DESIGN REQUEST FORM
Company Name
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Full Name
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First Name
Last Name
E-mail
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Phone Number
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Area Code
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Hour
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Minutes
AM
PM
AM/PM Option
NEW UNIT DATA / LOAD CALCULATION DATA / REPLACEMENT UNIT DATA
New Unit / Air Conditioner
TON / BTUH (s)
Humidity Control
Please Select
Required
Not Required
Heating
Please Select
Electric
Steam
Not Required
Heating kW
Voltage
Phase
Hertz
Type of A/C Unit
Please Select
Wall Mount
Window
Roof Mount
Pad Mount
Split System
Cabinet Cooler
Mini-Split
Cabinet constructoin
Please Select
Galvanized
304 Stainless steel
316 Stainless steel
Coil Coating / Blygold
Please Select
Evap and Condenser coil
Condenser coil only
Evap Coil only
none
Anti Corrosion cabinet coating
Exterior (not including base or base rails)
Base Rails
Interior condenser section
Interior evap section (un-insulated surfaces)
Outside air inlet
Please Select
Stack, Guy wire type
Stack, Free standing type
Weather hood
Not required
Stack height
Evaporator (Inside):
Type:
General Purpose
Hazardous Duty
Class
Please Select
I
II
Division
Please Select
1
2
Groups
Please Select
CD
BCD
EFG
Zone
Please Select
1
2
Groups
Please Select
IIA
IIB
IIB+H2
Condenser (Outside):
Type:
General Purpose
Hazardous Duty
Class
Please Select
I
II
Division
Please Select
1
2
Groups
Please Select
CD
BCD
EFG
Zone
Please Select
1
2
Groups
Please Select
IIA
IIB
IIB+H2
Load Calculaton Data:
Building / Enclosure Dimensions:
Dimensions specified in:
Feet
Meters
Milimeeters
Other (specify in comments section below)
Length
Width
Height:
Building Location (City / State / Country / Body of Water):
Temperature specified in:
Fº
Cº
Ambient Temperature: High
Ambient Temperature: Low
Desired Internal / Maintained Temperature:
Internal Equipment Heat Load (watts - or - BTUH)
Lighting Load (watts - or - BTUH)
Number of Doors
Height of Doors
Width of Doors
Number of Windows
Height of Windows
Width of Windows
Occupancy Level
Air Changes Per Hour (ACHR):
Pressurization
Pressurization Type:
NFPA 496, Type X, Division 1 to Unclassified
NFPA 496, Type Y, Division 1 to Division 2
NFPA 496, Type Z, Division 2 to unclassified
Slight positive pressure above atmospheric
Chemical Filtration
Chemical Filtration Type:
H2S
SO2
Hydrocarbons (VOCs)
Other (specify in comments section below)
Outdoor level GX, (Severe)
Outdoor level G3, (Harsh)
Outdoor level G2, (Moderate)
Outdoor level G1, (Mild)
Small trace Amounts
Auxiliary Blower
Location:
Side Mount on A/C (SMAB)
Remote Wall Mount (WMAB)
Air Changes Per Hour (ACHR)
Gravity Dampers Required:
Please Select
Yes
No
Type:
General Purpose
Hazardous Duty
Class:
Please Select
I
II
Division:
Please Select
1
2
Groups:
Please Select
CD
BCD
EFG
Zone:
Please Select
Option 1
Option 2
Option 3
Groups:
Please Select
IIA
IIB
IIB+H2
Repalcement Unit
Original CCC Job Number:
Serial Number:
Model Number:
Attach Spec, Photos, CAD files, or Purchase Order
Attach File:
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Comments:
NOTE: Must Provide
Load Calculation Data
Listed above
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