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1510 Thomas Lake Pt' 300 PaOF EAGO ot Knob14 P.O. Box 21199 flan, MN 55141 Zoning: Doi Owner..---- „ddresa: --5 Site Address: Plumber 1 agree to comply Ordinanca. By Date of Insp.: - Insp.: SEWER SERVICES PERMIT NO.: --- No. of 3 , 920.10pa > ferteltFee' .inn, c Surcharge: Misc. Charges: Total: Date Paid: CITY OF EAGAN SEWER SERVICE PERMIT 3830 Pilot Knob Road nc 7'', P.O. Box 21199 PERMIT NO.: Eagan, MN 5517 4 DATE: 4,ar as Zoning: Domain nst. No. of Units: L Owner. Address: 1510 Thomas lAke Pointe Ll B11 Thomas , o me Site Address so a e u m g Plumber. , f E an Cit Connection Charge: 1 P , 620.00pd y o ag 1 agree to comply with the Ordinances. Account Deposit: 10.00nd Permit Fee: . 50pd Surcharge: BY Misc. Charges: Date of Insp.: Total. CITY OF EAC 1 SEWER SERVICE PERMIT 3830 Pilot Knob 9$04 P.O. Box 21198 PERMIT N0: Erman, MN 55121 DATE: Zoning: R?` No. of nits;, 48-& 1 Car Wash Un i Domain Cons t: . OOwner. ntldreas: ? ? Site Address: omas $ nt B1 Thomas U• Point e Plumber. 1 some to comply Ordinances. BY Date of Insp.: Inap.: ,920.00pd Conn o Ch o Deposit: 'Permit Fee: Surcharge: Misc. Charges:. Total: Date Paid: CITY OF EAGA 3830 PIM Knok P.O. Box 21199 Eagan, MN 551 Zgning: r Qwner. 0 Address: Site Address: C Plumber: _ SEWER SERVICE PERMIT PERMIT NO.: ?F, 04 _ No. of I agree to amply with Ordinances. Surcharge: - BY / Misc. Charges: Date of Insp.: Total: 3,920.00pd Conn.Chg: *19 200, NO Zoning RA Acct Dep No. of Units: 68 Utn1 a IS 1 rar Permit Fee: 10.002d Wash Unit Surcharge: . 50pe I agree to comply with the City of Eagan Tr. Plant 6,125.0024 Ordinances. Meter. Misc.: By WATER SERVICE PERMIT 3830 Pilot Knob R dI P.O. Box 1-1 9, Eagan, MN 55121 13057 PHONE: 454-8100 BUILDING PERMIT Receipt # To be used for APT. BLDG'd( Est. Value $1 , 375 , 00 Gate DECEMBER 31 19 d Site Address RO I N T E Erect Occupancy RI/B1 Lot l Block 1 Sec/Sub. "FiQN'A.; LK POINTBemodel ? Zoning PD Parcel No, Repair ? Type of Const. V t AR/11N SP Addition ? No. Stories Name LAKE HOUSING ASSOCIA'? ? Length 15 I' h ? h z A . ,. 4 `. r, A R BOR LN Address,_ Demo is Int. Impr. ? Dept l -? Sq. Ft c City dJ"' Phone 559-1711 Install ? d 3 , 10 0 o Name . i CONSTRUCTORS INC Approv als Fees 0 Address ' r_ 4 ,j ? '? t3OK LN Assessment Permit ? 3 , b 2 U . 5b city Phone r15.9-1711 Water & Sew . Surcharge b 50). 0J Police Plan Review 1 810 • 2 W Name ? . SHELDON & SORENSEN Fire SAC 22,540.04 Address i `r!'i'LOw CIR DR Eng. Water Conn.i'f 5 City Phone y a 5- 6 3 3 7 Planner Water Meter Council Road Unit 11 • 1 s ? I hereby acknowledge that I have read this application and state that the i Bldg. Off. 1 2/6/8 6 Tr. Pl. 5 . 01, nformation is correct and agree to comply with all applicable State of Mi t St t t O APC Parks 1 nneso a a u es and City)of Eagan rdinances. Signature of Permittee Var. Date Copies Total 7 j M) . .7: A Building Permit is issued to: DOhIA I N CnNST2:JC 1 ??iZS 1 ivt; on the express condition that all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Building Official Permit No. Poo 0l Holder Data Telephone A plum" H.V1l. rY?? C Electric / ' / / 1 9 J Jr X94-2 SoRener Irupect(on Date [nap. Commends Foounpel Footlnga 11 Foundation Framing y7 Ll1?j . ?,y? Rooting Rough Pft Rough Htg. j? Ineul. Fireplace 7 _ . Final Htg. 17 1/ 7 t?® Final Plbg. -1-14 7 l Mdg. Final Cart. Oct. Deck Fig. Deck Frmg. Well Pr. D[ap. vr2!, r Tertifiratr of Orrupoinry Citp of eagan Etp rbnnd of Diu bWU , rrtinn This Certificate issued pursuant to the requirements of Section 306 of the Uniform Building Code certifying that at the time of issuance this structure ms in compliance with the carious ordinances of the City regulating building construction or use. For the folio Wng. APT. BLDG. use Quark&*M 13067 M4 Pormic No. O„P-lyTa RI/BI zo"Dbu;a PD .nay ]' I HR/IIn SPRI EREt Oww 0( e? THOM.LK.HOUSING ASS 3140 FARWR LN., KPLS 1510 THOMAS L K PT ton>. L1, B1, THOMAS LAKE POTNTTE ADD AYju s i 3 , 19 F; 7 POST IN A CONSPICUOUS PUCE CITY OF EAGAN r 3830 Pitt Knob Road, P.O. Box 21-19! PHONE: 454-8100 BUILDING PERMIT To be used for FOUNDATION Eat. Value Eagan, MN 55121 12948 Receipt # DECEMBER 5 86 snvR-ula Unnn rylLV ab Site Address Erect Lot 1 Block 1 Sec/Sub. THOMAS LK POINTJIemodel ? Parcel No. Repair ? Addition ? W Name THOMAS LK HOUSING ASSOC. Move ? z 314 0 HARBOR LN Demolish ? o Address Int Impr. ? City PLYMOUWne 559-1711 Install ? Occupancy Zoning Type of Const No. Stories Length Depth Sq. Fr o Name DOMAIN CONSTRUCTORS INC Approva ls Fees Address SA14E Assessment Permit $15.00 City Phone Water 8 Sew. Surcharge a Police Plan Review W Name Fire = SAC c=i 8 Address Eng. Water Conn. - 1 City Phone Planner Water Meter I hereby acknowledge that 1 have read this application and state that the Council Bldg. Off. information is correct and a ree to co l ith li ll bl Road Unit Tr. PI. g mp y w a app ca e State of Minnesota Statutes and Cit APC f E di O Park y o agan r nances. s Signature of Permittee VAr. Date Copies ' A Building Permit is issued to: DOMAIN CONSTRUCTORS g Total on the express condition that all work shall be done In accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Building Official . • Penult No. Pbrmk Holder Do" Telephone 0 Plum" H.V.A.C Electric SORMW Inspection Dale Insp. Comments Foolk N Foundation Framing Roofing Rough Plbg. Rough Htg. Insul. Fkeplaea Final Htg. Final Plbg. Bldg. Final Cert. Oee. Deck Ftg. Deck Fang. Vllell Pr. MP. 4 '7 Site Address Lot -L Name Addre c City _ PERMIT # PLUMBING PERMIT RECEIPT # CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: _ PHONE: 454-8100 _ BLDG. TYPE WO Phone Name -a' Address O City Phone FEES COMM/IND FEE - 1% OF CONTRACT FEE APT. BLDGS - COMM RATE APPLIES TOWNHOUSE & CONDO - RES. RATE APPLIES MINIMUM - RESIDENTIAL FEE -$12.00 MINIMUM - COMM/IND FEE -$20.00 STATE SURCHARGE PER PERMIT - .50 (ADD $50 S/C IF PERMIT PRICE GOES - i SI NATURE OF PERMITTEE FOR: CITY OF EAGAN Res. Mult. ? Comm. Other New Add-on Repair N9._ FIXTURES TOTAL Water Closet - $3.00 _%aBath Tubs - $3.00 Lavatory - $3.00 hower - $3.00 L/ Kitchen Sink - $"a Urinal/Bidet - $3tdO Laundry Tray - $3.00 Floor Drains -$x1.50 1?3Water Heater - $1.50 Whirlpool - $3.00 Gas Piping Outlets - $1.50 (MINIMUM - 1 PER PERMIT) Softener - $5.00 Well - $10.00 Private Disp. - $10.00 Rough Openings - $1.50 FEE: STATE S/C: U a GRAND TOTAL- ?• S °? 2gY dog , 14- e a?- RlP1 q-,5- F7 a/0 Ps/ w ??-r7 ?- P pi ev, -!-e CONTRACT PI Site Address _ Lot ?- m Name _ Address c City - Name _ c Address O City - "s MECHANICAL PERMIT CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN, MN 55122 ifk 41, (a-'7 c1 PHONE: 454-8100 RECEIPT # L_ 7 / DATE: 2 - ,-_T- z :z Y BLDG. TYPE Blo ec/Sub Res l? r T Mult ? L Comm. Other TYPE OF WORK Forced Air = < Boiler Unit Heater G Air Cond. Vent Gas Piping Outlets # Other WORK DESCRIPTION New y" Add-on Repair r FEES ' RES HVAC 0 100 M BTU 2 . - 4.00 -$ i ADDITIONAL 50 M BTU - 6.00 /? ILL-It' II O Phone - - 174 (RES. HVAC INCLUDES A/C ON NEW CONSTRUCTION) GAS OUTLETS MINIMUM 1 PER PERMIT - ) ( - 1.50 EA. COMM/IND FEE - 1% OF CONTRACT FEE -- <r; M BTU M BTU APT. BLDGS. - COMM. RATE APPLIES TOWNHOUSE 8 CONDOS - RES. RATE APPLIES MINIMUM RESIDENTIAL FEE - ALL ADD-ON 8 t z M BTU M BTU $ REMODELS MINIMUM COMMERCIAL FEE - 12.00 - 20.00 CFM STATE SURCHARGE PER PERMIT (ADD $.50 S/C IF PERMIT PRICE GOES - .50 BEYOND $1,000) ! / > FEE: ` ' - S/C: SIGNATURE OF PERMITTEE TOTAL- FOR: CITY OF EAGAN FOR: a f'? '12 vfr `?. /-ZI 87 ???-2 I wS -c^ 2,-o 'BLDG. )$ERMIT 'NO;-/-,CI, ' 0 01-3YI"-0w 'Bldg. erm 01-8+f22 Plan Check 01-3445 Surch./Adm, 01-3446 SAC/Adm. 5 01-2155 Surcharge 17-3860 Road Unit 20-2275 SAC 74 20-3865 Water Conn. 20-3868 Water Trmt. 20-3716 Water Metez 20-2252 Acct. Dep. 20-3713 Water Permi 20-3743 Sewer Permi 79-3866 Sewer Conn. 11-3855 Park Ded. TOTAL RECEIVED • 19 AMOUNT -& _DOLLARS 100 0 CASH D CHECK rnR FUND CooE AMOUNT Thank You BY CASH RECEIPT CITY OF EAGAN 3830 PILOT KNOB ROAD .EAGAN, MINNESOTA 55122 DATE White-Payers Copy Yellow-Posting Copy Pink-File Copy CASH RECEIPT CITY OF EAGAN 3830 PILOT KNOB ROAD EAGAN, MINNESOTA 55122 ?w 1 DATE 19 ReCtrveD FROM AMOUNT $ I -& _DOLLARS too ? CASH ? CHECK FOR ? ?L J? 1 _ FUND CODE AMOUNT PIA tx?,e -0 SJl3SI Thank You BY '7 " White-Payers Copy Yellow-Posting COPY Pink-File COPY ? I 48 UNITS - RENTAL CITY OF EAGAN . 3830 Pil K b R P N 2 13067 ot 11 no oad, .O. Box 21-199, Eaga n, MN 55121 I PHONE: 454-8100 4 ? BUILDING P ERMIT Rece ipt If 1(i?•? Tobeusedfor APT. BLDG Est Value $1, 375,000Date DECEMBER 31 1986 Site Address 1510 THOMAS LAKE POINTE Erect L9 Occupancy R1/B1 Lot 1 Block 1 SecrSub. THOMAS LK POINTI£lemodel ? Zoning PD Parcel No Repair ? Type of Const. V 1 SE . Addition ? No. Stories a THOMAS LAKE HOUSING ASSOCIATRR ? Length w Name 3140 HARBOR LN Demolish 310 ? Depth - O Address I I ? S F ? nt. mpr. Cit MPLS Ph 559-1711 I ll q. t ? 83 100 y one nsta , o Name DOMAIN CONSTRUCTORS INC Approve 3140 HARBOR LN $ a Address Assessment _ City MPLS Phone 559-1711 Water & Sew. . I Police :i Name JOHNSON. SHELDON & SORENSEN Fire ma Address 10249 YELLOW CIR DR Eng. <w City MTKA Phone 935-6337 Planner_ Council- I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and C "f Eagan Ordinances. Signature of Permittee A Building Permit is issued to DOMAIN ONSTRUCZ all work shall be done in accordance with all applicable Stgtepf Minngso 6 Bldg. Off. 12/8/8 APC Var. Date Fees Permit ?? ?3 , oz v Surcharge 650 Plan Review 1, 810 SAC 22,540 Water Conn 19 , 2 0 0 Water Meter N/A Road Unit 11,136 Tr. PI. 6,125 Parks N/A Copies T,..., i -i INC on the express condition that a an it of Eagan Ordinances. Building CITY OF EAGAN M0 12948 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55 1 - PHONE: 454-8100 ^7 ??7 BUILDING PERMIT Receipt If / FOUNDATION 86 DECEMBER 5 To be used for Est. Value Date 9 Site Address 1510 THOMAS LAKE POINTS Erect IN Occupancy Lot 1 Block I Sec/Sub. THOMAS LK POINTMemodel ? Zoning Repair ? Type of Const. Parcel No. Addition ? No Stories THOMAS LK HOUSING ASSOC. Move ? Name Length m z Demolish ? Address 3140 HARBOR LN I I ? Depth - S F nt. mpr. City PLYMOUT4one 559-1711 Install ? q. t. o Name DOMAIN CONSTRUCTORS INC $ a Address SAME a ? City Phone ?a w a Name .i ? Address z i m City Phone Assessment Water & Sew. Police Fire Planner Council I hereby acknowledge that l have read this application and state that the Bld .Off. 125/86 information is correct and agree to comply with all applicable State of g Minnesota Statutes aindCily of Eagan O ins S. APC Signature of Permltt e ? _ )ar. Date DOMA CONSTRUCTORS Permit QlJ. VV Surcharge Plan Review Water Conn. Water Meter Road Unit Tr. PI. Parks- Copies- Total 15.00 A Building Permit is issued to: on the express condition that all work shall be done in accordance with all applica State o Mm of; Statutes and City of Eagan Ordinances. Building Official q5 8 -13o a V- 3 S n Z,6 It- ?zo LUG & 2-ad D s e -O yLCl 7X?i s tkl I, 77 This request void 18 moyths from C 13 816 % fie; 1 3 74-10& 1/ Request Date Z Fire No. Rauph-in Inspection ?J 4 ~ ~ S Repuu od' ?Ready Now ? Will Notify In spec 5 / - ?Yes ?No for When Ready tensed Electrical Contractor 1 hereby request inspection of above Owner electrical work installed at t Street Address, Box or Route No_ City Sl0 1 .- PIL U ection No. Township Name or No. Ran0c No. Gou c i (PRINT) D Phone No. / v v Fewer Supplier AJtlrQ55 E l c , t Ical Contractor (Company Name) n o t traUOr's License No. / ailmp Address 1 n ,actor or ner Makmp Instailauonl vv / S5 -16 5`0 ! ll - cvV Authorized 5 azure ISontrac r/Owner mp Installat ronl Phone Number -22 -• 2 MKC9STA STATE BOARD OF ELECTRICITY THIS''INSPECTION REQUEST WILL NOT Q:14 ipgs-Midway Milo. - Room N-191 BE ACCEPTED BY THE STATE BOARD 1821 University Ave., St. Paul, MN 55104 UNLESS PROPER INSPECTION FEE IS o.--- m11, 10, 1111 ENCLOSED. 5/0798 % REQUEST FOR ELECTRICAL INSPECTION E9-00001.04 ?See instructions for completing this form on back of vsllow copy. C 13 Q 16 "X" Below Work Covered by This Request New Add pap Type of Building Appliances Wired Equipment Wired Home Range Temporary Service Duplex Water Heater Lighting Fixttues Apt. Building Dryer Electric Hearin Commercial Bldg. Furnace silo Unloader Industrial Bldg. Air Conditioner Bulk Milk Tank Farm other pec' y Olhel (Sncr,ifyl t m spec, y t el olhu, Compute Inspection Fee Below a Fee Service Entrance Size n Fee FeedersrSubtoeders a Fqa Circwts 0 to 200 Am 1s 0 to 30 Amps O "? 0 to 30 Am Above 200 gmps 31 to 100 Amps 31 to 100 Am s Swimming Pool Above 100 _Amps Above 100-Amps Transformers Irrigation Buoms U Pa rtia L'Other Fee Signs Special inspection ' Remarks ' ?-o 1 TOT JA. el) n / r 1 P r. Rough-in Date ' (( ? ?•y7 I, the el Inspector, herohy tif th h b Final ?/ D l ? cer y at t e a ove Inspection has been n G•b O 1/ 7 me do. This request void 18 months from Thrs rentiest void ?// //` 18 nth,lrom 7 0 Dmo 41107x/ al '?;? 61 89 '?.o -2 ?' Renuest Date Fire No, Rouph-?n Inspection .? Renu red' ?Ready Nuw ? Will Nnuly InsDec- ?Yes ?NO , for When Ready (Licensed Electrical Contractor I hereby request inspection of above ? Owner electrical work installed arm Street Address. 80s or Route No. C I /D A?IxAl a /w !L ecbprn No. Township Name or No. gauge No. Co ty "V e Occu Gant (PRINT) Phone No. Power Supplier Address yy- Incal Cp? it,,tor (Company Name) Contractor's License No. tc?Kir/rv P c7 <16 1'pL Mailing Address (Crinfir, tm Owner Ma km0 Inslailauon) ? I Aulho Signature antra for/O nor Mnk inU Installs t ionl Phone Number It '2 3G US7lZ MINNESOTA STATE BARD OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT Griggs-Midway Bide. - Room N-191 BE ACCEPTED BY THE STATE BOARD 1821 University Ave.. St. Paul. MN 56104 UNLESS PROPER INSPECTION FEE IS Phone (612) 642 0800 ENCLOSED. REQUEST FOR ELECTRICAL INSPECTION ?4 EB-00001-0p6 =L Sec instructions for completing this form on back of vollow copy D? 117 "X" Below Work Covered by This Request Nev4 Addj Rep. Type of Building Apphancea Wired Enugomom Wired Horne Range Temporary Service Duplex Water Heater Liyllhny Fixun es Apt. Building Dryer Electric Hearin Commercial Bldy. Furnace Silo Unloader Industrial Bldg. Air Conditioner Bulk Milk Tank Farm mgr peci Y nmo, ISnrclfvl t nr Snoufy thcr Ome, v uinpute rnspecuuu ree below g Fee Service Entronee Slza n Fee Feeders/Subfaeders C Fee circuits 0 to 200 gmps 0 to 30 qm s 0 trr 30 Am is Ahove 200 Amps 31 to 100 Amps 31 to 100 qm Swimmino Pool Ahro,o inn Am- nt....._ ,nn n.??.. 7rk5 /r //,ti 01 / /?/rrN1 M.//./t /,-, //,.- o-4AL FEE ?a Rough-m ?? zB -- }f?{djl ectr i ca l `1???Ftor. hera'V Final Oa j J7 pp tifV that the above Inspection has bean -11 areda. _t . mw roguem wlv lonwnno.. v... y.?./ Yn 'w This request void 18 months Irani 7 4 4 2 4 moo? 3 S S 0:,7O ,/7. GO Request Date Frre No. Rough-iii Ins DeeLO n ??T1 p - I flequ ned7 ?Reatly Now ?WiII N.Gfy, Inspem f Wh C & ?yes ?NO or o. Ready a Licensed Electrical Contractor I hereby request inspection of above ? Owner electrical work installed at: Street Address, Bo. or Route No. City ?J A Isla Ti/aaas ?A?E ?a?,rr£ CABAL Secitifn No. Towns hip Name or No. ange No. County D,4,f /0 r,4 Occupant IPRINT) '/ /,, ' f 4J,'ws /1-914 14 /Yel'tr Phone No. Power S.Pplie, Address actor (DOTDagy Namel E lectn%?c 1 Con Contractor's License No. //?/ /loo 'a E/EeT2,c , ZN? 05 0 Malhng Address (Contractor or Owner Making Instailation) a5-2g -S oa Fro /! I.? Authp i IBnature I ntrac ner Making Installation) Phone Number d/?-?36-vsaa- MINNESOTA STATE BOARD OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT Griggs•Midwev Bldg. -Room N-191 BE ACCEPTED BY THE STATE BOARD 1821 University Ave.. St. Peul. MN 55100 UNLESS PROPER INSPECTION FEE IS -,- yarn..,-.nn ENCLOSED. z1113/S7 REOUP,T FOR ELECTRICAL INSPECTION EB-oooot-os _ see ,ett ons for completing 'k, / c? this loan on beck of yellow copy. C 1 7 4 4 / 4 "X" 8elow Work Covered by This Request Add Rep. Type of Building Appliance. Wired Equipment Wired Horne Range Temporary Service Duplex Water Heatgr Lighting Fixtures J( Apt. Building Dryer Electric Heat n Commercial Bldg. Furnace Silo Unloader Industrial Bldg. Air Conditioner Bulk Milk Tank farm thwi one, v X Cher Is pert fvl ?? r ,r pecifY Other ?( Othcr ,y Cfj <?' Compute Inspection Fee Be/ow B Fee Service En 'a ca site " d Fee Feeders/Subteoders a Fee circuits , 0 to 200 Am p, 0 to 30 Am s U IV-Yd- 0 to 30 Amos .3 /09:- Above 200 ?Ampa /Y ,eo 31 to 100 Amps Jyd, is 31 to 100 Anrlps? Swimming Pool a /d?po Above 10 i0 Amps Above 100_Arrj Transformers IrngaUOn Booms Q Partial,"Other Fee Signs Special Inspection Remarks veW zpj TOTAL FEF ry/A L? V /Qj I, the Electra I nspectpr, M1ereby p certify that the above Final inspection has been made. Thle reauest i old 18 months from G CASH RECEIPT CITY OF EAGAN 3830 PILOT KNOB ROAD EAGAN, MINNESOTA 55122 X? DATE //? J -7 RECEIVED l FROM Y / AMOUNT 77? loo & DOLLARS 0 CASH CHECK ,uu FDR 3 `/?/ ICJ I ?J 2//J 1 US's Y`'F`? FUND CODE AMOUNT ,?JJ)) V O lair L? A 1 n / ? LI ? I, - Thank You 00 BY N2 -79166 White-Payeri Copy Yellow-Posting Copy Pink-File Copy 6 T A ? L? e +. 379 ?3? 5?- P?,,u? g6 S3 R,6.,# // A' 6 7a P r 7??3? Al 670 ?b ?Al 3a f??,u?C.Pf 3 -7? 8 ? ? ?? n???6Ss // N 7o 7F w4 0 !?N ?7c%7 HEATING TEST RECORD ?-f ?? I & r ADDRESS I YW-'1' A-S & APT.6 FLOOR 1- CTj,Y __ ?U; OCCUPANT OWNER r?C! (.pyl?Cjl.d _ HEAT LOSS D TE HTG. INST. -8-7 SOLD BY `P I) e INSTALLED BY 64 Electrical Work By LOA { Gas Line By j^r OAAXI 1 TYPE OF HEAT GA CFA HW -STEAM SPACE HTR. -UNIT HTR. -OTHER AS DESIGN .ONVERSION MAKE MAKE OF BURNER Modal Model Serial Ing- - Moz. BTU Rating INPUT MAKE OF FURNACE Model CONTROLS 181 F rr !f` THERM T T Heat Plug Vent Size _ Valve f) - A R F5q- KIND OF LIN SIZE_ ?? N NE Limit 1.12AJC rl A Draft Hood R egular, Limit Setting Filters Size O W Number Fan Setting l -' e Chimney Location 1Innsiid utside y u Pilot Type ? / Chimney Construction l? Cam} E S Pilot Make G Pilot Model 1 Smoke Bomb -_' Wiring // - Pilot Timing Draft Test Tag - L.W. Cut Off Door Pressure - Lighting Inst. Pressure •`?'?t Percent CO •? 1 ?+ •7 Date Tested 2 Input CFH DQ Percent 0 Z Company Testing -Rouse Mechanical, Inc. Stack Temp. Percent CO 11348 K-Tel Dr. Minnetonka, MN 55343 U, IJ Name of Tester ?i-1" HEATING TEST RECORD 60 Z ADDRESS -APT.A - ELOOR C Y SUB OCCUPANT OWNER L __ HEAT LOSS _?D TE TG ST. ?r . IN -&-" g SOLD BY OU ? . A g ?4 -INSTALLED BY Electrical Work By J? 1A) tW - Ga s L i no By _-K ?9=2 TYPE OF HEAT GA _??HW -STEAM -SPACE HTR. -UNIT HTR. -OTHER GAS DESIGN MAK E MAKE OF Model 01 Model - Se,iol a6J313104 Max. BTU INP 2'5?600 MAKE OF THERKQS-[A Valve Lirni t Limit Setting Fan Setting Pilot Type Pilot Make Pilot Model Pilot Timing CONTROLS Heat Plug Rating - FURNACE Model Vent Size 4it-0 KIND OF LIJR L Sill N E_ Draft Hood 44&t Regulato Filters Size J&aN I Number Chimney Location d gutside Chimney Construction 95S1121_3 Smoke Bomb Wiring Ll?_ Draft 62 L.W. Cut Off - 1? Door Pressure Lighting Inst. Pressure ?3,1511(,J(! Percent CO 2 Date Tested _7_7 Input CFH 120 - P rcent 0 1 Company Testing -Rouse Mechanical, Inc. Stock Temp. hl-52!E Percent CO 0% A?7 Name of Tester BURNER 11348 K-Tel Dr. A etonka, MINI 55343 . CC,, ADDRESS ?c_.l!(] ?/` t r C Yrn L,) la ? HEATING TEST RECORD APT. ?OOR t 5- J7? CITY/-SUBURB ??- OCCUPANT OWNER ( J[Sl'Y _ ?Ct w.r. l ?YV/1D'?? HEAT LOS D TE rf INST. - SOLD BY c ?`+' INSTALLED B ma .Q-?p7I rPC .. Electrical Wart By AAR74 j:V u-_ Gas Line By - , TYPE OF HEAT GA L_-FA _HW - STEAM -SPACE HTR. -UNIT HTR. OTHER ?Jr1 A SAS DESIGN CO VERSION MAKE k_ - MAKE OF BURNER Model (a Kaj)R -06CA- Model Serial "-"?7???1"(• ?28? ??3 ?? Max. BTU Rating INPUT MAKE OF FURNACE Model F CONTROLS 8? THERMQS AT 1 16 Heat Plug Vent Size Volvo + KIND OF LIN _ ?- SIZE NONE Limit Ae-hEWO)011 Draft Hood Regulamr Limit Setting lu Filters Size I&K x Number Fan Setting s Fe C Xf O - Chimney Location I p s '?d e 11ut.id.. Pilot Type t nt ?sYJ? ? { LL Chimney Construction Pilot Make h Pilot Model :a?-2 L5A Smoke Bomb ? Wiring Pilot Timing < Draft / Test Tog ? L.W. Cut Off Door Pressure cl Lighting Inst. P 3---151.1 P Vi% '? ® D T d Z9 _A:2 ressure ercent C02 ate este Input CFI-Izb; Percent OZ Company Testing -Rouse Mechanical, Inc. Stack Temp. Percent CO 11348 K-Tel Dr. Minnetonka, MN 55343 43-'1•C, Name of Tester HEATING TEST RECORD ?I--? &t., ADDRESS f?6yV1?S lo N.. APT. LOOR ITY ?SUBURB_S.Sdd OCCUPANT OWNER I,>Qi , HEAT LOSS D TE TG. INST. 10 _ SOLD BY INSTALLED BY I& ADO Electrical Work By Gos Line By 14 0 TYPE OF HEAT GA I-FA _HW -STEAM-SPACE HTR. -UNIT HTR. -OTHER GAS DESIGN CONVERSION MAKE MAKE OF BURNER Model _ Model Serial M-M F- 8 ? -7 316 Max. BTU Rating INPUT MAKE OF FURNACE Model Valve Q Limit Limit Setting Fan Setting Pilot Type A Pilot Make Pilot Model Pilot Timing L.W. Cut Off 4TROLS 41 it ' f Heat Plug Vent Size KIND OF LIN R SIZE?? 7N ONE Draft Hood Regulator X7.5 J Filters Size Number O Chimney Location Inside JJ?'r t.ide Chimney Construction Pressure 5 tic Percent CO2 1-3% Input CFHPercent O4 Stock Temp. Percent CO 0 q(4 Smoke Bomb_ 1 Wiring Draft Test Tag Door Pressure Lighting Inst Dote Tested Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. J{?innetonka, MN 55343 Nome of Tester 1?1?• ADDRESS VfUM( OCCUPANT HEAT LOSS DA E HTG. SOLD BY Electrical Work By TYPE OF HEAT GA -lie- i- 1 HEATING TEST RECORD ?rDt. APT. 195!'RLOOOR TY UBURB OWNER 1-[11 TtCPJM INST. INSTALLED BY °PCUtlWX- - m?.A Q, Gas Line By W-STEAM-SPACE HTR. UNIT HTR.-OTHER ^(? GAS DESIGN MAKE ?Y MAKE OF BURNER _ Model Model Serial M3 ?aQ Maz. BTU Rating INPUT MAKE OF FURNACE Model CONTROLS THERMOSTAT ' J? F Hea 1 g Vent Size S Valve, RtAT KIND OF LIN R SIZE ?TW NONE ZC? '-3 Limit - Draft Hood Regulator Limit Setting Filters Size -Y( Number ' Fan Setting Chimney Location Igsi dA _r_?j utside Pilot Type Chimney Construction ??' , VS Pilot Make Pilot Model C-- Smoke Bomb_Wiring l Pilot Timing ?-GC Draft L.W. Cut Off Door Pre d Pressures ? Percent COZ Date To Company StaInputck CF Temp. ?Percent OZ Percent CO ? e Test Tag LQ ssure ? Lighting Inst. sted 7- 7-5-477 Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. Minnetonka, MN 55343 Tester .k A ?•? Name of ADDRESS ?S?D`T.?iorv, WAGP ,[HEATING p1?• TEST RECORD APT. doxiiLOOR AI Y SUBU OCCUPANT OWNER IZ.?'1-PT'i'u0(LQ HEAT LO ATE rI TG. INST. - SOLD BY ?S.jh ?.,' ? INSTALLED BY Q Electrical Work 'By Gos Line By r - n4 4 012- 1? TYPE OF HEAT GA ?A ?_-_HW - STEAM - SPACE HTR. UNIT HTR. -OTHER GAS DESIGN MAKE MAKE OF Modal M Model _ Serial Max. BTU INPUT /6M MAKE OF THER"STP Valve l Limit Setting Fan Setting _ Pilot Type _ Pilot Make _ Pilot Model _ Pilot Timing Model CONTROLS r.r - Hat Plug Vent Size J V.11 1 - KIND OF LI SIZE =-5__" NONE Draft Hood Regulator ?7S s Filters Size ??kX ( Number Chimney Location n??s-i/d -7l L Outside Chimney Construction ?`sg' L.W. Cut Off t 7_ 1 OX Pressure ?Percent C02 Input CFH 00 Percent 02? Stack Temp. L Percent CO Smoke Bo h Wiring 21' 1 Draft GOMC L Test Tag Door Pressure ^ Lighting Inst. Data Tested L- L N Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. ?MMiinnnetonka, MN 55343 Name of Tester (ten BURNER Rating FURNACE / A H TING TEST RECORD ADDRESS I?IO n .[ z CyTY1 (? ` O APT. U LOOR / YUBU B ICI OCCUPANT OWNER '-7 y,C r HEAT LOSS TE TG. INST. e SOLD BY fem. `Q INSTALLED g 61r A 0 'ee Electrical Work By 0. A(DA yJ Goa Line By J 'OL.? IAPr - TYPE OF HEAT GA 'FA ? _ STEAM -SPACE HTR. -UNIT HTR. OTHER ? GAS DESIGN CONY RSION MAKE MAKE OF BURNER _ Model 'C?t/EC-C -Model Serial I t y b4 - F11$1- J{J ? Max. BTU Rating INPUT _ ?rLY X? MAKE OF FURNACE Model Limit-Hr Limit Settir Fan Setting Pilot Type Pilot Make Pilot Model Plug Vent Size 4'f -,57'r KIND OF LI R SIZE__N ONE Draft Hood , ? Regularor Filters Size kXZ0xl Numbe Chimney Location - n ode-- Outside- Chimney Construction a e ?S Pilot Timing, L.W. Cut Off N P- 7k 0-110 ressure 1B'5 L ? Percent COZ Input CFMTPercent OZ Stack Tamp. '--'"'llLL----Percent CO gyf3 Smoke Bomb Wiring Draft / Test Tag Door Pressure + Lighting Inst. ? y Date Tested j? (y^ Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Or. Name of Tester Min'nnetonka, MN 55343 9 ? - [,-?/ / /9? ADDRESS 1510 /n D ,cTmct?o-?-+?4 {t??}?ICEATING / Cam' TEST RECORD APT. ?? LOOR TY S BURB OCCUPANT OWNER /y «n HEAT LOSS D TE TG. INST. O SOLD BY L? `? -' - - INSTALLED BY OC n,1410 I:Uffln Electrical Work By -P / A Gas Line By Q TYPE OF HEAT GA STEAM - SPACE HTR. UNIT HTR. -OTHER GAS DESIGN CO ERSI N MAKE MAKE OF BURNER Model 410 Model Serial Mox. BTU Rating :v0Xr) INPUT MAKE OF FURNACE Model Va THRM,ffl Valve -ILU Limit Limit Sett_in Fan Setting Pilot Type Pilot Make . Lo Plug Vent Size KIND OF LIN SIZES S41 ONE Draft Hood 0- talt 0111 Regularor Filters Size Number Chimney Location ,? nF ?de?.JO?ut?side Chimney Construction M E r•r"? t"i v-c+w.'t ? Pilot Model Gam' Its 1-'r Pilot Timing L.W. Cut Off // Pressure Percent CO2 Input CFH 5 ?b Percent 02 c9 d Stack Temp. Percent CO O i0 c 0 Smoke Bomb Wiring l/ 0.a{t ? Test Tag / C Door Pressure p Lighting Inst. Date Tested Company Testing -Rouse Mechanical, Inc 11348 K-Tel Dr. Minnetonka, MN 55343 Name of Tester G ADDRESS I-.J ?? 1 n'? Q,D vLt- EATING ??` TEST RECORD APTJQjjjfLOO It ITY S BURB OCCUPANT ?- - OWNER ?JIT'n2-'i`` ? ? HEAT LOSS A E H G. INST. _ SOLD BY INSTALLED B ?'. Electrical Work By ! - " ? Gos Line By d:) (2 `e TYPE OF HEAT _Ifn FA_HW- STEAM - SPACE HTR. UNIT HTR. - OTHER GAS DESIGN MAKE MAKE OF BURNER Oat Model Serial 3 Q Max. BTU Rating - INPUT 10CO MAKE OF FURNACE Model Valve-? Limit Limit Setting Fan Setting Pilot Type Pilot Make Pilot Model ! Pilot Timing L.W. Cut Off Heat Plug Vent Size KIND OF LI R ? SIZES r/NONE = Draft Hood ?? Regularor -7 S Filters -- -Size /&XWA ?-Number l Chimney Location s de utaide Chimney Construction I Pressure ?-5rrGr/ `__ Percent COZ 8 10 Input CFH S! Portent 02 Stack Temp. Percent CO 97.0 Smoke Bomb Wiring Draft ?9f?CJQ Test Tag s? Door Pressure -7 ?7 Lighting Inst. Date Tested -/- LCj'A-7 Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. Minnetonka, MN 55343 Name of Tester ]?RECORD ADDRESS /61V I /I(JYY1Cb? 7T? ??/y O 1.10 ?n,f?0_ Q?OU L HEATING TEST ? /Q•? j/a^A ?,l - APT./(?6? "TY 8641 / OCCUPANT OWNER 'U m oyW..P//(?/.J 1 HEAT LOS DAT HTG. INST. SOLD BY INSTALLED BY 6ytp_Q .a r Electrical Work By Gas Line By rk 'Q 'Q .'C TYPE OF HEAT GA HW -STEAM SPACE HTR. UNIT HTR. OTHER GAS DESIGN MAKE MAKE OF BURNER Model Model Serial Maz. BTU Rating - INPUT MAKE OF FURNACE CONTROLS THERMOSTAT TFiAE He PI, Volvo Limit (A &U 0 Limit Setting_ Fan Setting Pilot Type Pilot Make Pilot Madel Pilot Timing L.W. Cut Off Pressure .S .. Percent COY Z Input CFH Percent 02 Stack Temp. Percent CO AT3 Model tr ?e? Vent Size KIND OF LIN _ IZ Draft Hood Regularor Filters Size N b Chimney Location ?I?i,&? utside Chimney Construction Smoke Bomb Wiring dl_^ Draft Test Tog Door Pressure ! Lighting Inst. Date Tested 77=2-7-o 7 Company Testing -Rouse Mechanical, Inc. 11348 KTel Or. Minnetonka, MN 55343 Name of Tester j/ 7??s'i HEATING TEST /RECORD ? ADDRESS `?/?0 / /1(J IYI?? ?FX?fL,r [ APT. •' FLOOR ?C I TY - --y?g OCCUPANT OWNER fYh fi .tin O ?6L SGg3•6?? HEAT LOS L--_? DA E HTG. INST. SOLD BY INSTALLED BY? 0?611A 0 .Pr. Electrical Work By j6d t A LOA Gas Line By 42 TYPE OF HEAT GA CFA _HW -STEAM SPACE HTR. -UNIT HTR. OTHER GAS DESIGN O V SION MAKE MAKE OF BURNER Model - Model Serial 01 - Max. BTU Rating INPUT MAKE OF FURNACE Model CONTROLS r/ THERMOTJ T t ! Heat Plug Vent Size ?- Valve O KIND OF LI R SIZE NONE Limit (-?p Draft Hood - Regularor Limit Setting Filters Size -OX- J Number Fan Setting Chimney Location sid?e utside Pilot Type ?; Chimney Construction E, Pilot Make r/ Pilot Model Smoke Bomb -Wiring Pilot Timing n Draft CBB?D Test Tog L.W. Cut Off Door Pressure Lighting Inst. R r' S ~ ?7 1ry-1 :7_? Pressure ' Percent C02 G 1 Date Tested Input CFH SPercent 02? Company Testing -Rouse Mechan ical. Inc. Stock Temp. 4M Percent CO vv!!cc 11348 KTel Dr. 42A.` Minnetonka, MN 55343 Name of Tester ?n 9 HEATING TEST RECORD ADDRESS ? ?? O7yt Ckwg 1 Z JU TLS APT. FLOOR ?CtITY S?BURB OCCUPANT OWNER j, tIlY1 .. l /7'tAa%% HEAT LOSS faPyTE hTG. INST. QD_ i t0 (' SOLD BY t<l? M ,?y- - INSTALLED BY A-74 Electrical Work By !/?il - Gas Line By ALlO on. TYPE OF HEAT GA __L,-?F_A HW -STEAM -SPACE HTR. UNIT HTR. -OTHER GAS DESIGN MAKE MAKE OF BURNER_ Model Model Serial 1 =%36Mas. BTU Rating INPUT MAKE OF FURNACE Model Valve Limit F CONTROLS I Hgat Plug I t rr Vent Size _5 KIND OF LI R ` SIZE NONE ?- Draft Hood Regularor Filters Size X ? Number Fan Setting ®r Pilot Type Pilot Make Pilot Model Pilot Timing r- L.W. Cut Off ? r?Q??-?pp Pressure 3.51.WC Percent CO2 ' ( Input CFH dqaloon Percent 02 76 Stack Temp. 4ro Percent CO 0,70 q77-& Chimney Construction Smoke Bomb Wiring v Draft /e7.' n Test Tag Door Pressure ? GG Lighting Inst. Date Tested ??G_60 Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. Minnetonka, MN 55343 Name of Tester HEATING TEST RECORD .[ /. ADDRESS C TY SU URB APT. OOR ? OCCUPANT OWNE r 3Q HEAT LOS DAT HTG. INST. - SOLD BY - INSTALLED BY Electrical Work By Gos Line By QIAA? 1O TYPE OF HEAT GA-LtFA-HW STEAM SPACE HTR. -UNIT HTR. OTHER GAS DESIGN C V RSION MAKE e np MAKE OF BURNER Modal Model Serial « Max. BTU Rating INPUT MAKE OF FURNACE Model CONTROLS F tf a rr THERMO A Heat Plug Vent Size Valve KIND OF LIN R _ AWC SIZE_ NONE Limit w n-M 11 4 Draft Hood Regularor 3 Z? 3 _ Limit Setting w Filters Size _Z'O X Number Fan Setting _ Chimney Location Insi a Ouisida pe Pilot T Chimney Construction ?T y _ Pilot Make t? Pilot Model Smoke Bomb Wiring Pilot Timings Draft (90'a Test Tag L.W. Cut Off Door Pressure Lighting Inst. d?y 7 ?7 Pressure Percent CO y ' Date Tested Input CFH 0 00 Percent 02 Company Testing -Rouse Mechanical, Inc. Stack Temp. Percent CO 11348 K-Tel Dr. ylirinetonka, MN 55343 G_IK/x- 4?7.3 Name of Tester PL_ TEST )RECORD - ! I? y? ADDRESS 1510 ?y:]MC,0 Yt _ APT. OOR CIT/l ?? ?? SU.BU B ?0 OCCUPANT OWNE'rM `?(?,LI-Li.(. =n HEAT LOSy7?DATE HTG. INST. SOLD BY Itll-Ll[1t f'M.' - INSTALLED BYn1L O Electrical Work By V-PA J1_A0.1? fir- Gas Line By t.PC TYPE OF HEAT GA-L--STEAM -SPACE HTR. UNIT HTR. -OTHER GAS DESIGN MAKE MAKE OF Model Model Serial 70 Maz. BTU INPUT MAKE OF Model _ -CONTROLS Valve Limit- -Limit Settin Fan Setting Pilot Type Pilot Make . Pilot Model Pilot Timing L.W. Cut OfF Pressure 3"S`Percent CO2 ltL?d Input CFH Percent 02 Stock Temp. F Percent CO 876 RSION BURNER Rating _ FURNACE R_ SI _ _ Regularor Vent Size KIND DF LI Droft Hood _ Filters Chimney Construction Smoke Bomb - ng + Draft 6!7C Z i! Test Tag - Door Pressure Lighting Inst. Q 7 Z5- 9 Date Tested Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. nnetonka, MN 55343 ? A- Name of Tester `rT,? y? / HE TING TEST ?R??EjRCORD + ADDRESS I?10 3fffl r1"5 L - i' APT.J `L OR_/ Cl Y SUT?RB OCCUPANT OWNER HEAT LOS '_? DATE HTG. INST. SOLD BY INSTALLED BY QM IQ 0 L ue.P Electrical Work _ By Gas Line By ^ TYPE OF HEAT GA ?FA 4-HW -STEAM-SPACE HTR. I UNIT HTR. -OTHER GAS DESIGN MAKE 0,7 - MAKE OF Model /CL^ ov? Model - Serial U3ylD Max. BTU INPUT '75.z m MAKE OF Model _ THERMO?I Valve Limit _Limit_Settir Fan Setting Pilot Type Pilot Make. Pilot Model FCONTROLS Vent Size '7 KIND OF LI I IZE (n `( NONE Draft Hood 0Y1 Regularor Filters Size_ Zpx-I Number Chimney Pilot Timing ??- - L.W. Cut Off rt Pressure S Percent CO2 Input CFH 1? 0M Percent 04 Snick Temp. Percent CO D/ AC) Chimney Construction Smoke Bomb Wiring v Draft Test Tag Door Pressure Lighting Inst. Date Tested Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. Minnetonka, MN 55343 Name of Tester /?- / / BURNER Rating - FURNACE ?/,,,?_- HEATING TEST RECORD ?' ADDRESS 1510 `' y'rw/ Cult -APT. "FLOOR CIjj' C R?1 B? OCCUPANT ?- OWNER f?Y\n 4? ('tj1 r dd I HEAT LOSS ATE HTG. INST. SOLD BY .,. C/I-t _ INSTALLED BY(QV0 P for Electrical Work By VPA Gas Line By ?6b1kL1 'eC TYPE OF HEAT GA __4,AA _L HW -STEAM-SPACE HTR. UNIT HTR. -OTHER GAS DESIGN CO V RSION MAKE -MAKE OF BURNER _ Model Model Serial 3-Max. BTU Rating INPUT 2SXt)C!l MAKE OF FURNACE Model .••? GCONTROLS - ff r fr THERMO AT ` r Heat Plug Vent Size Valve KIND OF L ER Limit )wj Draft Hood O'K ?O Limit Settina _ E Filters Size Fan Setting Pilot Type Pilot Make Pilot Model I)r Pilot Timing L.W. Cut Off 5'r Pressure Percent C02 Input CFH Percent 02 Stack Temp. " F Percent CO a V7.I Chimney Construction Smoke Bomb Wiring ?/ Draft ce? Test Tag Door Pressure -•?7? Lighting Inst. Date Tested ?-/ T9-?') Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. `"Miinnnetonka, MN 55343 Name of Tester /?' ` ^r_-,, - L/J? HEATING TEST RECORD ADDRESS 1510 '' ' ?-/at ? )OIL-1 APT. FLOORD ITY 5 BURG OCCUPANT OWNER HEAT LOS DAT HTG. INST. 7 SOLD BY INSTALLED BY[II? Electrical Work By _ A' Gas Line By 4<'l-lA)_e ? TYPE OF HEAT GA J.G FA _HW -STEAM -SPACE HTR. -UNIT HTR. -OTHER GAS DESIGN CONVERSION MAKE -MAKE OF BURNER Model ' Q Model Serial fo QZ Max. BTU Rating INPUT ?5•? MAKE OF FURNACE Model PCONTROLS J tt^?„ THERM Heat Plug Vent Sire Valve KIND OF LIRER P' SIZE ?r NONE Limit Draft Hood y Gl Cw? R.glarar ?i25'^3 Limit Setting Filtm.s Size' 7??-1--Nam6er- Fan Setting Chimney Location Inside Outside Pilot Type Chimney Construction tl"t Q? e Pilot Make Pilot Model -11 Smoke Bon' Wiling Pilot Timing Draft Test Tag L.W. Cut Off Door Pressure Lighting Inst. Pressure 3.?J rr«?? Percent COY --I%ate Tested '7 -G 11 ` 6 , Input CFH 54_iClo Percent OZ Company Testing -Rouse Mechanical, Inc. Stack Temp. Percent CO 11348 KTel Dr. Minnetonka, MN 55343 Mp 1y Name of Tester HEATING TEST RECORD ADDRESS to ??rYTYYCG4-P APTov_F OOR? TY-?S URB OCCUPANT OWNER HEAT LOSS • ATE HTG. INST. SOLD BY INSTALLED BY ,?,.,?(7S.(?0 _ I P Electrical Work By ?21 Gas Line By +/.TIAU iY?CJn r TYPE OF HEAT GA HW STEAM -SPACE HTR. UNIT HTR. -OTHER GAS DESIGN CONVERSION MAKE MAKE OF BURNER Model Model Serial 3 Max. BTU Rating INPUT MAKE OF FURNACE Model THERMQjT4 L Limit Setting Fan Setting _ Pilot Type - Pilot Make _ Pilot Model _ Pilot Timing L.W. Cut Off CONTROLS _.kleat Plug «_- !t Vent Size KIND OF LINER SIZE ?y NONE -- Draft Hood (•f / JU gula.or S 3 Filters Size l&?I? Number Chimney Location I ide Outside Chimney Construction Smoke Bomb Wiring Draft ?ac,,,gg Test Tag Door Pressure Lightina Inst. Pressure 6 W Percent COZ IVbDate Tested Input CFH Percent OZ ?%?:mpony Testing -House Mechanical, Inc. Stack Temp. y, ?l zo-r- Percent CO 095 11348 K-Tel Dr. Minnetonka, MN 55343 g?5 Name of Tester HEAT II.NG TEST RECORD ADDRESS to ABM Y APT. I FLOGR ITY SUBURB OCCUPANT OWNER IMPS-Giyr-P7t ?.A HEAT LO SOLD BYS in 160 i;PO ?. HTG. INST. n _ INSTALLED BY.?T? O[7 Electrical Work By -f eA Gas Line By TYPE OF HEAT GA _-L--FA LHW STEAM -SPACE HTR. -UNIT ;TR. -OTHER GAS DESIGN MAKE MAKE OF BURNER_ Model _ Model Serial 3 Max. BTU Rating _ INPUT 000 MAKE OF FURNACE Model Valve Limit Limit Setting CONTROLS - Heat Plug Vent Size KIND OF LIN SIZE NONE Draft Hood ! Regularor 25`3 Pilot Type X1 i2A Pilot Make -? Pilot Timing CY`C= r L.W. Cut Off ``It N?O Pressure ' J Gfr? Percent C02 jj Input CFH rPercent 02 Stack Temp. ? 1 Percent CO ^I'S Chimney Location Ipsidoe} 1.Ql-15side Chimney Construction ? e! '^ A v Smoke Bomb/-wiring Draft `.-e;0 Test Tag Door Pressure Lighting Inst. Date Tested Company Testing -Rouse Mechanical, Inc. 11348 KTel Dr. 'fMinnnetonka, MN 55343 Name of Tester ?Mi4- l/ D,y? HEATING TEST yyyRECORD ADDRESS 0?1(Im_`IL rAPTQSLlt{LOOR ?Y- ' AS&R B aqdaAJ_ OCCUPANT OWNER -?? yy VIA t 9-ytn,f HEAT LOSS ? Q ATE HTG. INST. f? SOLD BY INSTALLED BY QAQ4 , Electrical Work By POA OP^ Gas Line By Ola_D `Q(' n ' TYPE OF HEAT GA /?[GHW -STEAM -SPACE HTR. UNIT HTR. -OTHER AS DESIGN C NV RSION 10 0 MAKE MAKE OF BURNER Model _0 Model Serial (21L) NOS ( Max. BTU Rating INPUT MCOO MAKE OF FURNACE Model ?? CONTROLS THERM TAT 1 Heat Plug Valve Limit / Limit Setting .rc _r ?. rti Pilot Type t Pilot Make Pilot Model Pilot Timing L.W. Cut Off Pressure /3/?'5,.,?'fu?1?_ Percent COY FH ?? Stock - _LOJ1? _Percent O Stack Temp.?-- Q!pf Percent C02 Mo '311 rf, rr Vent Size KIND OF LIN R S SIZENONE Draft Hood _ Regularor 73Z,(:7_-3 Chimney Location µ"In ide ?? Outside Chimney Construction / ISQS Smoke Bomb Wiring Draft y?cvc Test Tag - 11 Door Pressure 'C/ F) Lighting Inst. Date Tested -7 n ? b Company Testing -Rouse Mechanical, Inc. 11348 KTel Dr. Minne onka, MN 55343 Name of Tester K ADDRESS I tJt - y ' /qqq /y ?/yj EATING ?-,„ ""' `C? Lahep-- ' TEST RECORD (_ \ APT.(2/ OR-CITY&SUBXur OCCUPANT - OWNER (NV\-Q.LVN (,[` HEAT LOSS DAT HTG. INST. SOLD BY INSTALLED BY AQ11110 p- gyp - - Electrical Work By Gas Line By Eg)A,O - 4c TYPE OF HEAT GA _ FA HW -STEAM SPACE HTR. - UNIT HTR. OTHER G DESIGN MAKE MAKE OF BURNER_ Model 6 k Model Serial Maz. BTU Rating INPUT :45+&Q MAKE OF FURNACE Model Valve 111114 L I Limit Setting Pilot Type Pilot Make Pilot Model Heat Plug Pilot Timing L.W. Cut Off Pressure "t' = Percent Cot ?a Input CFH p3y) ?-pPercent OZ Q Stack Temp• -f. P ercent CO gq.5 Vent Size KIND OF LI R SIZ Draft Hood Regularor _ Filters Size Number_ Chimney Location nside Chimney Construction Smoke Bomb Wiring Draft 1e5 Test Tag Door Pressure Lighting Inst. Date Tested Company Testing - Rouse Mechanical, Inc. 11348 KTel Dr. Minnetonka, MN 55343 Name of Tester )e - HEATING TEST RECORD ? 1V I KlOW1Q O LG?IT?o ADDRESS - . - ? APT. LOOC Y -SUB l?J2S OCCUPANT ? ? - OWNER •) ((// HEAT LOSQ__ DA HTG. INST. -- SOLD BY "?u.,/.u[ ,, J' 0,('.ln ' - INSTALLED BY Electrical Work By Gos Line By ka'k e V: - it ` TYPE OF HEAT GA L'FA r-HW- STEAM -SPACE HTR. UNIT HTR. -OTHER S DESIGN CO (VE SION MAKE MAKE OF BURNER Model 7 C115(4! -CE Model Serial 3 V- _r /..? Max. BTU Rating INPUT MAKE OF FURNACE Model CONTROLS ? /y THERM T T Heat Plug Vent Size W Valve KIND OF LI R " `- Jft# 60410 SIZE 75 NONE Limit a. Draft Hood S to-, Regulator 75--3 Limit Setting Filters Size ( Number Fan Settin Chimney Location Outside Pilot Type Chimney Construction Pilot Make 6 Pilot Model Smoke Bomb Wiring Pilot Timing Draft L Test Tag L.W. Cut Off Door Pressure Lighting lost. Pressure 3 -S "54 X? Percent CO Date Tested `'7 / ?•? rn 02 Input CFH QS?? Percent 02? Company Testing -Rouse Mechanical, Inc. Stack Temp. ?706F Percent CO 11348 KTel Dr. Minnetonka, MN 55343 ,tr1®/ Name of Tester lt?l TEST RECORD (/?'? ??, \1 ADDRESS APTrg_q OCCUPANT `'r- OWNER FLOORCL TCt71 Y',p _ SUB J HEAT LOSS DAT HTG. INST. SOLD BY INSTALLED Bp';p[1/r,, ('Q-I,c- - RMA Electrical Work By E'eck r Gas Line By 'I,JL'`'?o'r`^n'? a...t? ' TYPE OF HEAT GA v HW -STEAM -SPACE HTR. -UNIT HTR. -OTHER GAS DESIGN MAKE L& MAKE OF M Modal Model , Serial Max. BTU INPUT MAKE OF Model Rating - FURNACE CONTROLS f I I THERMO AT F Heat Plug Vent Size `S Valve Of jA r- KIND OF LI f;_ SIZE y ONE Limit Draft Hood Reguloror Limit Setting Filters Size k Number Fan Setting Chimney Location Ilgsid utaid. Pilot Type `?- Chimney Construction 4 Pilot Make i Pilot Model f Smoke Bomb /-- Wiring Pilot Timing - Draft (wrest Tag e / _ L.W. Cut Off _/ Q? Door Pressure ^7 -'1 Lighting Inst. y Pressure lr Percent CO2 / /t? Dote Tested Input CF Percent 02 Z5 0 Company Testing -Rouse Mechanical, Inc. Stack Temp. Percent CO d 11348 K-Tel Dr. %3-V lylinnetonka, MN 55343 Name of Tester TY 16 BURNER y--?_,,,__,, / HEATING TEST RECORD ?- I ?? ' I `E",ran ADDRESS (n Q ???n t -APT APT ???FFLO,O ITY -S? B-URBC10.&AJ OCCUPANT OWNER j)n Y.?f?Q31reK(t /1 I HEAT LOSS ? TE H G. INST. :Rp y^)_ _ 3r_ SOLD BY INSTALLED BY???77"Y.71A-4 Electrical Work By Gas Line By W1 , .A1! TYPE OF HEAT GA -1L16A W STEAM SPACE HTR. -UNIT HTR. -OTHER GAS DESIGN MAKE MAKE OF BURNER_ Model Model Sari al 31NI)A -F05-7 Max. BTU Rating - INPUTMAKE OF FURNACE Volvo _tll? Limit Lmt Limit Setting CONTROLS Heat Plug Pilot Type Pilot Make 4;in1k:l'e s' Pilot Model Pilot Timing L.W. Cut Off Pressure Lr Psreent COZ -?? Input ?.Icill0.--Percent O' Stack Temp. -At 4`- Percent CO IP-o Model Vent Size KIND OF L Draft Hood VERSION E Chimney Location Ins'de Outside Chimney Construction . 11Z Smoke Bomb 77-- -- -wiring I:f Draft /? L Tag Door Pressure Lighting Inst. .-y 87 Date Tested / Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. Minnetonka, MN 55343 Name of Tester EATING TEST RECORD ADDRESS 15 tbr}O 4 1LP/I'[2-APTLOORCTYSU?U_R Ba OCCUPANT - OWNER )a)m k'CYl.. AA,,i 'LItL!? HEAT LOS DATE/HTG. INST. _ SOLD BY .LC'.l INSTALLED BY t-QQ Electrical Work By _IVAPQ id per- Gas Line By Qd O ?[' r TYPE OF HEAT GA -L, FA -,-HW -STEAM SPACE HTR. -UNIT HTR. -OTHER GAS DESIGN C V RSION MAKE MAKE OF BURNER Model' Model SerraI Moz. BTU Rating INPUT MAKE OF FURNACE it 1I Model _ CONTROLS THER S AT Heat Plug Vent Size ?!? ry _ Vulva/n KIND OF LI ER ' SIZE NONE Limit '- a».e_a.t LL)4_U Draft Hood Regularor GV Limit Setting _ (qc)?J_= _ Filters Number , Pilot Type Pilot Make Pilot Model Q7? 5 Pilot Timing L.W. Cut Off Pressure Percent CO2 Input CFH 45)0M Percent 02 0?0 Stack Temp. y`?? Percent CO 67.Z_ Chimney Location Chimney Construction Smoke Bomb Wiring Draft ? aa_ Test Tag Door eor Pressure pp Lighting Ina L Date Tested _7-ZS-8? Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. Minnetonka, MN 55343 Name of Tester <A As TEST RECORD ADDRESS -61c) rr, A-5 / Lam' APT. OR CIP BUR OCCUPANT OWNER HEAT LOS DATE HTG. INST. SOLD BY ?.,? INSTALLED BY w Electrical Work By k,Qfk -W-4 /Gas Line By r Jn 0 ?r ?- TYPE OF HEAT GA -L,-5A' GF-A ?Fl'W STEAM SPACE HTR. -UNIT HTR. OTHER GAS DESIGN MAKE MAKE OF Model Model - Serial L)),Q"q -1_06X61 Mo.. BTU INPUT MAKE OF Model THERM Valve Limit Limit Setting Pilot Type Pilot Make Pilot Model VERSION L] / Plug Vent Size (r - KIND OF LI 1 Draft Hood Cu cUla'a _ Regularor Chimney Location Chimney Construction Smoke Bomb Wiring Pilot Timing Draft L.W. Cut Off Door Pre Pressure - ? t f Percent CO, g'- m3610 Date Input Percent 02 't 15';6 Company Stack Temp. e Percent CO a'7' /^ Name of T BURNER Rating - FURNACE GV Test Tag ssure Lighting Inst. Tested Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. Minnetonka, MN 55343 ester ?_ ?/ HEATING TEST RECORD • 4 ADDRESS 1 J/© / D1QYY1C74 d Y APT-_L00?1? ?j?jTY SUBURB OCCUPANT OWNER t-Une7 ?-? (.' ??h.n HEAT LOS DATE ITG. INST. SOLD BY INSTALLED BJ('a0 Electrical Work By Gas Line By ?,Q TYPE OF HEAT GA -_6-,FA -&- ---H`I STEAM -SPACE HTR. -UNIT HTR. -OTHER GAS DESIGN CON ERASION MAKE MAKE OF BURNER Model G Model Serial - Max. BTU Rating INPUT_ MAKE OF FURNACE Model CONTROLS THERMO, A Heat Plug "?- 1 Volre Limit It AQ Limit Setting iQn Pilot Type Pilot Make Pilot Model Pilot Timing CJ--?"?- L.W. Cut Off Pressure S" Percent C02 0 ?j Input CFH Percent OZ 'r G Stock Temp. H10 F Percent CO 91,1 Vent Size - - ` KIND OF LI R SI Draft Hood Regularor Chimney Location /1?n de Outside Chimney Construction ?'/E-7 Smoke Bomb Wiring Draft Test Tog - Door Pressure ?- Lighting Inst. Date Tested Company Testing -Rouse Mechanical, Inc. 11348 KTel Dr. Minnetonka, MN 55343 en Name of Tester HEATING TEST RECORD ADDRESS ILs APTER FLOOR TY SU RB OCCUPANT ^ OWNER /? HEAT LOSS AT?7 HTG. INST. SOLD BY fCI.R['Jh • _ -INSTALLED Dd7 LQ O O,n Electrical Work By V 0 ; Gas Line By -a D 'LtiIA?G? r t TYPE OF HEAT GA _!:!:?_'FA L!FW -STEAM -SPACE HTR. UNIT HT-R. OTHER PPA-0 a' -}GAS DESIGN MAKE ^-? MAKE OF BURNER Model _ `L Model Serial 6-213-20 !Of - EIAS:2 -6 W6 Max. BTU Rating - INPUT-(? MAKE OF FURNACE THER T T 1- Hear Plug Valve Limit Limit Setting _ _ Pilot Type Pilot Make Pilot Model ?? Pilot Timin 3" L.W. Cut Off tr R Pressure '5 Percent COZ 8,0 ?a Input Cmp. &W / Percent OZ O Stack Toemp. Percent CO O 800 Model Vent Size (/- q KIND OF LI R SI7_ Draft Hood 671 Regularor _ Chimney Location Chimney Construction NONE -- Outside 4--i Smoke Bomb Wiring Draft Test Tog ?- Door Pressure "- Lighting Inst. Date Tested - 7-7$ Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Or. .Minnetonka, MN 55343 '1K?/.W. Name of Tester G ?j'? HEEATIINNyAG. TEST j RECORD ?? ADDRESS l 1 J?L? , ? ?LdO (?p // I-AaP`T. LOOR CIry+(e SUBU B OCCUPANT OWNER `" ?-C[C HEAT LOSS -_? D T HTG INST. SOLD BY INSTALLED B?Cl9'LC Electrical Work By R 4 AP4 )r- VJ Ir Gas Line By 1 TYPE OF HEAT GA _!I, 7 HW -STEAM-SPACE HTR. -UNIT HT-R. -OTHER GAS DESIGN MAKE MAKE OF BURNER _ Model A-6 - Model Serial rf? Max. BTU Rating_ INPUT MAKE OF FURNACE CONTROLS THER TT? - Heat Plug Valve l 1 Limit Limit Setting Pilot Type Model Vent Size 11 11 KIND OF LINF.2_ Draft Hood -:06 Chimney Location Chimney Construction RSION Regal ator -72 e J Pilot Make ?- Pilot Model Smoke Bomb Wiring Pilot Timing c-?S2C' Draft Test Tog L.W. Cut Off Door Pressure Lighting Inst. L '3 rt ? ' J Pressure - Percent CO2 Date Tested A400 Input CFH4 Percent 02 - Company Testing -Rouse Mechanical, Inc. Stack Temp. Percent CO 6 /h 11348 K-Tel Dr. Minnetonka, MN 55343 ?i 7.') Name of Tester HEATING TEST R ECORD ADDRESS ???IO ? /1 1 9 /" /,m APT ` LOOR 12-C ? . SUBURB OCCUPANT ? - OWNER' (i .M ni,cl? HEAT LOSS ATE IJITG. INST. - SOLD BY INSTALLED BY]Q RUR Electrical Work By N -e,-_ Gas Line By TYPE OF HEAT GA L HW STEAM SPACE HTR. -UNIT HTR OTHE R . GAS DESIGN CO r SION MAKE MAKE OF BURNER Model Cc A -ME(s.4 e- Model Serial ? - "? Max. BTU Rating INPUT MAKE OF FURNACE Model CONTROLS THER ST T Heat Plug Vent Size Valve KIND OF LI R SIZE er NONE Limit Draft Hood el't Regularor ?9 ?' Limit Selling Filters Size umber _ ?- -far Setting r - V T0I /V -cal T- Chimney Location Insi a Outside y/ Pilot Ty pe Chimney Construct ?? d ion Pilot Make Pilot Model J 0 r Smoke Bomb ?^ Wiring ,. Pilot Timing 2 Draft (box-A Test Tog L.W. Cut Off Door Pressure Lighting Inst. , it D T d V 7 Pressure Percent COZ ate este / Input CFH Percent OZ vin Company Testing -Rouse Mechanical, Inc. Stack Temp. Percent CO 11348 KTel Dr. Minnet rAa, MN 55343 K ^I/"\t ?8 2 Name of Tester HEATING TEST RECORD )?1Ca `f? f P X10- ADDRESS 1/S"fhG?O a_ A-r/h t APT. FLOOR? J rTITY SU URB OCCUPANTS-' OWNER °.02'1C?:111.;ai'r7+?i?r?]tQ HEAT LOSS ATE HTG. INST. SOLD BY INSTALLED BY ; -VMAdA- X: Electrical Work By V1 A, - Gas Line By v ? k- Q1t TYPE OF HEAT GA -1sP1C HW-STEAM -SPACE HTR. -UNIT HTR. -OTHER GAS DESIGN CONVERSION MAKE MAKE OF BURNER Model Model Serial ?r Max. BTU Rating INPUT JS% A MAKE OF FURNACE Model THERMO,SfTAT ?_ Heat Plug Valve y 4 t --.?n/1- A-/-- Limit JI LA" A^ Limit Salting _? Pilot Type Pilot Make d - C r LAT Pilot Model I S7a Pilot Timing- L.W. Cut Off '?- i -Q Pressure ?'? Percent 002 r Input CFH /i Percent OZ .-Z_-Z Stock Temp. ??aF Percent CO /f - ! Vent Size KIND OF LI§ &CnilOZ SIZE " NONE Draft Hood Regulator Chimney Location \? I si a Outsida L -? Chimney Construction r lE?'Pa F?CJ tS Smoke Bomb Wiring Draft & Test Tag v_ Door Pressure Lighting Inst. Date Tested 7 -z r " Company Testing -Rouse Mechanical, Inc. 11348 KTel Dr. Minnetonka, MN 55343 Name of Tester HEATING TEST RECORD ADDRESS rJl?n^ APT.C"&)_QOR2 ,CITY yq SUBURB OCCUPANT OWNER t)n'YV,ri t?y-+ HEAT LOSS7DA-Tl F7,H TG. INST.-6O` 7 SOLD BY?71-?-1?'?'?t-?? . - INSTALLED BQ Electrical Work By Gos Line By ? n TYPE OF HEAT GA JCFA SCHW -STEAM SPACE HTR. -UNIT HTR. -OTHER GAS DESIGN CONVERSION MAKE MAKE OF BURNER Model Model Serial Max. BTU Rating INPUT MAKE OF FURNACE Model CONTROLS THERM T T12?Heat Plug Valve Limit Limit Setting Pilot Type Pilot Make Pilot Model Pilot Timing L.W. Cut Off !/ S Pressure Percent C02 Input CFH n M Percent 04 Stack P. -TEL r r Percent CO !/? !I Vent Size KIND OF LIR - IZE NONE Draft Hood LLL L7Y? R g lar - - 7 Chimney Location Itn?id aq? Outside Chimney Construction 1`-'t Smoke Bomb Wiring Draft Test Tag Door Pressure Lighting Inst. Date Tested Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. Minnetonka, MN 55343 Nome of Tester ?7 ' i `, EAT.IfN?G TEST RECORD ADDRESS I5 10A J / 01L APT OOR ?Cla SU UR OCCUPANT OWNER [.n i•r?.Oi,r HEAT LOSS W %G. INST. SOLD BY QL? f p NW? V,_\ ' INSTALLED BY P-au ?'PAC Electrical Work By M?il// Gos Line By-?-- TYPE OFF HEAT GA JCFA BMW-STEAM -SPACE HTR. -UNIT HTR. -OTHER P GAS DESIGN CONVERSION MAKE aa MAKE OF BURNER Model \?. 'O EW C Model 1 Serial Max. BTU. Rati ng 1 INPUT ?7 S,000 MAKE OF FURNACE Model THERMOrT! Valve --rQ Limit Limit Setting Plug Vent Size KIND OF LItF?R Draft Hood ?C2 SIZ ?- Pilot Type F J_ Pilot M.kvjqo?? Al _ Pilot Model Pilot Timing L.W. Cut Off Pressure 3' yL'UG" Percent C02 Input CFN S Percent OZ Stock Temp. , Percent CO pp, '21 Fi ters Size RX70X1 Number I Chimney Location f I Isir_?fde^ Outside Chimney Construction /"t 0'H'f Smoke Bomb ?- -Wiring ?- Draft Test Tag y Door Pressure a? -t Lighting Inst. Date Tested Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. Minnetonka. MN 55343 Name of Tester EAT-Iy/?-fG TEST A rlflaFff ??/? 1 r't d) •<i/ClT/yt/l, ?RECORD oT q02_.. nn. R' r?-rv.. e??a??oo 1;/ -,j OCCUPANT - OWNER I.LT1'1'1(t-+?-. l.( ?M L'Iz 'S HEAT LOSS DAT HTG. INST. n - SOLD BY f1>?-? INSTALLED BYE-77-- ?r Electrical Work By Gas Line By t?6n1Ak/ ( 'r TYPE OF HEAT GA _1GFA _HW STEAM-SPACE HTR. UNIT HTR. -OTHER AS DESIGN CONVERSION MAKE ' k MAKE OF BURNER Model Model Serial U?? T ' .-9y??+ Max. BTU Rating INPUT MAKE OF FURNACE Model r? CONTROLS THERMC T T I A r Heat Plug Valve 77 Limit G uU`-"? Limit Setting [ r Pilot Type Pilot Make Pilot Model Pilot Timing L.W. Cut Off Pressure -3 'S Percent CO2 ' -5 02 Input CFH 7.5rC)Oc7 Percent 02 Stock Temp. 4F70 "F Percent CO 83.7 Vent Si.. . KIND OF I Draft Hood !(_ I it Filters Si.. )6KZOXI Number I Chimney Location nsi e?tside Chimney Construction ha Smoke Bomb Wiring Draft (? Test Teg / Door Pressure Lighting Inst. -} Date Tested Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. Minnetonka, MN 55343 Name of Tester 4v t' 1 - ADDRESS HEATING TEST RECORD AP T. FLOOR ITY ??,?;mm?om?..,, UBURB OCCUPANT OWNER :?? HEAT LOSS DA E HTG. INST. 61 SOLD BY , V INSTALLED BY `p Electrical Work By - ,4- k!LX Pat' Gas Line By TYPE OF HEAT ? ,?FA's GA C HW - STEAM -SPACE HTR. -UN IT HTR. - OTHER GAS DESIGN MAKE MAKE OF BURNER_ --OA V Model - "i Model Serial 1 iU I g6 3?' Max. BTU Rating - INPUT 01000 MAKE OF FURNACE ?-?? CONTROLS T }'-T-- Heat Plug KO? Limit Volvo Lmit .? Limit Setting Pilot Type Pilot Make a - /11_lr- Pilot Model Pilot Timing L.W. Cut Off 4 GG t PC?o ressure I Percent CO2 - Z Input CFH O Percent OZ ? Stack Temp. 4??Percent CO 6 <Qti. Z Model Vent Size I{F?R W KIND OF L 4 - SIZE ?t NONE fS Draft Hood R.p_.larar FS2S3 Chimney Location ((In??si,d,ppe?? tside [? Chimney Construction JL'/? ?yn?? S Smoke Bomb Wiring ?wf!? Draft Z?Z' Teat Tag 6? _ Door Pressure ? Lighting Inst. Date Tested 7 4_l Company Testing - Rouse Mechanical, Inc. 11348 K-Tel Dr. M netonka, MN 55343 Name of Tester ???-' I ) H ATING TEST RECORD '+ ADDRESS ?C, ? e c. mo u [? p q APT.131 Fp CITY SUBU ? rQ? OCCUPANT ? ? OWNER -t r d ? 3'r+'re M41C ?? HEAT LOSS//?? ' ? [['--f J DATrp HTG. INST. ` ( ? _l SOLD BY ?SL ( 1 - INSTALLEDg+ [S? S6.ld?'. ?IIC-. Electrical Work By (r ott / Lr- Gos Line ByVM A.,o IL _ WP TYPE OF HEAT GA A-Fi? ?HW STEAM SPACE HTR. -U NIT HTR. -OTHER GA. DESIGN ONVERSION MAKE MAKE OF BURNER Model _ Model Serial Max. BTU Rating , INPUT MAKE OF FURNACE Model O CONTROLS I(f THERM AT F Heat Plug Vent Size_ Valve 0 i't (4 111-- KIND OF LI R SIZE?'?5? _ NONE Limit Draft Hood ?YL Regularor Limit Setting Filters Size Z6)L Number ?? - Pilot Type urU41 Pilot Make Pilot Model Pilot Timing L.W. Cut Off 6 Pressure '? ? LkXZ- Percent CO Input CFH LLB Percent O--79O Stack Temp. 1 I Percent CO'. 6 58 Chimney Construction Smoke Bomb Wiring /+ Draft `? Test Tog Door Pressure Lighting Inst. Date Tested A - 7:8 Company Testing -Rouse Mechanical, Inc. . 11348 K-Tel Dr. ,Minnetonka, MN 55343 ) Name of Tester «< -?NH' ? EAT l ING TEST RECORD JJ??•• ADDRESS /J?? ^ ?T'J r 4 ? 1 gg _- ..{?t AP2Tr ,.? FLOOR ? ITYSUBURB OCCUPANT f OWNER i HEAT LOSS DAT HTG.-INST. SOLD BY 'e ' INSTALLED BY Electrical Work By 9 yr Vu f Gas Line By TYPE OF HEAT GA - -VFA IGW_ STEAM SPACE HTR. UNIT HTR. OTHER GAS DESIGN CO VERY ON MAKE .9 MAKE OF BURNER f Model ?'7 F,? UF n ( Model Serial -5 /Q/' - FLV-7 Max. BTU Rating INP IT inC-X ? MAKE OF FURNACE Model CONTROLS att •r V ?S THERM STAT Heat Plug Vent Size t Valve KIND OF LIN R fAS SIZE '? Syr NONE ?- ' Limit Draft Hood Regulator ' Z ! '-3 L Limit Setting IF Q Filters Si.. Lb1C Z0 A'? Number Pilot Type L? ? lJ XA a Pilot Make RLr ? 7 ? Pilot Model ?1"??J `?- Pilot L.W. Cut Off y Pressure -= Percent CO Input CFH 1`'F Q? Percent OZ ' Stock Temp. Percent CO 0 I'A 9 _A;s 9- Chimney Construction Smoke Bomb Wiring V Draft 6NXJ?Test Tog J Door Pressure ?i Lighting Inst. Date Tested Company Testing - Rouse Mechanical, Inc. 11348 KTel Dr. Minnetonka, MN 55343 Name of Tester A A - G _ ATING TEST RECORD 2r` , ESS /J 10 ' ADD ?'?/)7 I Y11) I `r R APT. LOORtLC TY SUU URB OCCUPANT 'r Q-c....?.?111 ([`,Iw 4'L!1 OWNER HEAT LOSS A, //DAT HTG. INST. ? -?7 SOLD BY JT'I.f%)0_ M?C INSTALLED BY r7 y'}7.L0? -?i Electrical Work By P C 1.dJl?U pc- Gas Line By 64.:,_0& TYPE OF HEAT GA ALFA !?n'_HW - STEAM SPACE HTR. -UNIT HTR. OTHER GAS ESIGN V SION MAKE MAKE OF BURNER Model Model Serial ?10 -,P 7 - Max. BTU Rating INPUT MAKE OF FURNACE Model CONTROLS rf .? THERM T T 7 Heat Plug Vent Size _ Valve KIND OF INR NONE Limit - ' -/" Draft Hoo- Regulator 23 z? 3 Limit Setting 1 pL __? - _ _ _ Filters Size Number Pilot Type Pilot Make Pilot Model ?J Pilot Timing L.W. Cut Off n Pressure Percent COT Input CFH '?? Percent 0 2 (O J O 4? Stock Temp Percent CO 0 Chimney Construction Smoke Bomb -ice Wiring Draft .O? Test Tag Door Pressure Lighting Inst. Date Tested Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. Minnetonka, MN 55343 Name of Tester -,?. HEATING TEST RECORD _rA ADDRESS )610 QYYkr.? Pa-c t.f APT.3FLOOR CITY SUBURB 21.1 OCCUPANT OWNER (t s..-? DY1- iii' A HEAT LOSS ?DATFr HTG. INST. SOLD BY b7n AA-0 gw -rAn INSTALLED BY a14-?--0 Electrical Work By f&eQ e"ikPA "fl°. Gas Line By _ 1I1.A.Q_Q_. "'pol-N 1 TYPE OF HEAT GA _Z?FA 4?HW STEAM-SPACE HTR. UNIT HT-R. OTHER GAS DESIGN CO VERSION MAKE _ MAKE OF BURNER Modal - Model Serial 3 I g7- 0 Z- Max. BTU Rating _ INPUT MAKE OF FURNACE Model Valve L Limit Setting CONTROLS - Heat Plug r /. ? 14 ?V Vent Size - KIND OF LIN R SIZE -err NONE Draft Hood 0.-1 Regulator Filters Size 1n -OX I Number Pilot Type Pilot Make Pilot Model Pilot Timing s L.W. Cut Off Pressure R C4 4 Percent CO Input CFHPercent OZ Stack Temp, Percent CO 07.6 Chimney Construction Smoke Bomb Wiring 41? Draft Test. Tag L, _ Door Pressure ?f Lighting Inst. Date Tested Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. Minnetonka, MN 55343 Name of Tester EATING TEST RECORD ADDRESS 10`{'h=on' o - `APT. FkOOR CITYA?SUBURB OCCUPANT OWNER HEAT LOS DATE HTG. INST. C?-?7 n 5 0 L D BY 'PM /.dQ =' INSTALLED BY 9'C PSI.ao o S`- u7f Electrical Work By Waa 0 ?' - Gas Line By CI L .a `%I, TYPE OF HEAT GA-1L?A &-?'HW STEAM SPACE HTR. -UNIT HTR. -OTHER J? GAS DESIGN CONVERSION MAKE ag MAKE OF BURNER Model Model Serial ?`?•?3n?Dy? t'/7f6 / -??Q? Max. BTU Rating INPUT 4.5 '? MAKE OF FURNACE Model CONTROLS ?f' THERMO TIT _ Heat Plug Vent Size _ Valve t KIND OF LI R SIZE S r NONE Limit Draft Hood /?h Re_gule.ar 7,S3 -' YMUA44r4tQ-V1 Limit Setting I 0 Filters Size ?(rrC2c?X f Number Pilot Type r?'t^" ?•?- Chimney Construction (r [LRAU-f Q VL 41-' 1 Pilot Make b effl L/<T- Pilot Model 7c74 - Smoke Bomb .-? Wiring Pilot Timing Draft Test Tag L.W. Cut Off ?- Door Pressure Lighting Inst. l l 7ry? c/? Pressure J Percent COZ J < Date Tested !I'z-7-d / Input CFH Percent OZ 7 Company Testing - Rouse Mechanical, Inc. Stock Temp. Percent CO CL) 11348 KTel Dr. innnnetonka, MN 55343 9yt S Name of Tester r 1 /_? E_TIN TEST RECORD ADDRESS ' ` C)APT. FLOOR 3- ITY TSU URB OCCUPANT OWNER j HEAT LOSS[ ? DATE HTG. INST. ??g7 n SOLD BY Tom' r? INSTALLED BYE PC A U a 0 Electrical Work By Pek- xeA- e%ok • Gas Line By 'Al TYPE OF HEAT GA LFA ?HW -STEAM SPACE HTR. -UNIT HTR. -OTHER G' S DESIGN !VERSION _K0 00,4v MAKE MAKE OF BURNER 0 Model `) Model Serial R7 Maz. BTU Rating INPUT MAKE OF FURNACE Model \ CONTROLS \ THERMO TAT '6rr,, r1T~Heat Plug Vent size 'y-S?0 Valve KIND OF LIN R ?SIZENONE Limit Draft Hood L IU;Y _Ragularor 3z Limit Setting Filters Size ZO X t Number Pilot Type kk,?(trt?v? ? Pilot Make 11p Avnat/rte Pilot Model ?,5' 7/ a Pilot Timing ? L.W. Cut Off Pressure 3,?S,'/r'yf p PercentCO2 _E?2?J t O Input CFH Percen Z cpb Stack Temp. Percent CO 50, 7 Chimney Construction Smoke Bomb Wiring Draft - Test Tag Door Pressure •? Lighting Inst. y Date Tested -7' C- 2- 9-? Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Or Mi n on a, MN 55343 Name of Tester ,\ j I,, /n_ HEATING TEST RECORD ADDRESS 1510 i`om?-L?'- APT. 3140 F)/ OR ??CITY UBU OCCUPANT -' - OWNER 1 ? B HEAT LOSS DATE HTG. INST. SOLD BY INSTALLED BY ISI! A 0 a C' Electrical Work By Gas Line By 0<a-M4 2"-e C ^ TYPE OF HEAT GA!vFA HW-STEAM -SPACE HTR. -UNIT HTR. OTHER GAS DESIGN CO VE SION MAKE J9100 ?A -) MAKE OF BURNER Model - ?r- '.C Model Serial '31 10 Max. BTU Rating INPUT MAKE OF FURNACE Model CONTROLS _/i THERM T.AT tT Heat Plug Vent Size / _ <CI' - Valve ? ]`CJ <+7 KIND OF LINER SVF 5 r NONE Limit )-tMNA'41 A ?_) 0 u Draft Hood (!WiX 6-y''N RegulUTor Limit Setting Pilot Type t Pilot Make Pilot Model '- / Pilot Timing L.W. Cut Off cps /? Pressure Percent CO2 C Input CF O 9 Percent 0 Stack Temp. 71f15 Q 2 Percent CO Filters Size Chimney Construction Smoke Bomb Wiring Draft 64,Z90 C( Test Tag Door Pressure Lighting Inst. Date Tested I"C / - Company Testing -Rouse Mechanical, Inc. 11348 KTel Dr. Minnetonka, MN 55343 3 J,d Name of Tester HEATING TEST RECORD I ADDRESS 616 - y/ /,, mal C_)e ICI '-?-t-?fJ 0 n LC7 APT. L00 ?CI T? )L SUBUR 9? OCCUPANT l , _rL _ OWNER '- HEAT LOSS, J ATE TG. INST. SOLD BY 1 1 e ? t INSTALLED BY fTLt,A aa0 Electrical Work By ?9 21.W_4 Qr - Gas Line By L -- •On -1 TYPE OF HEAT GA FAC?HW - STEAM SPACE HTR. -UNIT HT-R. -OTHER t /? // GAS DESIGN N ERSION MAKE K- ? MAKE OF BURNER ? / ? J Model Model // Serial (9? 7 //,, 0b"I '1Sg7- Max. BTU Rating INPUT s"?Y t?r` ? MAKE OF FURNACE Model CONTROLS THERMO T T Heat Plug Vent Size Volvo KIND OF LI R SIZE NONE Limit Draft Hood Regulator Limit Setting Filters Size MX Number Pilot Type Pilot Make Pilot Model Pilot Timing QS-`-r L.W. Cut Off _- Pressure J' s a! Percent C02 Input CFH?Percent OZ O Stack Temp. Percent CO Chimney Construction -- Smoke Bomb?? -j Wiring Draft 6Z; ' Test Tag Door Pressure Lighting Inst. Date Tested Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. Minnetonka, MN 55343 e- Name of Tester /' KE A TING TEST RECORD ADDRESS 15l0 ' ' ` ?Q? r , A, •? APT. FLOOR TCI/ SUB RB OCCUPANT ?^ - OWNER 1n ?M .frntP , rn? HEAT LOSS i? DATE 4TG. INST. ? SOLD BY 071-0 O i/X"? _ INSTALLED BY -? ^ Electrical Work By Q - Gas Line By KIDAAS= S-On A TYPE OF HEAT GA jLFA r---'HW STEAM SPACE HTR. OTHER UNIT H _ - - . - GAS DESIGN CO VERSION MAKE _ MAKE OF BURNER Model Model Serial - g8?- Max. BTU Rating INPUT - MAKE OF FURNACE Model ?F CONTROLS ? 4 - THERMO A _ Heat Plug Vent Size Val re 0 rn1l, -0 KIND OF LI R SIZE NONE Limit _ 17M Ct Z 1A 0,9 Draft Hood Or Regularor'?- Limit Selling _, Filters Size fbY?ADX ) Number Pilot Type 1 Chimney Construction M42;A y p qd? Pilot Make ?l1lnt '100.0 Pilot Model Smoke Bomb .? Wiring Pilot Timing ??..6G "• Draft Test Tog L.W. Cut Off t- Door Pressure p Lighting Inst. -z7?07 Pressure 3'6rrWr- Percent CO?.?, -Y??d? Date Tested Input CFH-?S/OCX? Percent 02-7- - Company Testing -Rouse Mechanical, Inc. Stock Temp,'` 0 f` Percent CO -?D 45 / Name of Tester 11348 KTel Dr. Minnetonka, MN 55343 kA- HEATING TEST RECORD ADDRESS APT. FLOORITY UBURB !d.Y1LL1 OCCUPANT OWNER 4 )n020 rm &/I_VI!(ie. uA HEAT LO5?}?--?-? DAT }} HTG. INST. 62- ?/'/? A SOLD BY TCl7l A-4)_Q lM wrln n INSTALLED BY !/?/J?1-C7 D lOr' Electrical Work By eQn?' a I?_.( Gas Line By WIT7.(Ao_a 'a,-O TYPE OF HEAT GA JGFAZ HW -STEAM -SPACE HTR. -UNIT HTR. -OTHER GAS DESIGN MAKE MAKE OF Model D Model _ Serial l q _4159 7 / Max. BTU INPUT 5? MAKE OF Model I CONTROLS THERM T.AT Heat Plug Vent Size ?r' Valve 6bL'P r 1?X /.C 1- KIND OF LIN R SI Limit Draft Hood c-n Regulator Limit Setting ! ?Ll Filters Size r xI Number Fan-Settinc-l ?- -Chimney Location ..Inside C? ONE pe L - ot? Pilot T A_Ce2TV Chimney Construction R 11929? y Pilot Make Pilot Model Smoke Bomb Wiring Pilot Timing Draft Test T g ! L.W. Cut Off Door Pressure Lighting Inst. ?l Pressure E-5 Percent C02 Dote Tested v `z -7 a 7 Input CFH S ['QD Percent O2 Company Testing - Rouse Mechanical, Inc. Smock Temp. Percent CO 11348 KTel Dr. Mi netonka, MN 55343 ?7 p7-7 Name of Tester BURNER Rating _ FURNACE 1(('',?J HEATING TEST-R??E/CORD ? ADDRESS ??I? M A - tam APT.314/1511c OR _ CITY UBURB ?}---? OCCUPANT OWNER L AZ HEAT LOS?DA?ITE HTG. INST. SOLD BY ??t-La-e • n INSTALLED BY -f Q p `P? Electrical Work By rVE U EC Gas Line By -C TYPE OF HEAT GA __4?FA ?HW STEAM-SPACE HTR. UNIT HT-R. OTHER GAS DESIGN CONY RSION MAKE MAKE OF BURNER Model r Model Serial o4 -EI8 - Max. BTU Rating INPUT '?SiG?Gb MAKE OF FURNACE Model CONTROLS THERMO AT Heat Plug Valve Limit L44 jp-" Limit Setting _ Pilot Type .1 L'If Pilot Make r Pilot Model Pilot Timing L.W. Cut Off G Pressure 3 "? Percent COZ Input CFH Percent OZ Stack Tempe Percent CO ?O 40O 98.Z q n r Vent Size ? KIND OF LI R NIQ &t& _151 SIZE Z f ``NONE Draft Hood Iffet CEO Regularor Filters Size &)XZQ I Number I Chimney Location jrpideOu)s ide Chimney Construction ! 1 c?-/rY r r--/ w? C Smoke Bomb _ Wiring Draft Test Tag / Door Pressure- Lighting Inst. y Date Tested Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. Minnetonka, MN 55343 e q Name of Tester l JI - EATING TEST RECORD ADDRESS I,5 y-4jma6 L A e ( MSC APT.36FLOOR CITY%; SUBU B OCCUPANT OWNER(?p?'1?-Q/t,« HEAT LOS DA E HTG. INST,Lly ?//? SOLD BY ?'71.A0 l ax n INSTALLED BY -1+!»4" M•A^ Electrical Work By t IAPA Gas Line By -KmrA--Q- ?nJ TYPE OF HEAT GA CFA L__ IW -STEAM-SPACE HTR. -UNIT HTR. -OTHER GAS DESIGN MAKE MAKE OF BURNER _ Model Model Serial _ 663 Max. BTU Rating INPUT 7S,C1?? MAKE OF FURNACE Model '_'FF^?, CONTROLS THERMOPTAt?2? Heat Plug Vent Size Valve `-' KIND OF LIN R SIZE NONE Limit Draft Hood Ch Regulator ?ZS_3 t Limit Setting ? Filters Sire _ 14471U I Number Fan-Setting- Chimney Location Inside t/side {{ Pilot Type C. ^- ? - Chimney Canstruc*'on ?- Pilot Make Pilot Model Smoke Bomb ? - Wiring Pilot Timing Draft ls'+ Test Tag / L.W. Cut Off Door Pressure Lighting Inst. ?? P D d -7 T - 1 - d Pressure - ercent COZ ate este Input CFH 5,660 Percent OZ 7-69c, Company Testing - Rouse Mechanical, Inc. Stack Temp. Percent CO 11348 KTel Dr. Minnetonka, MN 55343 Name of Tester kil - HEATING TEST RECORD ADDRESS APT.?L1?l_OOR TY? UB?URB? OCCUPANT OWNER V UPjT1 HEAT LOS DAT HTG. INST. SOLD BY f 2, INSTALLED BY Electrical Work By V--t& .t"A Gas Line By yt'1Q? TYPE OF HEAT GA Le_. a -HW -STEAM SPACE HTR. -UNIT HTR. 11 JOTHFR GAS DESIGN MAKE MAKE OF BURNER _ Model Model Serial 3 _ Z- Max. BTU Rating _ INPUT t MAKE OF FURNACE CONTROLS Hear Plug Valve ?IW?J Limit _.h Limit Setting Pilot Type- Pilot Make nC g a-r- tModel J?1« Pit, Pilot Timing L.W. Cut Off cJ t I Pressure Percent C02 Input CFH Percent Oz Stack Temp. Percent CO Model 4f ?- Vent Size KIND OF LINER Draft Hood -101 Filters Size Chimney Location Chimney Construction A E Smoke Bomb Wiring y Draft (6FOTest Tog ?l Door Pressure Lighting Inst. Date Tested Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. Minnetonka, MN 55343 Name of Tester / HEATING TEST RECORD 1.1 ADDRESS 1510(lY1'ICbO ??(. • APT. LOOR?-?y? TY UBURB OCCUPANT "- OWNER !,U HEAT LOSS?,??' DAT HTG. INST. SOLD BY gU.u?Y-r a..(-C& ' INSTALLED BY Electrical Work By .L _(.(A" X1-r Gas Line By QLLA ? ?o aA, TYPE OF HEAT GA A HW -STEAM SPACE HTR. -UNIT HTR. -OTHER n GAS DESIGN CONV RSION MAKE ?/ J044M: MAKE OF BURNER Model )?6D1AV-10C-0^6?, Model Serial AAj3Dio4•-F1(pg7-/z-77 Max. BTU Rating INPUT )MADE) MAKE OF FURNACE Model Valve Limit Limit Setting P CONTROLS Heat Plug Pilot Type Pilot Make Pilot Model c, JJ -7 Pilot Timing L.W. Cut Off Ir Pressure S ? Percent COZ Input CFH Percent 02 Stack Temp. Percent CO 97I5 . n r , tr Vent Size T KIND OF LI R Iff 841&1 SIZ Draft Hood ii Regularor _ Filters Size Number_ Chimney Construction Outside E Smoke Bomb ?- Wiring Draft Test Tag Door Pressure Lighting Inst. Date Tested Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. Minnetonka, MN 55343 Name of Tester HEATING TEST RECORD /rn? ADDRESS ??,?- APT.?z1?E1 ?LO?OR ?ITY SUBURB OCCUPANT _ OWNER +'o?ylnw?t?sn?Tl?iA11 HEAT LOSS v AT HTG. INST. 19-6 / SOLD BY 2] 'Pr _ INSTALLED BY t' Electrical Work By -o l.f.lDif 17 _- Gas Line By TYPE OF HEAT GA ?F-?_HW -STEAM -SPACE HTR. -UNIT HTR. -OTHER -_ Ap,?? ?n? _ GAS DESIGN ON ERSION MAKE ?s CV/f'tF MAKE OF BURNER Model Model _ Serial Max. BTU Rating INPUT ?? ?? MAKE OF FURNACE Model ONTat Pl ?fy ??/ THERMO TAT Heat Plug Vent Size Valve Lz1 KIND OF LINER SIZE r? NONE Limit Draft Hood 1? Regulator 3z s'3 Limit Setting Filters Size 8 '? Number Pilot Type Pilot Make Chimney Construction Pilot Model ^ ` _ ` Smoke Bomb Wiring ?? Pilot Timing ?4 .)V/ Draft ???Test Tag L.W. Cut Off ?( qq Door Pressure Lighting Inst. Pressure ?'S Percent COZ? ???1 66?.E? Date Tested ??-y7 Input CFH_ 5;5 ,OO Percent 0 __I_ Company Stack Temp. r Percent CO Testing -Rouse Mechanical, Inc. 11348 KTel Dr. in etgnka, MN 55343 Name of Tester ff/T 1?ro ' HEATING TEST RECORD I ADDRESS f1 6 h?1Q.4 D APT FLOOR $ CITY B R11 , . U U OCCUPANT OWN E + ?(?7L,[) HEAT LOSS f?TG. INST. ATE SOLD BY j INSTALLED BY Electrical Work By O - A4 Gas Line By K (n/VQ._QN...P TYPE OF HEAT GA . FA _HW STEAM SPACE HTR. -UN IT HTR. OTHER GAS DESIGN C NV RSION MAKE MAKE OF BURNER Model Model Seriol Max. BTU Rating INPUT lS? MAKE OF FURNACE Model J ?-CONTROLS ? rrJ n s THERMO AT Heat Plug Vent Size Volvo KIND OF LI R NONE_- SIZ ? Limit Draft Hood r egularor Limit Setting Filters Size Number LAS a?- Pilot Type ?d?a?fli?.'?C Chimney Construction ".4-1ay?QQ„4 LN Pilot Make Pilot Model Smoke Bo Wiring Pilot Timing Draft n?U -Test Tog L.W. Cut Off ?- Door Pressure Lighting Inst. Pressure '3j? ,'G? •<? Percent COY Date Tested 3 Input CFH J? Percent OZ Company Testing -Rouse Mechanical, Inc. Stack Temp. 3 Percent CO C3% 11348 K-Tel Dr. Minnetonka, MN 55343 Name of Tester I HEATING TEST RECORD 'y'-I' / ADDRESS 1510 111.6Y (w (_ ? f CJ APT. LOOR- ITY SUBURB OCCUPANT OWNER YY?C9 ,{M ?w HEAT LOS DAT HTG. INST. _ _ SOLD BY AiQp a ? - INSTALLED BY Electrical W rk By fYT Gas Line B `-" Y TYPE OF HEAT GA _ FA _HW -STEAM -SPACE HTR. -UNIT HTR. OTHER ?--{-? n _ GAS DESIGN NVERSION MAKE linf MAKE OF BURNER Model Model Serial W7 ?L'1-573 Max. BTU Rating INPUT Ono MAKE OF FURNACE Model CONTROLS ? y P THERM TAT 1 - Heat Plug r Vent Size Valve KIND OF LINER?? SIZE 5 NONE _' Limit _ Draft Hood Regulator 3 }? 5-- ? Limit Setting Filters Size - Number - Fan-Setting Chimney Location ,yInsi Outside Pilot Type f ly Chimney Construction Mc Il h`i O.[1?II1 ? Pilot Make / Pilot Model Smoke Bomb ? Wiring Pilot Timing - ? Draft r Test Tag L.W. Cut Off Door Pressure Lighting In st. P Z ressure - Percent CO2 Date Tested Input CFH Q 0 Percent 02 r Company Testing - Rouse Mechanical, Inc. Stack Temp. Q Percent CO ?D 11348 K-Tel Dr. Minnetonka, MN 55343 <„ Name of Tester t r AGREEMENT THIS AGREEMENT, entered into this 1V - day of , 1986, by and between Thomas Lake Housing Associates, a Limited Partnership, a Minnesota limited partnership, hereinafter referred to as "Owner" and the City of Eagan, hereinafter referred to as "Eagan". WHEREAS, Owner owns in fee simple the following described real estate: i Lot Six (6), Block One (1), and Lot One (1), Block One (1), Thomas Lake Pointe, Dakota County, Minnesota. WHEREAS, Owner has obtained certain approval for development of said parcel by the Planning Commission and the City Council of the City of Eagan pursuant to plans and specifications submitted to Eagan, and WHEREAS, the City of Eagan desires that the above two lots be taxed and assessed jointly and severally for all of the real estate taxes and special assessments, if any, and Eagan also desires the same use limitations for both parcels to be construed jointly. NOW THEREFORE, for good and valuable consideration, the parties hereto agree as follows: That Lot 6, Block 1, Thomas Lake Pointe, and Lot 1, Block 1, Thomas Lake Pointe, Dakota County, Minnesota, will be assessed for all real estate taxes and improvements and that both parcels will be jointly and severally responsible for all real estate taxes and soecial assessments, if any, which may now be due or become due and that said two lots will be assessed and taxed as one, and that the taxes and assessments for! Lot 6, Block 1, Thomas Lake Pointe, shall act as a lien upon and be enforceable against Lot 1, Block 1, Thomas Lake Pointe. That Lot 6, Block 1, Thomas Lake Pointe, and Lot 1, Thomas Lake Pointe, Dakota County, Minnesota, will separated at any future time. DATED: 1 QLA ' Q ATTEST: Asa- Its er Block 1, not be CITY OF EAGAN is Mayor THOMAS LAKE HOUSING ASSOCIATES a Limited Partnership, a Minnesota Limited P tnership BY: Ja/rlc W. S fa It's:- General a tner , STATE OF MINNESOTA) ss. COUNTY OF O?KOT1?) On this 1'1} day of Q.Cl.v 1 1986, before me a Notary Public within and for said County, personally appeared Beatta Blomquist and E. J. VanOverbeke to me personally known, who being each by me duly sworn, each did say that they are respectively the Mayor and Clerk of the City of Eagan, the municipality named in the foregoing instrument, and that the seal affixed to said instrument was signed and sealed in behalf of said municipality by authority of its City Council and said Mayor and Clerk acknowledged said instrument to be the free act and deed of said municipality. -tiwmecow>N - ---------------- PYKSTRA 11,`,t?(&tYIE8 -MINNESOTA ?9 DAKOTA COUNTY My Commission Expims &pl.8,1880 . I a. C4? / Notary Public STATE OF MINNESOTA) ) ss. COUNTY OF N ) On this /VT day of _7jpue_M,k_,t, 1986, before me a Notary Public within and for said County personally appeared Jack W. Safar to me personally known, who, being by me duly sworn to be the General Partner of the Limited Partnership named in -the foregoing instrument was signed on behalf of said General Partner of the Limited Partnership by said individual and he acknowledged said instrument to be the free act and deed of the Limited Partnership. S E A L /,.?"? WENDY J. STEINMETZ NOTART PUBLIC • MINNESOTA HENNEPIN COUNTY MY Commisrbn E>tpYw BEa. 1B,1wo Notary Pu i j \ r• n ?i y ii 49 •;jt • x }?el'???urw P n. l? I S f? I1°8' .. It. I THOMAS LAKE ft Poiwirt _ _ihi?ax s I f' I sx J'.4s A..ner• ? B x C E t P N ? O 8 T e .r- ; I ' x/520 \ , 'x/530 a ? ?'. B S I A d/?: V A xN xy. - ..>m •..•6em .-.y ..1? ^i ?'? ? ' ? `? ?? ___ ? ? Cdr '?. d ,' i A ? f-` ? aa°'?m • :n `' 40 C y_,__ 4H ? 4 A' ±? ¢L ? Ot ?,. ?''• ? P, A ?^? ?4e-eWem Le n:r•r DUTi' 0 ?•m e. 1 e?'arn. >r win \ ?? IUI .. ...em._ O 89 THOMAS 1 g 9 k LAKE _ c LAKE a .• e _ :\ I P IiD r_? 10C-L I LCJ--e 2004 COMMERCIAL BUILDING PERMIT APPLICATION City Of Eagan 3830 Pilot Knob Road, Eagan Mn 55122 Telephone # 651-675-5675 FAX # 651-675-5694 • Structural Plans (2) se' • Civil Plans (2) • Certificate of Survey (1) • Code Analysis (1) " • Project Specs (1) • Spec. Insp. & Testing Schedule " • Soils Report (1) • Meter size must be established 1 L 1 1 1 1 • SAC deteuninahnn - rail RR1-fin9-l non • mrcrmemurai rians • Structural Plans • Civil Plans • Landscaping Plans • Code Analysis • Certificate of Survey • Spec. Insp. & Testing Schedule • Meter size must be established • Project Specs • Energy Calculations • Electric Power & Lighting Form • Master Exit Plan • Emergency Response Site Plan • Soils Report (2) sets • Architectural Plans (2) sets (2) • Code Analysis (1) " (2) • Project Specs (1) (2) - Key Plan (1) (1) " • Master Exit Plan (1) (1) • Energy Calculations (1) not always" (1) " • Elec. Power & Lighting Form (1) not always- - Meter size must be established-if applicable (1) (1) (1) Call MN Dept of Health at 651-215-0700 for details regarding food & beverage or lodging facilities. Contact Building Inspections for sample and if required when it states "not always". Permit for new building or addition will not be processed without Emergency Response Site Plan. 1, c r, LI n 7 r ,VV . -1tD" Date 3 / 12- / U Construction Cost e--tG / Site Address S /O Tf/o s L /-?F /?T ?d Unit/Ste # ?t Tenant Name l Mo?._J 1a ?_e Former Tenant Name Description of Work TC / o ?Y / /e_C moo T u3 r`.- i Z V 7/ // +*? Ser Property Owner 00 uH • ?: f, -? ?1gr...N4- I Telephone # ( ) Contractor Address :F0 ??. ! 72V C Sr r l G S,0,3 City L r'4- / State Yt I N Zip S3_11_7 Telephone # (Cori `/P;;? -O y _7fJ ?f'I nl LFC ?` av3.?o3/8 Arch/Engr Registration # Address City State ?• Zip Telephone # ( ) Licensed plumber installing new sewer/water service: Phone #: I hereby apply for a Commercial Building Permit and acknowledge that the information is complete and accurate that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of ND Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without : permit; that the work will be in accordance with the approved plan in the case of work which requires a review an( approval of plans. / 2/1 U 16Z Applicant's Printed Name Applicant's Signature OFFICE USE ONLY Sub Types ? 01 Foundation C 26 Public Facility 30 Accessory Building ? 14 Apartments ;] 27 Commercial/Industrial 32 Ext Alt-Apartments ? 15 Lodging ? 28 Greenhouse ? 34 Ext Alt-Commercial C 25 Miscellaneous D 29 Antennae 35 Ext Alt-Public Facility C 37 Nail Salon Work Types ? 31 New ? 32 Addition ? 33 Alteration ? 34 Replacement Valuation A 000 Census Code SAC Units Nbr. of Units Nbr. of Bldgs - Type of Const ? 35 Int Improvement ? 38 Demolish (Interior) ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 37 Demolish (Bldg)' Er'13 Reroof 'Demolition (Entire Bldg only) - Give PCA handout to applicant Occupancy f) °A Zoning Stories Sq. Ft. - Length Width Required Inspections Footings (new bldg) Footings (deck) Footings (addition) _ Foundation Drain Tilei Roof „/ Ice Pr _ Decking _ Insul _ Final Framing Fireplace - R.I. -Air Test -Final Approved By: Base Fee Surcharge Plan Review MCES SAC City SAC Water Supply & Storage SAN Permit S/W Surcharge Treatment Plant Park Dedication Trails Dedication Water Quality Copies Other Pool _ Ftgs _ Air/Gas Tests - Final Siding _ Stucco _ Stone Windows Planning /)?4 Building Inspector '713,7-:5r_ q0. 00 MCES System City Water Booster Pump PRV Fire Sprinklered ? 44 Siding ? 45 Fire Repair ? 46 Windows/Doors i Insulation Final/C.O. FinaVNo C.O. Other Total 753. ?? 1986 BUILDING PERMIT APPLICATION - CITY OF EAGAN NOTE: ALL CONTRACTORS MUST BE LICENSED WITH THE CITY OF EAGAN SINGLE FAMILY DWELLINGS INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEY, 1 SET OF ENERGY CALCULATIONS MULTIPLE DWELLINGS - RESIDENTIAL INCLUDE 2 SETS OF PLANS, CER 1 SET OF ENERGY CALCULATIONS COMMERCIAL RENTAL UNITS 48 FOR SALE UNITS OF SURVEY - CHECK WITH BLDG. DEPT., INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS, 1 SET OF SPECIFICATIONS AND 1 SET OF ENERGY CALCULATIONS, J $2,000 LANDSCAPE BOND To Be Used For: APT.ELn(a. Valuation: $ 1,375,000 Site Address 1510 Thomas Lake Pointe Lot 1 Block 1 Parcel/Sub 1I 0"k5 1-,64« Poi N7C Owner Thomas Lake Housing sGjQQjatQB j p, Address 3140 Har r ane _ City/Zip Code Minneapolis AIN 55441 Phone (612) 559-1711 Contractor Domain Constructors Inc_ Address City/Zip Code Minneapolis. DIN 55441 Phone (612) 559-1711 Arch./Engr. Johnson. Sheldon & Sorensen Address 10249 Yellow Circle Drive City/Zip Code Minnetonka- MN 1,9943 Phone 4 (612) 935-6337 Date: 11/18/86 Erect ? Occupancy R I 6 1 Remodel Zoning ?C> Repair Type of Const Q I HK •/[[N Addition # of Stories 3 Move Length 3io Demolish Depth 611 Int.Impr. Sq Ft L3,ioo Install APPROVALS FEES Assessments Permit 3610.so Water/Sewer Surcharge (050. Police _ Plan Review I5to -, Fire SAC 2-L, 540, Engr Water Conn l 7oo_ Planner Water Meter N/A Council Road Unit 131. Bldg Off/ . _? Treatment Pl 6 Iz APC Parks Variance i Copies TOTAL o L14i.75 P NK' NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR /HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED. PeP-M1T I oo, coo I.7- "75,Oc:>o 4;ur?cH-tNRC,C 433 12'75xZS= 3i37.? 36 2D, SO 5(90 + ( .ocn 4-x 3'15,oc%? _ (o Jo (?AfJ ?l-"tl1 £tr1 2S '?Co 2D . So - 2 = I ? 10. 5a c 4?C? X 49 = Zz,s4a WAC 4cx::, ?C 4 8 M ?TEa2 ?A 'I?oap 19,2co 23Z K 48 = 11, 1°-? G T PL 12S X 4`i = ?IZS 3rcz.o , So torso, (alo is ZZ 5 4 I (, 200 11,13 l?lz5 1986 BUILDING PE CATION - CITY OF KAGAN NOTE: ALL CONTRACTORS MUST BE LICENSED WITH THE CITY OF EAGAN SINGLE FAMILY DWELLINGS INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEY, 1 SET OF ENERGY CALCULATIONS MULTIPLE DWELLINGS - RESIDENTIAL RENTAL UNITS _,Y_ FOR SALE UNITS INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SURVEY - CHECK WITH BLDG. DEPT., 1 SET OF ENERGY CALCULATIONS INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS, 1 SET OF SPECIFICATIONS AND 1 SET OF ENERGY CALCULATIONS, $2,000 LANDSCAPE BOND To Be Used For:T14LL^ kj?/-. Perw,?-Valuation: Date: 11-13- Site Address 151o THoKA!, LK. aN7EI OFFICE USE ONLY Lot 1_ Block % Parcel/Sub -THoMf\5 LK r0lN7t- Owner R' Qw ye, l yl<< ? osj? ?Fss . L. P. Address .31V-t, Nnr?6?? Ca?? City/Zip Code ??M rnok1?, M v- SSVV/ Erect ? Occupancy Remodel Zoning Repair Type of Const Addition # of Stories Move Length Demolish Depth Int.Impr. Sq Ft Install Phone (ol ? -- C5?3- //17 // Contractor Uuvr yNk COnS)ru(Avns,T?Qc . Address 3114o 6?v uK C o-+.c City/Zip Code 64Y^ ,x , NK), Ss?r?l Phone (011_- SS? /71 l Arch. /Engr.30?nsnn-S?\e 1?1cr?So:?nyc? Address (O Z99 Yclluw Grc(r t)r City/Zip Code UY1inN:+u..ka VY)N. S ; 3V? Phone 11 el 3S (0 3 311 APPROVALS FEES Assessments Permit Water/Sewer Surcharge Police Plan Review Fire SAC Engr Water Conn Planner Water Meter Council Road Unit Bldg Off Treatment P1 APC Parks Variance Copies TOTAL ?S R NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR /HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED. 1993 PLUMBING PERMIT (COMMERCIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN MN S5122 (612) 631-4675 PLEASE COMPLETE FOR ALL COMMERCIALINDUSTRIAL BUILDINGS. ALSO FOR MULTI- FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH DWELLING UN-7. NEW CONSTRUCTION ADD ON REPAIR WORK DESCRIPTION: N? ?? 3 PASS"?` ?.y ' l 4? CONTRACT PRICE: $ FEE: 1% OF CONTRACT FEE. STATE SURCHARGE: $.50 FOR EACH $1,000 OF PERMIT FEE. MINIMUM FEE: S 25.00 .... ........ CONTRACT PRICE X 1% STATE SURCHARGE TOTAL $ C)?5. So SITE ADDRESS: )S!O us G. Zc TENANT NAME: /dry/?S /N?l L, zu /251- STE. # OWNER NAME: INSTALLER: SPz i??os . G ADDRESS: ?? 7 Z 6 J- '_? CITY: STATE: ZIP CODE: s 53/? PHONE #: , ?- 4, L FOR: L), a L CITY OF EAGAN ?1-,7 45;_,?Idw PLEASE COMPLETE FOR SINGLE FAMILY DWELLINGS. ALSO, FOR TOWNHOMES AND CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT. NO. FIXTURES EACH TOTAL SHOWER WATER CLOSET BATH TUB LAVATORY KITCHEN SINK LAUNDRY TRAY HOT TUB/SPA WATER HEATER FLOOR DRAIN GAS PIPING OUTLET • minimum - i ROUGH OPENINGS WATER SOFTENER PRIVATE DIISP. • DaLCry. lic. U.G. SPRINKLER • home under cont. ALTERATIONS • to edsting WATER TURN AROUND STATE SURCHARGE SITE ADDRESS: OWNER NAM INST. ADDRESS: CITY: STATE: ZIP CODE: PHONE #: ( TOTAL: 3.00 3.00 3.00 3.00 3.00 3.00 3.00 3.00 3.00 3.00 1.50 5.00 15.Ou 3.00 15.00 15.00 .50 SIGNATURE OF PERMITTEE 1993 PLUMBING PERMIT (RESIDENTIAL) CTTY OF EAGAN 3830 PILOT KNOB RD EAGAN MN S5122 (612) 081467S CITY OF EAGAN APPLICATION FOR PERMIT SEWER AND/OR WATER CONNECTION NOTE: PAYMENT OF FEE AT TIME OF APPLICATION DOES NOT CONSTITUTE APPROVAL OF PERMIT. INSPECTION OF SEWER AND/OR WATER INSTALLATIONS WILL NOT BE SCHED- ULED UNTIL PERMIT HAS BEEN APPROVED. (Please Print) x 1) PROPERTY ADDRESS: LEGAL DESCRIPTION: - Lot Block Subdivision or Tax Parce ID ) IF EXISTING STRUCTURE, DATE OF ORIGINAL BUILDING PERMIT ISSUANCE: PRESENT ZONING/PROPOSED USE: (Mon Year) ? COMMERCIAL/RETAIL/OFFICE ? R-1 SINGLE FAMILY 0 INDUSTRIAL ? R-2 DUPLEX (Two Units) ? INSTITUTIONAL/GOVERNMENT ? R-3 TOWNHOUSE (Three + Units) ( Units) 2t--9-_4 APARTMENT/CONDOMINIUM (_±'Units) 2) -- ( NAME: ADDRESS: CITY, STATE, ZIP: PHONE: 3) For City e NAME: GAS Plumbers License: ADDRESS: // 3 G o Active i CITY, STATE, ZIP: Expired Not recorded PHONE: LICENSE# 21 2 / _ Sta Initial NAME: ?Q /rt' i 9 U -< ADDRESS: CITY, STATE, ZIP: PHONE: '5) n w• i r • x' :: _0 • ©--`60NNECTION TO CITY SEWER 0 CONNECTION TO CITY WATER ? OTHER 6) "' ? PLEASE HOLD APPROVED PERMIT FOR PICK-UP BY ONE OF ABOVE ? PLEASE MAIL APPROVED PERMIT TO 1, 2, 3, 4, ABOVE ?? (Circle one) 7) W-50-777 FOR CITY USE ONLY PERMIT # ISSUED Pd w/Bldg. Permit FEES: $ $ SEWER PERMIT (INCLUDE SURCHARGE) $ $ WATER PERMIT (INCLUDE SURCHARGE) $ $ WATER METER/COPPERHORN/OUTSIDE READER $ $ WATER TAP (INCLUDE CORPORATION STOP) $ $ SEWER TAP $ $ ACCOUNT DEPOSIT - SEWER $ $ ACCOUNT DEPOSIT - WATER ?a q G $ / / Zfl0 O V $ WAC ?U $16 Z 2, SL/G • b d $ SAC $ $ TRUNK WATER ASSESSMENT $ $ TRUNK SEWER ASSESSMENT $ $ LATERAL BENEFIT/TRUNK SEWER $ $ LATERAL BENEFIT/TRUNK WATER 6/JL l$ G a $ WATER TREATMENT PLANT SURCHARGE $ $ OTHER: $ 471 6 5- , U D $ /C° TOTAL RECEIPT RECEIPT DOES UTILITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY? YES 'IF YES, THEN A "PERMIT FOR WORK WITHIN PUBLIC ROADWAY" MUST BE ISSUED BY THE ENGINEERING NO DIVISION. LIST AS A CONDITION. SUBJECT TO THE FOLLOWING CONDITIONS: APPROVED BY: TITLE: DATE: 5 - // - 1' CITY Q F E A G A f? * ?: PAYMENT OF FEE AT TIME OF *APPLICATION DOES NOr Corsi um * * APPROVAL OF PERMIT. rt APPLICATION FOR PERMIT * INSPECTION OF SEWER AND/OR WATER * INSTALLATIONS WILL NOT BE SCHED- SEWER AND/OR WATER CONNECTION * uLED uNTm PST HAS BEEN * APPROVED. * rt * rt rt * rt --' **#YY######Y**Y************YYYY**YYY 1) PROPERTY ADDRESS: LEGAL DESCRIPTION: Please Print IF EXISTING STRUCTURE, DATE OF ORIGINAL BUILDING PERMIT ISSUANCE: PRESENT ZONING/PROPOSED USE: (Mon Year ? Ca4,1ERCLAL/RETAIL/0FFICE ? ? Tnmr'STpLjT_ Ll ? INSTITUTrIONAL/GOVE12 ZEE ? R-1 SINGLE FAMILY R-2 DUPLEX (Two units) R-3 TOWNHOUSE (Three + Units) ( Units) R-4 APARTMENT/CONDOMINIUM 2) r NAME: l AjcovN oyi- C TIES ADDRESS: /53 o f- e W PIP CITY, STATE, ZIP: PHONE:_ !.2j 7 1 ?Ss _?3 ") 7 3) u :: NAME:/D Pc.U 561 ADDRESS : J S" 27 D &1#( CITY, STATE, ZIP: ??US I&ZLs- UN 5S? 7 PHONE: Lon MASTER LICENSE# 4) NAME: Ddb /,c %, Gets IV ADDRESS: '31¢o / /,{ ?lrSaK 1, /?(/Gr CITY, STATE, ZIP: PAG. ts) ? }?' 1L_,2z-C- Active Expired Not recorded St Initial e b la" PHONE: r 5J Y• 1 Y •7' :7 D• w :i CONNECTION TO CITY SEWER CONNECTION TO CITY WATER ? OTHER 6) • ? PLEASE HOLD APPROVED PERMIT FOR PICK-UP BY ONE OF ABOVE PLEASEM?I L APPROVED PERMIT TO 1, 2, 3, 4, ABOVE /I /& Iri rr&.) FOR CITY USE ONLY PERMIT # ISSUED 3 Pd /Bld P it C FEES " W g. erm : $ $ SEWER PERMIT (INCLUDE SURCHARGE) $ $ ?r S z WATER PERMIT (INCLUDE SURCHARGE) $ WATER METER/COPPERHORN/OUTSIDE READER $ $ WATER TAP (INCLUDE CORPORATION STOP) $ $ SEWER TAP $ $ ACCOUNT DEPOSIT - SEWER f7S $ - ACCOUNT DEPOSIT - WATER 41b$Ib $ WAC ?C1$' 07 ,7 SAC .( I $ SAC $ $ TRUNK WATER ASSESSMENT $ $ TRUNK SEWER ASSESSMENT $ $ LATERAL BENEFIT/TRUNK SEWER $ $ LATERAL BENEFIT/TRUNK WATER / ?,C ?$• ( ?Z S.C P $ WATER TREATMENT PLANT SURCHARGE $ $ OTHER: S y ?, ?? S Cr Z $ /' C? TOTAL RECEIPT RECEIPT DOES UTILITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY? YES IF YES, THEN A "PERMIT FOR WORK WITHIN PUBLIC ROADWAY" MUST BE ISSUED BY THE ENGINEERING Q NO DIVISION. LIST AS A CONDITION. SUBJECT TO THE FOLLOWING CONDITIONS: APPROVED BY: TITLE: (? DATE: Z112 C /`J 7 ,L l , 6 l , ?f?Qlomtro ":'ew MEMO TO: TOM COLBERT, DIRECTOR OF PUBLIC WORKS JIM STURM, PLANNING DEPARTMENT BILL AKINS, ELECTRICAL INSPECTOR CRAIG KNUD.SEN, ENGINEERING TECH FROM: DOUG REID, BUILDING INSPECTIONS DEPT DATE: /goo? The Protective Inspections Department will be performing a final inspection for occupancy of 1J1O-AC on Please return within 48 hours with your approval or denial. Failure of response within that time frame will be determined as approval. It will be each departments responsibility to contact the construction firm with necessary requirements before final inspection and notifying the Building Inspections Department when all requirements have been taken care of. Thank-you. DR/,js APPROVAL: (SIGNATURE _DATE) ®F eagan I 3830 PILOT KNOB ROAD, PO. BOX 21199 MC ELLISON EAGAN. MINNESOTA 55121 Mwor PHONE (612) 454-8100 THOMAS EGAN DAVID K. GUSTAFSON PAMELA MCCREA THEODORE WACHTER Council Members THOMAS HEDGES City A ministrafor January 28, 1988 EUGENE VAN OVERBEKE City Clerk MR BOB LUX DOMINIUM GROUP INC 3140 HARBOR LANE MINNEAPOLIS, MN 55441 Dear Bob: The Thomas Lake Pointe apartment project located along Thomas Lake Road in Eagan received final plat approval on November 19, 1985 and was recorded by Dakota County on December 14, 1986. This project contains 228 rental apartment units. Final Certificate of Occupancy permits are issued after all City departments have granted approval. The last Certficate of Occupancy was issued on December 23, 1987. Enclosed are copies of these certificates for all buildings, including the office/recreation building. I hope this letter is sufficient for your needs. Please feel free to call if I can be of further assistance; it has been a real pleasure working with you on this project. Sincerely, c 71?- Jim Sturm Landscape Architect/Planner I JS/js k THE LONE OAK TREE THE SYMBOL OF STRENGTH AND GROWTH IN OUR COMMUNITY t-D-r I BI k I CONTRACTOR'S MATERIAL & TEST PART "A" GENERAL PROCEDURE I UPON COMPLETION OF WORK. INSPECTION AND TESTS SHALL BE MADE BY THE CONTRACTOR'S REPRESENTATIVE AND WITNESSED BY AN OWNER'S REPRESENTATIVE. ALL DEFECTS SHALL BE CORRECTED AND SYSTEM LEFT IN SERVICE BEFORE CONTRACTOR'S MEN FINALLY LEAVE THE JOB. A CERTIFICATE SHALL BE FILLED OUT AND SIGNED BY BOTH REPRESENTATIVES COPIES SHALL BE PREPARED FOR APPROVING AUTHORITIES. OWNERS AND CONTRAC. TOR. IT 15 UNDERSTOOD THE OWNER'S REPRESENTATIVE'S SIGNATURE IN NO WAY PREJUDICES ANY CLAIM AGAINST CONTRACTOR MR FAULTY MATERIAL. POOR WORKMANSHIP. OR FAILURE TO COMPLY WITH APPROVING AUTHORITY'S REQUIREMENTS OR LOCAL ORDINANCES. 15 )0 x owe DATE n[ 9-3(7 - 87 PROPERTY ADDRESS 11t, L G Q PrG o T AJ o L Ate! ?A v /YI Al ACCE D BY APPROVINO A NORITY('5) NAMES C' - PLANS A0051e5s3?.7 j ?le-e /?NJA D d 0 imK G s5 y riw s e/ 7•14 - /} /..IJNAI tyT''1/V L-/S H/N.y SSy3? LUMro ACCEPTED INSTALLATION CONFORMS TO ACCEPTED PLANS yYES Cr No EQUIPMENT USED IS APPROVED YES Q? NO 0 IF NO. STATE DEVIATIONS HAS PERSON 1st C/IAPCE OP Fipb EpUIPMEN'n BEP.N INSTRUCTED AS TO LOCATION OF LONTROL VALVES AND CARE OF THIS NEW EQUIPMENT? YES p-- no 0 IF NO. EXPLAIN INSTRUC• TIONS it A COPY Oi INSTPLCTION AND MAINTENANCE CHART BEEN LEFT AT PLANT: YES Q,-? NO IF NO. EXPLAIN ELI'?III\C- Inoat th, "Ili nod wull rmaer lot u Indlratn! by an collection Pf foreign tlnlerfal In burlap Not* at outlets such as i rant. nn blow-offs. Yloxn ." Oowe nut lean Chit" :511 GPM fur 6-loch lips And emnller, I00 GP5I for I-Inch Pipe, ISM GPM for 10-Inch pipe, and 2000 GPH far li- b.n: InP'. N'n.n xu lrVlp i.ub.n Iand.rr .11111l,,Ird flow rate., nbtOla ura[bnum .,.liable. TEST HYDROSTATIC.. H>dngtatic Irnt..hall us mad. it not less than IN PSI fur two hours or MPSI above mtic pressure In excess Of 150 PEI. Dlffrrruunl d.,ldne valae JopPU'v roan be left open dodos lest I. Prevent dnmeae. All 41bovenoun0 nlpla, IuNata hall be elopPEd. DESCRIP- I.F:AKA:IFA \.a ?i,n, laid ..it, Inmrcr E+•Moirdj.1w. .:..dl, If the wurkmmrixhlp 1. •e Uxtsalnl'), IMvr owe or no leakage at the Joim•. Tree ' nt of .u Ine luwlx shall not a erd Vaenls per hour Per IN joints Irrespectively of PIPE dlarratee. The ..,,Inc. lshall be dM- Irnbalyd o e .dl Jnlnu. If such IeakaKr :a at a sew Joints the Installation .Mil W considered un aDahkrtury and .uy ' topoh. TION o0de. \vw phw land with e..Ard lead or lend-rubwlitute Jnlntx xh.ill, If the wOr4nu0ahlP lot aausfnetory, have little or no llenka5e at the Joel.. At,, jinn[ bnk MB leakage or real! in,,, n "•llp:t drill' rrplag" whall be rt,pahi 1. Leekaga shell at c vrd l at. (11,11d a-ao- ure) Pro noun Prr Inch of Pipe dlameler per Pink. The leakage xh.ul be distributed over ell JOIOts. If such Iva Yage gal.- n 1-.1 en torch .1k a (rw lulob, the IneLdbHlon hall be considered aik-Umfnrtn0' and nevessary reMlrll m+its. )'SI:V VATIC: Glabll•h 40 PSI air pressure and measure drop which shall net exceed IM PEI In 21 hours. Test pressure tanks at normal weter Icvel nod air Pressure rend Measure air pressure drup which shall not eadsad I" PSI In 21 hours. PART "B" - UNDERGROUND PIPING FEEDS BLDGS. LOCATION PIPE TYPES AND CLASS TYPE JOINT UNDER. I GROUND CONFORMS TO STANDARD y[a ? no O IF NO. EXPLAIN PIPES AND JOINTS NEEDING ANCHORAGE CLAMPED. STRAPPED OR BACKED IN Yu ? No ACCORDANCE WITH STANDARD JOINTS IF NO. EXPLAIN TESTS FLUSHING HYDROSTATIC LEAKAGE REQUIRED NEW UNDERGROUND PIPING FLUSHED ACCOPIIING TO STANDARD Yp 0 BY (COMPANY) L/ HOW FLUSHING PLOW WAS OBTA Iyrµ- AI pis MAE wall, '[] tin[ oa EE• .tit ? nets PUMP ? THROUGH WHAT TYPE OP ING: -- • FLUSHING Nva. sun. ? OPEN nra LEAD-145 FLUSHE ACCORDING TO TANDARD Tag TESTS BY (COMPANY HOW 11LyW ZING FLOW WAS OBTAINED: / PUBLIC WATn ? TANK ON EEwmu p nit PUMP ? THROUGH WHAT TYPE OPINING: Y CONN. TO FLAMM a snEOT p OPEN ran: p I. Ne. B PH.IN 1e U.S A. uVTCnCTA TF!` ALL NEW IINDEPC POUND PIPING HYDROSTATICALLY TESTED AT TEST LEAKAGE TOTAL AMOUNT OP LEAKAGE MEASURED GALS. HOURS TEST ALLOWABLE LEAKAGE GALS. HOURS . NUMBER INSTALLED TYPE AND MAKE HYDRANTS ALL OPERATE SATISPARORILY , Yo ? NO WATER CONTROL VALVES LEFT WIDE OPEN: in ? MO CONTROL IF NO. STATE REASON HOSE THREADS OF FIR! DEPARTMENT CONNECTIONS AND RING ALARM( Yu ? nR ? SW VALVES - E HYDRANTS INTERCHANGEABLE WITH THOSE Of PIPE DEPARTMENT AN DATE LEFT IN SERVICE , REMARKS I NAME OF SPRINKLER CONTRACTOR POP PROPERTY OWNER (SIGNED) TITLE PARTS A & B ' FRSPRINKLER CONTRACTOR ISIGNEDI DATE O SIGNATURES I'ICSTS WITNESSED BY TITLE DATE PART C" SPRINKLER & WATER SPRAY ABOVEGROUND PIPING (FILL OUT SEPARATE PART "C" FOR EACH RISERI LOCATION -- ?I SERVES BLDG'.: It D RB6TATIC: ALL PIPING. TESTS PNEUMATIC: DRY PIPING. DRAIN: ... ... .... ..... . ....... .......... .... . REQUIRED I EQUIPMENT OPERATION: ALL. -----_-_ SPRINKLERS OR ?_ - - -- MAK F. MODEL _ SIZE. QUANTITY TEMPERATURE. DATING --'-"--- -' --y2 14 %6 a , - SPRAY 7 NOZZLES - (, - - PIPE AND MATERIAL AND KIND CONFORMS TO?? GP n -, _. STANDARD T ?r-T I IF NONE. EXPLAIN FITTINGS --" -- '-- A L A R M D E V I C E MAXIMUM TIME TO OPERATE THROUGH TEST PIPE ALARM VALVE . SEC. TYPE AtAKP. MUUEL MIN OR FLOW INDICATOR )OPERATING TEST RESULTS, - DRY MAKE MODEL PEP. 0.P l 'TIME TO TRIP I T I'IIROUGH_TEST PIPE WATER AIR POINT - TIME ALARM WATER PEACHED OPERATED NO. j PRESS. I PRESS. I AIR WITHOUT WITH TEST I PROPERLY Q. O. D. O. O. D. PRESS. OUTLET PIPE MIN. SEC. MIN. SEC. P.S.I. P P.5.1. MIN.. SEC. YES NO VALVES 1 IF NO, E PLAIN OPERATION. rn KuMAT,c ? Iw="lc ? HYMMULlc ? PIPING SUPERVISED: Yu ? No O DETECTING MEDIA SUPERVISED: Yu ? •o DELUGE DOES VALVE OPERATE FROM THE MANUAL TRIP AND/OR REMOTE CONTROL STATIONSI Yu O No ? G IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT MR TESTINGI YKA O NO ? IF NO, EXPLAIN PREACTION DOK> EACH CIRCUIT OPERATE GOBS EACH CIRCUIT :HlRATE R I I MAXIMUM TIME TO OPPJUTB RELl138: VALVES E MODEL SUPERVISION LOSS AURMI VALVE ELFJ SE MAK YES NO YES NO MIN. SEC. ALL PIPING HYDROSTATICALLY TESTED AT 26 of PSI FOR HOURS DRY PIPING PNEUMATICALLY TESTED: Yu ? No 0 TESTS EQUIPMENT OPERATES PROPERLY: Yu ? No Q IF NO. STATE REASON DRAIN TEST: READING OP GAGE LOCATED N R WATER SUPPLY TEST PIPE. RESIDUAL PFLSSURE WITH VALVE IN TEST PIPE OPEN WIDE STATIC PRESSURE D PSI NUMBER REMOVED NUMBER USED LOCATIONS I BLANK TESTING WELDED OR GRAZED PIPING YKa IF No RANTOR THAT THE. WELUE.RB OR RRAEERB ARE. QUALIFIED FOR WELD- THE NI' :R T M YO11 N A I L TS E, UI O V ACO NU , U I.V YE WELNODE, RE W .: RR.AEM PRO AtlHN ROILF.It ADD YRHRIIU RE VESSEL M INO OR U IV AND WELDING AND H ' URAZERtl LDKIIE \D i'ROCED UREtl WF GASKE AZI N-DAR1 R KAZOO , , , . .D 11 AZI WE..,,: :I I Po f[P ? No 0 QUALIFICATION O Q TI 1 ED uWERl•4:RAA T(1RR-1!Q EDITION. DATE LEFT IN SERVICE WITN ALL CONTROL VALVES PEN. REMARKS LI NAME OP SPRINKLER ONTRAROR R P P OWN LN 1 e PART "C" id afz U? G'? I' I N ?L ?.2 SIGNATURES I FOR SPRINKLER CONTR OR (SIGNED) TESTS WITNESSED BY Alk S ,? DATE ;v_ 0 ,: i' it00441 r02r For Office UseE AGA N Permit#: 9AR 1 0 Do. Permit Fee: l9 3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 Date Received: (651)675-5675 I TDD: (651)454-8535 I FAX: (651)675-5694 buildinainspectionse..citvofeaoan.com Staff: L CROSS CONNECTION CONTROL PROGRAM INSPECTIONS PERMIT APPLICATION 4t� Date: 3/10/2020 Site Address: 1510 Thomas Pointe Lf , Eagan, MN 55122 Tenant: THomas Lake Pointe Apartments Suite#: Property Owner Name: Nationwide Housing Corporation Phone: 763-512-7720 Name: Jayhawk Mechanical Inc License#: PC644834 Contractor Address: 3307 N 2nd St city: Minneapolis state: MN Zip: 55412 Phone: 612-522-3499 Email: jlee@jayhawkmechanical.com New Replacement _Repair —Rebuild Type of Work Description of work: Replace backflow device with new RPZ. COMMERCIAL Irrigation System( yes/✓no)('// RPZ/_PVB) Permit Type • Rain sensors required on irrigation systems • Avg.GPM (2"turbo required unless smaller size allowed by Public Works) Avg.GPM High demand devices?_Yes_No Flushometers Yes No Permit Fee $60.00 You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's website at www.citvofeaoan.com/subscribe. CALL BEFORE YOU DIG. Call Gopher State One Call at(651)454-0002 for protection against underground utility damage. I hereby acknowledge that this information is complete and accurate;that the work will be in conformance with the ordinances and codes of the City of Eagan;that I understand this is not a permit,but only an application for a permit,and work is not to start without a permiti-ttlartwill bei ccordance with the approved plan in the case of work which requires a review and approval of plans. /' Applicant's Printed Name Ophcan"tigFtae ��