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40 I+ • 0 CenterPoint.
House heating test record
Owner Ue :� Oa (AS Controls Conversion
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Address /5 /(. 1.1.,Fre rs PIKS Thermostat `Og' eat plug Vent Size 2
City Pf i 0 i 1.- Ake- Valve yule Kind of liner/ size isle //04s
Heat loss Date htg. inst A ^ ? l'1 Limit / LQ Draft hood Regulator
Sold by CenterPoint Energy Limit setting f- fiete/t/ Filters: Size /41$5 Number
Installed by CenterPoint Energy Fan setting — Chimney locations: Inside 0 Outside
Electrical work by CenterPoint Energy Pilot type • Chimney construction ••
Heat type 0 FA 0 Space heater Pilot make "-- Wiringaolder Test tag !`
Gas line by C.. 9 e Pilot model Lighting Inst '— Date tested a-2-6
Unit heater Other Pilot timing Company testing CenterPoint Enemy
Gas design Pressure: Hi fire /Lo fire,.. I. 7 Tester's name 7 //k
TNL � Vr e rcent CO2 , ,/
MakeQ.��j'Q Model
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Serial no., � ( 3 /�O �! 7' / Input CFH � Percent 02 l
Input `6 0 ) Stack temp le, o Percent CO 0I1
CNP 235 (11 -2008)
.
01 PR10 CITY OF PRIOR LAKE Date Rec'd
.1 HEATING /AIR CONDITIONING/FIREPLACE PERMIT
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I �P 1. Pink File PERMIT NO.
LANES 2. Green City � 3
1
3. Yellow Applicant f (J
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
/6316, •1ecr—s T&.55 '
LEGAL DESCRIPTION (office use only)
LOT ISC BLOCK CO / ADDITION - 0 A Q -- PID O2S 3a (Q b( '' I v
OWNER b
(Name) am�� (Phone) 9.5c2 - FS S ' 9/3y
(Address) /53 /4 ,��. -'. 5 ?S5 Ncd Pri s /11N 55372
APPLICANT
(Name) CENTERPOINT ENERGY (Phone) 763 -- 785 - -5404
(Address) 9320 EVERGREEN BL NW SUITE B COON RAPIDS MN 55433
(Contact Person) JOANN Z I N _ / (Phone) 763-785 5404
APPLICANT SIGNATURE i ,4■1■141 ire , i DATE r ai/�S� /�
A PPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION X1REPLACEMENT ❑ALTERATIONS
FURNACE MAKE AND MODEL C 6,4- e-r 5q ( •$O FUEL IV eL r a
FLUE SIZE RETURN OPENINGS INPUT 760 OUTPUT .76 FO0
TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE: Air Conditioner
❑ Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
❑ Gravity ❑ Hot Water into Required Side Yard Setbacks.
❑ Mechanical ❑ Radiation Fireplaces with Box Additions or
❑ Air Conditioning ❑ Special Devices Cantilevers to the Outside of Buildings
❑ Vent. System ❑ Other Devices Require a Building Permit.
FIREPLACE MAKE AND MODEL
FEE SCHEDULE
Industrial, Commercial & Multi Family 1% of job cost Residential, Gas Fireplace $49.50
$49.50 minimum
Residential, Heating & A/C (New Construction) $149.50 Residential, Additions & Alterations $49.50
Residential, Heating Only (New Construction) $64.50 Residential, AC Only $49.50
Cost $ Building Permit#
HEATING PERMIT FEE $ 4/9e S
STATE SURCHARGE $ 5.00
TOTAL PERMIT FEE $ 5
,
This Application Becomes Your Building Permit When Approved Paid Weipt N c . W
010
Building Official Date Date' , l o0111111111
24 hour notice for all inspections (952) 447 -9850 III
4646 Dakota Street S.E., Prior Lake, Minnesota 55372