31VD1030 1 l Sm � C3 S138VI ONINM V 83iN30 OVOI 44 LL S13 V1 V 13NVd NOIAGI&Slt3 r . - a E3 6 A S138VI V X0 d3Nl8r4O /NOli Nnr C1 2 S138VI ONINM V 133NNOOSIG OV S138VI ONIN80 V 103NNO SIG 00 asnOH JO lUOJd TdW - T � 0 OOSll1 DO 03IV803,I.NI /M 83183AN1 138VI ONINM V 8313V4 Ailllill (3 g 0 393 i AU1. U) AIOMgANG (3) u7 N c1" � g, 4s 4 P �} s 4s °1VId31V -N ut ujo `!.7 1Ldi °J � e g C � S �y�µg J ^� . }� '. y�p�p p� ^� k �y ^��/ p �p�l OlZ : Cl nY lZ AV88Y Vt4 °Hinry aY y�,y;Yi Ed Yit i7T :HDlld 0888 K ' ild saliols z •)kld( IS al ul4 S dwu °1V18 31VVV OST ° inviizv kv68v osT TdW -H ild 088V VT :H llcl C E) 2x4 IDE VIEW 01MP1 � S III III I II I , STAGGERED ROOF A RRAZI 270 PITCH 14 RAFrER 2x6 @ 24" OC STORIES: I I AY AZI 270 PITCH 14 C'J' 2x4 @16" OC Comp Shingle PV MODULE 5/16 BOLT WITH LOCK & FENDER WASHERS ZEP LEVELING FOOT ZEP ARRAY SKIRT m INSTALLATION ORDER - ----------- LOCA T E R A FT E R M A R K HOL E 0 C LOCATION, AND DRILL PILOT L 0 C HOLE Pm" 0*1m DEBACA, CHRISTINE DEBACA RESIDENCE miu# MOtt TOMOMOtO INSERT FLASHING. V"Tw sysTaf, Comp Mountj - wo PLACE M 0 U NT 4255 PIERCE ST 3.825 KW PV ARRAY INSTALL LAG BOLT NTH I LOW- 11MA WHEAT RIDGE, CO 80033 m ( V1E.W0.1M.P1 NT �S JB-8004992 00 Pm" 0*1m DEBACA, CHRISTINE DEBACA RESIDENCE MOtt TOMOMOtO V"Tw sysTaf, Comp Mountj 4255 PIERCE ST 3.825 KW PV ARRAY WHEAT RIDGE, CO 80033 ADIAN SOLAR # CS6P-255PX PAM K4C SaT RD', :inu 0 ONE # Z" 7206129300 STRUCTURAL VIEWS P V 3 6/10/2014 UUM61 ( V1E.W0.1M.P1 NT �S �o �} AID w( ) t+l{} t G/ d S O ivionvo iJi ldl } ? v— — n— - °{�ino—o' °� id . sZO7t -K9 (099)',J OZn: ° , (099)',l 6 :31va A38 I a ino m 'i 3 o OW M 3U 00 00 `300N 13�fM s� � o I ON#& kVMV Ad MA Z2 1S 30d3ld �,n v o d � �► 11 N , I OJOWOWDA jjDvj 30 3alS38 VDV83a 3 IISIaH:D `VOV 3 sas r V a x n AD WAN 3 Sn ON s { 00 - u S 011b 11 3� w8nio m5 X03 13ADVd 31VdVd3S 335 GROUND SPECS MAIN PANEL. SPECS G ENERAL N(JTES INVERTER SPECS MODULE SPECS (# it 4 S .AINC 80X 2x2 S SEA, CFtOUN LICENSE BOND (N) #8 GEC Tt} (E) GR� UND ROD Panel Number: Inv 5: DC Ungrounded INV 1 ( 1 POWER --ONE AURORA PM- 3.0 -OUTD— —US— —A ) AFC! — (1) CANADIAN OLAR CS6P -- X E C 841 1 AT PANEL WITH IRREVERSIBLE CRIMP Meter Number: 1 19891 (# }Gt3TC -HA AG221 Inverter;�Zlgbee W, 277V /24QV/208V, 96%/96%/96% PV Module; 255 234.3W PIC, Block Frome, MC4, ZEP Enabled Overhead Service Entrance t, 30A, 240V0: -Fu e, NEMA 3R INV 2 -(!)CG d trtd 4 Duty (DG) .,., Vac; 37.4 VpmaX. 31302 1 "AWE ,., a2 81ock (# )AW ##0. THM -2, Red (I)AWG 10; THWN -2 Voc* = 355.T5Vt?C Isc = ADC # ( } (# )AWG #10. IH*4 -2, Red Vmp =241.6 VDC IMP= 8.43 ADC , t E l � �•� (2)AWG #"40,.PV ._ ... _ { 8 }AWG #10. Solid e EGC ..... , ... ..,. _ Vey = 310,76 VDC ...tsc, . A V p = 2i1.4 V% C Smp $,43 ADC INV 3 a • ( #) AWG #10, THWN-2. Witt NEUTRAL VmP =240 VAC Imp = #4.5 AAC Ise AND Imp ARE SHOWN IN THE DC STRINGS IDENTIFIER E 2DDA MAIN SERVICE PANEL SolorCity { # }AW s #& THWN -2. {d EGC jGEC - { 1) #Kit; 3 j4" EMT E 15OA /2P MAIN CIRCUIT BREAKER t !) Inverter I } Vcac* = 365.1 VDC isc = 9 ADC VmP = 245.6 VDC Imp= 8,43 A DC MILBANK Meter Socket CUTLER—HAMMER Disconnect POWER —ONE � A � DC+ 00 NOT ADJUST MIN, A''nON V 15£}A /P URORA PVI ^3.(} t?UTD —S US Z —A -� Q4 2 0 E ACA, C RI R IN CHRISTINE € p A C p _ _ p �{Cpf1�tmttA UGi AA RESI r. MCItt Y ssd) a a�s (E)LOAAS MIAGE SYS Comp Mount Type C 4255 PIERCE ST 1825 KW PV ARRAY ml� t PART TO 0TWRS OUM THE RECIPIENT'S HEAT RICE CC)} ORGANI ZATION, EXCEPT IN C VH THE E AND USE OF THE RESPECT* (15) CANADIAN SOLAR P -5PX - __ _ ___ __ _ ___ m _____ ____ ____ T AATE; SOLA RCITY ECG T, WITHOUT THE PE OF TY INC. W1#ERTER: POKIER —ONE AURORA PVI- 3.C— OUTL}— S— US� -Z —A 7 2061293 0 0 PAGE N , TEEPEE SINE CCACPA PV 5 6 2(}14 � 1 t } � Ti(650) 638 -1428 F:(650) 1023 ( )- _CITY (765-2489) cl #y # I i 20A *G E L a H 2 f, T C MA'n()N V DO N ADJUST MIN, A A: _. A. GNG ... «. _ — _ _. ° ..�.. �. _ _ _ ... _.....a ..... _ .. ....... ,.. ».................. _ , - I String(s) Of 8 On MP I MTAG 6 GNtD �.... cGC ... _ ___ - -- - -- __ --- ---_...,. -- -- C+t„ _...__...._.. ----- w B p 6 (I)Conduit Kit;. 3/4° EMT I N VoC* = MAX VOC AT MIN TEMP - `✓1 120 PV BACIt A AKER Ctreaker; 20 /2P. 2 s ( #) U ' T4 Mete et; A #6- W.O. (# it 4 S .AINC 80X 2x2 S SEA, CFtOUN DC _(3)M K4 77-011 TAI tor #OOA #12 - I f0 AUI� - `( # ) U # Box 1Taetckei. [EKG 8] (# }Gt3TC -HA AG221 t, 30A, 240V0: -Fu e, NEMA 3R -(!)CG d trtd 4 Duty (DG) .,., (� J 1 "AWE ,., a2 81ock (# )AW ##0. THM -2, Red (I)AWG 10; THWN -2 Voc* = 355.T5Vt?C Isc = ADC # ( } (# )AWG #10. IH*4 -2, Red Vmp =241.6 VDC IMP= 8.43 ADC , t E l � �•� (2)AWG #"40,.PV ._ ... _ { 8 }AWG #10. Solid e EGC ..... , ... ..,. _ Vey = 310,76 VDC ...tsc, . A V p = 2i1.4 V% C Smp $,43 ADC a • ( #) AWG #10, THWN-2. Witt NEUTRAL VmP =240 VAC Imp = #4.5 AAC � - ( I)AWG #10, TH*4 -2, Gr GC { # }AW s #& THWN -2. {d EGC jGEC - { 1) #Kit; 3 j4" EMT { I ) ANG #10, THION - 2, Block Voc* = 310.76 V Isc = 9 ADC: I I (# )AWG #10, THV4 -2. Red Vmp == 215.4 VDC imp= 8,43 A t !) (2) AWG #10, PV (1)AWG #t0. Solid e C EGC Vcac* = 365.1 VDC isc = 9 ADC VmP = 245.6 VDC Imp= 8,43 A DC .: (1)RWfG #10„ THNPI - Grew, EGG CONIFIDENTIAL - THE WMMATION HEREIN T SHALL LL NOT BE U FOR THE -� Q4 2 0 E ACA, C RI R IN CHRISTINE € p A C p _ _ p �{Cpf1�tmttA UGi AA RESI MCItt Y r e `# FIT OF AN EXCEPT TY INC, ., NOR SHALL IT BE DISCLOSED IN WHOLE 1 " SYS Comp Mount Type C 4255 PIERCE ST 1825 KW PV ARRAY ml� t PART TO 0TWRS OUM THE RECIPIENT'S HEAT RICE CC)} ORGANI ZATION, EXCEPT IN C VH THE E AND USE OF THE RESPECT* (15) CANADIAN SOLAR P -5PX ? 3M5 Oearview way Yelee, CA T AATE; SOLA RCITY ECG T, WITHOUT THE PE OF TY INC. W1#ERTER: POKIER —ONE AURORA PVI- 3.C— OUTL}— S— US� -Z —A 7 2061293 0 0 PAGE N , TEEPEE SINE CCACPA PV 5 6 2(}14 � 1 t } � Ti(650) 638 -1428 F:(650) 1023 ( )- _CITY (765-2489) cl #y �� II�IU lNlul U�� ICI q��N - 1 130X 00 •. trg' 069 033 J 00d) ( ) - =W30 . 1 I q -1 �v i r �f1'w " " " C9 '069 0 WOO a9 (AN0 (0a) SolarCity SleekMountTM - C The SolarCity SteekMount hardware solution is optimized to achieve superior strength and aesthetics while minirnizing roof disruption and labor. The ehinination of visible raH ends and mounting clamps, combined with the addition of array trim and a lower profile all contribUte to a more visually appealing system, SleekMount utHizes Zep or modules with strengthened frames that attach directly to Zep Solar standoffs, effectively efirninating the need for rail and reducing the number of standoffs required, in additton, composition shingles are not required to be cut for this system, allowing for minimal roof disturbance, * Utikzes Z Soiar hardware and UL 1703 ksted Zep CompatibleT" rnodOes * interlock and groun*ng devices .'n systerrk UL. ksted to LA, 2703 * h and Ground Sep ETL listed to UL 1703 as "Grormdrng and Bending System," * GrOUnd Zep UL and ETL ksted to UL as grounding de0ce * Painted ga�vanized waterprorofiasNng * . node zed components for corrosicrr'r resrstance * ApphcaUe for vent spanntrigfunctions Components 1# ""'k E, ea c h .ac. f S craw �`16" M, 0 .eve crap Foot p, i.ag screw 11 0"I t, comp Mount *1 Cornp Mount Flashing "Solarcity" I january 2013 DnH Not Hoe of Prope Diarneter for Fastener Size Per NDS Secirmi 1. 1,12 ,sal pRat hole with roofing seat insert Comp Mount flashing under kipper gayer of shing e Rase COFTIP UIOUnt centered upon, flashing Install iag pursuant to NDS Section 11. 1.3 with seaing washer. 1#" Secure L-evisirig Foot to the Cot rip Moi,mt uvng machine Screw Race modwe a 4 J,, t`ai"s 61 jejoS uetpeueo InoqV eiw-oud ajpafqrs &,4! .i poprqn.x 3033�� (a 97"'q t VIV) s"/Mooz ctl JO aouetpejjt ue tuoj{ Aoua*W0 OMPOW %9'96+ 'IU0WU0J1AUa uo!je!poijf mol ie oauttwoped Buipeai Ajisnpul — z oz as M'401"o i,, G' h -t' s AWWOU13 OMNI (ast) juaiino jmi�o jjoqS 9 oueqdLU 0 0 HOV3�i - sa+uedwoo eomnsu� dol ppom C Aq painsul . 86RJ8A00 gje�POWW� . 9 6qe11 8 0ue 0 - U0N - sjq6p Aojdnj�ueq AjJed PJtt4j 6 U$P!AOJd - 05eJOA00 WJ91 Aluejjem %OU - 96eJOAM) ap!mppom sjeaA SZ . juejsssqj Isp Iles Pajtpejoov . eouewjojjedLUO;S4SOAojdwiol6uiutaiqluejjno . slooloplinpoideleuiwqaoibuiuOOJ - uoelonpojdelnpotuu�siusodgoiluoo4ixlenbgcz - ZEE=.. Jelosuelpeue:) Almiem Ind1no jamod jeauq jeaA 9Z d�Lisuew),liom pue siepajew uo Almiem jonpoid jeaA 66 'aouelslsaj 11041 pue6u pu;104 Olt) e 'eauejeadde Ssapeas 0�jqqjsae 'SjSoa walsAs jewp�w jo anjEA pappe aqj sjowo1sno sjo4o'swalsAs Buqunow jo sadAl ajM jo4 peub�sapajnpow uo�jeiauaB jxau a4j' ainpoW Je1 UOReJOU IXON 77 SOPW c '99di )(09-r i je wnmLunje paztpouv pajadwaL 18AODiU01i I ?'qt) 6 x9 '0z r ATZE aUg"S X Z 9VI 9 Vq) uAU0 x ?,96 x 9f,'91 (XdS,S'4-d9S3) Ajn - 1 (0i,4 04°) T -1 i(joulejuOD •" . ----- ------- ------ — z oz as M'401"o i,, G' h -t' s AWWOU13 OMNI (ast) juaiino jmi�o jjoqS 9 oueqdLU 0 0 HOV3�i - sa+uedwoo eomnsu� dol ppom C Aq painsul . 86RJ8A00 gje�POWW� . 9 6qe11 8 0ue 0 - U0N - sjq6p Aojdnj�ueq AjJed PJtt4j 6 U$P!AOJd - 05eJOA00 WJ91 Aluejjem %OU - 96eJOAM) ap!mppom sjeaA SZ . juejsssqj Isp Iles Pajtpejoov . eouewjojjedLUO;S4SOAojdwiol6uiutaiqluejjno . slooloplinpoideleuiwqaoibuiuOOJ - uoelonpojdelnpotuu�siusodgoiluoo4ixlenbgcz - ZEE=.. Jelosuelpeue:) Almiem Ind1no jamod jeauq jeaA 9Z d�Lisuew),liom pue siepajew uo Almiem jonpoid jeaA 66 'aouelslsaj 11041 pue6u pu;104 Olt) e 'eauejeadde Ssapeas 0�jqqjsae 'SjSoa walsAs jewp�w jo anjEA pappe aqj sjowo1sno sjo4o'swalsAs Buqunow jo sadAl ajM jo4 peub�sapajnpow uo�jeiauaB jxau a4j' ainpoW Je1 UOReJOU IXON 3�n'stl 1 QJMMdw81 000 6WMIOdO MLUION SOPW c '99di )(09-r i je wnmLunje paztpouv pajadwaL 18AODiU01i I ?'qt) 6 x9 '0z r ATZE aUg"S X Z 9VI 9 Vq) uAU0 x ?,96 x 9f,'91 . .... ...... suwsuema Wo 8 xpwd AZ A K AO 09' A6 U, e100 1e*1UB4 mote pu'. "'U, 01"Wodw Wolq.pl "S 60 M11110N 19P-r, 'V6Z L [ I I I I I'll, V90 1 V96,9 il- �i jue pn'�. njf o jj I oq�,; ... ....... . . .. At PC I r AZ K, A. K AO K MT F, ......... (30A) 06e MA isn sr 0 .. ........ (dw�)juajjnn u Wnw 6 qaiado qdo At ZZ ACW AZ 4 M� MRL� I mvd.S mok� . ..............W...._... (ii LJ7 iW6Wi!iiiiLTipVj IeWWON . ...... ... ... 13ON ,9Z M WnAllad-*� fw' 'tang L viv wnww 'k-�Moao x 6a.Vtpem jo (DIS) suompuoo mi, popuels ;ap-p ------ ----- ------- uoqeoppssaj0uoqc9qddv MU 088 , I I - 0 , Aw 81SAS W nWL x - 8 V4 — z oz as M'401"o i,, G' h -t' s AWWOU13 OMNI (ast) juaiino jmi�o jjoqS 9 oueqdLU 0 0 HOV3�i - sa+uedwoo eomnsu� dol ppom C Aq painsul . 86RJ8A00 gje�POWW� . 9 6qe11 8 0ue 0 - U0N - sjq6p Aojdnj�ueq AjJed PJtt4j 6 U$P!AOJd - 05eJOA00 WJ91 Aluejjem %OU - 96eJOAM) ap!mppom sjeaA SZ . juejsssqj Isp Iles Pajtpejoov . eouewjojjedLUO;S4SOAojdwiol6uiutaiqluejjno . slooloplinpoideleuiwqaoibuiuOOJ - uoelonpojdelnpotuu�siusodgoiluoo4ixlenbgcz - ZEE=.. Jelosuelpeue:) Almiem Ind1no jamod jeauq jeaA 9Z d�Lisuew),liom pue siepajew uo Almiem jonpoid jeaA 66 'aouelslsaj 11041 pue6u pu;104 Olt) e 'eauejeadde Ssapeas 0�jqqjsae 'SjSoa walsAs jewp�w jo anjEA pappe aqj sjowo1sno sjo4o'swalsAs Buqunow jo sadAl ajM jo4 peub�sapajnpow uo�jeiauaB jxau a4j' ainpoW Je1 UOReJOU IXON 3�n'stl 1 QJMMdw81 000 6WMIOdO MLUION voo 6 vie 1 9, VVL 9 V65 9 4- M IC r ATZE JOA VU 9 voc 9 1 V� 8 Wo 8 xpwd AZ A K AO 09' A6 U, M99Z CAW m0le mote s*!1S1J ainjejedwo.L x35 Zd95s citS d9 1X 3519495 X§SAZdS XdSSZ/OSZ/SVZ/OVZ/SCZ — z oz as M'401"o i,, G' h -t' s AWWOU13 OMNI (ast) juaiino jmi�o jjoqS 9 oueqdLU 0 0 HOV3�i - sa+uedwoo eomnsu� dol ppom C Aq painsul . 86RJ8A00 gje�POWW� . 9 6qe11 8 0ue 0 - U0N - sjq6p Aojdnj�ueq AjJed PJtt4j 6 U$P!AOJd - 05eJOA00 WJ91 Aluejjem %OU - 96eJOAM) ap!mppom sjeaA SZ . juejsssqj Isp Iles Pajtpejoov . eouewjojjedLUO;S4SOAojdwiol6uiutaiqluejjno . slooloplinpoideleuiwqaoibuiuOOJ - uoelonpojdelnpotuu�siusodgoiluoo4ixlenbgcz - ZEE=.. Jelosuelpeue:) Almiem Ind1no jamod jeauq jeaA 9Z d�Lisuew),liom pue siepajew uo Almiem jonpoid jeaA 66 'aouelslsaj 11041 pue6u pu;104 Olt) e 'eauejeadde Ssapeas 0�jqqjsae 'SjSoa walsAs jewp�w jo anjEA pappe aqj sjowo1sno sjo4o'swalsAs Buqunow jo sadAl ajM jo4 peub�sapajnpow uo�jeiauaB jxau a4j' ainpoW Je1 UOReJOU IXON sized family home, This family of single-phase string inverter 41 17116A size of the imirti, This rowed outdoor inverter has been desi ned MF conditions. ........... 01WA-'s The high s%ee—d MPPT offers real-time power tracking and improved energy harvesting, 97.0%, The wide input voltage range makes the inverter suitable to low power installations with reduced string size. ") output Power W 30M YAK3 .tickle JWU machnum Output Pulver W 30WI 3eCM 3300 16W 400W 40VP 332+0 38% 4 3000 46V 460 Rated Grid AC Votta" V ZN 240 277 XX 240 21"? 209 240 2?7 ZOR 240 277 input $We (Do summer of halerendeet JAPPT Channels 2 2 2 2 Maximetric usattle Power for Each clemorn t9' ...... 2000 11100 1000 3000 Absolute maximum Voltage (Vmax) V 6M Start - Upvc,"Age testairtF V 200 lady 12:0 Fell Power tappy voltage Ran" V 12OS30 14q S30 140530 Costratmil sappy Voltage Rarsee V -Ov� Maximum Current piumard for both Miner in Parallel A 20 12 32 32 Maximum usablocurrent pet channel A 10 16 16 16 maximum Short Ocrull Current Limit per Channel A 125 20,0 20,0 20.0 Number of Who Landkir; Terminals Per Charund 2 parrs ArraylkiringTerminatern Nominas biock, Pmiswe Clamp, AWGI0,Fuaf(4 Ovubul$W*00 Gne Contraction Type 10/2w Split I 012 013%V i0/21ts SPW- 10,2K' 110t2w SpM- 100W 03W 0/3W 023k 5;13A- 1011W F313W AdjustableVokage Range Omm-Nimax) 183 2 �64 244304 181228 7s1�264 10-n8 211 744,304 181228 211264 244-304 Grid "oncy . 144304 60 Adjustable Gild Frequency Range 57-Ks Maximum Current Uncured A- 143 14,1 12C 1 �6'0 16,1K ltiD 16,6 M1.0 X'o 20,0 20,0 Powerfactor 0,995 Teruel Harareek: Distortion At Rated power % <.Y Grof Wiring Termination Type Protection Davit" iermvnib bprck, Pnesium Ctamp AAIG 10 -, to R"OrSO filthilitel PRAIKorns YM Own4oitafter Protection Type VoMor 2 for each chamet PV Array Ground Fault Detection Pre Man up Reo aT,d dyeamc GFIb „Reqvires Naarng Ancyb output Anti-hat"ding Protection Meets Ut 1741AEE1547requ4mrelft ExtruisP OCPO Rating 4 70 20 is 2 20 2 20 2a < ^ 0 25 25 Own-Voltage Protection Typo Silicate" Maximum Efficiency 96 969 97 97 91 CEC Efficiency % 915 opw"opwwmar" Night time Consumption sq-, < 0,6 Stand by Consumption Complorboadmi, User,intinfirce 16 chafacues x 2 fines KD deiplay Remote Monitoring 0 XRS495 hrcl.l AURORA-UNNIFFSAL k pt' Wired seem Monitoring iIXRS495 mCIJ PW-U56-R" 485 kopt), N-DESK HcPQ VVITtrans local monitormil fK7-Df5XMP (Qpt} Mir, PW RAMOMODUU Wist) &Wkamnerm Ambient Air Operating Immattature Range t 13 to k s Q E n W 40) wlth derabAgabosc. 122 OW Amboint Air Storape, temperature Range 1 i r0l 40tDIW-40104M Relative Normally %PH 01M condenung Acoustic Noise Emotion Level dbt-Ai @ �m < S4 Maximum at Affituck without Derating ftem) 6560 2600 furniture rsties NEMA coating Nlatulalconvecwr Dimonlions 011 x W x CA 318. QAx67?,859x325x222) Weight <473UI,3t Stopping Weight Ib Ng) <60�27,0) mounting System WaR bracket t rade size, K0s: 42ea x 112'! a �'ea A a AM' , 3 places sale, front, rear; Conduit Connections' Ssde 2} P1099ed 374'0Pari?Iq5, C?i Con=,WC (KOS. 314*, 1' Bock Comeet6c Ex0s 14"; DC Switch Rating-fixer Contact) NV 23 aw Supply isolation Level Turmforrce0ecs lFroatmg Amyx Safety and EJAC Standard UL1 741,(-'SA C22, N, W7.1-01, Ut 391 ai M tl69413, FCC Part 15 Cwss 8 Safety Approval W—ty Standard Warranty Yaws fixterefrafWarranty Yes's M40" Me" Standard Without DC solicit and Wines Box FV@ 3COUTD-US PNIF16-OUTD-US Pei 33-OU 1 PVI 41-CUR) Standard - With DC Switch and Voting Box pt"I 3 0 OU 5 us F"; 1 34- OU I'D S i J S PVF- I&IOU" D-S-Us PA•4,2-05k1TD-5 -U5 With OC Switch, Wiring box and Arc Fouft Detector PVI-10�OUTD-S�U""-A Pk2 16 ()UTD 5 A PVO4OU M S-U5-A and interrupter Al' dea u wt'�etn' it cha " W"" 'Uo.Wily mhAn mt r ue e+na AC us-Ave 41d WO, Wffil"*M DC 0— .-Oure 4266 Pierce St. Wheat Ridge, CO 80033 Property Owner (ptease print): Doug Snavely Phone: 303-9074279 Mailing A ddress: ds #. Address: above Cit Stat Zip: Credit Card Payment* Use credit r listed l . ate: Print name* _,..__.. __.. w...._ ------- _ ... Signature: C cr �a c :r> ro ro m r.z tj 4 C6 tz kAl ° ca w 0 v� va ca w 0 �cr ca a� c ca, 0 a c ° cis #cr ce m' e� O 4? C7 o a� G� C cr �a c :r> ro ro m r.z tj 4 C6 tz kAl ° ca w 0 v� va ca w 0 �cr ca a� c ca, 0 a c ° cis #cr C cr �a c :r> ro ro m r.z tj 4 C6 tz kAl ° ca w 0 v� va ca w 0 �cr ca a� a ce o a� G� o era cr, er, > tv ». c w 0 c c ' Cr a c c c w "" c # Building Permit Application (Complete jlH highfighted areas) Address: City, State, Zip: Electrical: Gk-e—e, Loam]= City License # [IT, M22MR= Nc, Ob c"A co Review Fee (due at time of submittal): Squares _ BTU's _ Gallons _ Amps _ Sq Ft. # �Isgza= Pimce s (please print): ' Nus SNOVL-LV Phone: I Address: City, State, Zip: r-A mmm= WE= WEE= MMEM fl, WAY Ai I M I I I I 1 11 1,; '1 1 YVJ11W'TWr' 1 faMNAME: SIGNATURE: DATE: W= NM=