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HomeMy WebLinkAboutBuilding Permit 00-0921 ~x PRIO", QAT" R"""","'1 CITY OF PRIOR LAKE - r ~~ ' l' B' I g. 00 BUILDING PERMIT, C ..(71'1 TEMPORARY CERTIFICATE OF s,....,., ,V\ cJ 8~C8-ZO:So ZONING COMPLIANCE \S AND UTILITY CONNECTION PERMIT 1. White 2. Pink 3. Yellow Permit No. I DIRECTIONS SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom) 2. SITE ADDRESS S3&S" <3>~f"e... TrrJ...\ \ 1. DATE ~ /I S-JelJ e..tSD BUILDING 11. SIZE OF STRUCT (Height) (Width) (Depth) 3. LEGAL DESCRIPTION 12. NO. OF STORIES ADDITION LOT Se{!;7 2.5 AI~,e7H S#OL6 BLOCK PID /h-9z.s-0/8-0 "'A,t:::,," f 13. TYPE OF CONSTRUCTION 4. OWNER (Name) -Sfu^e~ hp,,,,1?,1\ 15. ARCHITECT (Name) 6. BUILDER l?,~f/ (Address) Stf",-" <)Lcl~ 112. (Address) ~ __ (Tel. No.) TI~~, 41q,-072.'1 (Add'eSs)ID>Ji.~ 7-> "~(,p~o.) ~ 7(1r Of' Lfi./':i - )000 ,'g~75 (IEAQV,~w ~~ SHM"GPfL (Tel. No.) 14. FLOOR AREA APPORTIONMENT USE {tirl'\ ~ DL<;\O~~ ,,- J r-J( 15. NUMBER OF OCCUPANTS OR SEATS OCCUPANTS 7. TYPE OF WORK Fireplace Q Septic 0 Deck 0 New Construction 0 Alterations 0 Addlli9r.i)( \ Finish Attic 0 Chimney 0 Misc. \ fY'lOlir:___~tT.::rO IS. PROPERTY AREA OR ACRES -[i PROPERTY DIMENSIONS 10. CULVERT SIZE Sq. Ft. Width Depth Yes No I hereby certify that I have fumished information on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for the above mentioned property and that I construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building OffiC~ re}fke this it f just cause. Furthermore, I hereby agree that the city official or ~ designee may enter upon the property to perform need. eel inspections. X / I J </7/0 x- /<;.-()o - - Signature Mculc VV\t&A..o-~_ License No. Data FOR ADMINISTRATIVE USE Re-roofing 0 Porch 0 Re.siding 0 Finish Basement 0 SEATS 16. PROJECT COSTNALUE 17. COMPLETION DATE SETBACKS: Required Actual Front Back Side Side MATERIAL FILED WITH APPLICATION SOIL TESTS 0 ENERGY DATA LI USE OF BUILDING 00 ~ A-\K OFF STREET PARKING PILING LOGS 0 PERCOLATION TESTS 0 SPACES REO. PLANS & SPECS 0 SETS SPACES ON PLAN SURVEY 0 COPIES PERMITVALUATIOr/3{ ,~. a>~ PLOT PLAN 0 I BUILDING DEPARTMENT VALUATION TYPE OF CONSTRUCTION: I II III IV Occupancy Group A B E F HIM Division 1 2 3 4 Permit Fee ................................... $ V R S U City: Amount Brought Forward .................. IJ' Park Support Fee ........................... IJ' SAC ......................................... <to Collective Street Fee ....................... <to Sewer Tap ................................... $ Plan Check Fee ............................. $ State Surcharge ............................. $ Lol/z. iX'5"" r/ll.t../c", ~..,o Plumbing Permit Fee ....................... $ q() .00 r.[() .OC> ~ IC>' $ Penalty. ............. ................. ........ $ Pressure Reducer .......................... <!: Meter Horn ................ .... .... .... ....... <!: Water Meter ................................. $ Sewer & Water Connection Fee ........... $ WaterTowerFee ........................... <l:: Mechanical Permit Fee ......................'1: Sewer & Water Permit ...................... $ ~~~~:;m~'W'"Zooo Certollcale of OCC~ Water Tap ................................... C(:: Builder's Deposit ............................ $ Other .........................:............... $ Paid ;g~5:-:~T......~~;~I~~$1a~;~zt Dale /()./(p.(/1j BY~ This is to certify that the request in the above application and accompanying documents is in accordance with the City ZO~ing Ordinance and may proceectt~ requested. This document when sig b the Planner constitutes a temporary Certificate of Zoning comPlian?:nd allows c1!\truction to commence. Before occupan~ Certif~tr~f qccupancy must be issued. tplf;./,,(J-(J M _\ e~ t'\N.~~ ~~ City Planner . ate Special Conditions n any Issued 24 hour notice for all inspections (952) 447.9850 , o~,oq2-1 Thr Crnln of thr r..kr COun11')' White - Building Canary - Engineering Pink - Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT j--/ /'/J I f~~;:/:::~~ . APPLICATION RECEIVED ,..... . / ./ . e, The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: - I , c,- <.1/ I . ,;: ,I'~'}-j I; . __ I I.. ;'-_. l~" ..... ~ Accepted v Accepted With Corrections Denied _ Reviewed BY:~~ Date: _ If) //.1. /~ Comments: ~~.e- M'~ r ~<.I9r1L~ f? AJx;y~ ~ ~ .4u~tz:n, I ~'~~\~ ~~~ r ~{\iTb7'l6 (~ 1J1A.~1AM.M. ~ ~ ~ ~,&-.t-- (f.toU, "The issuance or granting of a permit or approval of plans, specifications and computations shall not be construed to be a permit for, or an approval of, any violation of any of the provisions of this code or of any other ordinance of the jurisdiction, Permits presuming to give authority to violate or cancel the provisions of this code or other ordinances of the jurisdiction shall not be\@lid." .. ... s~~ 0o-9ZI Th",C",nltroflh",L.ktCounlry White . Building Canary - Engineering Pink - Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT /-/7' /1 BL--!.),K5. 9. ?? ' () 0 APPLICATION RECEIVED The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: 53ro5 5Ho/2.c 7I21-1/t- Accepted ./ Accepted With Corrections Denied Reviewed By: ~...a."t ~rlsan.... Comments: ,')ee fie reVfY~1' ~;Ll:.r Date: ~ no/Jd-inI1Q! irJ.hmlll-;~ S....e o.f.l.at:JMe,rl-,5: I. 8na! GrAk ~L.fr4112hGrM~ .;7 a'/>o~ 3. Erfl<;Oft Ct,,,frlll MIA~l{f'e~ if. En,Sidh fJmfd PlfUJ "The issuance or granting of a permit or approval of plans, specifications and computations shall not be construed to be a permit for, or an approval of, any violation of any of the provisions of this code or of any other ordinance of the jurisdiction. Permits presuming to give authority to violate or cancel the provisions of this code or other ordinances of the jurisdiction shall not be valid," ~~ oQ.orv/ Th.. C..n.... of lh.. L.k.. Counlr) White . Building Canary . Engineering Pink . Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT APPLICATION RECEIVED H ~' 11 Bt.-D,es , ~, 2 CJ ' () 0 The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: 53 ro5 5Hoe.6 -,;e/J / t.- Accepted Accepted With Corrections Y Denied r2e ---i' Reviewed By: ~ / . T Comments: ~ aPO. ~ - ~ Date: 16..../f-3:::Jo;p "The issuance or granting of a permit or approval of plans, specifications and computations shall not be construed to be a permit for, or an approval of, any violation of any of the provisions of this code or of any other ordinance of the jurisdiction. Permits presuming to give authority to violate or cancel the provisions of this code or other ordinances of the jurisdiction shall not be valid." 00 voql f Tht Crnlll'r of lhe L.b Counlry White - Building Canary - Engineering Pink - Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT APPLICATION RECEIVED j-j ~'11 BL-DK5. 9. ? 7 . () 0 The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: 53ro5 SHO/?b 7lC1-t/t- Accepted ./ Accepted With Corrections Denied wed By: c'...a.nf ~,.1s0J1_ ents: SP~ lie ('pvent! silt'. {or Date: //J};/n / / a oIJdi{)I/Q! in {;rP/ q liM. S....e 0 ~~ : l hita/ Gr4.b ~~di4n Urf"fdim, '.;J a"'0 Pkt.... 3, Er{},,;o~ C,,'+rlll MHSl{f'e~ 1. bsioh.. f}on!ro/ Pia" "The issuance or granting of a permit or approval of plans, specifications and computations shall not be construed to be a permit for, or an approval of, any violation of any of the provisions of this code or of any other ordinance of the jurisdiction. Permits presuming to give authority to violate or cancel the provisions of this code or other ordinances of the jurisdiction shall not be valid." FILE No.034 12/04 '00 PM 05:03 ID:D & D MECHANICAL FAX:6128904650 PAGE 1 I. II.. 1110 Z. 001,1 aq :J. Y.ltI,. AI9I- It 00 -Q1z../ Applicant: )) ~ D en ~ HAAI"(!,A L _Phone:..!..i..2 - ~9tJ - 'iI~ Address: --y" ~ ,<; - w. ~r I" t' #' ,q SIgna lure: .l...l... _. - ~.' Legal OescrlpUo~: lot Block Sub .-- Slla Address: 5.-3' $" S 1-1.. IE.. T/lA1 t... Building Pannltll "'lAl J PIO " 26 - q2-'5 - 0 I B -0 NOTE; Thll permit will not be prooeated without oomphts Informatll,". FIXTURE UNITS CITY OF PRIOR LAKE PLUMBING PERMIT ......C.lrlf'..'.,....U(:....." Quanllty I , Type of Fixture EIIllh Tub with or wllhout shower Cifhwa.her Floor Drain lavalory (bathroom 8lnk) Laundry Tray (1 or 2 compartmant link) Showwr Stall Slnlce EIIlrSlnk Walar Cleaa. (Iollal) RoU!~h'lns Wet,,, Heater Web Ir Sollner Stard Pipe (wa.hlng rr.ohlne) Sewage Ejeotor BackftoW MeINlly (RPZ, DoWie Cha. PVB) 8Bclcllow AlIaembly T... law; 1 Sprinkler Othllr Quantity Type 01 Fb~ure FBI! SCHEDULE Industrial, Commercial I!. Mulll-Famlly (1% 01 Job coal, $39.50 minimum) Realdenllal, New On8 e, Two Family Fle.ldentlal, Addltlona P. Alterallona Slate Surcharge $99.60 $39.50 $ $ .,,,. SlJ $ $ .50 GRAND TOTAL $ ""J, O() f PAIDW\ll1 , BU\\.D1NG PERtl/lil ~ "r i'ill pern,U i. .ranted upon the expl'CIl coudit;olllhat ,alu l.llllr,ctQr, .hall comply tnlll fOIpectl with the ordinance. 1>1 Ih. S,... l>'u1nblllM ~lf omond"",nlllhe...,r. , RJ:.C _17 - f\ -00 DA.1'B " ^-- Al'l'IlST Call for all inspeJlolIs 24 hours illllLlllllllec, 16200 Eagle Creek Av, S.B., Prior Lake, Minnesota 553721 Ph. (612)447~~230 I FAX (612) 447-4245 An EIlUII Opportunity Employer FLOYD LAUMANN, CONSULTING CIVIL ENG~ER 10332 Humboldt Avenue South, Bloomington, MN 55431 9528881217 Floyd Laumann@aol.com October 3, 2000 Mr. Stuart Bell 5365 Shore Trail NE Prior Lake, MN 55372 Re: Engineering Report for the New Addition to the House @ 5365 Shore Trail NE, Prior Lake. MN In compliance with the City of Prior Lake Zoning Ordinance 1104.305 I have made the folIowing review and findings: 1. The ~"r....J addition will meet the minimum requirement of a 25 ft. setback from the top of a bluff that exceeds 18.0 %. The plan is not to add any fill in the area between the addition and the top of the bluff. There wilI not be any additional load to cause any slope instability. 2. The excavation for the addition will be a maximum of .....~.'...:mateJy 10 feet below the ~...._" ground elevation. The excavation material will be hauled away from the site. The soil observed at the site is a top layer of clay loam about 10 inches deep and a stiff clay below the loam. 3. There should uot be any impact on the bluff stability. The bluff has a good growth of shrubs and trees with a good root system. There are no signs of past erosion or sloughing. 4. The drainage off the proposed site and some of the house currently drains across the back (south) lawn. There is no ~~~...~... con~..~~~":ou of the flow in a waterway, so sheet flow must occur reducing the chance of erosion as it overtops the bluff. There will be no apparent change in the existing flow pattern. There are no existing sewers or drainage facilities that will be affected. The quality of the storm water nmoff should not change since there will not be any new unturfed areas for sediment to be picked up and the sheet flow across the turfed lawn acts as a filter. My recommendation for drainage off the proposed addition is to either use gutters with the d.,..'.....rdt directed to the southwest comer of the building, or not use any gutters and have the ground next to the building higher than the adjacent ground to assure drainage unifonnIy away from the building. 5. I will inspect the project after completion to see that the approved grading plan and my recommendations have been adhered to. I certify that this repo was prepared by me, a duly ~df~ ,_.,,- Floyd J. Laumann, P.E. Minnesota Registration 6090 Lot Block Add~ion Ownefs Name~j/ ~ Address. .~ '< I.. Sc..L-,,_ "-- j J.-t:A ; / Heating Contractor (} L -:' A..-"&./ ,-,_ ;j. ~ ~ I'? /C r:>1 C Address 2.!I/J.:J (..LIt/- c.. L.l~..'--.-.:J .l4vc. S......". Telephone # 4- <-/1- / 0 V 1./ E ~~~'" -,'""J-/c...- ~ SsJ'<.IyPemember to add the State Surcharge on the bottom of this application. . / Furnace Make & Model ~'rL_'5i)' TYPE OF SYSTEM /J /l -.. Warm Air Plants Model Size Y/ L. - "> () Gravity Mechanical Air Cond~ioning Vent. System. (oF /<1 &/7- c;( CITY OF PRIOR LAKE MC - . 16200 Eagle Creek Av. S.E. Permit No. Prior Lake, MN 55372 T~CII" / Conn. Load Fuel Flue Size -'/ S Supply Openings 7- j- HEATING OR POWER PLANT Steam Hot Water Radiation Special Devices Return Openings Input Output. Edr. Other Devices Cfm. TYPE OF WORK 'i- Merations New Construction 0;1./&//0/ ~O - 92/ Replacement Est. Comp. Date ~ ' Est. Cost $ 3 c>1'JCY:'1- Building Perm~ # HEATING PERMIT FEE $ J ~ t./. 00 STATE SURCHARGE $ _ .50 TOTAL PERMITFEES f j (P 'l.so Receipt # Repair TYPE OF STRUCTURE, 1. Pink 2. Green 3. Yellow File City Conttactor Single Family .~ Multi-Family Other Two-Family Industrial Commercial Public Fee Schedule Industrial, Commercial & Multi-Family Residential, Heating & AC Residential, Heating Only Residential, Gas Fireplace Residential, Additions & Alterations Residential, AC Only 1 % of job cost ($39.50 minimum) $99.50 )( $64.50 y:. $39.50 $39.50 $39.50 1j~'1 Cb - The price of your heating permit includes one rough-in and one final inspection. Additional inspections will be billed at $35.00 each. House Heating Test Record must be submitted with buildino oermit number before build- ing certificate of occupancy will be issued. HEAT CALCULATIONS REQUIRED with number of supply and return openings listed per room with CFM's per opening_ New structures or additions send floor plan w~h supply and return locations shown. HEAT LOSS CALCULATIONS, PAYMENT AND APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 16200 EAGLE CREEK AVE. S.E. PRIOR LAKE, MN 55372. City Hall business hours are 8 a.m. - 4:30 p.m. ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL 447-9850 I hereby apply for a mechanical systems permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the city and with the state building/mechanical codes; that this form dor ~.ot become a permit until signed by the BUILDING OFFICJ.'IL~' that .e,~.. ..". oJ'" ,,::srdance WIth the approved plan In the caseAlf A" wo hie requires review d approval of plans. 1/- ;2/-tJt1 :::1~~~gn-;'ture- . . Date -' ~ /1-21-70&"\ - ui g Offical's Signature Date PRIOR LAKE INSPECTION RECORD DEPARTMENT OF BUILDING AND INSPECTION SITE ADDRESS SS("t:::;" -~~N'.. I;::I"~..I NATURE OF WORK ~I ArM.VI. USE OF BUILDING ~ F i""- . PERMIT NO. OiJ.09Z/ DATE ISSUED 9-~~-200o CONTRACTOR 14 "*" M&il~ "15'2 - 4CfS -7tJo(J NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW THE PERMIT IS BY SEPARATE DOCUMENT I FOOTING f~ fjp !{)j31/~ ~. I 1~//i'/6G . . . , FOUNDATION (Prior to BaCkfill)V~~ ~ I /~/3~j~ PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ROUGH - INS I~SPECTOR DATE I fh, / 2/jZ;1~ ./~ tLhllrD I ,I . 'I GASLlNEAIRTESTk~J ~ ~, 12;h/e-c ~~ ~,//s)l COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED ~j/...-dt... I~ d/dl I Pr. 'flt!/f) \ . FINALS 7- ( I NLS .,)/ t./J 10 I 0i.1 , FRAMING INSULATION ELECTRICAL PLUMBING 64- p",,^, 1 ~ HEATING (if required)~ u..Gst. lJf/~ &. I (z/7/~ y-'-z ,0<>. BUILDING T.~"O . ELECTRICAL PLUMBING HEATING DO NOT ~ I~(P ttJ'6 :2 '1 / jc::j/i / f::/7 vI; / v/ v I UNTIL ABOVE HAS BEEN NOTICE This card must be posted near an electrical service cabinet prior to rough-in inspections and maintained until all inspections have been approved. On buildings and additions where no service cabinet is available, card s~all be placed near main entrance. OCCUpy SIGNED Call between 8:00 and 9:00 A.M. for all inspections FOR ALL INSPECTIONS (612) 447-9850 DATE nUE ADDRESS _~Vu(~ .-)3!;"s ~~~, SCHEDULED CITY OF PRIOR LAKE INSPECTION NOTICE OWNER CONTR. PHONE NO. PERMIT NO. ~ .Ci Z I o FOOTING o FOUNDATION o FRAMING t 0 INSULATION ft: r;( FINAL to SITE INSPECTION o PLUMBING RI o MECH RI o WATER HOOKUP o SEWER HOOKUP o PLUMBING FINAL o MECH FINAL o EXIGRADIFILLING o COMPLAINT o FIREPLACE RI o FIREPLACE FINAL o GASLINE AIR TST o COMMENTS: ~ ~_o. 'L-:- I ..V (l 3 '- - '"' I WORK SATISFACTORY, PROCEED o CORRECT ACTION AND PROCEED o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING 4k Inspector: Owner/Contr. CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.. CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI INSNOTI -~~,._-----_.-"--_."""--~'--- - DATE TIME CITY OF PRIOR LAKE INSPECTION NOTICE SCHEDULED Z--/5-0 J ~'. 3-0 ADDRESS 53&S- s!1O;z..{;7 1// OWNER CONTR. PHONE NO. PERMIT NO. () - 092--1 o FOOTING 0 PLUMBING RI 0 EX/GRAD/FILLING o FOUNDATION 0 MECH RI 0 COMPLAINT o FRAMING 0 WATER HOOKUP 0 FIREPLACE RI ~NSULATION (j) 0 SEWER HOOKUP 0 FIREPLACE FINAL FINAL 0 PLUMBING FINAL ~ 0 GASLlNE AIR TST SITE INSPECTI N J MECH FINAL ~ 0 COMMENTS: IfSJ J~ d.fi /J-o.-11 ~ ~ ~~~~ @J 4t~. -Prj(J~ ~'.' -,-- - ~.. /7';;,0. I (I ~ //J \. --- ~ WORKrn ,..' ,.,.. .. : "nu'",C:c.J o CORRECT ACTION AND PROCEED :S::~:ECT ~F~R REINS:::~:::::FORE COVERING f CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE CODE REQUIREMENTS ARE F7JR YOUR PERSONAL HEALTH & SAFETY/ INSNOTl DATE TIME CITY OF PRIOR LAKE INSPECTION NOTICE SCHEDULED PJ~z-oz..... ADDRESS .53t/:;- ShfJ/C_ t,.../ ( OWNER CONTR. I-I~/YI B/lJ~ PHONE NO. PERMIT NO. ~-9L I o FOOTING o FOUNDATION o FRAMING o INSULATiON ~INAL o SITE INSPECTiON o PLUMBING RI o MECH RI o WATER HOOKUP o SEWER HOOKUP o PLUMBING FINAL o MECH FINAL ~LLlNG o COMPLAINT o FIREPLACE RI o FIREPLACE FINAL o GAS LINE AIR TST o COMMENTS: br~d (J a f/ J( WORK SATISFACTORY, PROCEED o CORRECT ACTION AND PROCEED o CORRECT WORK, CALL FOR REINSPECTiON BEFORE COVERING Inspector:~~' OWner/Conlr: CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.. CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY! INSNOTl _ HOUSE HEATING TES,c:t~~1 ADDRESS ,<~~ Shan..- 72-",,- / APT._FLOOR OCCUPANT ~V..h> L l-k...br OWNER HEAT LOSS DATE HTG. INST. SOLD BY INSTALLED BV EI.."..o' W..~ By Ga. LI". By. L.6--/l ~J ,....., /./-Jr v 0 TYPE OF HEAT GA -,-- FA __HW --/,",-STEAM__.SPACE HTR. _UNIT HTR. _OTHER_ MAKE -4lffC-~A~ DESIGN MAKE OF BURNER CONVERSION Modol, ~(Q'?I'~ ""0101 s.,;ol _ tJtfZIt./) r:: ') d~' . ,_ ...... BTU Roll", INPUT ~/::;~~ __ MAKE OF FURNACF Mod.1 ;tOI!7ROL S THERMOST~~'i~oo' PI"" Val.,. _~~.4/' limit j~F. Limit 54"i",' I~IT'__ Fan S.tting _ V / #' Pi!':)t T)'~ .. Pilot Ma~. __~~) Pilot Mod.1 - Smole. 80mb Pilot Timing __~ Otaft V- L.W. Cut Off Door Pr..."". ~ P,...u,. {;;~1- Pmo"' CO !d'h Oa'o T....d ::2 /~.;- /, / 2 , L.. ' '/I . Input CFH _Percent 0, F-f? eo...,."., T.stan, f!. ... ,"_' ___ Stack Temp a.~"7Z- P.rc.nt CO -;&.1~o/4--_ Na.....fT..t., t./I_~(J..L.-~ '1:""""'-' :~;. ~.. f. /Ill... Cf2r! /1- KIND OF LINER. SIZE._ _ ~OHF 0,0" Hood ___ Ro,ulo.., _~ ~ ( J-L-<t; Filte,. Sia. lNu...... ' Odrnney Location Inide ')( Ovhid. Otimne,. Construction _ V.n' 51.1:. v- v-" .- Wiring _ Tu. T.~ Lightlne In.'. c..-- ~~ '/a~' ..!TOUSE HEATING TEST ~~-& ~l~~ fJ&t.; / ~QRD . '~~~RJ.'tJOJR -- ~~~pr----- SUBURB ~ lItrf (hPJ,l ADDR ESS OCCUPANT HEAT lOSS SOLD BY ('..~ f~,E':TG. INH. EI..";col W..k By ~ c:r- TYPE OF H ...> EA T GA _ FA INSTALLED BY CCol'\-1. __HW){-HEA Goo ll.. B {I' - r-_,r( I.Jci/ _ M ,.....~ · _m"~,"~.' ".,_.,.,. (.. ' LJ(/~ _UNITHTR ~o..1 <,"nor . _OTHER ,,;. l-J.AI.~ ~ MAKE - L-eJ~s:..-:h. OF BURNER CONVERSION -!3<, ~t'I. Mo...1 , _~ ,_Mo.. BTU R . otl~ __ MAKE OF FURNJ~c Mod.1 THERMOSTAT Hl.J Val.. _ \..fu limit itW Limi' So"i." I ,><Od F Fa" 5.ttin9 _ P.bl Type -3U~ P.lotU-k (") --- ~ . __ c----- -- Pilot Mod. I _ r?r~ Pilot T" ~ u..unl "\ S~ L. W. CuI Off p'."u,. >.S"Yf- ' I,.ul CFHJ7~zri, _Pm..,CO 1,3 . Sto k T P 2 --- c emp. ~'f) OF - .,cent O2 --..:3..'":t P....., CO ,All S MAKE Mod.1 S-iol INPUT CONTROLS Heat PI", v / \\ en.s..u (<:) KIND OF LINER Draft Hood Fil..... --S- o. ia. 1m,...,. Location O'limM Co ., "structian Smok. 80mb Droft 0001 Pr..."". Oat. T UI.d Co ....", T ..tin N " Q~ of T ..f., SIZF Rogulator v' Number Inaid, r I...." ~ /" ./ NONE Outside ./ WI,inr T..t T.~, V l.... 2- lri. -'0'''" I..,. ('_~,^.ri' 1k? sf-' / y I HDUSE HEA."ND Ta:.~~:r;; _.~i-!:;5 ADDRESS c13txS; _Sj1-(r(,;JJ"..,... APT._FLOOR CITY r SUBURB OCCUPANT S- "'L-,"./P'/-. ~_ OWNER HEAT LOSS DATE H.Tg.~IN~T. - , SOLD BY '(1_. A (f'l-&<-7JrL if:J '> J.r IL_ .LnC INSTALLED BY 1 . L /..u. Ie EI.."i..1 W..k 8y~A.-C</~( I./R f /rI/f G.. LI.. By (A/Y1~__ ,,~, /-//'1 CYF /1 TYPE OF HEAT GA~FA~_~EAM___SPACE HTR. _UNITHTR. _OTHER II 1 . I. GAS DESIGN CONVERSION MAKE ~'fJ(/T, lolAKEOFBURNEP Mod.1 t. -' J~- <;.::- .J 1olo"1" So,..1 14I!)/J1{-~:1 1olo.. BTU Ratlng_ INPUT _ .1::>. MAKE OF FURNACE Mod.1 _ CONT LS If ,/) L THERMOS ~ ea. PI.,. _ _ Ven,Slu L/- /ly~ ) P Valv. V Jt?f:.&J6rn_ KIND OF LINER - SIZF limit <: ~ _ - Draft HOOd ___ ,-R.gulator. L.m" SoHing. /htI.J- Fo.... SI..~~..),q::;t. Nu.....,_ ? . Fan s..f1ng _~~ ~h"ney Location Insic&. (Nt.id. P j l:lf Type G.il'ftneY' Construction Pilot Ma~. Pilol Mod.1 NONE Pilot limino _ L.W. Cut Off '7 r-" /'7'.:10 "'.4 Press"r. ~~__ _.ojP.rcen'CO 4- ~ Input CFH. j9J,. (;FP'. P...... 02..1,)t' S.... T.m.. al&P F P.....t CO 1 tV, C t,.. t'L,~~ ) 1&5& '. ~ Wiring ~' T..t T.. --- --- . I ithllnl In... O...T....d.2-/I;:,/tfl . ,1/. c.......n,Tnting L~ I' ~ ff LA No,,",.f T..t., .x J ~ V. ./ / - - Smoke Bomb . Draft L----"' c----- 0001' Pr.. .ur.