HomeMy WebLinkAboutPermit M92-0178 - CHRISMAN JOHNm92-0178 chrisman john hvac
15633 44th avenue south
1tk
City of ThkWi& C. 431 -3670
Community Development / Public Works • 6300 Southcenter Boulevard, Suite 100 • Tukwila, Washington 98188
Permit No: M92 -0178
Type: B -MECH
Category: RES
Address: 15633 44 AV S
Location:
Parcel #: 810860 -0125
Contractor License No: NORDIHI099BJ
UMC Edition:
1991
Permit Center Authorized Signature
MECHANICAL PERMIT
TENANT CHRISMAN JOHN
15633 44 AV S, TUKWILA, WA
OWNER ROBINSON STEVEN L
15633 44TH AVE S, . TUKWILA WA' 9,81 ;88
CONTRACTOR NORDIC HEATING ,INC. Phone: 206 931 -0503
33014 36TH AVENUE SW,. FEDERAL—WAY, W 98023
********************* 444***************** i***** * * **4(4',r * * * * * *,r * * * * * * ** * * *,r
Permit Description:
INSTALL ,05 FURNACE AND HOT WATER TANK.
Valuation
Total Permit Fee:'
* * * * * * * * * ***; r*****************:*. * * * * * * * * * * * * * * * * * * * * * * * * * * * * 4 * * * * * **
I hereby,,,cer,,,t i fy that I have. read" _and exam ned this permit and Know . the
same to'. be true : and correct. All 'provisions,. of law and ordinances
governingthls work will be complied w'ith'; whether specified herein or not
The granting of this permit does not ,presume to _give authority to .violate
or cance the . pr,ovisions of any other state or local, laws regulating
construction or: the performance of work. I am authorized to sign":. for and
obtain this bu.i l,d - nng permit.
Signature '� 'z" SY' -` D a't e '9
Title: has7r7LGe'g
This permit shall: :become null and'vodd.i.f. :.t. work is not`_;:oammenced within
180 days from the `da ";.of issuance;; Or; i`f work is :: or
abandoned for a peri "180 days,f,rom ;the..'last inspection.
Status: ISSUED
Issued: 09/14/1992
Expires: 03/13/1993
Phone: 206 246 -5245
q
Date
1,500.00
38.13
PERMIT NO.
CONTACTED '
DATE READY
DATE NOTIFIED
I BY:
l init.
PERMIT EXPIRES
2nd NOTIFICATION
BY:
Init.
AMOUNT OWING
•
3RD NOTIFICATION
BY:
init.
INSTRUCTIONS TO STAFF
• Contacts with applicants or requests for information should be summarized in writing by staff so that
any time the status of the project may be ascertained.
• Plan corrections shall be completed and approved prior to sending on to the next department.
• Any conditions or requirements for the permit shall be noted on the plans or summarized concisely
in the form of a formal letter or memo, which will be attached to the permit.
• Please fill out your section of the tracking chart completely. Where information requested is not
applicable, so note by using "N /A ".
DEPARTMENTAL REVIEW
"X" in box indicates which departments need to review the project.
O FIRE
O PLANNING
O OTHER
BUILDING -
final raviaw
BUILDING -
initial review
I
REVIEW COMPLETED
PROJECT NAME
SITE ADDRESS
11 A't'C` 11
q -q-co
CONSULTANT: Date Sent - Date Approved -
of it (4,—L.
▪ OUTED
FIRE PROTECTION: ( ) Sprinklers n Detectors nI17F
INIT:
INIT:
INIT:
MECHANICAL PERMIT
APPLICATION - [RACKING
Cn,r i (D rYtcar) Sohn
jgA)53 1 -14
FIRE DEPT. LETTER DATED:
ZONING: BAR/LAND USE CONDITIONS? Yes
SCREENING REQUIRED? (lYes it No
REFERENCE FILE NOS.:
UMC EDITION (year):
SUITE NO.
INSPECTOR:
SITE ADDRESS SUITE #
1 '5 (, 3 `) Li c_/ ,
VALUE OF CONSTRUCTION - $
/ 500 , 0 t;
PROJECT NAME/TENANT
e 1 R ►K., iii A 1 ') 3o 1.i,
TYPE OF WORK: 0 New /Addition t.. Modifications O Repair 0 Other:
DESCRIBE WORK TO BE DONE:
0 - c. 1 - 4 1 u (=-t. - 1.-c.c�,ti.f t_
;< < TYPE: :<> > << ° < <> > <; ><<< > '<' >; < <> >:imi A T �S .
RA ING/ 1ZE °::<:: < » >> >:: :: >:::::: <::::»: >:?:::<:: °NUMBER OF::i1fdITS .
6 r r 4 ,1,•, -,, AltrY. r /G /(e), ekie) I
6r r, LCJ I t. r Ally P v P To - c.TO GYLA
c. r1 l3�'
PHONE 7
EXP. DATE
/--
3j_6'SG�
ZIP
BUILDING USE (office, warehouse, etc.)
S , r) L.L/ .C' L C I lr
NATURE OF BUSINESS: f
WILL THERE BE A CHANGE IN USE? 2: No 0 Yes IF YES, EXPLAIN:
WILL THERE )3S STORAGE OR USE OF FLAMMABLE, COMBUSTIBLE OR HAZARDOUS MATERIALS IN THE
BUILDING? No 0 Yes IF YES, EXPLAIN:
PROPERTY OWNER c) f4 All C /4 R I .S lrl.l- 11
PHONE ` . I ,- 5 ,, i.j:7
ADDRESS / r 6 `Z " `m 4 c 3
;DATE
7 ui<c.v /L A--
ZIP
CONTRACTOR NORDIC HEATING, INC.
l l� l
c. r1 l3�'
PHONE 7
EXP. DATE
/--
3j_6'SG�
ZIP
ADDRESS 340 c, b I. N.E., BAY 1
AUBURN, WA 98002
WA. ST. CONTRACTOR'S LICENSE #
A.12i�
DESCRIPTION ;
:::'::::':AMOUNT::::
RCPT :4V"
;DATE
BASIC:: PERMIT:: FEE' ` --
:.$15.00
UNITS) FEE
PLAN CHECK FEE :
OTHER.
TOTAL' ..
, :.
PLAN CHECK
NUMBER
CITY OF TUKWILA
Department of Community Development - Building Division
6300 Southcenter Boulevard, Tukwila WA 98188
(206) 431 -3670
0
a- on$
APPLICATION MUST BE FILLED OUT COMPLETELY
TIE
it7 iCO
RR
1f ORt
SIGNATUREp
5 1DATc) -O/2e
MECHALCAL PERMIT
APPLICATION
Mechanical Fee Worksheet must also be tilled out
and attached to this application.
FEES (for staff use only)
DATE
KNOV
BUILDING OWNER
OR
PRINT NAME R L
ADDRESS -- � U CITY /ZIP
CONTACT PERSON PHONE
APPLICATION SUBMITTAL In order to ensure that your application is accepted for plan review, please make sure to fill
out the application completely and follow the plan submittal checklist on the reverse side of this form. A completed
"Mechanical Permit Fee Worksheet" must accompany this permit application. Handouts are available at the Building
counter which provide more detailed information on application and plan submittal requirements. Application and
plans must be complete in order to be accepted for plan review.
BUILDING OWNER / AUTHORIZED AGENT If the applicant is other than the owner, registered architect/engineer, or
contractor licensed by the State of Washington, a notarized letter from the property owner authorizing the agent
to submit this permit application and obtain the permit will be required as part of this submittal.
VALUATION OF CONSTRUCTION The valuation is for the work covered by this permit and must be filled in by the
applicant. This figure is used for budget reporting purposes only and not to calculate your fees.
EXPIRATION OF PLAN REVIEW Applications for which no permit is issued within 180 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 180 days upon written request by the applicant as defined in Section 304(d) of the Uniform
Mechanical Code (current edition). No application shall be extended more than once.
If you have any questions about our process or plan submittal requirements,
please contact the Department of Community Development at 431 -3670.
DATE APPLICATION ACCEPTED I DATE APPLICATION EXPIRES - n
* * * * * *, * * * ** * * *:.k fir ter******* do* ;k: ktie**'* k* ** ** ** *i* t**' !r* * ** * **fit*th*'
CITY ! , : OF TUKWIL,A, 'WA • TRANSMIT
* * * * *. * * *,1F *', **; * * * *' *'* r.*'***** ,* * ** * * * * * * * * * * * *,* ** **,•k *.* k •
. .TRANSMIT Numbere :92000972; Amour!t. =.' ;;3 .1 09' 10. -3
Permit;: No .M924:0178:;' Type: El.
.1 MECHANICAL :. ' PER,MIT ,
Parcel : No: ;81;0860 01.25
. Site .Ad dre.s� s 15633 44 ,AV S.
Payment Methoda::CHECK Notation: NORDIC HEATING Iri9W 2 0
: * * * * * *, *.* * * * *'; * *** *;,
;k,* k *,t* *, ** * * * ** **:* * * * **. * ** *** * * * * * * * * * *' *4' * *,*
..: Accournt:: :Coda Pescr" i pti an. ' .:. Pa i d
'000/345:.8S,6*:' ". PLA N . CHECK - RES 7 «63
':,(,)061322.;106:" MECHANICAL RES . 30.'50,:
: Tatil l . (1TM):s P`atyment) ;' 38.`13:
T . F, ees 38 ;.13
Ta'tal ,A `Paymantb`. 38.`13
�t H.alncea ' .00
GENERA' 7.63
GENERA 30.50
GENERA : 7.63
GENERA . 30:50
,TOTAL 76;26
CHECFt 76.26
' 0.00.
3350A000 16 :.20.
Address: 15633`44 AV S
Tenant: CHRISMAN JOHN
Type: B -MECH
Parcel #: 810860 -0125
* •k * * *** ** Ir* * * * **•k * **** * * * * * **** * * * * ** k h *'k * *'k ***** k* * *** *•k ** **"k* **** * * * * *•k **
Permit Conditions:
1-. No changes will be made to the plans unless approved by the
Architect and the Tukwila Building Division.
2. Plumbing permit shall be obtaj„n,e:d.....th.r : ough the. Seattle -King
County Department of Public Health Palu`mbi,n,g will be
;inspected by that ag06:y ; ;1' n'cl "tiding a'll 'gas'plP
(296 -4722) . ,..; S , . "" .� r;h ,,
3. Electrical peri- ?,,;shal V be abt iinedj,�throug the' ~Wa'sh,.ington
State Divist r �of ;Lab'orrand� Industries and1 all r=ele"cct.rical
.work w 11 b• i°nspected;�,b L that agency. `(24 -66 °'� \''
4. All permit�s•♦,�•.inspec. record "s, an approved, {'p,lans shaylrtl�.be
f',t °J� �,. at r ; t, t;,f 'Oar
'maintain.e 4ava�i table ,t jab, site priorl th:e. t\
any construction. '" These docume s°eare to be maintained
avai lab, a unti 1 ` - 'f final ins00ilon aWoval is gi' anted..:'
) CITY Or TUKWILA •
Permit No: M92 -0178
Status: ISSUED
Applied: 09/09/1992
Issued: 09/14/1992
ti i �z•
5. Any e p se Insulations �ba:d � nrg material shall have a Y :Fl ,
Spread,{ ati of $x25 or;,less, �y n d�,�rraterial shall bear g'i�den`ti -� #'
f i c l i�i in showing ' the f ;re per�formance.y rating thereof .',. {„ : \,: s
Al 1 construct 1 on to be`: done.. .,.i conf:c romance with apprpv'edj ,,, 'y
pla *Ian htrr equiremepta ! of,,thelUnifor'B(111d.fng Code (199'1"
Edit' on) as amended bv' '•'the- ; Wasliil�rrgfo # 1n State�'s,Bui1 ding �`Cod'e "'''
E net 7t BY
. nil Vion1, : ,Washi ngton Sta
i , on
i) ` . ...
w and ._. 31
7. Va 11 ty , f Permi•t'. The i s`sruaance \c if a.,••p'ermi t or apprrova�l ;.,:{o,��f
p 1 a , 5:p,, ,c i f ;c a t 4:c /a 9 d c p m Ot,a t s, ;s h f.�1 `l not b e oo n - ,°,. , srra . n
.
�
r � s,
str to b`e al perh,i�ti; ;r or ar( \ap.prggval�.�of,, any viola
of of provisio of this'b.c'Ode „ ,,
fQr'of : ?.arny other :,:,, ,
ordi nc�e'•6f the jurisdiction. o prlrii rning,�to
auth q ty to t v io.:late or cancel th.e p,,,O,i' � s "i.o 1 ,`r s,,Lo t '�
f is c zo
�' v i i
shat i� �
8. MANUF �TURERS INSTALLATION INSTR,U'CTIONS EQUIRE D.;, ON
FOR T »ILDI INSPECTORS REV J: - ` \t ./- ,r-,„'
Project: - //
00 C. ` , a1,5 one, G Al
Type of Inspe « "-
�!
.�
Address: 3 3 r `/
S�
Date Called: , _
`g L
Special Instructions:
Ce .t�Le■L..
Date Wanted:
/07
C�
% ?--a
p.m.
Re q u es ter: J /
Phone No.:
COM
INSPECTION RECORD
Retain a copy with permit
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 98188
Approved per applicable codes, ❑ Corrections required prior to approval.
7
Inspector: '' l .)?„. _ Date: /V
2 ! /
❑ $30.00 FEE REQUIRED. Prior to reinspection, fee must be paid at
6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
�Gt' 9L
o/ ?
PERMIT NO.
ro ect: �-hr i.5 rN0A i `��1'111
re o ns : ion: F,, nco
Address: 1 6 (05,3 144 �1 J5
Date Called: ci„czacj q„ i
Special Instructions:
Date Wanted: -)
1/4-1 cc O am. p.m.
Requester: Toh n
Phone No.: CD a t5
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 98188
O Approved per applicable codes.
COMMENTS:
rTh INSRE TION RE
Retain a copy with permit
Inspector:
receipt No.:
y3 /- (& 67g
Date:
MCO
PERMIT NO
(206) 431 -3670
Corrections required prior to approval.
Zy�
O $30.00 REINSPECTION FEE REQUIRED. Prior to reinspection, fee must be paid at
6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
(Dale:
DATE /�
.� I�
•� _ • ' �AWH -CH- WALL FURNACES- RANGES - DRYERS
WNG 836.3 S (2/92) '
.E1 NO h , ,� 1�� -�
L •-T iI�
Mq)
CUSTOMER NAME - OWNER 0 YES 0 NO
AOORESS,... -. .7.... Clry
HO ' PPPHOONN �^ f
WORK PHONt
MARKET P REP INSTALL _
•
CODE
SCHEDULE OA0
SCIi�DULE_DDATE
• • -
TYPE OF III DELIVER ONLY ❑ DELIVER TO INSTALLER • PICK.UP BY INSTALLER ❑ NEW SERVIC :� •• D LOAD
DELIVE j= DELIVER TO CUS & INST • C PIC -U ❑ EMPLOYEE SALE U METER ONLY ❑ OAS REPLACEMENT
F ROM TO IRAN CODE
AR/
F
I I
:311
I
i P. A •, [,/ ,
601.
I11� \ ��,
ACCT. NO. RESP.
EQUIPMENT LOCATION & PIPING ROUTE (SKE H) Liiin ., r
BID B REP
❑ INSTALLER
�� h�
KIM Ilea ITEM NO. OUAN DESCRIPTION
"IOW 04.048 WATER HEATER - FSG-40
r gIId
! �
'
�� at1� �� 04 -049 WATER HEATER - FSGL -40
r
�
**
I
/
,
"
� � 04-087 WATER HEATER - FSG -50
; 04.151 WATER HEATER - PRV -40 (w/15011TP)
04 -152 WATER HEATER R PRV •5 (w /150 #TP)
pm
04 -250 WATER HEATER • P -50 -2
04.252 WATER HEATER - P -50 -X (HIGH RECOV)
ai �
r � /
!
L /
1
� 77
�I
`
�i' 11•." - 11
tw
.�: 'C�I riii WATER HEATER - PVP -50
c� kill RELIEF VALVE - T & P IXL 150 LB,
di
I /
$`6/� ______
j
■
•
���
'
al
*,
1.19
l I
.. '-�
IP
85.684 CONCRETE BLOCK 6 x 8 x 16
ra 85 -685 CONCRETE LID 22"
N.
roam
03-212 No CONY. BURNER - ECONOMITE DS24A
Ill �Arr , y, y
1 /
. 1:T • • r
R • CONVERSION BURNER 23-524 SWITCH•COMB -L -40648 -1451
WORK = EOUIRED
23 -646 THERMOSTAT T- 87F•1859 w /WALL PLATE
• ROOF JACK TYPE'S' VENT 24-307 FLEX CONN RANGE /DRYER 3/4" 48• /VALVE
x w
•
NO OF STORIES INSTALL THERMOSTAT DIAMETER 24 -320 ECON MOUNTING FLANGE
❑ COMBINE VENT 0 OTHER FT
APPROX.
SIZE TYPE 'C' MIT 24-784 THERMAL STACK SWITCH 11700)
0 CHIMNEY CLEAN OUT • DIAMETER 26 ECON EXTENSION RING 8"
LINE CHIMNEY
Q CLEAV. OUT IN 'I ❑ A•' •' 28-540 BAROMETRIC DIVERTER (Req. w /DS24)
❑
Ht: CULU EUILER
/lam . 77 ir
. �
LABOR /MATERIAL IN EXCESS (PROVIDED BY INSTAL ER)
❑ ENCLOSE VENT THROUGH ATTIC $ • VENTING
U ■ (��
INSTAL$ /REPAIR FIRE POT $ PIPING ✓ ✓ FT.
- '
0
• PRESSURE RELIEF VALVE $ 0 ELECTRICAL $
•
A
COMBUSTION AIR• FROM WHERE $
LEASE CHARGE ITEMS
OTHER S 2 3 41 1
TRAN C0 1 ACCT NO 16 1 31 0 RESP l I 1 1
❑
❑
•
23-971 RELIEF VALVE • T & P 125 LB.
GENERAL INFORMATION 24 - 985 PRV • VENT CAP PROTECTOR
.1
0
❑ STAND REQUIRED INPUT 4O 00 PRV - EXT. KIT
ALPIIOXIMATE RR
COLD WATER LINE '2 EXISTING WATER LINE: LV. COPPER
HOT WATER LINE • 4' 01/2'
FUEL LINE J TIE INTO EXISTING •
YES ❑ NO
FUEL LINE FITTING?
SIZE
BILLING DATA
0 PRESSURE RELIEF
DISCHARGE LINE ! DISCHARGE TO: LOOK • DRAIN 0
DE .
INSTALL IN EXISTING AIR
INSTALLATION ANT SALE (] LEASE
OTHER Alf •
EXC
MESS AMT.
LOCATION? ES ❑ NO ADE ,YES 0 NO
ARE OTHER APPLIANCES BEING INSTALLED AT SAME ADORESS? ■ YESAJO INSTALLED DATE AMT. BILLED:
OLD SERIAL NO
EOU NT: TYPE: SIZE' • 0 LEAVE MTH CUSTOMER
MODELB TOTAL $
REMOVE & JUNK ❑ RETURN TO WNG ❑ OTHER'
RE V EXTRAS: ❑ DISMANTLE EQUIPMENT ❑ L��
DIF D r�IMST PIPING PIPING e � PLUMBINO�
• OTHER Kw MECHANICAL ill. ELECTRICAL N
vs low
COMMENTS. 011[101 RECEIVED SY: `A \ %Pr V . ` r i e
— •
PEfIMIfi CENTER MATE*AL RECIEWD RV: , 0ATE
MATE AL ISSUED E'/. DATE
,WASHINGTON NATURAL GAS COMPANY .
�P t' I &1PT{s11/'•41A�� /���Tr�A� nr�11
❑ SPEC, HANDLING ❑ ADO ON
❑ RUSH ❑ REWRITE
8
C CO
r.o
OATT 117-
ENTRY ARRA
GAS ❑ OIL ❑ ELECTRIC
EXISTING SYSTEM �❑ HER
MAKE
HEIGHT
WORK TO BE DONE
WIDTH
K F N ACE TYPE:
UPFLOW
❑ UNTERFLOW
❑ HORIZONTAL
❑ CONDENSING
et
MODEL
DUCTS:
❑ SULATE RUNS
ONT INSULATE RUNSINSULATE RUNS
❑ INSULATE PLENUMS
❑ INSULATE EXISTING DUCTS
❑ INSULATE TRUNK
❑ ADD BALANCING DAMPER
It NEW W / A.. _ •-
N NEW R/A
T` 0
( 'ASHINGTON NATURAL GAS COMPA(
ON.. CALLER'S INSTRUCTIONS /MATERIAL RECL SE
CENTRAL. HEATING SYSTEMS
WNG 836.10 S (8/901 OA.P 040.1
VENTING:
BTU
IA PLENUM (SIZE)
W D
OLD EOUIP�
❑ LEAVE REMOVE
O RETU N TO MG (LCR REOG)
X X
C VENT
B VENT 40
PVC
TERMINATION LOCATION:
ADD
H
Length Diameter
VENT TO:
LINED CHIMNEY ❑ ROOF JACK
ASONRY UNLINED ❑ POWER
❑ METAL
THER
ROVIDE LINER
❑ PROVIDE COMBUSTION AIR
FROM WHERE
EQUIPMENT LOCATION & PIPING ROUTE (SKETCH)
REP
HO Td HO WORK PHONE
SCHEDULE DATE (0 f C34.> SCHE ED�TE TYPE OF El DELIVE ONLY ❑ DELIVER TO INSTALLER ❑ PICK•UP BY INSTALLER
DELIVERY/ DELIVER TO CUSTOMER & INSTALL ❑ CUSTOMER PICKUP ❑ EMPLOYEE SALE
NO W /A
Y
R/A PLENUM (SIZE)
w 0
X X
NO R/A DUCTS
H
REMOVAL EXTRAS
❑ DIFFICULT ACCESS ❑ DISMANTLE EQUIPMENT
❑ TWO PERSON JOB ❑ OTHER
PLENUMS:
W /A:
❑ NEW XRANSITION
RR /A:
❑ NEW ANSITION
❑ EL ATE FUR ACE
GAS O•
LENG r - <AMETER
❑ DRILL THROUGH CONCRETE
PERMITS: S APIPING N
❑ ELECTRICAL N
IA MECHANICAL N
❑ BOILER PERMIT TAKEN
FROM
"Wate
I 1 I
I I
ORDER RECEIVED BY
1 {� � II NCITY
iTA E�� I CO OE��
mut
ATTIC INSULATION AOEOUATE
AUTO TISTAT
DAMPERS EXISTING
INSULATED DUCTS
COMB AIR ADEQUATE
C/A RETURN ADEQUATE
PROBLEM HTG AREAS
LOCATION
BIf INSTALLER
❑ MTKO REP
❑ waif i Dale
HEAT LOSS
TRAN CODE
CALM
❑ SPECIAL HANDLING
❑ RUSH
❑ COUNTY
❑ NEW SERVICE
❑ METER ONLY
❑ ADDED PL LOAD
REPLACEMENT
P•FLOW ❑ DOWN•FLOW ❑ HORIZ ❑ OCTOPUS
B SEBOARD ❑ OTHER
NO ❑
CFM REQUIRED
WIRING Al CONTROLS:
❑ ROVIDE SEPARATE CIRCUIT
USE EXISTING CIRCUIT
LOCATE THERMOSTAT
LOCATION
NSTALL E.A.C.
OVIDE CAC. OPTION
❑ SERVICE LIGHT WITH SWITCH
AT ENTRY TO FURNACE ROOM
❑ CONDENSATE PUMP REQUIRED
CONDENSATE LINE TERMINATION
❑ FLOOR DRAIN
❑ OUTSIDE TO FRENCH DRAIN
❑ OTHER
BILLING DATA
CO
,, 1 ■ I All Y ■■■
- ■■■■■■■■iii�i■ Mar ■■■ maimm"1114111111M _
h 1172111211W
r11r9,■ ■11, .. ■I■■Ir wrlr/■r - MIN
immmorm um swum
' 4 warms murmur
E4 VOW %,itifirPARP
I1P11I ■ ■■■ ■�■ ■■■■■■
MENTS
RFCEIVEO
CITY OF TUKWILA
SEP 0 9 1992
1
ITEM NO
ACCOUNT NO J ESP
4 1 1 1 6 1 3 1 0 JL6I
INSTALLATION MAT• �r��♦
EXCESS AMT:
DESCRIPTION
INSTALLED DATE: AMY BILLED
SERIAL I
MODEL I TOTAL
11■1011111111 t ``
70
TO