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HomeMy WebLinkAbout2001 - P03931 - mechanical PERMIT CITY OF ORONO 2750 Kelley Parkway- PO Box 66 Permit Number: P03931 Crystal Bay, Minnesota 55323 Permit Type: Mechanical Permits (952) 249-4600 Date Issued: 6/12/2001 SITE ADDRESS: 200 Woodhill Rd Wayzata,MN 55391 PID: 02-117-23-12-0001 DESCRIPTION: Proposed Use: Commercial Permit Class: General Permit Sub-type(s): Mechanical Undefined Permit Type: Mechanical Permits DETAILS: Approved per resolution#: Separate permits required: NOTICES/REMARKS: HVAC for Remodel&New Addition Barn Bldg. See Plans FEE SUMMARY: Permit Fee: $ 320.06 Valuation: $ 25,605.00 State Surcharge Fee: $ 12.80 Misc.Fee: $ 1.50 TOTAL FEE: $ 334.36 APPLICANT: Yale Incorporated OWNER: Woodhill Country Club 9649 Girard Ave S. 200 Woodhill Rd Bloomington,MN 55431 Wayzata MN 55391 THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF MINNESOTA BUILDING CODE REQUIREMENTS. 7Y1GL-C J aifan APPLICANT PERMITEE SIGNATURE ISS JED BY SIGNATURE Copies: City,Applicant,Assessor,Finance Page 1 SOl–l1 O Wl-F V-E 534.3(A oz-Oot - I to-MA CITY OF ORONO APPLICATION FOR MECHANICAL PERMIT BOX 66(2750 KELLEY PARKWAY), CRYSTAL BAY,MN 55323 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(952)249-4600. 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 (952)249-4600. Please ck one: New X Addition Repair Replace Residential X Commercial JOB SITE: ZOO V\10Ot1-4 I LL 1 D Zip: 39 Owner's Name: DN I _L-6N/TRY C-1–U-B Telephone Number: Mailing Address: City: Zip: Contractor's Name: 'I/A LE /EN COM PA-SS Telephone Number: a 5Z-S 34-I(o(o - Mailing Address:Q b4cl G I RA RD A-VG- S City: BLOOM I NG TDNI Zip: ('4 N Co[4Tkc- PERSon1: w SYSTEM DESCRIPTIO Rt;t"t°DE _ NEW A:DDI Tl©tJ — G-3A- J R,LpG. E Pr P�Cl fit✓D PLAN'' HEATING SYSTEMS Quantity: Make: Model: Fuel: Flue Size: Input BTUs: Output BTUs: CFM: COOLING SYSTEMS Quantity: Make: Model: Tons: H.Power: . -- FIREPLACES Gas factory fireplace Wood burning factory fireplace with flue Wood Stove Wood stove with flue Brand Name Model No. VENTILATION No. Kitchen Exhaust ducted recirculating cfm No. Bath Exhaust(must be ducted outside) cfm No. Other Fans:Locations cfm 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) (Contract Price) IS 2 51 05.00 x.0125 $ 32-0.0(o 2. State Surcharge. **Add the State Building Code Division Surcharge to each permit. (Contract Price) if 2S l CO 2.00 x.0005 $ f 2.80 or$.50 3.Postage and Handling(Only mail-in applications) $ 1.50 4.TOTAL PERMIT FEE(Add lines 1-3 above) $ 34-.3( *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 is 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: Date: (0`1`0 Approved By: Date: 6i t/—`-3' Jut—CT—ON 09:O2am From—CITY OF ORONO +9522494616 T-191 P 002/003 F-332 CREDENTIAL CERTIFICATION APPLICATION CITY OF ORONO 2790 Kelly Parkway, P.O. Box 66 Crystal Bay, MN 55323 Phone: 249-4600 Business: pt,L,,,-9-n.-f, Phone: 95./ 6 C. / � n (Business and How)Address: 9 6 q /'�`�' . City: Zei,--9-7-/-4. -/-ts- State: ) ' Zip: cSSC�3 Type of License Held: Master PIumber House Mover Other Y'1.49G State License No. ExpirationDate Have you ever had a license revoked? IVO When Where NOTE: The City does not have a special bond form to use. Proof of Workers Compensation insurance coverage is required for all contractors. Check kind of trade applying for: Septic Contractor. (Required: MPCA Individual Sewage Treatment Systems License) House Mover (Required: $2,000 Bond, 10-50-100,000 Insurance) ___ Mechanical (Required: $2,000 Bond, 10-50-100,000 Insurance) Plumber (Required: $2,000 Bond, 10-50-100,000 Insurance OR a copy of the State Plumbing Insurance/Bond) Municipal connections (sewer/water) Yes No Fire Sprinkler Installers (Required: $2,000 Bond, 10-50-100,000) Work shall not commence until this application has been approved and required permits are issued. Please indicate any other •ersons autho : e• by you to appl i for p-rmits: • 4 '// , ' / A _- -4 The undersigned hereby makes application to e City of Orono, Minnesota, for credential certification as indicated above, subject to the laws of the State of Minnesota and the Ordinances of the City of Orono. All applications are subject to a ten (10) day approval period. If disapproved, written notice will be sent. Signature: Date: fi Ju4�-G7-iles1 09:02am From-CITY OF ORONO +9522494616 T-191 P.003/003 F-332 Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd- 1. Type of data. The tights of individual on whom the data is stored or to be stored shall be as sec forth in this section. Subd.2. Information required to be given individuaL An individual asked to supply private or confidential data concerning himself shall be informed of: (a)the purpose and intended use of the requested data within the collecting hue agency.political subdivision,or statewide system; (b)whether he may refuse or is legally required to supply the requested data;(c)any latown consequence arising from his supplying or refusing to supply private or confidential dam;and(d)the identity of other persons or entities authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply investigative data,pursuant ro section 13.82,subdivision 5. to a law caforcement officer. • The commissioner of revenue may place the notice requited under this subdivision in the individual income tax or property tax refund instructions instead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of stored data on individuals,and whether it Is classified as public,private or confidential. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown the dam without any charge to him and;if he desires,shall be informed of the content and meaning of char data. After an individual has been shown the private dam and informed of its meaning,the data need not be disclosed to him for six months thereafter unless a dispute or action pursuant to this section is pending or additional data on the individual has been collected or created. The responsible authority shall provide Copies of the private or public dam upon request by the individual subject of the data. The responsible authority may require the requesting person to pay the actual costs of making,certifying.and compiling the copies. The responsible authority shall comply immediately,if possible,with any request wade pursuant to this subdivision,or within five days of the date of the request.excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request within that time,he shall so inform the individual,and may have an additional five days within which to comply with the kequest,excluding Saturdays, Sundays and legal holidays. • • Subd.4;Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data concerning himself. To exercise this right,an individual shall notify in writing the responsible authority describing the nature of the disagreement. The responsible authority shall within 30 days tither: (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients of inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual that he believes the data to be correct Dam in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determination of the responsible authority may be appealed pursuant to the provisions of the administrative procedure act relating to contested casts. DATA PRIVACY ADVISORY • In accordance with M.S. 13.04, Subd.2, "Rights of subjects of data",we would like to inform you that your request for a permit or license from the City of Orono or any of its departments may require you to furnish certain private or confidential information. You are notified that: - 1. The information you furnish will be used to determine your qualification for the permit or license requested. 2. You may refuse to supply data, but refusal may require that the City deny the permit or license. 3. The information may be shared with other local, stare or federal agencies to the extent necessary to process the permit or license. 4. If your requested permit or license requires Council action to approve, some information may become public. 5. You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself. 6. Your full name is required to process this application or permit. Tom` ' First iidDdle Last Addre <5S-ci�3 / gsai88�-j ( .) City sm. Zip P one I understand my rights as stated -bove. Sig,•turn • • (Cie rfif c its of Jnzitranc" .� Aon Risk Services Insured Encompass Services Corporation Encompass Mechanical Services fka Yale,Inc. 9649 Girard Avenue South Bloomington,MN 55431 To: Certificate Holder City of Orono Important: If the certificate holder is an ADDITIONAL INSURED, the policy(es) must be 2750 Kelley Parkway endorsed. A statement on this certificate does not confer rights to the certificate holder ii lieu of such endorsement(s). If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, Box 66 certain policies may require an endorsement. A statement on this certificate does not confer rights to the Crystal Bay,MN 55323 certificate holder in lieu of such endorsement. Disclaimer: The Cent. of Ins. does not constitute a contract between the issuing insurer(s), authorized representative or producer,and the cert holder,nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. This is to certify that the policies of insurance listed below have been issued to the Insured named above for the policy period indicated,notwithstanding any requirement,term,or condition of any contract or other document with respect to which this certificate may be issued or may pertain. The insurance afforded by the policies described herein is subject to all the terms,exclusions and conditions ofsuch policies. Limits shown may have been reduced by paid claims. Co Type of Insurance Policy Number Policy Policy Policy Limits/Values Policy Effective Expiration A General Liability Each Occurrence $ 1,000,000 ®Commercial General Liability GL194318141 5-1-01 2-1-02 Fire Damage-Any one Fire $ 1,000,000 ❑Claims Made ®Occurrence Med.Exp.-Any one Person $ 5,000 B ®XCU Included GL194318169 Personal&Adv.Injury $ 1,000,000 ®Contr.Liab.(if an insured contract) (Stop Gap) General Aggregate $ 2,000,000 General Agg.Limit Applies Per: Products-Comp/Op Agg. $ 2,000,000 ❑Policy ®Project ELocation Policy Aggregate $ 50,000,000 A Automobile Liability Combined Single Limit $ 1,000,000 ®Any Auto BUA194318186 5-1-01 2-1-02 Bodily Injury-per person $ EAU Owned Autos (other States) BodilyInjury-per accident $ ❑Scheduled Autos Property Damage-per acc. $ ®Hired Autos BUA194318219(TX) ®Non-Owned Autos ®Auto Physical Damage BUA194322500(AOS) Deductible/Coll&Other than $ 2,500 BUA1943322481(TX) Collision A Excess Liability Each Occurrence $ 25,000,000 ®Occurrence ❑Claims-Made M194318236 5-1-01 2-1-02 Aggregate $ 25,000,000 ❑Deductible $ Prod/Comp Ops Agg. $ 25,000,000 ®Retention $10,000 C Workers Compensation and WC194318124 ®WC Statutory Limits ❑Other Employers Liability (All Other States) 5-1-01 2-1-02 E.L.Each Accident $ 1,000,000 B WC194318107 E.L.Disease-Ea Employee $ 1,000,000 (OR,NV&WI) E.L.Disease-Policy Limit $ 1,000,000 Insurance Company(ies): A Continental Casualty Company B. Transportation Insurance Company C. American Casualty Company of Reading,PA Description of Operations/Locations/Vehicles/Exclusions Added by Endorsement/Special Provisions: Certificate Holder is listed as Additional Insured (A.I.) where required by written contract under GUAUUMB. The insurance afforded to the A.I. as described in this Certificate of Insurance(COI)for work performed by the Named Insured,is primary and non-contributory to any similar coverage maintained by the A.I. A Waiver of Subrogation is issued in favor of Certificate Holder where required by written contract under the GUAUUMB/WC. As regards Workers Compensation for monopolistic States of ND, OH,WA,WV,and WY, Certificates of Insurance will be issued by the appropriate government authorities. Certificate Holder is Loss Payee as their interest may appear for Auto Physical Damage coverage. For an additional description,see above reference section. Cancellation: This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This certificate does not amend,extend or alter the coverage afforded by the policy(ies)shown hereon. Should any of the above described policies be canceled before the expiration date thereof,the issuing company(ies),will endeavor to mail 30*days written notice to the above named certificate holder,but failure to mail such notice shall impose no obligation or liability of any kind upon the company(res)or the issuer of this certificate. Aon Risk Services of Texas, Inc. *except 10 days notice for non-payment of premium Date: June 7,2001 By: Authorized Representative,Bill Burke Aon Risk Services, of Texas,Inc. 2000 Bering Drive,Suite 900 Houston,Texas 77057-3790 tel(713)430-6000 fax:(713)430-6560 c..4 D/�TE �,-1.15 CITY OFORONO CALLED IN �-� J�� INSPECTION E SCHEDULED -?—"--7— Y. .1 PERMIT NO. act COMPLETED Tt7/ �- 7c7 ADDRESS 2 00 ��� b Lf �?C_i � f.``�( OWNER CONTR. (_ Q k N4cr• ���� C� i q Svc - '5(4L --C3r TELEPHONE N0. � ` c'� DESCRIPTION C- 1 L r r ---� Lj 01 FOOTING -1'1- ECHANICAII 18, XCAV/GRADING/FILLING Q 02 FRAMING 13 M INAL 19 LAKESHORE/WETLANDS y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL Z04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP st 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL v 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL ct OWNER/CONTRACTOR TO MEET YOU: YES_NO o COMMENTS: it LitQ. CC pl.__ 7-4e9 ?--- (°'7...7 CC 0 W CC Q W Z W CC 4.1 XX ORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE CC W ❑CORRECT WORK&PROCEED CIISSUE CERTIFICATE OF OCCUPANCY O ❑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 El CITATION ISSUED ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952) 249-4600 Owner/Contractor on site: Inspector.XIdWA--<-0 White Copy/Inspector's File Canary Copy/Site Notice -0) (xi 6Ci IV? DATE 'f TIME CITY OF ORONO CALLED IN � INSPECTION NOTICE SCHEDULED — l( PERMIT NO. (/3 / 3/ COMPLETED -" —0 ©C) ADDRESS 2C � L--<:C /1 // ,yq1 OWNER CONTR. & �al� TELEPHONE NO. - G, CD 3 V�1.� • DESCRIPTION C--/ 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS h 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL • 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL Z OWNER/CONTRACTOR TO MEET YOU: YES NO o COMMENTS: cc W cc O cc O u. W cc W W CC• /ORKSATISFACTORY:PROCEED D PROJECT COMPLETE ❑_CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY CZ ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY 0 BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN INSPECTOR WILL RETURN ElSTOP ORDER POSTED.CALL INSPECTOR ❑CITATION ISSUED ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952) 249-4600 Owner/Contractor on site: Inspector. White Copyllnspector's File Canary CopylSite Notice DATE TIME CITY OF ORONO CALLED IN INSPECTION NOICE SCHEDULED t2' 3 0 /L1 PERMIT NO. po 3 C 3 / COMPLETED a- 3 r, ADDRESS ;POO (1t o ce iv /1 b---- , l OWNER / CONTR. y'1 - L. 1---A-1C NO.__,� n 1 CY 33 `.- �?1��- L .t-GY'�1-Gi� ", (' E DESCRIPTION 1.--( 7) 6,---e Se/ 97 /C r-� 4%J, • 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING Q 02 FRAMING ,.-"1 MECHANICALFL\ 19 LAKESHORE/WETLANDS h 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-UP 06 PROGRESS 1, 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT st v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP 09 PLUMBING RI 23 SEPTIC FINA 35 HARD COVER REMOVAL v 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL Z OWNER/CONTRACTOR TO MEET YOU: ES_NO • C77: Li f' 1,-) C1--- 11/1 . tc �� � y cc oz / 2 _ 1,---e Si22`'h !c Le-/— 5 k75 -C%- '2:4l,.r.j-/_ It) (C70/K/)1 ez_.L,t ( r44-e -1 ,- W z EE __ ) -J--- zll 4,-ef .-k c, ,(;01.--C / 1.)0..., )_I 441 • ❑WORK SATISFACTORY:PRO D , .-/- 7.q0 PROJECT COMPLETE W *ORRECT WORK&PROCEED 0 ISSUE CERTIFICATE OF OCCUPANCY O 0 CORRECT WORK,CALL FOR REINSPECTION TEMPORARY ✓ BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. 0 PHOTO TAKEN INSPECTOR WILL RETURN 0 CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR 0 INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952) 249-4600 Owner/Contract rr 1 -`16/(C6.4/1-1)on site,. Inspector. Y White Copy/Inspector's File Canary Copy/Site Notice 4 t ENCOMPASS YALE INCORPORATED An Encompass Company 9649 Girard Avenue South Minneapolis,MN 55431 Phone:952-884-1661 October 16, 2001 Fax 952-884-0295 www.encompserv.com City of Orono 2750 Kelley Parkway Orono, MN 55356 Attention: Heating Inspector Subject: Permit#: P03931 Gentlemen: Enclosed please find test report(s) submitted in compliance with applicable building regulation work done within your jurisdiction: WOODHILL BARN 200 Woodhill Road Orono, MN Should there be any questions regarding this work, please contact Bill Hicks or myself by telephone at 952-884-1661, and reference our Job Number J01-110. Very truly yours, ••••=p1-AI,CYn441.) M. /10.44/4/10 Thomas M. Rowles V.P. of Service Operations /amn Enclosure: Test Report I. ,N,1 4 P,,i3g3 LW Me MECHANICAL and SERVICE CONTRACTORS INCORPORATED HEATING • VENTILATING • AIR CONDITIONING • CONTROL SYSTEMS TEL:(612)884-1661 FAX:(612) 884-0295 9649 GIRARD AVENUE SOUTH MINNEAPOLIS,MINNESOTA 55431 DIRECT - FIRED MAKE - UP AIR FURNACE TEST AddressQ(O - (-c�Qb/ ,1/ (7)__ __Municipal i CrAik 0 Owner Cc xl il /91" `) _Space Use CA- — EQUIPMENT DATA : Make_ ( ( ,p,p — Modelsaj — SerialSOr)3gL19_ --_How Located? 0,4 _– Type Fuel ,ti _ Max. BTUH,7QL0, CFM )(5--(7D Fuel Supply Line Size3/4/ Supply Line Pressure__ (332::_ _ _ UNIT CONTROLS : Manual Shutoff Valve; Make_nilxi / Size? 47/ Gas Regulator:Make /'n ty,k0(. _Model RS-OC)5 Size 3 --- Safety Shutoff Valve :Make C _ Size 3/`/ --Y Fuel Input Valve : Make 1A / / Size3/V _ i, Flame Safeguard Relay: Maker-JF�`(.tle� __Model i)17g-01) Pilot Vale ( if used) : Make vti� `,�� we// / Size 77 _____— Modulating Valve : Make__ C /thtt Model g_3y,3�3 _Size34 Low Limit Control : Make74,L (J ' Model ()p()Q_ ___High Limit Control : Make ,ccij Model _71/n(_)______ rNi C5 �- Damper Open Proof Switch: Makeodeltdti'7 4/4/_ Main Air Proof Switch: Make_jv O£L 4iodel2__ High Gas Press . Switch ( If reqd) Make /0/00J Models/19P–, / _� TEST FIRING OF UNIT : Air In `ake Open Proof 7 Main Air Before Ignition ( — Premix Ai Proof ( if used) Blower Shutdown By Low Limit Control (40°F test) High Limit Burner Shutdown _ X- At What Temp? °F Pilot Turndown Test_ _ Low Fire Start Test__ Outdoor Temp at Test-times 5—°F Max Discharge Temps a °F Flame Characteristics : Modulating9_ ,� w Fire G��� C'� Medium Fire good High Fire 410 _ BTU Input on High Fire On Low Fir(aO_c2S C) (must be 20 :1 ratio ) d / Carbon-Monoxide : High Fire __ Medium Fire 6:=' Low Fire n Instruction Card Posted_' _Wiring Diagram_No .— — Unit Interlocked Witi,ai, 10Cid —� c _—_ Test Performed By_ 6.. Date ! �l Wittness or Inspector—_______ ___Yale Job,, /() HEATING TEST RECORDe 84.j/k) 163 -$ e03°I� l ADORE IS Vp0o 1'1 1� -I 1d. �cetio- MUNICIPALr1 Y 01Y-14/0 OCPUPANT foo CI I (0. n • OWNER • TYPE OF HEAT: ROOF FA HW STEAM UNIT HTR. OTHER. INFRA-RED • • MAKE Tit -e MAKE r� l✓ r9t, Model s �a� r��+ �1 Model oti 010g(91/.---4' Soria' <.o0 nZt7` /L/ Social C ! J INPUT )_5I0iV FUEL _vY4� INPUT FUEL76,21 - - � . CONTROLS CONTROLS • THERMOSTATXRAAjP THERMOSTAT 1n/941° - Valve W Valve v, ji. Limit rod/9j /634/(1) / Limit Limit Se tin ( !0/'T (3 y�� Setting Limit Setting po/ro Setting _ r l�/- _ Fan Setting Y�/`F>> ✓J Pilot Type jt../A20-n/�ti Pilot Type -4l✓/-5/91/) r-,C.) Pilot Make / 7r.JFyrc.i-ei Pilot Micky CCN Pilot ModeI S 9C)0� 4111°114°0,971/'I Pilot Mode4111°114°0,971/Pilot Timing . /—....5 oC Pilot Timing / -XQV L.W. Cut Off - L.W. Cut Off Pressure 73 e k...1Portent CO C ' Pressure Percent CO2 !.• L// Input CFH 0 Percent 02 el 9• ql Input CFH Percent 02-� . _ Stock Temp. ¢• Percent CO 0 Stack Temp. Percent CO Vent Size n� ( ( Vent Size �� • KIND OF LINER Det(/�1//(SIZE KIND OF LINER Q4SIZE fv( Draft ,A)!/' tr Test Tap W Draft 47VP, Test Tap ' - MAKE MAKE Model Model Social �`' Soria I INPUT • FUEL INPUT FUEL - CONTROLS CONTROLS • THERMOSTAT THERMOSTAT Va Iva YalYe Limit Limit Limit Setting _ Limit Setting Fan Setting Fan Setting • Pilot Type Pilot Type . Pilot Enka Pilot Make Pilot Model Pilot Model Pilot Timing Pilot Timing L.W. Cut Off L.W. Cut Off Pressure Percent CO2 Pressure Percent CO2 Input CFH Percent 02_ Input CFH Percent 02 Stack Temp. Percent CO Stack Temp. Percent CO Vont Size Vont Size KIND OF LINER SIZE KIND OF LINER SIZE • Draft Test Tog Draft Test Tap 91288 ' r ��--� Date Tes ted ?���* �/ �s-JT 1T 1 IJ f P� 9649 GIRARD AVENUE SOUTH Name o fT • FUEL"f----'-' tC MINNEAPOLIS,MINNESOTA 55431 INCORPORATED TEL(612)884.1661 FAY.:(6 12)B84-0295 Job No.\30}-1/0