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CenterPoint
House heating test record Energy
Owner Fr-551) ROkS D Controls Conversion \ _4
Address 1 L,,)J rNI.} A 51-) Apt Thermostat 6 CZ.' -- A Heat plug Vent Size 3 " (11 C p,
City ()hoc l,. Valve J) G' /) Kind of liner /size ' /.I/ V1-171
Heat loss Date htg. inst ( \ ,V5 . \y Limit T' k Draft hood b, al Regulator
Sold by CenterPoint Energy Limit setting 110 Filters: Size )6212. I Number
Installed by CenterPoint Energy Fan setting 1- , Chimney locations: Inside 0 Outside
Electrical work y CenterPoint Energy Pilot type S ?c, Chimney construction ti-40.) 1 /
Heat type 'FA ()Space heater Pilot make Wiring Test tag �/
Gas line by Pilot model Lighting lnst LV Date tested C\• \t.y `'\
Unit heater Other Pilot timing QLo. - \- Company testing Cente Poi t Energy
Gas design Pressure: Hi fire /Lo fire '5 Tester's nam
', ��A Percent CO2 (. j) ,C-N'S' w
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Make v� `" Model VAZ,C, di
Serial no. jh S 0 g II 0 71. Input CFH 75 Percent 02 1 \° \ J
Input ? ; vd Stack temp ��� Percent CO I- \ Q
(0 RI CITY OF PRIOR LAKE Date Rec'd
� HEATING /AIR CONDITIONING /FIREPLACE PERMIT
IIVrsitso P 1. Pink File PERMIT NO .
2. Green City /57 3. Yellow Applicant `�
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
ftA11 (A e- akS
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER °�� Q q / �- l j
(Name) ti ICS 1 1�1 (Phone) 15 "t 1`lv
(Address) t LA \ ‘ We (AA .� 9Y` or i Ci 1 I f r\ K 5 ;�
APPLICANT
(Name) CENTERPOINT ENERGY (Phone) 763-785-5404
(Address) 9320 EVERGREEN BLVD NW SUITE B COON RAPIDS MN 55433
(Address) (City) (Zip Code)
(Contact Person) JOANN ZI � /4"1")•1 EN (Phone) 763 - 785 - 5404
APPLICANT SIGNATURE !iii DATE 9/7b 1
7 '
APPLICANT PLEASE COMPLETE BELOW
NEW CONSTRUCTION W ^ *EPLACEMENT ❑ ALTERATIONS (�
FURNACE MAKE AND MODEL A A 1 IJ 0 . 1 E1 r 1 1 S FUEL �G.�► XYt„X COOLS
FLUE SIZE RETURN OPENINGS INPUT 1 S 0 CQ OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT 71' . "
PLEASE NOTE: Air Conditioner
❑Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
['Gravity ❑ Hot Water into Required Side Yard Setbacks.
Mechanical ❑ Radiation
Air Conditioning ❑ 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 $49.50
Residential, Heating Only (New Construction) $64.50 Residential, AC Only $49.50
Cost $ 3:75-6)° Q O Building Permit #
The Minnesota Statutes § 326B.148
"SURCHARGE" has been changed for one The Minnesota Statutes § 326B.148
HEATING PERMIT FEE $ 4 /9, year effective
c 0 "SURCHARGE" has been changed for one
July 1, 2010, until June 30, 2011. STATE SURCHARGE $ :eft co -.41- year effective
The minimum surcharge for a "fixed fee" permit TOTAL PERMIT FEE $ 5, c� 0 July 1, 2010, until June 30, 2011.
The
is $5, beginning July 1, 2010 minimum surcharge fora "fixed fee" permit
is $5, beginning July 1, 2010
This Application Becomes Your Building Permit When Approved Paid _ , 7 ,s --v ,s --v (( Rec t No. / ¢/ �/
Date ( / B
Building Official Date / • Z ['
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372