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House heating test record ci*iPoint®
Energy
Owner .B.1/ w,'/c/cf' Controls
Conversion
• Address /6 2 G / TY-gsL e4pt AvE,S ,Thermostat Z o OD Heat plug Vent Size c. zi
City ?r;p,r La,,/ C Valve Kind of liner/size '1.n 1-
Heat loss Date htg.Inst 1—N-t\ --\� Limit F- it-rd Draft hood j _)egulator.
Sold by CenterPoint Energy Limit setting Filters:Size
/bX'ZSX 1 Number
Installed by CenterPoint Energy Fan setting Chimney locations: Inside Q Outside
Electrical work by CenterPoint Energy Pilot type he.52- D%e-rc/ S Chimney construction B ✓emt (, it
Heat type &IA- 0 Space heater Pilot make
Wiring \,i' Test tag V-/
Gas line by . p . E: Pilot model
Lighting Inst Date tested ` -A`'
Unit heater Other Pilot timing t�ic�t.
-- • rr L. Company testinqenterPoint Energy
Gas design
Pressure:Hi fire/Lo fire3 ,Sj �-,(, `,1!'lsi-‘, Tester's name!' t,,,C j
Make rZ Db Model e e M - Percent CO2 l^�1�`
Serial no.//ySD-7v-e_ 0C,cMAE$ Input CFH � Percent 02 ��, Pi
10 0046
Input 60z4JO 4' O f 0,,q t y Stack temp) Percent CO 1-440{N-71\
CNP 235(11-2008)
.�4 PRID�e
CITY OF PRIOR LAKE Date Rec'd
U
B HEATING/AIR CONDITIONING/FIREPLACE PERMIT
rN E S0
2,I. GreenPinFiie
t PERMIT NO. /'- 0044.City /r
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
I lea Ca 1 [.- .sec f)v e S E .
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
(Name)OWNER UL .I 1 \•t aryl k...0► t cles (Phone) tPt Z--73a-s Iy--)
(Address) 1 .fl:Q.LsA --S-4-c.Se.c•.._ ArV S1-= g. rt Of 1 ektt,e 1 Vv N .S.3-1-7--
APPLICANT 1 11 C
(Name) (LeY\-ter PO;A k X e CO tit (Phone) i(..3 J"75-1- (a ao-a
(Address) Q 3 010 Ever (e ein I �, 54,.‘\--r•�. �n R4�.ds MN 64/33
( dress) (City) (Zip Code)
(Contact Person) IDA hto Z..;Yl k€e Y) (Phone) `7l03--75-7 - (00l0�,
APPLICANT SIGNATUREp--, DATE / -15- /0
APPLICANT PLEASE COMPLETE BELOW
[NEW CONSTRUCTION jZEPLACEMENT ❑ALTERATIONS
*� � 11
FURNACE MAKE AND MODEL ----9‘‘.4i. u(f2.YYl - 0�¶ VY11�C S FUEL 1 . eooL 5
FLUE SIZE to ti RETURN OPENINGS INPUT (&O)C) 00 OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
[ arm Air Plants 0 Steam
Units and Fireplaces Cannot Encroach
❑Gravity - 0 Hot Water
into Required Side Yard Setbacks.
❑Mechanical 0 Radiation
❑Air Conditioning 0 Special Devices Fireplaces with Box Additions or
❑Vent.System ❑Other Devices Cantilevers to the Outside of Buildings
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 L4.4 '
Residential,Heating Only(New Construction) $64.50 Residential,AC Only $49.50
'Estimated Cost$ x-2'500 .C)° Building Permit #
I
HEATING PERMIT FEE $ q Q .SC)
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ 5 0 , 00
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid —O• Cit) Re pt No3 7.54_
Date. . .�s-t1U BY
Building Official Date •
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372