A/C CHANGE OUT FORM

 

 

Job Name:    _____________________________________       Permit Number:__________________

Address:       ________________________________________________________________________

Existing Equipment

PACKAGE UNIT, MAKE & MODEL #______________________________________________________

MINIMUM CIRCUIT AMPS____________      MAX OVERCURRENT PROTECTION__________________

CONDENSER MAKE & MODEL #________________________________________________________

MINIMUM CIRCUIT AMPS____________      MAX OVERCURRENT PROTECTION__________________

AHU MAKE & MODEL #______________________    HEAT STRIP KW__________________________

MINIMUM CIRCUIT AMPS__________________      MAX OVERCURRENT PROTECTION____________

New Equipment

PACKAGE UNIT, MAKE & MODEL #______________________________________________________

MINIMUM CIRCUIT AMPS____________      MAX OVERCURRENT PROTECTION__________________

CONDENSER MAKE & MODEL #________________________________________________________

MINIMUM CIRCUIT AMPS____________      MAX OVERCURRENT PROTECTION__________________

AHU MAKE & MODEL #______________________    HEAT STRIP KW__________________________

MINIMUM CIRCUIT AMPS__________________      MAX OVERCURRENT PROTECTION____________

(S) E.E.R

(1)   SHOW WIRE SIZE____________________    TYPE_______________________             (TW OR THW)

(2)   SIZE OF DISCONNECT.  CIRCUIT BREAKER OR FUSE______________________________________

(3)   DISCONNECT READILY ACCESSIBLE:       _______________ YES                                                NO      

 

 

 

 

 

 

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               QUALIFIER                                   LICENSE NUMBER                                   PHONE NUMBER