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HomeMy WebLinkAbout1996-007977 - mechanical PERMIT CITY OF ORONO PERMIT TYPE: 2..,750 Kelley Parkway- P.O. Box 66 MECHANICAL CTystaa Bay, Minnesota 55323 Permit Number: 007977 (612)473-7357 Date Issued: 05/21/96 SITE ADDRESS: 980 TONKAWA RD je P. I .N. ; 0:_-117- :3-1*f21-000 I DESCRIPTION: I HEATING SYSTEMS FUEL NATURAL GAS MAKE PAYNE MODEL :34.�aMAVt 24 060 OUTPUT 54,000 INPUT 60,000 1 HEATING SYSTEMS FUEL 1EL NATURAL GAS MAKE PAYNE MODEL 340MAV0481 i�i r OUTPUT 1T 9 a,t y00 INPUT 100,000 c.}t. 0 I AIR CONDITIONING MAKE CARRIER MODEL C BSBXA-024. TON': 2 1 AIR CONDITIONING MAKE CARRIER MODEL CBSB X A-048 TONS 4 REMARKS: FEE SUMMARY: VALUATION $13,000 Base Fee $162.50 MAIL IN ------ — Surcharge —*�_5Q Total Fee 170.50 Subtotal $169 .00 CONTRACTOR: — Applicant — OWNER: ROUSE MECHANICAL INC: 5935:300 DORR LAWRENCE 11:348 K—TEL DRIVE 980 TONKAWA RD MINNETONKA MN 55:34:3 'iRONO MN 55:356 (612) 933—S300 ti THE UNDERSIGNED HEREBY 'REQUEST,,, PERI 155 T CIN TO MASE THE R5AI_ , I I ` SITS . SPECIFIED AND AGI E .3 TO D�:+ ALL WORK, I N STE2 I T C00 I ANCE 'W 1, 4 C 1 L_ OR I t RCiINANC:ES AND STATE [F # NNESDTA II1iDING , �t �1 y, APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE CITY OF ORONO APPLICATION FOR MECHANICAL RMIT Box 66 (2750 Kelley Parkway) Crystal Bay, MN 55323 PQR GENERAL INFORMATION 1. You may apply for mechanical permits by mail or in person at the City offices. Applications will be reviewed and a permit will be issued within 2 working days. 2. Permit cards will be sent by return mail after a review is completed. PERMITS ARE NOT VALID UNTIL YOU RECEIVE A PERMIT. WORK MUST NOT BEGIN UNTIL THE PERMIT CARD IS POSTED ON THE JOB SITE. 3. Mechanical Designs - Complete calculations, details and specifications are required for each heating, ventilation,humidification-dehumidification, and air conditioning installation including heat loss/heat gain calculation, design temperatures, equipment ratings and identification as to type, manufacturer and model. Data shall be presented on form provided. Identification of and specifications for water heating equipment shall also be provided. 4. When any new construction or remodeling is involved, a separate building permit must be obtained. 5. All work must be done in accordance with the Uniform Mechanical Code/State Building Code requirements. 6. All work must be inspected (rough-in and final). Call 473-7357. 24-hour notice required. 7. House Heating Test Record must be submitted before final. Instructions Complete all items on this application. Compute the permit fee. Sign and date the certification. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED. If you have questions, call 473-7357. Please check one: New Addition Repair Replace Residential Commercial JOB SITE: 9'80 TeAk ,jes Rd - Zip: Owner's Name: Telephone Number: Mailing Address: City: TelephoneNumbe r• Sq Contractor's Name: o 11s e /he�.1.�.�n C co-1 , I„c- MailingAddress: a9lb ilkmda. Ayc-. N• City: N" NoIO e Zip: 55N.17 SYSTEM DESCRIPTION HEATING SYSTEMS Quantity: ' Make: AQ- payne_ Model: 3y0A1AV0a40b6 3g0AAvo4810 Fuel: Flue Size: Input BTUs: 60i Doo nodi ocao Output BTUs: 5-14, 000 9y,000 CFM: COOLING SYSTEMS Quantity: Make: Car�c/ y Carr-r a i Model: E858X,*-6w Cg590, b47 Tons: a tam `f H. Power WOOD BURNING EQUIPMENT Wood stove with flue Wood combination or add-on Factory fireplace with flue Factory Fireplace (s) Freestanding Masonry Wood Stove (s) Franklin, other Brand Name Model No. Mfgr's Min., Clearances, side rear min. flue dia. Total VENTELATION No. Kitchen Exhaust ducted recirculating cfm No. Bath Exhaust (must be ducted outside) cfm No. Other Fans: Locations cfm Total FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) Installation Removal Fuel oil: gallons underground inside outside LP Gas: gallons Other Gas opening PERMIT FEE CALCULATION 1. 1.25% of Contract Price* or Minimum Fee ($35.00) -3,coo . .— x .0125 $ Jia (contract price) 2. State Surcharge. ** Add the State Building Code Division Surcharge to each permit. 13, °a 0., x .0005 $ (contract price) or $.50, whichever is greater 3. Postage and Handling (Only mail-in applications) $ 1.50 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ X70 . 5 C) * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted work including materials, labor, profit, and other fixed costs. It is the amount to be charged to the customer for the work done. If any material, equipment, labor,or installation are furnished by the owner, tenant or any other party the reasonable market value of such items must be added to the estimated cost or contract price for permit fee purposes. In the event that there is a dispute on the amount of the job cost, the City may request the submission of a signed copy of the actual contract. ** The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or $.50 - whichever is greater. For valuations over $1,000,000 call the Department of Inspectional Services for the price. The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all work in strict accordance with the ordinances of the City and the regulations of the Minnesota State Building Code, and certifies that all statements made on this application are complete, true and correct. Applicant's Signature: I Date: Approved By: - V Date: rr�a� oz DI 00:77 O1LTL7L077 t 1 HEATING AND COOLING BLOCK LOAD PROJECT= DORR RESIDENCE PROJE$j NO: , FILE NAME: FDR1 .LE6 DATE: 3-14-96 xc UNIT N0: AH-1 VENT AIR CFM= 0 NUMBER OF PEOPLE: 3 FLOOR AREA: 2144 CFM/SF : 0 .37 LIGWTING W/5F : 0.14 - - - - - w - - - - _. - - - - - - - - - - - - - - - - - - _ - - - - - DESIGN CONDITIONS - - - - - - - - - - - - - - - - - - - w w w - SUMMER -OUTSIDE INSIDE DIFFERENCE * DAILY RANDE GE 22 DRYBULB 92 78 WETSULH 75 65 10 * DESIGN TIME 10AM GR/LB 104 72 32 * WEATHER STA 4 36 WINTER -19 72 .r- -91 - - - W - - - �MPLS ./ST . PAUL.-MN w .r .r w w w w = w � - - - - - - - - - - - SENSIBLE HEAT LOSS TOTALS HEAT GAIN TOTALS- - - - LATENT- - - - - - - - - - - - - - - - - - - - - - TONS TONS STUH 2 .28 TRANSMISSION 37255 TRANSMISSION 0 .00 INFILTRATION 13607 INFILTRATION 0 .00 0.09 LIGHTS 0.09 PEOPLE 0.05 APPLIANCES 0 .00 0 .00 MOTOR - 0 .12 VENTILATION 0 .00 0.00 VENTILATION 0 0.05 2-55 TOTAL 50863 TOTALS TbTAI. + 15% 58492 _ - - -TOTAL-(S + L)- - - 2 .60- CALC- Y 2 - _SELECTED w - - - - - - - - - - - AIR DISTRIBUTION FOR 10AM _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ZONE -CFM-HTG CFM CLG CFM H&C CI:M/SF HTG CFM/SF CLG CFM/SF H&C 1 RECRE 171 83 i4 126 0 .32 0 .15 0 .23 73 0 .20 0 .00 0 .15 2 STORA 99 0 22 0 .21 0 .00 0 .15 3 LOWER 30 0 0 .24 `0 .05 0 .17' 4 BATH 14 2 S 10 0 .27 000 0 .20 . 5 MECH/ 58 0 42 0 .76 -6 PORCH_ 425 - - _ 713 1,254 - 524 - - - _ 0 .62- r - - _1.04 - _ - - - - - - UNIT SCHEDULE _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - - - - - - - - ~DESIGN HEAT (MBH ) DESIGN SELECTED UNIT CFM CFM MINIMUM MAXIMUM COOL COOL TONS TONS NO. SUPPLY OA IN/OUT IN/OUT AH-1 800 0 .63 / 00 73 / 59 2.60 2 'O 00; DO 0lZTZDZ077 rAac OJ HEATING AND COOLING BLOCK LOAD PROJECT: DORR RESIDENCE PROJE�T N0: r , FILE NAME: FDR2 .LE6 DATE: ,I-X4-96 SNIT NO: AH-2 VENT AIR CFM: 0 NUMBER OF PEOPLE: 7 'LOOR AREA: 3331 CFM/SF: 0 .48 LIGHTING W/SF: 1 .17 1ESIGN CONDITIONS ,UMMER OUTSIDE INSIDE DIFFERENCE * DAILY RANGE 22 lRYBUL9 92 78 14 * LATITUDE 44 IETBULB 75 65 10 * DESIGN TIME 1 PM iR/LB 104 72 32 * WEATHER STA * 38 (INTER -19 72 91 * MPLS ./ST . PAUL . MN - - - - - - -- - - - - - - - - - - - - - - - - - �- - -- -- - -- - - - - - - - IEAT LOSS TOTALS HEAT GAIN TOTALS LATENT SENSIBLE BTUH TONS TONS 'RANSMISSION 44350 TRANSMISSION - 2 .69 NFILTRATION 26206 INFILTRATION 0 .00 0 .00 LIGHTS - 1 .10 PEOPLE 0 .12 0 .15 APPLIANCES 0 .00 0.00 MOTOR - 0 .20 'ENTILATION 0 VENTILATION 0 .00 0.00 'OTAL 70556 TOTALS 0 .12 4 ,14 'OTAL + 15% 81140 TOTAL ( S + L ) 4 .25 CALC 4 SELECTED iIR DISTRIBUTION FOR 1 PM - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - ;ONE CFM HTG CFM CLQ CFM H&C CFM/SF HTG CFM/SF CLG CFM/SF H&C 1 LIVIN 130 71 107 0 .25 0 . 14 0 .21 2 ENTRY 127 60 105 1 .66 0 .79 1 .37 3 MAIN 48 24 S& 40 0.34 0 .17 0 .28 4 OINET 176 219 '115 181 0 .77 0 .95 0 .79 5 KITCH 96 237 33`f 196 0 .35 0 .86 0.71 6 REAR 27 34 q5" 28 0.63 0 .77 0 .64 7 LAUND 51 164 2�J 135 0 .53 1 .67 1 .39 8 REAR 34 9 17 28 0 .37 0 .11 0 .30 9 REAR 18 6 7 15 0 .34 0 . 12 0 .28 10 0 0 0 0 .00 0 .00 0 .00 it EXERC 161 134 210 133 0 .55 0 .46 0.45 12 UPPER 102 67 q l 84 0.46 0 .30 0.38 13 GUEST 32 23 as 27 0.42 0 .30 0.34 14 GUEST 126 117 ( 11 104 0.56 0.52 0 .47 15 BATH 18 10 /6 1s 0.27 0.15 0 .22 16 MASTE 70 41 1;q 56 0.43 0 .25 0 .35 17 MASTS 70 41 r+ se 0.47 0.28 0 .39 18 MASTS 195 202 135" 167 0.56 0 .58 0 .48 19 SEDRO 106 132 175' 109 0.44 0 .55 0 .46 -~ -4,- - - ». - - - - -- - - - - - - - - - - - - �NIT SCHEDULE ` - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - DESIGN HEAT (MSH ) DESIGN SELECTED mIfT ("CM MTAItM11M M6vTM11M !1+yn1 nn+o1 raa� oz p oo:oQ o» ,r "1 HEATING AND COOLING BLOCK LOAD PROJECT = DORR RESIDENCE PROJE • 1V, NO' e FILE NAME: FDRI .LE6 DATE: 3-14-96 UNIT N0: AH-1 VENT AIR CFM= b NUMBER OF PEOPLE: 3 FLOOR AREA: 2144 CFM/SF: 0 .37 LIGWTING W/SF : 0.3 4 ,.,. - - - - - - - _ - - - - - - - - - - - - - - - -. - - - - - DE5IGN CONDITIONS _ _ _ - ._ - - - _ - ,_ _ - - - - - - - SUMMER -OUTSIDE INSIDE DIFFERENCE * DAILY RANGE 22 LATITUDE 4a DRY8UL8 92 78 * WET8UL8 7g 65 10 � DESIGN TIME 10AM GR/L8 104 72 32 * WEATHER STA # 38 WINTER -19 72 91 - - - J - _ * - - -MPL- - - -PAUL .-MN - _ _ HEAT LOSS TOTALS- _ _ _ _HEAT GAIN TOTALS - - LATENTSENSIBLE _ - - - - TUH TONS TONS B TRANSMISSION 3TUH TRANSMISSION "" 2 .28 INFILTRATION 0 .00 0 .00 INFILTRATION 13607 LIGHTS - 0 .09 PEOPLE 0 .05 0 .06 APPLIANCES 0 .00 0 .00 MOTOR - 0 .12 VENTILATION 0 VENTILAT?:ON 0 .00 0 .00 TOTAL. 50863 TOTALS 0 .05 2 .55 TOTAL + 15% 1 - -58492- - - - _TOTAL-(S + L )- - - 2 .60- CALL- - 2 - _SELECTED - - - AIR DISTRIBUTION FOR 10AM _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - - - - - - ZONE -CFM HTG CFM CLG CFM H&C (.,rM/SF HTG CF=M/SF CLG CFM/SF H&C 1 RECRE 171 83 14? 126 0 .32 0 .15 0 .23 2 STORA 99 0 73 0 .20 0 .00 0 .15 3 LOWER 30 0 22 0 .21 0 .00 0 .15 4 BATH 14 2 S 10 0 .24 0 .05 0 .17 5 -MECH/ 58 0 42 0 .27 0 .00 0 .20 6 PORCH- 425 - - _ 713 /a S4 - 524 - - - _ 0 .62_ - - _ _1-04 _ - - -0 .76- - UNIT SCHEDULE _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ R - - - - - - - _ DESIGN HEAT (MBH ) DESIGN SELECTED UNIT CFM CFM MINIMUM MAXIMUM COOL COOL NO. SUPPLY OA IN/OUT IN/OUT TONS TONS AM-1 800 0 63 / 00 73 / 59 2 .60 2 a, 0 00;00 0lZTZJz0» raac oa HEATING AND COOLING BLOCK LOAD PROJECT: DORR RESIDENCE PROJECT NO: r FILE NAME: FDR2 .LE6 OATEN -X4-96 iNIT N0: AH-2 VENT AIR CFM: 0 NUMBER OF PEOPLE: 7 'LOOK AREA: 3331 CFM/SF : 0 .48 LIGHTING W/SF : 1 .17 IESIGN CONDITIONS I w - - - - - - - - - - - - - - - - - - - - - - - .. - - - - - - - - - - '-UMMER OUTSIDE INSIDE DIFFERENCE * DAILY RANGE 22 AYBULS 92 78 14 * LATITUDE 44 IETBULB 75 65 10 * DESIGN TIME 1 PM iR/LB 104 72 32 * WEATHER STA 4 38 (INTER --19 72 91 * MPLS./ST . PAUL , MN - - - - - - - - - - - - - - - - - - - - - - -- - - -- - - - - - - - - - IEAT LOSS TOTALS HEAT GAIN TOTALS LATENT SENSIBLE - - - - - - - - - - - - - - - - -- _ - - ._ - - - - - - - - - - - - - - - - BTUH TONS TONS 'RANSMISSION 44350 TRANSMISSION - 2 .69 ;NFILTRATION 26206 INFILTRATION 0 .00 0 .00 LIGHTS - 1 .10 PEOPLE 0 .12 0 .15 APPLIANCES 0 .00 0 .00 MOTOR - 0 .20 IENTILATION 0 VENTILATION 0 .00 0.00 'OTAL 70556 TOTALS 0 .12 4 .14 'OTAL + 15% 81140 TOTAL ( S + L-) 4 .25 CALC 4 SELECTED tIR DISTRIBUTION FOR 1 PM • - - - - - - - - - - - - - - - - - - - - - - - - - -- - r- - - - - - - - - - :ONE CFM HTG CFM CLQ CFM H&C CFM/SF HTG CFM/SF CLG CFM/SF H&C 1 LIVIN 130 71 adz 107 0 .25 0 . 14 0 .21 2 ENTRY 127 60 sf 105 1 .66 0 .79 1 ,37 3 MAIN 48 24 iL 40 0 .34 0 .17 0 .28 r4 OINET 178 219 4 t 5 161 0 .77 0 .95 0 .79 5 KITCH 96 237 3iq 196 0 .35 0 .86 0 .71 6 REAR 27 34 qr 28 0 .63 0 .77 0 .64 7 LAUND 51 164 x{d 135 0 .53 1 .67 1 .39 8 REAR 34 9 13 28 0 .37 0 . 11 0 .30 9 REAR 18 6 7 15 0 .34 0 . 12 0 .28 10 0 0 0 0.00 0 .00 0 .00 11 EXERC 161 134 210 133 0 .55 0 .46 0.45 12 UPPER 102 67 q7 64 0.46 0 .30 0.38 13 GUEST 32 23 6c 27 0 .42 0 .30 0.34 14 GUEST 126 117 ( 11 104 0.56 0 .52 0 .47 15 BATH 16 10 14 1S 0.27 0.15 0 .22 16 MASTS 70 41 S•1 56 0 .43 0 .25 0 .35 17 MASTE 70 41 S4 58 0 .47 0.28 0 .39 18 MASTS 195 202 Ilf 167 0.56 0.58 0 .49 19 BEDRO 106 132 115' 109 0.44 0 .55 0.46 JNIT SCHEDULE DESIGN HEAT ( MBH ) DESIGN SELECTED INYT CFM CFM MTNIMI IM M4k-TMf IM rani f`nni G� DATE TIME CITY OF ORONO CALLED IN ,Z49 r'_ INSPECTION NOTICE SCHEDULED ) PERMIT NO. "/ 17 COMPLETED ADDRESS OWNER CONTR. �/- TELEPHONENO. 3�3DU DESCRIPTION 01 FOOTING CHANICAL� 18 EXCAV/GRADING/FILLING ,:t 02 FRAMING EfiFb4iVICAL FINAL 19 LAKESHORE/WETLANDS 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION 05 FINAL 14 SEWER HOOK-UO 06 PROGRESS v 07 DEMO—SITE 27 SEPTIC MAINT. 21 COMPLAINT W 07 DEMO--FINAL 15 SEPTIC INSTALL 22 FOLLOW-UP = 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL v 10 PLUMBING FINAL 36 FOUNDATION REMOVAL 2 OWNER/CONTRACTOR TO MEET YOU:_YES_NO COMMENTS: CC W a O cc O W cc Q 2 W Z W cc � - PROLU �0�( ORK SATISFACTORY:PROCEED JECT COMPLETE W ORRECT WORK&PROCEED G ISSUE CERTIFICATE OF OCCUPANCY O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY 0 BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. C PHOTO TAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR ❑CITATION ISSUED ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspe ion 24 hours in advance.473-7357 Owner/Contractor on Inspector. White CopylInspector's File Canary Copy/Site Notice DATE G TIME CITY OF ORONO CALLED IN �7 INSPECTION NOTICE SCHEDULED PERMIT NO. rJ fl 7�I COMPLETED '� N ADDRESS WL/) ed OWNER h-el ZZ CONTR. � TELEPHONE NO. ✓� �� -S -3 d DESCRIPTION 01 FOOTING 41 MECHANICAL RI 18 EXCAV/GRADING/FILLING tQ 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION Q = 05 FINAL 14 SEWER HOOK-UO 06 PROGRESS ~ 07 DEMO—SITE 27 SEPTIC MAINT. 21 COMPLAINT J W 07 DEMO—FINAL 15 SEPTIC INSTALL 22 FOLLOW-UP = 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL J 10 PLUMBING FINAL 36 FOUNDATION REMOVAL Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO o COMMENTS: cc //11 a t& V cc O O a oz O LL W cc Q Z W Z W cc O W �WORK SATISFACTORY.PROCEED PROJECT COMPLETE � CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY W O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY 0 BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. r PHOTO TAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR []CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next iction 24 hours in advance.473-7357 OwnerlContract roit Inspector. White Copy/Inspector's File Canary Copy/Site Notice DOW 7-7 HEATING TEST RECORD ��� ADDRESS 4 S?U T-*7Jkk au CL APT. FLOOR CITY SUBURB OCCUPANT A)O22 OWNER HEAT LOSS DATE HTG. INST. ZQ 040 Ql Co SOLD BY INSTALLED BY /Z0us< 12152-4=41 Electrical Work By Gas Line By " `' TYPE OF HEAT GA FA ✓ HW STEAM SPACE HTR. UNIT HTR. OTHER GAS DESIGN CONVERSION MAKES N e-- MAKE OF BURNER Model -TyO 1 1w op4z oyy Model Serial y7!9Z A,0C.L�6, 3 Max. BTU Rating INPUT MAKE OF FURNACE Model CONTROLS 7� G THERMOSTAT Heat Plug Vent Size Valve kKIND OF LINER SIZE NONE Limit KL(xn n Draft Hood PIOGLC a or Regularor -3 2-5-—3 Limit Setting �g0" a Filters SP iIz��'�'� Number L Fan Setting T/Gl1CSL�t-� Chimney Location Inside Outside Pilot Type Chimney Construction �u C_ PilotMake Pilot Model d leer 2� Smoke Bomb Wiring r' Pilot Timing lei 136p d Draft //lTest Tag L.W. Cut Off Door Pressure Lighting Inst. Pressure 3, Percent CO2 7 Date Tested 5-11-91 Input CFH VO c Percent 02 g Company Testing —Rouse Mechanical, Inc. Stack Temp. Percent CO 11348 KTel Minn _ ka,MN yo0.6-f- Name of Tester �•� HEATINI TEST RECORD ADDRESS L� bd "��Q�'A APT. FLOOR CITY SUBURB OCCUPANT /-���� OWNER HEAT LOSS DATE HTG. INST. 16 © 9fp SOLD BY INSTALLED BY /2.127 SLS'e /me(n-41 Electrical Work By Gas Line By " c" TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER GAS DESIGN CONVERSION MAKE '�'�A/E MAKE OF BURNER Model _31-1e)AA VU Y /bC3 Model Serial !4::Z-1SQA t,7—I Max. BTU Rating INPUT MAKE OF FURNACE Model ee rr/Gt— 2omv6 CONTROLS THERMOSTAT 5 Srer'� y Heat Plug Vent Size Valve t c. ite R09.ers KIND OF LINER SIZE—NONE— Limit IZE NONELimit Ku ,M^ Draft Hood ���C t RegulaTor Limit Setting �� ``,to Filters iz5 a � � Number Fan Setting //rte d��y Chimney Location Inside Outside Pilot Type 6 Lnw Ca/G Chimney Construction Pilot Make — /mac=LLE Pilot Model /V Smoke Bomb Wiring Pilot Timing /fiw. /f e ,k Draft t_Q(IptCPd Test Tag L.W. Cut Off "— Door Pressure � Lighting Inst. y Pressure 3,511 Percent CO 2 Date Tested &-_l 1 --977 Input CFH 1QQ- Percent 02 -7 Company Testing —Rouse Mechanical, Inc. Stack Temp. Percent CO 1 KTel Dr. netonka, N 55343 Name of Tester 4�14j_ 614re