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HomeMy WebLinkAbout1994-006451 - mechanical PERMIT CITY OF ORONO PERMIT TYPE: 2750 Kelley Parkway- P.O. Box 66 MECHANICAL.Permit Number: )�:)�Ir�..��,�,45 Crystal Bay, Minnesota 55323 (612) 473 7357 Date Issued: 0q/20/94 SITE ADDRESS: t 450 ORONO ORCHARD RD S 58 P. 1 . N . . 02-117-23-:7-:1-004"/ DESCRIPTION: A HEAT I Nth -';`._ i EMS ht..,,........ NATURAL GAS MAKE L__NNOX. MOO ) GL.')i S-E-50 cit.)f l::Uj 150 CITY 7 / L'! ORONO !�1•�,Ae E. iw Ti'r .7 Trn I_•L L/! 1 .1.VL 1,313,JV000 ii 1222200000 V. mit 71 5.t i CITY OF ORONO APPLICATION FOR MEEICAL PERMIT Box 66 (2750 Kelley Parkway) P 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 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 ✓X Replace Residential Commercial JOB SHE: 5 D O 1��" d 2-• 't 011... V\. J Zip: Owner's Name: 0 Telephone Number: Mailing Address: City: Zip: Contractor'sName: V O G T HEATING & A/C TelephoneNumber: 9 2 9-6 7 6 7 MailingAddress: 3 2 6 0 G O R H AM AVE City: ST LOUIS PZip: 5 5 4 2 6 SYSTEM DESCRIPTION - V H HEATING SYSTEMS Quantity: Make: Model: G- )-op,3F- 50 G ;.0a311-1L -1re G- d k I50' Fuel: Flue Size: Input BTUs: O M. 7 5�h . 1 C'C /t1 ) a . Output BTUs: CFM: COOLING SYSTEMS Quantity: Make: Model: Tons: 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 VENTILATION 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) 4 ov0. x 1.25 $ . db (contract price) 2. State Surcharge. ** Add the State Building Code Division 3 Surcharge to each permit. x .0005 $ (contract price) 3. Postage and Handling (Only mail-in applications) $ 1.50 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ 7 9 , 5 d * 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. Lib Lo___47,A..) g DJ/1y Applicant s Signature: Date: Approved By: _V Date: Ct ce 4 PP , /._../.7 _ )_`7 _7 j l l=',6... I' . HEAT LOSS CALCULATIONS (/ Weatherstrips - •Guide Construction No. Insulation WindowsDoors Reference Out.Wall Int.Wall Ceiling Roof Floor Kind How Applied Yes-No I Yes-No 19— / Fl. 4j(,400mLength ,Width /c Height Fe?... FI.) r . Room Length a Width HeighYS•.>/ Windows and Doors-Crackage and Area Windo a and Doors-Crackage and Area Width Height No.e1 Lln.•I ft. Are• Width' Height No.of Lineal ft. Area . No. of pane of pant lights of crack on,ft. tJ No. of Dan• of van• lights of epoch • fl. (" ..-2., r F" / T'Y , > ?. -. G S- V✓. 1 1t n . �'3 K A d k- 771- /O • 0fe r o ,)®, # .5 . u i•-?,x ft.3 .. 9)— / ¢3 4z 3 5L 1'v /4. / /_v%z /op- 5G-- :LAT, 4' Coef. Btu EH Btu Infiltration //0 3 7 eFlre7 7 d Infiltration /t•/,(/ .S 7 s//-7(, Glass /fit) 47 . 7 u-1 • Glass .367 /) /kb 1/. Exp.wall 6 . ' 5/2- Exp.wall 37' )S5 Net exp.wall S1 y ..r 1/ ¢).g 4- l 7/ - Net exp.wall ,5"S s - 2o7-,-. .3r/f c/.. / jC ..1-' I1tsr•well- 7 o-1.1--r) Int.•+all Ceiling 5/er •--//.. 49r / 4f-9I/ Craing 2,c)- -../Lrt i ,•;el- I .(a r).-- Fl.ior _...--------_ Floor Total Btu. /.2297A Total Btu. -J`J72 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 11.1 'I 4 Room l Length r" Width i t Height�'� / Fl r�j� Room I Length...71( Width/c. FTeightg /'>, Windows and Doors-Crackage and Area ! Windows and Doors-Crackage and Area Width Height No.of Lineal ft. Area Width Height No.of ft. AraaNo. of pan* of pan* light' o9ayk •p.ft. No. of pan• of pane lights of crack *0.ft . 7 a. 411---• U• /7 .. gY'- .G/v.. ,2/A . Z 2 a5- G fit-• t'r -k cl 36 (, s it . 71- F)it...f•d'• 7y- Coef. Btu Coef. Btu Infiltration /4 .- 57 37 7 y Infiltration • Glass (.f'I( /7 7y1(, Glass Exp.wall3g'a+ 'pExp.wall 36.1/4,1 . � , /(e,y Net exp.wall /4"1:..., P•-- 5 �/(, Net exp.wall /G y y C</c'- Int.wall Int.wall Ceiling../..//V , .16.0 / Xiry Ceiling f 3 / ei3 .4-" , Floor .w.'- 1---- Floor Total Btu. j,2 ,,i S+e Total Btu. ,/, -c-) r Ir Required sq.ft.E.D.R.or sq.ins.W.A.Leader area Required sq.ft.E.D.R.or sq.ins.WA.Leader area / • ,-4y ' Room Length .Z2 Width /R' Height g/7 I / Fl. ..2,,,,,i-- Room 1 Length , 3 Width I Height9 - ' Windows and Doors-Crackage and Area Windows and Doors-Crackage and Area Width Height No.of Lineal ft. Area Width H.I.ht No.of Uncal ft. Area No. of pane of patio light. of crack eq.ft. No. of pane of pane Iltht• of crack on.ft. e*,. .7v 7 1- fix f3.f6 Gov C -) /fh. / p�1 . Coef. Btu • Coef. Btu Infiltration Infiltration `�,p j/ 4 7 7 3 Glass Glass /.LV V. I/ .5�',1-'G'' Exp.wall 44- ' x9• D /ye. Exp.wa11.73/ 3/t/' Net exp.wall s/c.. 4-- 799 y., Net exp.wall /f ra 5/ 76,0 las.-wall'-1-)....,...._. , 2p.r-. 0 Ld w.11 '"--r.,,.,., Ceiling 4.y, /jt t I acr.S Ceiling t.//-y , 3/3 / ci 3 Floor e,,.-" Floor ,..— _ Total Btu. 5^.1.-3 7 ., Total Btu. /5 75:r Required sq,ft.E.D.R.or sq.ins.WA Leader area / Required eq.ft,E.D.R.or sq.ins.WA.Leader area /F1,,Q4Room I Length ,,,.202v Width/d' Height 9• ° i F1.I ,1.r Room I Lengths It Width //;a Height' r_ Wi, ws and Doors-Crackage and Ara Windows and Doors-Crackage and Area Width P Height No.of ' Until ft. Arek ' Width Height He.at !Antal I1. area No. of 0on0 of pati* lights of crack •q.11. No. of pane of 5000 not. or crack •h.ft. . 3 IP Y Le e / q/ t9/, (i- Ya 7A-- 77i ..s"/ 5'C . G 3is /F•- i .5".1 .. 4. , Coef. Btu Coef. Btu ' infiltration Q• / 39 /5/ 7 Infiltration fo k` 37 3 /7(.. Glass ' / 'i/ /,t'5 2 Glass /3.-2,10i S,3 of Exp.wall 3.7/ Is ..•- Exp.wall/ ff e „ZG,.. Net exp.wall a./ 4,/,..11-y. Net exp.wall 7 ' ! :.3/ j„•.,... Int.wall Int.wall Ceiling ...,Q,, S.1 . ./l. 2 S/ Ceiling ,3dty / . .,'t, Floor Floor 3O 9- +'•Z 4 Total Btu. 416,0/ , Total Btu. (//a.542^ - Required sq.ft.E.D.R.or sq.ins.W.A.Leader area • / , Required sq.ft.E.D.R.or sq.ins.WA.Leader area r • HEAT LOSS CALCULATIONS , Weatherstrips A.S.H.V.E. Construction No. Insulation Guide WindowsDoors Reference Out.Wall Int.Wall Ceiling Roof Floor Kind How Applied , Yes—No I Yes—No 19_ '1;:t Fl.L. . 4,,.. . 'oom Length r3 g..—Width/0 Height g.1 . Fl.I Room I Length Width Height , Win:ows d Doors—Crackage and Area 1 Windows and Doom--Crackage and Area Width HNant No.of Lineal ff. Area Wrath Height No.of Llneal f1• Area • No. of Vane of Dane lights of rick sq. No. of pane of pPn• 111htP et crook q.IL •7 Z .. Cr 77f. Cod. Btu Cod. Btu Infiltration /....-- _, 044. Infiltration W Glass 33 117 /S 5 '/ Glass Exp.wall 1I-,17„h•..r/3) —31 s /0-A 4--- 0.4.$) Exp.wall Net exp.wall /7$0. ?Q'' /..t— "3 b.E. Net cap,wall Int.wall Iff J!7 . S .ala li•C Int.'rail • Ceiling Caring FI.lor ...-&,3‘.ss. 7 Sef— o .;-C,6 Floor Total Btu. _6 tre 71. Total Btu. Required sq.ft.E.D.R.or sq.ins.W.A.Leader arca _ ( Required sq.ft.E.D.R.or sq.ins.W.A.Leader area jorj}l.L 4,, Room I Length 76-e Width 5 Heights Fl•l Room I Length” Width Height Windows and Doors—Crackage and Area Windows and Doors—Crackage and Area Width !sign" No.of t.lneal ft. Area Width Hsieh( No.of Lineal ft. Area No. of Dana !Mint Ilghlo of crack .q.Il. No. of pan. of Done lights of trach eq fl. Coef. Btu Coef. Btu Infiltration Infiltration Glass Glass Exp.way,/2 f?A.., 3 !L- %1'.c Y Exp.wall Net exp.wall 4.,,e. in-./;— /53 G Net exp.wall Int.wall ,024 1G VY• ie'� 1-i ) Int.wall Ceiling r Ceiling Floor.5t c7V 3. L D • Floor .. Total Btu. c9..¢(4 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 FI•i Room Length Width Height i R.I Room I Length Width Height Windows and Doors—Crackage and Area Windows and Doors—Crackage and Area Width Height No.of Lineal ft. Area Width Height No.of Lineal ft. Area No. DI Dane of Dasa light. of!rack ad.fl. No• of pane of pane Ilahle of emelt q.ll. Coef. Btu • Coef. Btu Infiltration Infiltration _Clan Glass • Exp.wall Exp.wall Net exp.wall Net exp..wall ' - - Int.wall Int.wall Ceiling Ceiling Floor Floor Total Btu. 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 arca _ F1.1 Room I Length Width_ Height I Fl.I Room I Length Width Height , Windows and Doors—Crackage and Area Windows and Doors—Crackage and Area Width Height No.of Lineal ft. Area Width Height No.of Llnoal ft. Area No. of pane of Dane flights of crack ea.ft. No. of Dano of pane light. of crack sq.ft• _ Cod. Btu Cod. Btu Infiltration Infiltration Glass Glass Exp.wall _ Exp.wall • Net exp.wall Net exp.wall Int.wall Int.wall • Ceiling Ceiling Floor Floor . • Total Btu. Total Btu. Required sq.ft.E.D.R.or sq.ins.W.A.Leader aresRequired sq.ft.E.D.R.or sq.ins.WA.Leader area . • t . ` HEAT LOSS CALCULATIONS Weatherstrips A•• ' Construction No. Insulation Guide WindowsDoors Reference Out.Wall Int.Wall Ceiling Roof Floor I Kind How Applied Yes-No I Yes-No I9_ �� FLI �. Room Lengthy 3 Width/¢ Height e✓ it,Fl. •,.((r) Room ngt�, Widths Height S<.. Windows and Doors-Crackage and Area Windows and Doors--Crackage and Area Width Height No of Lineal fl,Area Width Height No.of Llneel ft. Area Ce? No. of pane of pane lights of creek so.Il. No. of pan. of pane lights of crack so.ft. / /,.t- .�y Gel% / /9.1-, /y 4` - 0 4-I$ / D.-% ,zS 7 fir. ,.2.. .9'— 4 •- t'). .3 A ,13 �, Coef. Btu Coef. Btu Infiltration „1„ t] . 37 TY'3f, Infiltration 7 rye .I7 lc.2 Glass /77 #7 W-3/4% Glass 5 d7 // 7 S. Exp.walls'•// wall �o Net exp.wall 9 p? Exp. D ��`""� ©'3 ) 41- 9.1-�a Net exp.wall tl:I"?YS SL 9.Y.) Int.wall int.•,all ,4-/,.n. it/J //...-/G,f ,) Ceiling -12.1- / ."/ 9 ?.- Ce.iine Fi,lor .3 A y- 44 1,1--18 Floor-fs•rr2 4$- 73 B .2-e .2.--• Total Btu. /9/.2 07 Total Btu. ?L) g'0 Required sq.ft.E.D.R.or sq.ins.W.A.Leader area Required sq.ft.E.D.R.or sq.ins.W.A.Leader area J / Fl,l -rtRoom I Length,,,,1(;) Width/9 Height ,.- -Afin F1 `� f%/Room I Length / Width/4L., 'Height, 4.2. • Windows and Doors-Creckage and Area Windows and Doors-Crackage and Area Width Heigh! No.of Lineal It. Area Width Height No.of Lineal ft. Aron No• . of pane of pane /slight, of lcrock W.ft. No. of pone of pans lights of crack sq.ft. / .34 (w '-- Dv a0, 19 / .l g• fin Fi• 1✓. . / �/ ,. G a ..,ir G&- / 3 a ' Ail / 9 s-S.-- sit.. 413., 3 g. Coef. Btu Coef. Btu Infiltration ?S" Glass ;;.5 32 %4'7 75 Infiltration /r ?7 "7e) ,;, e� 47 fie �eds Glass RC) a7 5.4j43 Exp. Exp.well/Cy/ s., ( / Y Net exp.wall 7 G -57- .3 y 0 /s'6 Net exp.wall - L. 3 G f! Int.wall Int.wall Ceiling 3 S."-:X.:- J4 4---/ , W L Ceiling Floor "7 frd 4- / S. ),—o Floor Total Btu. /4 7 3. //.,'e-Y• 9 2-S&' Total Btu. ? p 3 7j Required sq.ft.E.D.R.or sq.ins.W.A.Leader area Required sq.ft.E.D.R.or sq.ins.W.A.Leader area i / FI,�,rs,,,4, Room J Length �•a Width r/3 Height e9. I RIGe°luwr• m l Lengthy Q Width /X'• Height e , Windows and Doors—Crackage and Area Windows and Doors—Crackage and Area Width Height No.of Lineal ft. Area Width Height No.of Lineal ft. Area No. of pans of Dons Habig of sp.ft. No. et pen. of pane lights of creek es.ft. aLt `a- / ¢ / 3/ / c. 6.r 4W 3to• .13 • • G.K-. 7-/r '3/fl 33 Cod. Btu • Coef. Btu Infiltration ,Q! / ./' /g/ '7 Infiltration _ //k' '5 /77G, Glass 3 /, /y /4/S 7 Glass 4, Exp.wall 33. J{. Y Exp.wall,g' ,.,.ti / 8' 4. -2 1- Net exp.wall ,73 3 f,L, 97 3 •y. K. . Net exp.wall /q.6, � ! 1 .. /7 e- lnt.wall Int.wall Ceiling 3.6,t l ,..G,•,i) Ceiling Floor f Floor '$f /k- 73. /.3/V Total Btu. • 1-/e,c, Total Btu. 90 S ;- Required sq.ft.E.D.R.or sq.ins.W.A.Leader area / Required sq.ft.E.D.R.or sq.ins.WA.Leader area I / F l.�,..,.f- .!' Room(Length ."/�Width 3 Heigh914...st FI 03 Room I Length L f7, Width/j Height 97- Windows and Doori-Crackage and Area Windows and Doors-Crackage and Area Width Height No.of etneal ft. Area Width Height No.of Lineal ft. Area • No. f pane of pans lights t crack a.ft. No. et pane of page lights et so.ft. .3. 0.74/ le .... / d/ 3 / 21 3 a 4 Fr / ,,J 7.15_ Cod. Btu Coef. Btu • Infiltration Q' / . `S/ 7 Infiltration p ?j ,- 2 3 Glass 3 1 07 /g!3"e7 Glass 2 5' 9'7 //75. Exp.witty// tin Exp.wal1. 4.eh,..-4. ./GO -,1-S s /es 41 5"ei,7 Net exp.waII JO.c f 44 `4,,,,f3Z„ Net exp.wall 4-ce. Si-ed /Y /..(/") Int.wall Int.wall Ceiling. az 27G i.....rte7 (�O Ceiling Floor .2.'4.(. GL jib Floor-4+,02 .s, 2f, .-•b'~I`r. Total Btu. 7p Total Btu. 11/Jc/' Required sq.ft.E.D.R.or sq.ins.W.A.Leader area Z... LL Required sq.ft.E.D.R.or sq.ins.WA.Leader area , .r4i— e1451 16cer, 1:::_s.,.. ., HOUSE HEAII�1 ST RECORD ADDRESS y '0 U.(./ "" 4,e 0 i'0 P'f:94 FLOORS CITY-, SUBURB G,ec'L'ci OCCUPANT i2.' Zisff W RL.> HEAT LOSS J DATE HTG. INST. j` _ „, SOLD BY 1/G6 /!/ t.' INSTALLED BY T Electrical Work By /y,1e-�/S01�l Gas Line By a TYPE OF HEAT GA FA 1-------HW STEAM SPACE HTR. UNIT HTR. OTHER ` GAS DESIGN CONVERSION MAKE L�wG MAKE OF BURNER Model G,�?O �'Y -/GG-3 Model Serial Max. BTU Rating INPUT /l/Gh MAKE OF FURNACE Model CONTROLS THERMOST T J"' Heat Plug Vent Size ..5- Valve _ KIND OF LINER A�,`t SIZE "1NONE Limit Ti he viS ( Draft Hood Regulator Limit Setting J I-O Filters Size Number Fan Setting Da...44 !!"6-L�y Chimney Location Inside Outside Pilot Type C_ -�6�`' Chimney Construction 52;i1/-'2-elf Pilot Make 2 S Pilot Model Smoke Bomb Wiring 1.---- Pilot Timing -?G SFC Draft t Test Tag t- L.W. Cut Off Door Pressure 1------- i,, Lighting Inst. C Pressure 3^1Percent CO2 75- Date Tested 9'- 9y Input CFH /GG / Percent 0 a•O Company Testing (/C 2 Stack Temp. 38_5- , ti Percent CO 0 Name of Tester ___ Form 235 ev' a Lisl Joy S' 59HOUSE HEATING TEST RECORD ADDRESS 2/50 aCi C-xC-ie et A APT. t FLOOR '" CITY 535? SUBURB 0'� 1 OCCUPANT 113 .,Z ,s} ' iiisigg—HEAT LOSS Lb �, DATE HTG. INST. OCT (�q // SOLD BY l/�%6T Ll 1 INrA Q.Tb BY !/G6 -7— Electrical Electrical Work By ��`62P/S�'�-' y� q6 ,, —.e TYPE OF HEAT GA FA !�_ HW STEAM1 SP°ACE"NTR. UNIT HTR. OTHER / -.- ',4-'..,U0 GAS DESIGN CONVERSION MAKE ` ,4' JO>` MAKE OF BURNER Model (2Q 0_ E_.--3 G—/ Model Serial _5- .3Z. OG .5---- Max. BTU Rating INPUT 56 17 MAKE OF FURNACE Model CONTROLS 9„ THERMOSTAT Heat Plug Vent Size / Valve /y/ KIND OF LINER 4�//ZSIZE �y �� NONE Limit 7-jiPhG 0,S P Draft Hood Regularor Limit Setting 4/'0 Filters Size Number Fan Setting Dc/4 ' &_�AY Chimney Location Inside v Outside C .1 Pilot Type t-L' . 6/k" Chimney Construction S7/2//(4.E.SS Pilot Make a/S Pilot Model Smoke Bomb Wiring v Pilot Timing 30 StC" C. Draft L/ Test Tag 2 c� L.W. Cut Off Door Pressure Lighting Inst. Pressure 3.5 f' Percent CO `_ 2 O Date Tested 9' -,F� Input CFH 50 1 Percent 02 R G Company Testing U `':7' Stack Temp. 365- Percent CO 0 Name of Tester Form 235 3HOUSE HEATING TEST RECORD S`z ADDRESS L450 00e-c-.<-c., ake.A,lte-0 &n APT. FLOOR# CITY 5-35-- SUBURB O,e""C/ OCCUPANT &i -14ts /4 OWNER HEAT LOSS / / DATE HTG. INST. SOLD BY WCG / INSTALLED BY ...5-4/7,6"-z Electrical Work By /11/"e-/.51---� Gas Line By TYPE OF HEAT GA FA v-HW STEAM SPACE HTR. UNIT HTR. OTHER GAS DESIGN CONVERSION MAKE Z CA/A/c,/ _ MAKE OF BURNER Model Ga 0 4 -�/(v E-—/��-,) Model OCT �' '' e«jjj/// 3 i v 4 Serial k7 d /��5-7 Max. BTU Rating INPUT /5-6147 MAKE OF FURNACE i--\:'Cv,Q;- r° ice.) Model LL CONTROLS „ THERMOSTAT �/� Heat Plug Vent Size Valve Rib- KIND OF LINER 4Luill SIZE �y NONE Limit /9/9- Draft Hood Regulator Limit Setting /90 Filters Size Number Fan Setting 0 --1.,4->'/4">>' .46)'L4 Y Chimney Location Inside L"------- Outside Pilot Type p 6e, -Z i Chimney Construction /�LS� Pilot Make /� S Pilot Model Smoke Bomb Wiring t"----- Pilot Timing 3a 5o: Draft C/ Test Tag L.- L.W. Cut Off Door Pressure Lighting Inst. (' --.‘' Pressure 3'5 Percent CO2 7 ) Date Tested `6/ - Input CFH /rte Percent 02 .7Company Testing Stack Temp. 390 Percent CO ej Name of Tester .k�c ' Form 235 HOUSE HEATING TEST RECORD62145/ 3NS-4V g";5-9 ADDRESS 7'5 2 0.e io otee4/ '-D p ° APT. FLOOR#� CITY 533-2"SUBURB 0,6)G.t-G OCCUPANT -.:e/S/.24- OWNER HEAT LOSS ,J DATE HTG. INST. SOLD BY OG 7- INSTALLED BY --531/9/5-- Electrical Work By 4./.SG/-' Gas Line By c2—.4" TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER GAS DESIGN CONVERSION MAKE 2, ,,-./2/G)` _ MAKE OF BURNER 7J �'4 Model 6O?OQ3 L — 7J — / Model 00 Serial S£9V6 0.3c'/.S Max. BTU Rating INPUT —75 17 MAKE OF FURNACE Model CONTROLS THERMOSTAT /WI- Heat Plug Vent Size Valve aii KIND OF LINER /4L4-7 SIZE /y " NONE Limit Z/5`FiQ/fr/ 0,5 c Draft Hood Regularor Limit Setting /_gc Filters Size Number Fan Setting DC y Ro9Y Chimney Location Inside L' Outside Pilot Type r� e, . GA' Chimney Construction ,�7/4i'LG$-S-c Pilot Make /p- 1 Pilot Model Smoke Bomb Wiring _ (---- Pilot /Pilot Timing 30 __S"%f C • Draft [/ Test Tag 4----- L.W. ✓L.W. Cut Off . Door Pressure Lighting Inst. v ii L Pressure 3'.5 Percent CO2 G Date Tested 9` C / Input CFH 7s Percent 02 7'S Company Testing OG Stack Temp. 3e 2 Percent CO O Name of Tester - -' Form 235