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SIDEWALK EXISTING
" I
NAME drJ?hA44~
I
LOT ~I BLOCK.
SUBDIV. ~~.~.#;;t'~. ZONE k? //-1
STREET NO. ;L<(3S- #A---,./~,..JLOT DIMENSIONS 7S)('113
YES 0 NO ~
C1 - ?;:{
DATE
9....~'~?..3
c;(7~t:) ~~ ~~
.~
'~
ADDRESS
/.:L-
WARD
, 19.35
BY
~N
BUILDING GRADE ELEVATIONS STAKES SET AT SITE
FEE: $2.00
0p<---/./ ?~
DEPARTMENT OF PUBLIC WORK~ '~
I, the unders i gned, owner or agent of the above descr i be agree to have Ot~ ,-
grade establ ished before excavation has commenced.
3041.
i
/}.3cr/l
:/ ,1/'
.-t.
~ STATE OF WISCONSIN
Department of Industry, Labor and Human Relations
Safety and Buildings Division, Madison, Wisconsin 53707
.XEROY WORaSHEBT
JOB NAME:
LOCATION:
DESIGNER:
, ZONE:
DATE
/ /.
t '/ td':'/V3
/yf ._
'. if .-
.-:"".,:,
INSTRUCTIONS: This worksheet is recommended for determining conform-'
ance with the Uniform Dwelling Code's Energy Conservation Standards.
Dwellings may be evaluated by the System Design Method or the Accept- <
able Practice Method. Heat loss thru basement walls and floors where
insulation is not required by code may be included in furnace sizing
calculations at the option of the designer. System Design heat losses
not exceeding the losses determined thru the code requirements by
more than 1 % are considered acceptable.
area calculations
GROSS WALL AREA: ) FOUNDATION WALL ABOVE GRADE:
",
:d6/ ....
/
i' ,,' ,.,;,.......;
/ '/
./
/ /7
(/<~ / t.;-:? .
I 4. C) L. sq. ft.
[, ~ ~.v
WINDOW (.AREA:~glass size 0 unit size
!IL
FOUNDATION WALL BELOW GRADE:
,~,~
sq. ft.
/'?r- /0
/ c!I(::; )~..:5
%J-
,
sq. ft.
+0 f sq. ft.
FLOORS OVER UNHEATED AREAS:
DOOR AREA:
If? d~
fI
/
Ij
M sq. ft.
CEILING AREA: NET (OPAQUE)WALL AREA:
'2v {J 'I ;:t.;r~
i-
"'"
OTHER: f-dvf:io dJ,
I
4--f sq. ft.
OTHER:
1/ I~A
!. Ill-sq. ft.
sq. ft.
+D
sq. ft.
sq. ft.
Form No. SBD-5518
page
I
'UIJ
VALUES
INSTRUCTIONS: Calculate Rand U values using TABLE A-4in Dwelling
Code Book. Separate calculations for systems having the same insul-
ation but different interior orex:terigrfinishes is not necessary
.0 provided the system with the lowest R value isu.sed:i.nthe System
Design or Accepted Practice calculation. : .
r''-'
wall type 1 type 2
cay sol cay sol
i
exterior film ..17 .17 .17 .17
'---'---, --.-..- - #~?
siding ')'&>
~ ~,.,...
sheathing 1(.0 <;. (;
insulation /'3.9 xxxx xxxx
-----._~
framing xxxx 4 3)( jx:xxx
t. !;v
,---- Jqf .t1..t
into finish
'-----
interior film .68 .68 .68 .68
TOTAL R Ii, ~} (! ,-vl
llull l/R 0.:'0 \0(6''/
= I J
'),'.
fdtn above grade walls
cay sol cay sol
exterior film .17 .17 .17 .17
ext. finish &
masonry .&~
wood
into finish
inh.:rior film .68 .68 .68 .68
.--- f--
Insulation .-;;> -
TOTAL R r~~
UUIl = l/R 1/ "S
,
raal type 1 type 2
cay sol cay sol
exterior film .17 .17 .17 .17
-~.-
ext. finish
insulation :351 /9-
framing xxxx 4- ~g xxxx
J. /
insulation
into finish .r41 -fi .
interior film .61 .61 .61 .61
TOTAL R ~91Q ~451
llU" = l/R ,OZl? /O{I)
ather cay sol cay sol
exterior film
ext. finish
insulation
into finish
interior film
TOTAL R
"Ull = l/R
baaement* 1st 4tb ..
thru 3rd foot foot below grade
below grade to basement floor
no insulatioh .288 .094
walls R 5 rigid board .113 .063
R 11 fiberglass .072 .048
w/ 2 x 4 framing
floors no insulation .025 .025
-,
'* includes air film, wall, insulation & soil
page
z
B S lB. heat loss in
AREA tlUtI TD BTU per hour
tyPe l. ~,,/i 'i 9'(%) 1141 IC~D g-S~ 4s.5'4-'1
cav. C. ci::'L'~.q x ,j, .
walls 1 (. /'f,"':i x /5~-%) w'V" s..t1 'x.=)/ r;/ <,~.,.g
s 0 1.~1 '! ::J , 001
type ca v. ( x ------10 )
sol. ( '.
2 x ------10 )
. cav.( / / tJ 4-"Xf? :s %) ItPZ") ;{~ 2'2:10,
type l C/:Lb
roof 1 ;sol. ( / / t' (::f,.' x t/J %) ?? ( otiJJ,J ~")' Zf.t:;"'v'
,
type cav. ( x.------.fo )
2 801. ( x ------10 ) .
'.
Fdt 1 above grade walls q/ ! 'It.;"~ 15 5' c;,. ~5J'
, . j
n grade(3 feet) r:':.." It2f I;'~* ;'--1{ 1"1 .r
2 below ~1.l)Y ') t. '::l" j~
3
1 windows C;/ .3 ,~A .;;'5 '2 .Q.- c:.-;?
IEIass .... .~ "-' D
2 patio doors 1~.D '" .J' ~(;' /J '1'0
J S
3
doors 1 7' r:i~ :3:, () ,,' ''/ b'-'J:7'f ;Z.(..? ~,./ 5CS' 'S'{5~~
'0
2
,
atJ ~er 1 ( [I ft. "Jf:'.l/",,,u 44' IVS() 9~1 ;toT- i
w _
~
2
TOTAL .?~~31~
SYS TBM
D
CONSTRUCTION HEAT LOSS
.f
CODE COMPARISON
ADJUSTMENT FACTORS COMPONENT AREA CODE TD BTUH LOSS
FOR WOOD FRAMING 11 U"
cc studs joists walls above fdtn /1'1 Id IlV ,1t( / ('i Zl!;(',7/
.- _.c
1211 20% 14% walls above grade I"
1611 15% 10% fdtn above grade ~ \ .25 rl{ J ?1:J. 4-'
:.t f . ;;)..
24" 10% 7% ,
fdtn above grade
-
fdtn below grade(3~ ~~ .20 <1} ,': .4~DgtJ
roof/ceiling f I 04-. .029 :5'/ "'2 ("" (J I
V" I t...,
~l';~~:L~-''''-- q~I'( N1'f (J 3h7 l
ALLOWABLE j)fJ3'~:J '
HEAT LOSS
,
. .' .' . " '. .: " .
base COMPONENT AREA II u" ** TD * BTUH LOSS
. walls than 3 feet 4-S t o1t[ .4-~" S~O It{
more I i
ment below grade
floors fO<:::b I D'l-5' trO tlt14>V
, '.,-,. .
i . 1kl5cr
*TD = inside t E;mp . minus 20 degrees HEAT LOSS..
**
j..
page
I
From table on page 2
ACCBPTBD
PBACTICB
INSTRUCTIONS: for completion of acceptable practiae method, please refer to Uniform
Dwelling Code, Chapter Ind 22, Energy Conservation Standards, Appendix Tables A-l,2,& 3.
.
WINDOH GLAZING:DSingle w/storm DOORS:Dnsulated SIDINGS't'lOOd(R. 77)
WALLS ABOVE t:1Insulated glass ~Olid wood alum(Rl.82)
FOUNDATION OTriple pane . ninsul w/storm
WALL
-.
INSULATION TYPE: WINDOW AlID DOOR ~REA PEID1ITTED %
-
GROSS WALL AREA(from worksheet, page 1) = square feet.
GLASS/DOOR AREA (from worksheet. page 1) = . square feet.
PERCENT WINDOW/DOOR AREA = glass/door area
PERCENT WINDOW/DOOR AREA = glass/door area + gross wall area = %
INSULATION TYPE: R VALUE (per inch)
CEILING
REQUIRED THICKNESS(per table A-3): " in cavity _"over framing
FOUNDATION WINDOW GLAZING: Dsingle Osingle w/ storm [Jinsulated(double)
WALL INSULATION TYPE: ' R VALUE
EXPOSED FOUNDATION AP~A(from worksheet, page 1) = square feet.
(walls must TOTAL FOUNDATION AREA(includes above & below grade) = square feet.
oe insulated PERCENT EXPOSED = Exposed foundation + total fdtn = square feet.
to be in con- PERCENT WINDOW AREA PERMITTED(see Table A-2) = percent (%)
formance.) PERCENT HINDOW AREA(window area + exposed area) = percent(%)
IXI'lL TRATIDX
.~
"""
" t.
6~sli M
:Cd
'.cAIR CHANGES. Recommended changes bet'tveen
'depending on type construction, number of
weatherstripping, caulking etc.
"",
-
Basement
Level 1
VOLUNE CALCULATIONS:
~I
~" "2 4- ~
LEVEL
VOLUME
CON. TD
BTUH HEAT LOSS
Level 2
. 25 and 1. 00
openings,
.018
.018
INFILTRATION
HEAT LOSS
!
~
1
Level 3
rUBXACB
SIZB
.' ._~.._-----
TOTAL DHELLINGLOSS
J1/9tJ.:J'
x 1.15
a.-'~'!1 / *
,l:7IJ'jfJ?
ALLOHABLEHEAT LOSS(from page 3)
._."""'-----~.;.
INFILTRATION LOSS (from above)
BASEMENT__!lEJ:~ LOSSy~~m pa~e .3)
TOTAL DWELLING HEAT LOSS:
HAXH1UM FURNACE SIZE
FURNACE SPECIFIED
*
,~ Furnace output
4
STATE OF WISCONSIN
DEPARTMENT OF INDUSTRV, LABOR AND
HUMAN RELATIONS
DIVISION OF SAFTY AND BUILDINGS
201 E. WASHINGTON Ave.
BOX 1989
MADISON, WI. 53707
WISCONSIN STATUES 101.63
LJ~ ??~7 fa
WISCONSIN UNIFORM
BU~LDING PERMI'T
APPLICATION
PERMIT REQUESTED
VAC
~~ I V5~{-I
Contractor's Name
'E?
PROJeCT LOCATION
res/-/!/-t / (.Ot-/
tO~~~
%
%. SECTION
B
&"V~
Front Rear
z.s; ft. t.:, ~
4. HVAC EQUIPMENT
1. PROJECT
2. TYPE
3. ELECTRICAL
~New
tJ Alteration
o Garage
o Attached
o Detached
o Other
o Master plan no.
Ot applicable)
I?{Single family
o Two family
o Other
E.ntrance ~
Size: I
Se vice
Underground
Overhead
AMP
~orced Air Furnace
tJ Radiant Baseboard or Panel
o Heat pump
o Boiler
o Central Air Condo
o Other
OAddition
6. CONST.TYPE 7. FOUNDATION
o Site const.
Manufactured
Concrete
Masonry
o Treated Wood
o Other
D1-Story 11. USE
o 2-Story 0
o Other~"" Seasonal
/I.,; ijg Permanent
{' v .0 Other
8. PLUMBING
Jer
Municipal
o Septic
DPermit No.
9. AREA
~Basement <J-7t.
pLiving Area f 71 f..,.
o Garage
PERMIT NO. /4--1',,<,-0
(
PARCEL NO.
o PLUMB
Telephone
~-
Telephone
T N. R E(or)W
Lot No. Block No.
~
Left Right I. (
ft. Z? t 4- ft. 7{. ft.
5. ENERGY SOURCES
Fuel Space Water
Htg. Htg.
LP Gas 0 0
Nat. Gas ~ ,2S
Fuel Oil 0
Elec. 0 0
Wood 0 0
Solar 0 0
Coal 0 0
Other
12. WATER
e applicant agrees to comply with the Wisconsin Uniform Ding
that the issuance of the permit creates no legal liability, express or'
is accurate.
o Private
unicipal
nicipal Ordinances and with the conditions of this permit; understan
m nt or Municipality; and certifies that all the above information
SIGNA TURE OF APPLICANT
DATE
.Zl~
CONDITIONS OF A P. P R OVA" L This pe~mit is is~ued pu~suant to the fo lowing conditions. Failure to comply mSlY result in suspension or
revocation of thiS permit or other penalty.
13. ISSUING JURISDICTION
05~$#-
DVILLAGE
A::9CITY
DTOWN
NAME
o COUNTY
2t3-
2-.~ b
9- z7-f.$-
as-- 2/ olfL
MUNIC. NO.
FEES
PERMIT(S)
SSUED
CONST.
VAC
LEC
DPLUMB
PLAN REVIEW $
INSPECTION
WIS. PERMIT SEAL(S)
OTHER ( )
TOTAL $
CERT NO.
DI LHR-SBD-5823
ISSUING JURISDICTION/AGENCY
DSTATE