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Home My WebLink About1992-004824 - htg system PERMIT I `CITY OF ORONO PERMIT TYPE: MEC:H NIC:AL 1335 Brown Rd. South • P.O. Box 66 Permit Number: 00482 Crystal Bay, Minnesota 55323 Date Issued: 11/24 (612) 473-7357 SITE ADDRESS: coir 1 TONKAWA RD CH P. I .N. , 08-117-23-21-0001 3t 01 DESCRIPTION: HTG SY TEMS 3 HEATING SYSTEMS FUEL ., NATURAL GAS MAKE AMANA MODEL GUXOY-5830/906 3S 3 AIR CONDITIONING MAKE LENOX MODEL HS2 '- -E,1 411 10 VENTILATION MAKE kITIBATH/DRYER 1 GA': LINE INSPECT CITY OF MW FINANCE OFFICE 31 BOOM I REMARKS: jX��'pj�/� •� ' 9 1222200iI1 # X71GE .50 3 t k FEE SUMMARY: 01 G 1.50 CHECK TL 12t.00 MAIL I N f r�T_T � Yt31i Ease Fee $120. 00 ------ �+ O R01 T14:31 Surcharge ------ -I*s.i) Total Fee - `� #} 111,24192 Subtotal $120.50 CONTRACTOR: - Applicant. — OWNER: V+SGT FRED 6 CO 39296767 MO,-_,P I!_,ON JOHN 3260 GORHAM AVE S _lt)1 TONKAWA PD ST LOUIS PARK MN SS426 ORONO� MN S5356 (C,1 z) 929-6767 THE UNDERSIGNED HEREBY REQUESTS PLERM I -. . 10N, 1fTf I MAKE THE REAL I MPPi=!`dEME SPECI F I ED AND AGREE._: TO DO ALL- IN :,TRI--,T C:OMPL I ANCE WITH ALL C I TY OF t.:R ANO ORDINANCES AND =;'i'ATE OF M I NNE%--5C T A BUILDING CODE REQUIREMENTS. APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE 418zz CITY OF ORONO „y��V APPLICATION FOR MECHANICAL, PERMIT GENERAL INFORMATION 1 . You may apply for mechanical permits by mail or in person -at the City offices. Mailed-in permits are subject to the posNoge 1,a*'jWdlin4 fees shown below. 2 . Permit cards will be sent by return mail the same day the application is received. PERMITS ARE NOT VALID UNTIL YOU RECEIVE A PERMIT. WORK MUST NOT BEGIN UNTIL THE PERMIT CARD IS POSTED ON THE JOB SITE. 3 . When any new construction or remodeling is involved, a separate building permit must be obtained. 4 . All work must be done in accordance with State Building Code requirements. 5 . All work must be inspected (rough-in and final). Call 473-7357. 24-hour notice required. 6 . House Heating Test Record must be submitted before final. INSTRUCTIONS Complete all items on this application. Compute th per t fee. Sign Vand date the certification. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED. If you have questions, call 473-7357. ;{TALK-IN PERMITS apply at City Offices, 1335 South Brown Road (Cty. Rd 146p AAIL-IN PERMITS enclose fee - Mail to: P.O. Box 66 , Crystal Bay, MN 5532 ?lease check one : _N�elw� Addition Repair ti Replace JOB SITE: ', �U � �0�, �,- Zip: Owner ' s Name : Telephone Number: M ' , r T ' ' s VCG7 rmxs a s Co►t6n,SGNIW C i t. Z Contractor ' s Name: 3260 GORHAM A . Telephone Number: 5+EOHISPMI�MN 55426 `hailing Address PALMS H757 SERyIQ9294011 City: Zip MINIMUM FEE ( $30. 00 per project ) ******************************************************************************** SYSTEM DESCRIPTION: $15 . 00 each unit Heating Systems : / Quantity: Make : Model: C- U. XD Sb -3C & i.LX a9 D,6 35- Fuel: /V ct Flue Size : Input BTUs : Y � Output BTUs CFM: ******************************************************************************** Cooling Systems : Quantity: Make : I.Power: *WOOD BURNING EQUIPMENT $15 . 00 each unit Wood stove with flue Wood combination or add-on unit Factory fireplace with flue Factor Fireplace (s ) freestanding Masonry Wood Stove ( s ) franklin, other BrandName Model No. Mfgr ' s Min. , Clearances, side , rear min. flue dia. Total ******************************************************************************** VENTILATION $15 . 00 each project No. l Kitchen Exhaust ducted recirculating cfm No. — Bath Exhaust (must be ducted outside) cfm No. ( Other Fans : Locations qol. cfm Total ******************************************************************************** FUEL STORAGE (must be approved by fire marshal ) $30 . 00 Permanent/Temporary Fuel oil, gallons underground inside outside LP Gas , gallons Other Gas opening ******************************************************************************** GAS LINE INSPECTION High/Low Pressure $15 . 00 i�+:*�k** •*:k*�'*tttk*:+:***�c****�.****�t•***•********** k********�t*'*****ic*-k******�1'*�t**•**�h�t PERMIT FEE CALCULATION 1. Total of above Installations or Minimum Fee ($30.00) $ 2 . State Surcharge. Add the State Building Code Division Surcharge to each permit $ . 50 3 . Postage and Handling on all mailed-in applications , $ 1 . 50 4 . TOTAL PERMIT FEE add lines 1-3 above $ _�, c The undersigned hereby applies to the City of issuance of a Mechanical Permit, agrees to do all work in strict accordance with the ordinances of the City and the regulations of the Minnesota State Building Code, and certifies that all statoments made on this application are complete, true and correct. Applicant ' s Signature: n Date : a RA4 W, Al207D6 HEAT LOSS CALCULATIONS Weatherstrips _ A GuideE. Construction No, Insulation Windows Doors Reference Out.Wall Int.Wall Ceiling Roof I Floor Kind How Applied Yes—No I Yes— o 19— I Fl.1,F=WaL,cRoom I Length Width Height 81/6 FI.1 IL- Room Length Lis—width Height Windows and Doors—Crackage and Area Windows and Doors—Crackage and Area Width Nelfht No .9 Ll neat ft. Area Width Haight No.of Llnaal ft. Area No. of Dane .1 Dant 1lghte of.rack to it. No. of Daae of pane Ilghta of crack aq.fl. 1 3'6 '7 ,0 1 25 3 t-1 2_0 Z / f2 84 1 32 1 3 'O a, ell 4 t'l 2-K Za 2 G Coef. Btu Coe(. Btu Infiltration /s Infiltration 0 Glass 7 S Y 3600 36oGlass 7.5' IfH Moo Exp.wall 6 z Exp.wall D Net exp.wall Net exp.wall 5 3 I- Int. call Ceiling s z Ce,ling Fl,or Floor / 2 2 31 Total Btu. Total Btu. b 3 Required sq.ft.E.D.R.or sq.ins.W.A.Leader area Required sq.ft.E.D.R.or sq.ins.W.A.Leader area F1.1 A.0,00 Room ILength -L Width 1 Height FUHAtt IS?-wLRoomlLength 2-A.1 Width eight Windows and Doom—Crackage and Area Windows and Doors—Crackage and Area Width Height No.of Lineal fl. Area Width Helghl No.of Ltnfl. A- No. No. of Pana or Pane itghle of crack oq,rl. No. of Dane of Dana eallight. of crack aq.It. 2t 0 6' n 2- 10 Coef. Btu 'Coef. Btu Infiltration 7_3A40 Infiltration 3 703 Glaze H6 Glass d Exp.wall 2 Exp,wall Net exp.wall Zg Z Net exp.wall // 4R4-.all t t-(000 �p Ceiling Ceiling Floor Floor G 0 2 7 2 o Total Btu. K Z D Total Btu. H5 2 Required sq.ft.E.D.R.or sq.ins.W.A.Leader area Required sq.ft.E.D.R.or sq.ins.W.A.Leader area Fl.jW.&k-rff Room ILength Iff idth Height F1,1 Room ILength Width Height Windows and Doors—Crackage and Area Windows and Doors—Crackage and Area Width H.Ighl No.of Lineal It, Area Width Helghl No.of 1.1-1 It. Are. No. of pan. of Dan. Haht. of crack .q.fl. No. of pit". or Dana IIgh1. of creek aq.ft. 2 L 2C> Z 2 Coef. Btu Coef. Btu Infiltration jp Infiltration Glaze Glass Exp.wall t7 Exp.wall Net exp.wall ZZ Qj Net exp.wall Int.wall p Int.wall Ceiling Ceiling Floor 1 7 ? 2 Floor Total Btu. I q3 Total Btu. Required sq.ft.E.D.R.or sq.ins.W.A.Leader area Required sq.ft.E.D.R.or sq.ins.W.A.Leader area _ F1.1 INi 't A Room I Length I tj Width 4 Height $ I 1:1,1 Room I Length Width - Height Windows and Doors—Crackage and Area R S Windows and Doors—Crackage and Area Width Helghl No.of Llne.l ft. Area 1� Width Helghl No.of Lineal fl. Are. No. of Dan. of D►n. Iltht. of crack aq.ft. �— No. of Dahe of Dan. Ilghts of crack eq.ft. 7, Coef. Btu Coef. Btu Infiltration -33.3 Infiltration Glass 2 Q Glass Exp.wall ZZ Exp.wall Net exp.wall \ S0 17_5' Net exp.wall Int.wall Int.wall Ceiling Ceiling Floor o0 2 Lk Do Floor Total Btu. Total Btu. Required sq.(t.E.D.R.or sq.ins.W.A.Leader area Required sq.ft.E.D.R.or sq.ins.WA.Leader area F44J Ab. A92 0706 e HEAT LOSS CALCULATIONS Weatherstrips _ A.Guide E. Construction No. Insulation Windows I Doors I Reference Out.Wall Int.Wall Ceding Roof Floor Kind _ How Applied Yes—No Yes—No 19— Z Fl.1A?eOi.4r�L&oomj Length 3 / Width ZS Height 7 Z FI.I Efts. Bw 4 Room I Length Width 20 Height Windows and Doors—Cracks a and Area M /�t' /_qtr Windows and Doors--Cracks a Ad Area f ldlh Nelaht No.of gLlneel ft. Are• ED1� F, tulle• Width Helaht No.of gLlneel fl Aren No. or pe ne of pane Ilahte ......k Q.11. wr+�'� No. of pane of Dane llahle of crack sq.(t. 2 I 2 32 26 2 3 z z zd z 2 i zti, oqa s � 2 2Ll 6 1 /40 / 3 36 81 20 21 Co.f.1 Btu Coef. Btu Infiltration Zb3 /S QN Infiltration $Z /S 0 Glass d V6 7 t7 Glass 3 / Exp.wall 937 Exp,wall 3 Net exp.wall77 31 D Net exp.wall 3 q 2— krV Ir PARACE w 1710 1 ":,;Coo Int.,fall Ceiling S 3 O Ce"ing 121&13 Floor S—3 Zt/�S Floor Total Btu. 24,099 Total Btu. 7'O Required sq.ft.E.D.R.or sq.ins.W.A.Leader area Required sq.ft.E.D.R.or sq.ins.W.A.Leader area Fl.IE7Yf QClr f Room I Length ® Width- Height 21`11M" Q� Room i Length Width eight Windows and Doors—Crackage and Arean MQ Windows and Doors—Crackage and Area Width It•Ieht Ne.of Lineal fl. Area f� No. of pans of pane IIg1Ate of crack p.m Width Height No.of Llneel ft. Are• No. of pane of pane Itiht• of crack eq.Il. Zo Z_ / /D T (G / 2 2- 32- '7-6 Z 2 �� g21 Coef. Btu 'Coef. to Infiltration 53 Infiltration I6-5– Glass S Glass 39Aa: Glass 2A- Esp. A- Exp.wall /Z Exp,wall 12-0 Net cap.wall 117 Net exp.wall // (oQ Int.wall .wa A lt)C0 Ceiling OH 8r6 Ceiling d 240 Floor Floor Total Btu. .S/Z I Total Btu. 2(OS Required sq.ft.E.D.R.or sq.ins.W.A.Leader area Required sq.ft.E.D.R.or sq.ins.W.A.Leader area 2 Fl. ' l Room ILength Width 2L Height –2Q- fit, l«Room l Length t. Width 6 Height Windows and Doors—Crackage and Area Windows and Doors—Crackage and Area Width Helaht No.of Llneal ft. Area Width Heleht No.of Lineal fl. Area No. of Dane of pane liekl• of crack eq.Il. No. of pane or pan• Ilahte of creek eq.it. 20 IG /O 26 z 7. 5 2 37- 2 2.7 2 2a /S- /0 Coef. Btu Coef. Btu Infiltration 5'3 S 79 Infiltration go /$ 135'0 Glass 3Cj ( 7 Glass 8 310,11 Exp.wall S Exp.wall s't/ Net exp.wall 31 r Net exp.wall 7 lat-wall /MOO Int.wall Ceiling Ceiling Floor Floor 72 2(6, Total Btu. 7 S Total Btu. / Required sq.ft.E.D.R.ors .ins.W.A.Leader area Required sq.ft.E.D.R.or sq.ins.WA.Leader area _ Z FI. 's,, r Room I Length Width 40 Height l F1.1t lar.IItXk' Room I Length 3(o Width I Height Windows and Doors—Crackage and Area Windows and Doors—Crackage and Area 1 Width Height No.of Lineal It. Area Width Height No.of Lineal ft. Area No. of pane of _4 Ilahte of crack eq.It. No. of paha of pane light• of crack eq.H. 2 2 SLl 14 12 7 H 4 P, I �Z /Z Coef. Btu Coe(. Btu Infiltration S 6 15' tltp Infiltration Z3-7— S9CM Glass 1-1111103 jI y Glass /Z H G{ STSZ Exp.wall t6b Exp.wall 28 Net exp.wall L11L q ---77CrqV Net exp.wall Irl_"F J 000 w-w-w mei,,,cAtc Doo Ceiling 21 C> s(O Ceiling Floor Floor Total Btu. Total Btu. p Required sq.ft.E.D.R.or sq.ins.W.A.Leader area Required sq.ft.E.D.R.or sq.ins.W.A.Leader area DATE TIME T� CITY OF ORONO CALLED IN �` _ ) INSPECTION NOT I SCHEDULED PERMIT NO. COMPLETED ADDRESS ^ - OWNER` . �n� CONTR. � �- TELEPHONE NO. �oZGI6 7 7 DESCRIPTION 4 01 FOOTING FrHANIrAl RI 16 WELL TEST PUMP Q 02 FRAMING 11 MECHANICAL FINAL 18 EXCAV/GRADING/FILLING ti 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 19 LAKESHOREIWETLANDS Z 04 WALL BD. 12 WATER HOOK-UP 34 TREE REMOVAL Q 05 FINAL 13 METER SET/TURN ON 17 SITE INSPECTION 07 DEMO—SITE 14 SEWER HOOK-UP 06 PROGRESS v 07 DEMO—FINAL 27 SEPTIC MAINT. 21 COMPLAINT 09 PLUMBING RI 15 SEPTIC INSTALL. 22 FOLLOW-UP v 10 PLUMBING FINAL 23 SEPTIC FINAL OWNERICONTRACTOR TO MEET YOU:_YES_NO COMMENTS: fcc _ W U C J O C O W Qc Q Z W Z W cc W OR SATISFACTORY:PROCEED ❑ PROJECT COMPLETE W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUP NCY 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance.473-7357 Owner/Contract f: Inspector. White Copylinspector's File Canary Copy/Site Notice .1DATE x TIME CITY OF ORONO CALLED IN INSPECTION NOTIC SCHEDULED l6) 3d PERMIT NO. COMPLETED LI ADDRESS OWNER -�— CONTR. TELEPHONE NO. qa�� & 761 7 DESCRIPTION �OeL�/r" 01 FOOTING11 16 WELL TEST PUMP Q 02 FRAMING 11 MECHMECHANICAL RI AL 18 EXCAWGRADING/FILLING 03 INSULATION 24125 WOOD BURNER/FIREPLACE 19 LAKESHORE/WETLANDS Z 04 WALL BD. 12 WATER HOOK-UP 34 TREE REMOVAL Q 05 FINAL 13 METER SET/TURN ON 17 SITE INSPECTION 07 DEMO—SITE 14 SEWER HOOK-UP 06 PROGRESS v 07 DEMO—FINAL 27 SEPTIC MAINT. 21 COMPLAINT 41 09 PLUMBING RI 15 SEPTIC INSTALL. 22 FOLLOW-UP v 10 PLUMBING FINAL 23 SEPTIC FINAL OWNER/CONTRACTOR TO MEET YOU:_YES_NO y COMMENTS: 2 a P,XC.Lz s ° e44 (A c c 0 a cc 0 W cc Q 2 W z W QC Z) W M WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE W CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTOTAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR ❑CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance.473-7357 Owner;/Contractor site: Inspector. gAmm I White Copy/Inspect s File Canary Copy0te Notice DATE TIME CITY OF ORONO CALLED IN —.23'93 INSPECTION NOTICE SCHEDULED g-', 3 PERMIT NO. COMPLETED ADDRESS 90/ re-n.Aze-d OWNER CONTR. /240 qZf TELEPHONE NO. qZ f G' 7l° ' DESCRIPTION w 01 FOOTING 11 MECHANICALRI 16 WELL TEST PUMP 02 FRAMING 1 MECHANICAL FINAL 18 EXCAV/GRADING/FILLING y 03 INSULATION 24125 WOOD BURNER/FIREPLACE 19 LAKESHOREIWETLANDS Z04 WALL BD. 12 WATER HOOK-UP 34 TREE REMOVAL Q 05 FINAL 13 METER SET/TURN ON 17 SITE INSPECTION 07 DEMO—SITE 14 SEWER HOOK-UP 06 PROGRESS 07 DEMO—FINAL 27 SEPTIC MAINT. 21 COMPLAINT 09 PLUMBING RI 15 SEPTIC INSTALL. 22 FOLLOW-UP v 10 PLUMBING FINAL 23 SEPTIC FINAL Q OWNERICONTRACTOR TO MEET YOU:_YES_NO Z Q0 COMMENTS: CC w a cc O cc O LL w Q — I Z w W cc d )CWO ORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE w ❑CORRECT WORK&PROCEED E_ ISSUE CERTIFICATE OF OCCUPANCY O ❑CORRECT WORK,CALL FOR REINSPECTION' TEMPORARY BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN INSPECTOR WILL RETURN CITATION ISSUED ElSTOP ORDER POSTED.CALL INSPECTOR ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance.473-7357 Owner/Contract Inspector. White CopylInspector's F e Canary Copy/Site Notice H8 Z5��r- 0 S HEATING TEST RECORD p ADDRESS 0 t D ART. FLOOR CITY SUBURB OCCUPANT OWNER HEAT LOSS DATE HTG. INST. SOLD BY INSTALLED BYIr Electrical Work By Gas Line By TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER GAS ESIGN CONV 'RSION MAKE MAKE OF BURNER Model Model Serial Max. BTU Rating INPUT 21 0� Iti MAKE OF FURNACE _ - Model �t CONTROLS f/ Jty1V' 9 THERMOSTAT Heat Plug Vent Sizs Valve o-- Em KIND OF LINERPq SIZE NONE Limit Draft Hood Qt L�RegulaTor ) kS 0', Limit Setting Z 9,10 U Filters Size Number Fan Setting Chimney Location Inside /nu�tside Pilot Type k f Chimney Construction ,��'a Pilot Make f Pilot Model Smoke Bomb I Wiring t/ Pilot Timing 3 S E C_ Draft V Test Tag L.W. Cut Off �'"' Door Pressure Lighting Inst. Pressure Percent CO2 ' J Date Tested /� �� •A' Input CFH Percent 02 Company Testing IOU _ Stock Temp. Percent CO Name of Tester �-<<- Form 235 �� 11n /Ic ` C�� / HOUSE HEATING TEST RECORD ADDRESS v1 ""� "" "'��T APT. FLOOR CITY SUBURB OP-0140 OCCUPANT OWNER HEAT LOSS DATE HTG. INST. �q� SOLD BY INSTALLED BY V Electrical Work By Gas Line By - ::A 11 it�, TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR.,,. OTHER GAS DESIGN CONVERSION MAKE K — MAKE OF BURNER Model Model Serial Max. BTU Rating INPUT MAKE OF FURNACE Model CONTROLS �— THERMOSTAT Pug Vent Size Valva KIND OF LINERn SIZE NON Limit d Draft Hoods Regularor Limit Setting Filters Size Numb r Fan Setting Chimney Location Inside Ou side Pilot Type Ltf Chimney Construction Pilot Make �1 Pilot Model Smoke Bomb Wiring Pilot Timing �.� Draft Test Tog L.W. Cut Off Door Pressure LightinInst. Pressure Percent CO2 Date Tested Input CFH Percent 02 Company Testing �� Stack Temp. C� Percent CO D(0 Name of Tester Form 235 g r *1 oY1 fele(# HOUSE�HEATING TEST RECORD ADDRESS O ` Cd k1#4- APT. FLOOR CITY SUBURB t-10 OCCUPANT OWNER HEAT LOSS DATE HTG. INST. on SOLD BY INSTALLED BY Electrical Work By Gas Line By WL ^ TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER GASSIGN CONVERSION MAKE K MAKE OF BURNER Model Model Serial Max. BTU Rating INPUT MAKE OF FURNACE Model CONTROLS THERMOSTAT H t 1 �^ Vent Size Valve KIND OF LINER,1 �SIZE ONE Limit �9 �r-U Draft Hood ' Regularor & � Limit Setting Filters Size N..-6&r Fan Setting Chimney Location Inside Outside Pilot Type Chimney ConstructionAjq 0\1C Pilot Make Pilot Model Smoke Bomb Wiring Pilot Timing �C— Draft Test Tag L.W. Cut Off Door Pressure Lightin Inst. Pressure 31 Percent CO2 7, Date Tested Input CFH 4 \ Percent 02 7, Company Testing r 7 Al (Cff- Stack Temp. Percent CO Name of Tester --I-- d .": �� Form 235 6 P ��r�T IOUSE HEATING TEST RECORD ADDRESS 90 ""LA k'4 kilt 20 APT. FLOOR CITY SUBURB OCCUPANT OWNER HEAT LOSS DATE HTG. INST. SOLD BY INSTALLED BY Electrical Work By Gas Line By TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER GAS DESIGN CONVER*IbN MAKE V4,N Ll P, MAKE OF BURNER Model () Model Serial Max. BTU Rating INPUT �� n MAKE OF FURNACE Model -- I/LdCONTROLS r1 LI 'JUN 2THERMOSTAT He t I Vent Size p� tY 9 � Valve KIND OF LIN SIZE ON Limit "rbDraft Hood Regularor �L u Limit Setting A,10 Filters Size Number - Fon Setting Chimney Location InsideEl0utsids Pilot Type Chimney Construction 12V C 1 Pilot MakeIdA l Pilot Model Smoke Bomb ` � Wiring Pilot Timing Draft (/ Test Tag L.W. Cut Off / Door Pressure Lightin Inst. ol- Pressure Percent CO2 ` Date Tested Input CFH Percent 0 (0 Company Testing / 2 Stack Temp. 1-U� Percent CO Name of Tester Form 235 CoHOUSE HEATING TEST RECORD� ADDRESS APT. FLOOR CITY SUBURB gC) � �k� � OCCUPANT OWNER HEAT LOSS DATE HTG. INST. SOLD BY INSTALLED BY v� j Electrical Work By Gas Line By TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER GAS DESIGN CONVERSION MAKE wi MAKE OF BURNER Model V o Model Serial G 1 0 5 y 3 Max. BTU Rating V INPUT MAKE OF FURNACE Model CONTROLS �( THERMOSTAT Feat lug r------- Vent Size Valve Co j KIND OF LINER SIZE NO Limit Draft Hood A-- Reguleror Voc- &- Limit Setting 0() Filters Size w—har Fan SettingfiLA-yChimney Location Inside0utside Pilot Type Chimney Construction Pilot Make k Pilot Model Smoke Bomb Wiring Pilot Timing S�L Draft Test Tag L.W. Cut Off Door Pressure Lighting Inst. Pressure Percent CO2 �� Date Tested Input CPercent 02_�� Company Testing Stack Temp. —�(.�70 Percent CO 010 Name of Tester Form 235 n ^ �2& n