HomeMy WebLinkAboutPermit M2000-259 - HALBERT RESIDENCEM2000 -259
Halbert
Residence
4007 S 117 P1
EXPIRED
City of Tukwila
Community Development / Public Works • 6300 Southcenter Boulevard, Suite 100 • Tukwila, Washington 98188
Permit No: M2000 -259
Type: B -MECH
Category: RES
Address: 4030 S 117 PL
Location:
Parcel #: 734060 -0101
Contractor License No:
MECHANICAL PERMIT
TENANT HALBERT JACK
4007 S 117 PL, TUKWILA WA 98188
OWNER HALBERT JACK E +JULIE L
4007 S 117 PL, TUKWILA WA 98168
CONTACT JACK HALBERT
4007 S 117 PL, TUKWILA WA 98168
******************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Permit Description:
INSTALL A NEW FORCED AIR FURNACE IN THE ATTIC,
INSTALL NEW DUCT WORK TO EACH ROOM, THE FURNACE
WILL BE POWERED BY PROPANE, TANK LOCATED OUTSIDE
AND INSTALLED BY SUBURBAN MECHANICAL.
UMC Edition: 1997 Valuation:
Total Permit Fee:
****,************************************** * * * * * * * * * * * * * * * * * * ** ** * * * * * * * **
— CO rrr rrrr rr rr 1. 2 _:Z. 1
Permit Center A prized Signature Date
I hereby certify hat I have read and examined this permit and know the
same to be true and correct. All provisions of law and ordinances
governing this work will be complied with, whether specified herein or not.
The granting of this permit does not presume to give authority to violate
or cancel the provisions of any other state or local laws regulating
construction or the performance of work. I am authorized to sign for and
obtain thi uilding permit.
Signature : ,4 ∎. Date: )
Print Name: �-'��— � � LA-CZ Title :, LO! ?L_
This permit shall become null and void if the work is not commenced within
180 days from the date of issuance, or if the work 1s suspended or
abandoned for a period of 180 days from the last inspection.
EXiD
AUG 3 0 2001
Status: ISSUED
Issued: 12/27/2000
Expires: 06/25/2001
Phone:
(206) 431 -3670
Phone: 206 -619 -7670
1,500.00
47.88
Address: 4030 S 117 PL
Tenant: HALBERT JACK
Tvoe: B-MECH
Paecel #: 734060 -0101
*** tit***** **'A*********** * * * * ** * # * *** * * * *M•k * * *•k* * *,k* k * *•k•* k ** *•A *•k *•k * ** k- 4 * *3k ** A
Permit Conditions:
1. Electrical permits shall be obtained through the Washington
State Division of Labor and Industries and all electrical
work will be inspected by that agency (248-6630).
No changes will be made to the plans unless approved by the
Engineer and the Tukwila Building Division.
All permits, inspection records, and approved plans shall be
available at the lob site prior to the start of any con-
struction. These documents are to be maintained and avail -
able until final inspection approval is granted.
All construction `to be done in conformance with approved
plans 'end requirements of the Uniform Building Code (1997
Edition) as amended. Uniform Mechanical Code (1997 Edlt1o'rt),
and Washington State Energy Code (1997 Edition).
5. Validity of Permit. The issuance of a permit or approval Of
plan;, spec,1fications, and computations shell not be con-
strued to, be a permit for, or an approval of, any violation
ofaany of the provisions of the building code or of any
other ordinance of the Jurisdiction. No permit presuming to
g1've: authority to violate or cancel the provisions of this
code shall be valid.
6. 'Manufacturers installation instructions required on site
for,. the b u i l d i n g inspectors review.
I hereby certify that I have read these conditions and will comply
with them as outlined. All provisions of law and ordinances governing
this work will be complied with, whether specified herein or not:'
The granting of this permit does not presume • to give authority to
violate or cancel the p r o v i s i o n s of any other work or local l aws
regulating construction or the performance of work.
S , igr► atU
Print Narne:
CITY OF TUKWILA
OOP
Permit No: M2000-259
Status: ISSUED
Applied: 11/13/2000
Issued: 12/27/2000
ate _I,.I.. _4 _
R
Project Name/Tenant:
Value of Mechanical Equipment:
r— —
State/Zip:
Site Address : <~ t t i� fi" ( - iv1 -V-;1l l ,s�
Tax Parcel Number:
-- City
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Property Owner:r.— [1....t, b �T 1 3 CLtLi r"-'
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Phone: ( o2b� ) t �L�
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Street Address:
City State/Zip:
Fax #: 6) (�
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Contractor:
City / State/Zip: T
Phone: ( )
t I/���p � ► �/�}� "�� {�� may/
Street Address:
City State/Zip:
Fax #: ( )
Contact Person :..
Phone: ( e.) (( e,
,..z 0
Street Address:
City State/Zip:
Fax #: ( )
BUILDING ! NER OR AUTHORIZED AGENT:
Signature: '
cAok,
Date: (616100
Print name: 3-
Ph: ne: ic21�c, ) (4 541 asst.
Fax N: (6)c)(0) t cyl I (.Q
Address: j,, lG )
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City / State/Zip: T
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t I/���p � ► �/�}� "�� {�� may/
Mechanical Permit Application
MECHANICAL PERMIT REVIEW AND APPROVAL REQUESTED: (TO BE FILLED OUT BY APPLICANT)
Description of work to be done (please be specific):
00 ►7. _ V ni, �p Csv i h ct-�•} }'�'�G I ) 1\}e ta.:
Current copy of Washington State Department of Labor and Industries Valid Contractor's License. If not available at the time of
application, a copy of this license will be iequtred before the permit Is issued OR submit Form H.4, "Affidavit in Lieu of Contractor
Registration ".
Building Owner /Authorized Agent: if the applicant Is other than the owner, registered architect/engineer, or contractor licensed by the
State of Washington, n notarized letter from the property owner authorizing the agent to submit this p omit application and obtain the
permit will be required as part of this submittal.
1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE UNDER
PENALTY OF PER JURY BY THE LAWS OF THE STATE OF WASHINGTON, AND 1 AM AUTHORIZED TO APPLY FOR THIS PERMIT.
Expiration of Plan Review • Applications for which no permit is issued within 100 days following the date of application shall expire by
limitation. The building official may extend the time for action by the applicant for a period not exceeding 100 days upon written
request by the applicant as defined in Section 114.4 of the Uniform Mechanical Code (current edition). No application shall be
extended more than once.
Date application accepted:
11/2/99
Huth perniltdoc
CITY OF - 'JKWI LA
Permit Center
6300 Southcenter Boulevard, Suite 100
Tukwila, WA 98188
(206) 431 -3670
Application and plans must be complete in order to be accepted for plan review.
Applications will not be accepted through the mail or facsimile.
I I.0
Date application expires:
• , R STAFF USE ONLY
Project Number. (�j
Permit Number: �"� 256
Application taken by: (initials)
✓
Submittal Requirements
Floor plan and system layout
A,
�'
Roof plan required to identify individual equipment and the location of each installation (Uniform
Mechanical Code 504 (e))
Details and elevations (for roof mounted equipment) and proposed screening
Heat Loss Calculations or Washington State Energy Code Form #H -7
x j
,,
H.V.A.C. over 2,000 CFM (approximately 5 ton and larger) must be provided with smoke detection shut-
off and will be routed to the Fire Prevention division for additional comments (Uniform Mechanical
Code 1009).
10A
Specifications must be provided to show that replacement equipment complies with the efficiency ratings
and other a licable re uirements of the Washin ton State Nonresidential Ener Code.
i t i4
``�q
Structural engineer's analysis is required for new and the replacement of existing roof equipment
weighing 400 pounds and greater (Uniform Building Code 1632.1). Structural documentation shall be
stamped by a Washington State licensed Structural Engineer,
Mechanical Permits
COMMERCIAL: Two complete sets of drawings and attachments required with application submittal
RESIDENTIAL: Two complete sets of attachments required with application submittal
.. Heat loss calculations or Form 146.
Equipment specifications.
1 PM
sukcpasidoc
NOTE: Water heaters and vents are included in the Uniform Mechanical Code — please include any water
heaters or vents being installed or replaced.
Su b ,utit /al Re quire /Ile S
New Single Family Residence
Change -out or re
lacement of existin
mechanical e
ul
ment
Narrative of work to be done includln: modification to duct work,
Installation of Gas Fireplace
Narrative with specification of equipment and chimney type.
� 4 If using existing chimney, provide a tatter by a certified chimney sweep stating that the chimney is in safe
condition.
NOTE: Water heaters and vents are included in the Uniform Mechanical Code — please include any water
heaters or vents being installed or replaced.
•
.***************** ********* ** * * * * * * * * *****k * ** *** ***fir* ** * *** ***h
flV OF TUKWILA. WA TRANSMIT
* ** ** * * * ** * * *** ' � * ** ** * * ** * * * * * * * * * * * * **
47.88 12/27/00 12z57
SACK HALBERT xrnits !LB
TRANSMIT Numbers R9900413 Amounts
Payment Methods CHECK Notations
Permit kilos M2000 -259 types U -MECH MECHANICAL PERMIT
Parcel Nos 734060.0101
Site Address& 4030 8 117 PL Total roses 47.843
This payment 47.99 Total ALL feet && 47.118
Balancers .00
************* * ***************ir *** ** *A* * *** * ** * * * * * ** * ** *** *fi r
Account Coder I>reewr i of 1 an Amount
000/345.890 PLAN CHECK RES 9.5O
000/333.100 MECHANICAL - RES
1 090 12/29 9 7. 0 TOTAL
PERMIT NO.: /4' g
MECTIANTCAL PERMIT APPLICATIONS
INSPECTIONS
0 00002 Pre•const;uction
❑ 00050 WSEC Residential
❑ 00060 WA Ventilation/Indoor AQC
❑ 00610 Chimney Installation/All Types
❑ 00700 Framing
❑ 01080 Woodstove
❑ 01090 Smoke Detector Shut Off
F . 01100 Rough -in Mechanical
01101 Mechanical Equipment/Controls
01102 Mechanical Pip/Duct insul
01105 Underground Mech Rough -in
01 115 Motor Inspection
1400 Fire Final
01800 Final Mechanical
04015 Special -Smoke Control System
B
CONDITIONS
g 0001 No changes to plans unless approved by Bldg
Div
❑ 0014 Readily accessible access to roof mounted
equipment
0016 Exposed insulation backing material
0019 All construction to be done in conformance
w /approved plans
❑ 0002 Plumbing permits shall be obtained through King
Co
• 0027 Validity of Permit
E 0003 Electrical permits obtained through L & 1
0036 Manufacturers installation instructions required
on site
"BTU maximum allowed per 1997 WA State Energy Code"
0041 Ventilation is required for all new rooms &
spaces
"Fuel burning appliances
"Appliances, which generate...."
"Water heater shall be anchored...."
*saw
Additional Conditions:
TENANT NAME:
FEES
Basic Fee (Y/N)
Supplemental Fee (Y/N)
Plan Check Fee (Y/N)
Furnace/Burner •
to 100,000 BTU (qry)
Over 100,000 BTU (qty)
Floor Furnace (qty)
Suspended/Wa1VFioor- mounted Heater (qty)
Appliance Vent (qty)
Heating/Refrig/Cooiing Unit/System (qry)
Boiler /Compressor
to 3 HP/ 100,000 BTU (qry)
to 15 HP /500,000 BTU (qty)
to 30 HP /1,000,000 BTU (qty)
to 50 HP /1,750,000 BTU (qry)
over 50 HP/1,730,000 BTU (qty)
Mr Handling Unit
to 10,000 ctmn (qty)
over 10,000 cfm (qry)
Evaporative Cooler (qry)
Ventilation Fan (qty)
Ventilation System (qry)
Hood (qry)
incinerator — Domestic (qry)
Incinerator — Comm/ind (qry)
Other Mechanical Equipment (qty)
Other Mechanical Foe (enter SS)
Add'I Fees — Work w/o Permit (Y/N)
!asp Outside Normal Hours (hrs)
Reinspections (hrs)
Miscellaneous inspections (hrs)
Add'1 Plan Review (hrs)
Pian Review
Permit Tech:
Date: l )1-19)
August 17, 2001
Mr. Jack Halbert
4007 So. 117th Place
Tukwila, WA 98168
RE: Permit Status M2000.259
Site Address: 4030 So. 117th Pl.
Dear Mr. Halbert:
City of Tukwila
Department of Community Development
In reviewing our current permit files, it appears that your permit for installation of furnace in
Halbert residence issued on December 27, 2000, has not received a final inspection as of the date
or this letter by the City of Tukwila Building Division.
Per the Uniform Building Code and /or Uniform Mechanical Code, every permit issued by the
building official under the provision of this code shall expire by limitation and become null and
void if the building or work authorized by such permit is not commenced within 180 days from
the date of such permit, or if the building or work authorized by such permit Is suspended or
abandoned at any time after the work is commenced for a period of 180 days.
Based on the above, if a final inspection is not called for within ten (10) business days from the
date of this letter, the Permit Center will close your file and the work completed to date will be
considered non - complying and not in conformance with the Uniform Building Code and /or
Mechanical Code.
Please contact the Permit Center at (206) 431.3670 if you wish to schedule a final inspection.
Thank you for your cooperation in this matter.
Sincerely,
KCit ,, .
Kathryn A. Stetson
Permit Technician
Xc; PQ It Fllc No, M20000259
- Duane Griffin, Building Official
Steven M. Mullet, A
Steve Lancaster, Dirt
6300 Southcenter Boulevard, Suite #100 • Tukwila, Washington 98188 • Phone: 206.43! -3670 • Fax: 206.431.3665
it
1997 UNIFORM MECHANICAL CODE
305.4 Prohibited Connections. Equipment shall not be con-
nected to a fuel supply by means of a hose.
EXCEPTIONS: 1. Movable laboratory or shop equipment using
approved fuel hose material not exceeding 6 feet (1830 mm) in length.
2, Outdoor portable appliances using an approved outdoor fuel hose
material not exceeding 15 feet (4512 mm) in length connected to an
approved outdoor shutoff valve and piping.
Equipment shall not be connected to fuel piping by quick -dis-
connect devices, swivel joint mechanisms or devices that rely on
the use of gaskets, ferrules or similar compression sealing meth-
ods unless such fittings are listed for the intended use and
approved for the specific installation.
SECTION 306 — ELECTRICAL CONNECTIONS
306.1 General. Electrical connections to equipment regulated
by this code shall be in accordance with the Electrical Code.
306.2 Means of Disconnect. An approved, independent means
of disconnect for the electrical supply to each piece of equipment
shall be provided in sight of the equipment served when the supply
voltage exceeds 50 volts.
306.3 Service Receptacle. A 120 -volt service receptacle shall
be located within 25 feet (7620 mm) of, and on the same level as,
the equipment for maintenance. The service receptacle shall not
be connected on the Toad side of the required means of disconnect.
306.4 illuminntlon. Permanent switch controlled lighting shall
be installed for maintenance of equipment required by thin code to
be tu:cessiblo or readily accessible. Such lighting shall provide
sufficient illumination to safely approach the equipment and per-
form the tasks for which access is provided. Control of the lighting
shall be provided at the access entrance.
EXCEPTIONS: 1. When rued lighting of the building will provide
the required illumination. separate illumination is not required.
2. Equipment located on the roof or exterior wall of a building nerd
not be provided with permanent lighting,
SECTION 307 — ACCESS AND SERVICE SPACE
307.1 General. Equipment requiring routine inspection or
maintenance shall be provided with sufficient access to allow
Inspection, maintenance and replacement without removing per-
manent construction or other equipment or disabling the function
of required fire- resistant construction.
307.2 Equipment in Rooms. Rooms containing equipment
requiring access shall be provided with a door and an unobstructed
passageway measuring not less than 36 inches (914 mm) wide and
80 inches (2032 mm) high.
EXCEPTION: Residential•typc appliances installed in a compart•
meat, alcove, basement or similar space may be accessed by an open.
ins or door and an unobstructed passageway measuring not less than
24 inches (610 mm) wide and large enough to permit removal of the
largest appliance in the space, provided that a service space of not less
than 30 inches (762 mm) deep and the height of the appliance, but not
less than 30 inches (762 mm) is present at the front or service side of
the appliance with the door open.
3073 Equipment in Attics. Attics containing equipment
requiting access shall be provided with the following:
1. An access opening large enough to remove the largest piece
of equipment, but not less than 30 inches by 22 inches (762 mm by
559 mm);
2. An unobstructed passageway which:
305.4
307.5
2.1 is large enough to remove the largest piece of equipment but
not less than 30 inches (762 mm) high and 30 inches (762
mm) wide,
2.2 Is no more than 20 feet (6096 mm) in length when measured
along the center line of the passageway from the access
opening to the equipment, and
2.3 Has continuous solid flooring not less that 24 inches
(610 mm) wide throughout its length; and
3, A level service space at least 30 inches (762 mm) deep and
30 inches (762 mm) wide located at the front or service side of the
equipment.
EXCEPTION: The passageway and level service space may be
omitted if the equipment can be serviced and removed through the
access opening.
307.4 Equipment under Floors. Underfloor spaces containing
equipment requiring access shall be provided with the following:
1. An access opening large enough to remove the largest piece
of equipment, but not less than 30 inches by 22 inches (762 mm by
559 mm);
2, An unobstructed passageway which:
2.1 is large enough to remove the largest piece of equipment but
not less than 30 Inches (762 mm) high and 30 inches (762
mm) wide, and
2.2 Is no more than 20 feet (6096 mm) in length when measured
along the center line of the passageway from the access
opening to the equipment;
3, A level service space at least 30 inches (762 mm) deep and
30 inches (762 mm) wide located at the front or service side of the
equipment; and
4, Where the depth of the passageway or the service space
exceeds 12 incites (305 mm) below the adjoining grade, the wails
of the passageway shall be lined with concrete or masonry extend-
ing 4 inches (102 mm) above the adjoining grade and have suffi-
cient lateral-bearing capacity to resist collapse.
EXCEPTION: The passageway may be omitted If the level service
space is present with the access open and the equipment can be serviced
and removed through the access opening,
307.5 Equipment on Roofs or Elevated Structures. Roofs or
elevated structures containing equipment requiring access shall
be provided with the following:
1. An approved means of permanent access, the extent of which
shall be from grade or door level to the equipment and its level
service space. Such access shall not require climbing over
obstructions greater than 30 inches (762 mm) high or walking on
roofs having a slope greater than 4 units vertical In 12 units horl-
zontal (33% slope).
EXCEPTIONS: 1. Equipment may be accessed by a portable lad.
der on the single•story portion of a Group R Occupancy or a Group U.
Division 1 garage or carport.
2, Equipment may be accessed by portable ladder on the single.
story portion of an existing building that does not exceed 16 feet (4880
mm) in height.
2. A level service platform at least 30 inches (762 mm) deep and
30 inches (762 mm) wide located at the front or service side of the
equipment. The sides of the service platform shall be provided
with a substantial railing not less than 42 inches (1067 mm) high
and constructed so as to prevent the passage of a 21 -inch- diameter
(533 mm) sphere where a side of the platform is within 10 feet
(3048 mm) of a drop greater than 30 inches (762 mm).
Ladders and catwalks providing the required access shall be as
required by the relevant safety regulations but shall not be less
than the following:
19
3
GAS FURNACES
M CD 0
:=1 }�-a p m
m
r � C.4.9 X m
Models with Input Rates from a
45 000 to 150,000 BTU /HR
UGPH- SERIES
nd
m
RUUD
SILHOUETTE" IE
80% AUF.UIE.t
UPFLOW/
HORIZONTAL
GAS FURNACES
FORM NO. G22-448 REV. 2
Supersedes Form No. 022.448 Rev. 1
The Ruud° Silhouette` A line of upflow /horizontal gas fur•
naces are designed for utility rooms, closets, alcoves, or
attics. Because of the Silhouette's Iow•profIlo 34 Inch
(864 mm] height, the upflow model can also be used to
satisfy most applications that traditionally call for a
horizontal furnace.
The design is certified by the American Gas Association.
Canadian models are certified by the Canadian Gas
Association.
Features
1 Patented Turbulex` Heat Exchanger, constructed of both
stainless and aluminized steel for the maximum in corro-
sion resistance.
• Low profile "34 inch" design is lighter and easier to hen
dle, and leaves room for optional equipment.
▪ Convertible from upflow to horizontal left or right without
field conversion.
▪ Left or right side gas and electric inlet connections with
quick, simple change.
1 Hot surface ignition models equipped with remote sense,
feature an integrated board with humidifier and electronic
air cleaner hookups.
MODEL
UQPH•
A
1
C
E
REDUCED CLEARANCES (111.
(mml
SIDE
BIDET
TOP
FRONT
L15w kTI
04.05
14 1356)
12 (326j
10 /a (263)
El
11
0
4
(1021 f2.
0
1 (25)
3 (761
6
115211
85
(38.6)
06, 07
Man
16 "3214151
12
isi
15 ' 13811
0
3
1761 '2 ,
0
1 (2 5)
31761
6
(152 (2,
105
:47.61
10 (A)
11=211
16 1415)
12 1308)
mmiu
0
3
17611
0
11=11
3 (761
6
(162) :1
115
;52.21
10 (8)
EOM
19
igi
18'/2 (470)
0
0
0
Mill
3 (76)
6
[152) a
120
,54.4)
23"/32 (593)
15 /e (397)
w
22 (559)
0
0
0
Mall
3 (761
6
(152) a
140
163.5)
24 (622)
23 "/32 (593)
15 /8 (397)
c1)
22 (559)
0
0
0
1 (25)
31761
6
1152) 4
150
(68)
NOTES: ' Mav reauire a 3' 176 mml to 4'1102 mml or 3'176 mmt to 5'1127 mml adapter.
4-
LEFT END
24
- (622 mm[
( 1 Designates Metric Conversions
(tA mm[
24"'/M" 1616 mm) --•
14 mm(•
11 NO
(202 mml
OAS I LOW VOLTAGE
CONNECTION ELECTRICAL
I CONNECTION
26 3 /10" 26° /8'
(691 mm) (070 mm[
FRONT
OOTTOM VIEW
TABLE 1. DIMENSIONS AND CLEARANCE TO COMBUSTIBLE MATERIAL (INCHES) (mml
RIOHT END
WARNING
HIP) 1lllifdnl,l ► , N(►I AF I'III►VI I�
(►11 Ill (,OMMI NI)) I► I OIZ IN!,IAI I AI II ID
l i n ( , i ( W I T H n(;CI I ►DHli',
I ALINO UPWARD!)
1s May be 0' (0 mmj with type B vent.
3 May bo 1' (25 mm) with type B vent.
Furnaces must be vented In accordance with ANSI 221.47.1993 • CAN /COA•2.3•M93 venting table guidelines included with each furnace, and in accordance
with local codes.
5
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IICAL6: 3I1G APPROVCO 111Y:
I Understand that t'ne Plan Ctva k approval3 ar
sub rct to errors and omissions and approval of
plans roes not authorize the violation of any
adopted code or ordinance. Receipt of con -
tractor's cope of approved plans acknowledged.
By
Date I °Z`7
Permit No.
PERMIT
' f'•. k.. ti xi �.�1t'
.L D FOR:
• :.ECI-IANICAL
O ELECTRICAL
O PLUMBING
GA S PIPING
CITY OF TUKWILA
BUIL• NG DIVISION
CITY O
� �R���� II.A
OEC 19 2000
AU!1_1510 c; t-5 v 1
DATES I I ?too
b lw1•46041 6444I1JAL
ck.kk - A-4)
rm
Nov ; � 200
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acv I
•
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ACTIVITY NUMBER: M2000 -259
PROJECT NAME: JACK HALBERT
SITE ADDRESS: 4007 S 117 PL
Original Plan Submittal
Response to Correction Letter #.._
DEPAR_ _TMEN_T_S:
B ilding Division DO
Public Works ❑
DETERMINATION OF COMPLETENESS: (Tues., Thurs.)
Incomplete El
Complete
Comments:
1PILKOIJII
TUES/THURS ROUTIDIG:
Please Route
REVIEWER'S INITIALS:
PERMIr COORr COPY
PLAN REVIEW /ROUTING SLIP
Fire Prevention
Structural
Structural Review Required
APPROVALS OR CORRECTIONS: (ten days)
Approved ❑ Approved with Conditions
REVIEWER'S INITIALS:
minnirma
CORRECTION D TE M NATiO :
Approved ❑ Approved with Conditions Li
REVIEWER'S INITIALS:
DATE: 11 -13- 2000
SUITE NO: , W
Response to Incomplete Letter #
__Revision # After Permit Is Issued
Planning Division
Permit Coordinator
■
DUE DATE: J �-� 4•Z000
Not Applicable ❑
No further Review Required
DATE:
DUE DATE 12: 12 -2000
Not Approved (attach comments) LJ
DATE:
DUE DATE
Not Approved (attach comments) El
DATE: