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1520 Thomas Lake PtCITY OF EAGAN SEWER SERVICE PERMIT 3330 Pilot Knob Road P.O. Box 21199 PERMIT NO.: 9805 Eagan, MN 55121 DATE: 4-20-87 Zoning: - R4 No. of Units: 43 d 2 Car Wash Unit Owner nomain Const. Address: Site Address: 1520 Thomas L2 B1 'homas U Pointe Plumber. Consolidate . Phimbinn 12-3I-?iuf?l , .0 3,92(Y'.00pd I some to comply wm tlQW1 L4TA4 h&Clfarge: IS , 690 QUpd Ordinances. R E Q U I Rt D ?tt ----=?? Surcharge: Misc. Charges: Date of Inap.: Total: Insp.: Date Paid: " EAGAN SEWER SERVICE PE RMIT PBot Knob Road 9 8 0 5 Box 21199 PERMIT NO- n, MN S51 1 DATE- 4 - r 4b 1. r as g soma n .onst. No. of Unlta r.owne r. Address: _ Site Address: Plumber. _ 1 agree 110 comply with the City of Eagan Ordinances. 13y Date of Insp.: Inap.: t, CITY OF EAGAN 3330 PW Knob Road P.O. Box 21199 1 Eagan, MN 55R4 Zoning: Owner. Domain Const. Address: A e 18 620 00 d -Conn ctlon Charge: , . p Account Deposit: E? Permit Fee: 10.00pd 'Surcharge: . 50pd . Misc. Charges: Total: ?ate I ? SEWER SERVICE PERMIT PERMIT NO.: 9805 DATE: 4 .20-87 No. of Units: I Car Wash Un it Site Address: Plumber Consolidated Plumbing 12-33-56 6956 3,9213',00pd 1 agree to comply with the City of Eagan t Connection Charge: t R 1120 - 00ju3 Ordinances. Account Deposit: Xs"s Permit Fee: AA -A Surcharge: By Mlsc. Charges: Date of Insp.: Total: Insp.: Date Paid: ...,.j Pilot Knob Road of Insp.: with the City of Eagan SEWER SERVICE PERMIT PERMIT NO.: 9" 7 f, DATE: No. of Units 7, 7.11 [ Connection Charge: Account Deposit: _ Permit Fee: Surcharge: Misc. Charges: Total: 4-20-87 No: 8654 Sa Permit Meter No. Date aaAder No. 1 agree to comply with the CRY of Eagan ordinsnces• - By CITY OF EAGAN ' . 3830 Plot Knob Road, P.O. Box 21-199, Eagan, MN 55121 N2 13068 PHONE: 454-8100 BUILDING PERMIT Receipt Tobeusedtor APT. A(..''t.fi8 + Est. Value $1, 375, OOOnate DECEMBER 30 1986 Site Address t >> t.,J}"!H.3 1ut1^T• ryAE41_G Lot 2 Block Sec/Sub. Tt O" TAS LAKE PC Parcel No. a w z 39 0 = o Name )Q 9A I N ' c Address ` AA E 0i < a ~ City Phone WW Name JOHNSON, SHELDON 6 SORENSEN = Address 1 0 2 4 9 YELLOW C I R DR ,a - City Phone 935-6337 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 City. of, Eagan Ordinances. Signature of A Building Permit is issued to: all work hhall be done in accordance Building Official Sq. Ft 113 3 Ti 0 0 Assessment Water 8 Sew. Police Fire Permit $ 3,620.5( Surcharge 650.0( Plan Review 1,810.2t SAC 22, 540.0( Water Conn. 19, 200 . Ot Water Meter ?ti/A Road Unit 11,136-0( Tr. PI. 6,125.0( Parks Planner Council Var. Date 1 Copies Total 1 Sc on the express condition at Statutes and City of Eagan Ordinances. Permit No. Permit Holler Dab TNephono M Plumbing H. VA. '/ GK S?S Electric 0/1 Fly 101-,Vo 0-11:? Inspection Dab imp. comment Footinge 1 Footings 11 Foundation Framing s eel _ i Roof Rough Plbg. it'r Rough Hig. s? IV8' T Llt7? Y?uict j Insul. Firepiaoa Final Htg. f C • J/• Final Plbg. /1-W ". Flu' sat? Cart Ooc. 9 srm?7 B R - Dock Fig. y? g E Deck Frmg. YMI Pr. Dlop. 30 AV,4 ,O-A&A • G?(047Noa! MECHANICAL PERMIT RECEIPT # ? 2 15 -.? CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: CONTRACT PRICE: PHONE: 54-8100 Site Address X'_ r 4 BLDG, TYPE WORK DESCRIPTION Lot 19 x Block --? S ub Res. New Name v t ,A, Mull Add-on Address Comm. Repair %. c City { /? ! r Phone _ r^ Other FEES Name c Address - r T r - L RES. HVAC 0-100 M BTU ADDITIONAL 50 M BTU -$24-00 - 6 00 p City _ _ •<< ?? Phone = ` (RES. HVAC INCLUDES A/C ON NEW , CONSTRUCTION) TYPE OF WORK GAS OUTLETS (MINIMUM - 1 PER PERMIT) - 1.50 EA. COMM/IND FEE - 1% OF CONTRACT FEE `forced Air M BTU APT. BLDGS. - COMM. RATE APPLIES Boiler M BTU -:::::d TOWNHOUSE & CONDOS - RES. RATE APPLIES ;AJnit Heater M BTU MINIMUM RESIDENTIAL FEE - ALL ADD-ON & REMODELS 12.00 y?1ir Cond. Vent M BTU CFM MINIMUM COMMERCIAL FEE STATE SURCHARGE PER PERMIT - 20.00 - .50 Gas Piping Outlets # (ADD $.50 S/C IF PERMIT PRICE GOES BEYOND $1,000) Other r ! FEE : S/C: SIGNATURE OF PERMITTEE TOTAL FOR:,CITY OF EAGAN CITY OF EAGAN t? • ' 3830 PNot Knob Road, P.O. Box 21-199, Eagan, MN 55121 t i 1 ? 9 4 7 BUILDING PERMIT PHONE: 454-8108 Receipt M To be used for FOUNDATION Est Value Date DECEMBER 5 19 86 Site Address 1520 THOMAS LAKE POINTE Erect 6 Occupancy Lot 2 Block 1 Sec/Sub. THO MAS LK POINTAemodel ? Zoning Parcel No. Repair ? Type of Const Addition ? No. Stories Name THO14AS LAKE HOUSING ASSOC Move ? Length : I 314 0 fiARBOR LN Address Demolish ? I I ? Depth r S ° cily PLYMOUT& 559-1 nt. mpr. 711 1-1 q. F Name DOMAIN CONSTRUCTORS INC Approvals Fees Address SAME Assessment Permit $15.0 0 City Phone Water & Sew. Surcharge a Police Plan Review Name z o Fire sac Address < W City Phone Eng. Water Conn. Planner Water Meter I hereby acknowledge that I have read this application and state that the Council 12/5 Road Unit /86 information is correct and agree to comply with all applicable State of Bldg. Off. Tr. PI. Minnesota Statutes and City of Eagan Ordinances. APC Parks Signature of Permittee ?'. Var. Date copies ? A Building Permit is issued to: DOi!?IAI? CONSTRUCTORS I NC 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 I Panne No. I Pat Molder I Dal. I Ti WW- N ' Plbp. ft. Mo. Final Oce. DNP- a , PLUMBING PERMIT CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN, MN 55122 4TRACT PRICE 6 p D _ PHONE: 454-8100 Site Name //?S 5 ?'!o Address " 3 o - i? c City f x Phone Name /?>?'? , .7 C Address 0 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 OF FOR: CITY OF EAGAN PERMIT # RECEIPT # DATE: BLDG. TYPE WORK DESCRIPTION Res. New Mult. Add-on Comm. Repair Other RES. PLBG. ONLY - COMPLETE THE FOLLOWING NO. FIXTURES TOTAL jrQLWater Closet - $3 00 $ _,1LBath Tubs - $3.00 _;Lavatory - $3.00 / 'Shower - $3.00 4 Kitchen Sink - $3.00 -Urinal/ Bidet - $300 undry Tray $3.00 AF?l04 r Drains - $1.50 ater 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 STATES/C: OU ?• u? GRAND TOTAL ?3 3 ?_? ?.?. ' / ^ ? O ^?T A??' ???is? LLCM L/'G` 'Z ^ 6, lQ-S? ?1.?.f. ,q._6 F?er??G 3 S'?x1eK1' ?^- ?uFSi L'7?cb e? P?6, ?: SITE ADDRESS Unit N / Permit #I 1,069 Et' / Sect/Sub. ? INSPECTION DATE INSPECTOR OTHER RUIMIIII .s•-.2p - P7 • G- J . -7 [v, ! ROUIH PLM. ROUEN NTI. °/?7 w. 3 INSUL RREPLACE RNAL NTI. 7 I8 -2 RNAL PLU. UNIT RNAL CERVOCC et. f9rrtt#tratr of Orrupanry citp of Cagan #rvw t Md of bag JwrrtftM This Certificate issued pursuant to the requirements of Section 306 of the Uniform Building Code certifying that at the time of issuance this structure was in compliance with the various ordinances of the City regulating building construction or use. For the jo!lowing.- Uie aam6aem 47. BIX - "B" lids. ttrmit No. _ OMWSM Type r. I /B ! -zoning Distria C I1?R M RM Type Cona O,w of lL4;- AS LAM EMS`X; ASKS Ad&. 5140 10MIR t}1??, lb&Mns Addrm 'M1AS Id1Ki' L-sky L2, b i r rP t+ ; 1. ?;FfZtf :;?`0, Dar 1987 &Wdins OffcW POST IN A CONSPICUOUS PLACE This re. quest void / 18 months Irom -76 O C.13822,/,-.2 RequesV Date (? Fire No. Dough-in Inspection 6 - - 1 ' Pegwred7 ?fleady Now C] Will Notify Ins pm?' - 3 7 T 0 Yes ?Nn 1 for When Deady ady yensed Electrical Contractor I hereby request inspection of above Owner electrical work installed at: Street Address, Bo. or Route No. City 1-52-0 713 d YY) &A fir. ection No. Township Name or No. Rnnge No. my Occup. (PRINTI / Phone No. L C.a? LZi C.r L Power Supplier Address le t I Con jractor I ompori - me) - Cunt actor's Lwense_No. // Mailing Address I tractor or Owner Making Installation) S' / So i Ss?f! uthonr Y'S ignalure ICo r ctor wne Making In stallation) Phone Number f 2 27'Z . a -j?OTA STATE BOARD OF ELECTRICITY THIS INSPECTION BEQUEST WILL NOT Ortg9s-Midway Bldg. - Room N-191 BE ACCEPTED BY THE STATE BOARD 1821 University Ave., St. Paul, MN 55104 UNLESS PROPER INSPECTION FEE IS Phnn. 16121 297.2111 ENCLOSED. REQUEST FOR ELECTRICAL INSPECTION •. E13-000011-04 See instructions for completirp this form on back of yellow copy. ? L 7??s? r? C • 1 3 8 2 2 "X'' Below Work Covered by This Request Nev4 Add j flop Type of Building Applmnees Wind! Equipment %i Home Range Temporary Service Duplex Water Heater Lighting Fixtures Apt. Building Dryer Electric Heabn Commercial Bldg. Furnace Silo Onloader, Industrial Bldg. Air Conditioner Buik Milk Tank Farm Olhw peel v Thor IS Pqu lyl t r Specify Other Othur compute inspection Fee Below ' M Fee Service Entrance Size n Fee Feeders/SubleAders rt Fen cpcurts U to 200 Amts 0 to 30 Am OS 0 to 30 Amos Above 200 Amps 31 to 100 Amps 31 to 100 Am s Swimming Pool Above 100 Amps Above 100_Amts Transtormers Irrigation Booms Partial•'Other Slgns Speual lnspecLOn t ---_ gem'tr4s - -===____ __ - __ -- -- -_ -- - Q/ TOTAL F iV flough-in /r' ,r / f Date /y? I. the Elec el so .,or. hereby Final v ?, ty C1? 7 J J certlly thAt the above inspection has been made. This request void 1B months from This request void IS This months from Y- D-4110 4z ,_?q q, ? Own ,r Electrical Contractor 17f?i 1!Ta?7 h- in Ins pact wo ed? ?Ready Now E] W,II Notify Insigne- Yes ?No for When Ready I hereby request inspection of above electrical work installed at Street Address. Box or Rome No. City Clm? ' Qct on No. Township Name or Nn. Range No. Co rty OccuVanl lPglNT) Phone No, U /71 A; I7 e D/J Ti+C1L?`O ?$. Power Supplier Address E_I cal-Conyy??ctor )Company Name) _ - - -- --- Cun tractors Lmense No. ? '2 /??,/w f',P--? 16-1011-2- -Mailing Address ICont -ctor or Owner Making Installation) Author gna LUre nirac r/Own Making Installation) Phone Number ... / MINNESOTA STATE B RD OF ELECTRICITY THIS INSPECTION BEQUEST WILL NOT G,eigs•Mldwey Bldg. - Rome N•191 BE ACCEPTED BY THE STATE BOARD 1821 University Ave.. St. Paul. MN 55104 UNLESS PROPER INSPECTION FEE IS Phone (612) 642-0800 ENCLOSED. y/i?87 REQUEST FOR ELECTRICAL INSPECTION .: EB-00001p-Ob IF See instructions for completing this form on back of yellow copy. >r /J 9 D-41104 ..x.. Below Work Covered by This Request Add Rep Type of Building -ApphadLes Wired Equipment Wired Home Range Temporary Service Duplex Water Heater Lighting Fixtznes Apt. Building Dryet Electric Heating Commercial Bldg. Furnace Silo Unloader Industrial Bldg. Air Conditioner Bulk Milk Tank Farm _ th,rr peci v n,c, IS,",fyl 71M. r pqufv the, Other Compute Inspection Fee Below If Fee vice Entrance Size a Fee Feeders/Subfeeders s Fee ei,cuns o 200 Amps 0 to 30 Amps 0 to 30 An, IlAbovu 200 Amps 31 to 100 Amps 31 to 100 Am mming Pool Above 100_Anips Above I no-Amps nstor Irrigation Bourns Partial."Other Fee ds- Special In$peclion $t rks ;? TOTAL FEE " Rough-in (/ L?• if^,y7 7 51 J ( the Electrical Inspector, her P Final _ ` (/c.i, yt?q, U.+Ie /? y/ d ertifv that the above ns pec tton hes been maaa. This request void 18 months from / 4F l iIns request void y// v2r/ 1B months fromi ?, ??PlJ Lr22.G{'Je 74423?,? . So sr /oral? $?AcV2..CO 1 1 Request Date ?1 p ^ 3- Fire No. G ReQuved)Inspection Ready Now ? Will Notify Inspec- 0 O ClYes ON. I., When Ready ,& `1Fensed Electrical Contractor I hereby request inspection of above ? Owner electrical work installed at: Street Address. Box or Route No . City o. y/ (J - /. d 1-71awAS Li4'e'j A ',,-'z ',,-'z Z-'? e"q-" ecti o. Township Name or No. Range No. County /Dgwj TAY Oc.UPdn1(PRINT) ,-14,- mas 244;'r L6/c 16 Phone No. Power Supplier Address dTA ,Ec?T?,G / /Tx/JJ/N Td nl ? /Y1 N ractor (Company Name) - - _ Elect??yyal C _Contrartor's Lucc.se,No.- '- - 2 /?eJ:e Mailing Address (Contractor or Owner Making Installation) ?J?oti 3 /( Tff rNUC / ? /LbKrfF_A? . ? ? Authoriz - nature ( trac ner Making Installatmn) Phone Number aid'- a36- Oso.? MINNESOTA STATE BO OF ELECTRIC ITV THIS INSPECTION REQUEST WILL NOT Griggs-Midway Bldg. - Room N-191 BE ACCEPTED BY THE STATE BOARD 1821 University Ave.. St. Paul, MN 66104 UNLESS PROPER INSPECTION FEE IS Phone (6121 642-0800 ENCLOSED. RtUUEST FOR ELECTRICAL INSPECTION EB-00001-05 _ 1 See instructniga for completing this form on back of yellow copy. ya3 C/ C 7 4 4r? / ? '*X" Below Work Covered by This Request Fdd Rep. Type of Building Apphances Wired Equipment Wired Home X Range Temporary Service Duplex Water Heater Lighting Fixtures Apt. Building Dryer Electric Heating Commercial Bldg. Furnace Silo Unloader r Industrial Bldg. Air Conditioner Bulk Milk Tank Farm Other pyci v then ISnec rtvl tr?[i/A7ri t ,r sucufv Cher X Other 0?Gfl E tP L OMPUre lnspecuon tee Helow a Fee Service E ntrenee Sixe M1 Fee FeaderrrSobfeedere a Fee Circuits U to 200 qm s 0 to 30 Arm's O iOWV, 0 to 30 Am ,j /D, .ov Above 20 MI)S WJ9 /f/ , 31 to 100 Amps ?Icf J:ve 31 to 100 Am Swimming Pool cti Ir" Above 100_Anls Above 100_Am - Transformers Irrigation Boort?s - -5C Partial,-'Other Fee= _ = Special inspection - v aemnrks ?G y7 OTAL E) w-s r Hough-in tq I, the it i C/, 30 certify to ere Final D^ certify that the above r inspection her been 02 7 a' made. This raquest void 18 months from /L q? a/, HE TING TEST RECORD ADDRESS t 1?na?l^L?.fG.A. APT. /? FLOORJ, TY S 6UR8?M.. OCCUPANT OWNER I JM 112 HEAT LOSS D T HT . INST. ` SOLD BY 1 - INSTALLED BY n A.r:I1j- Electrical Work By Gas Line By ? n 4 TYPE OF HEAT GA _4,FA _HW -STEAM-SPACE HTR. UNIT HTR. -OTHER ?S DESIGN CON ER ION MAKE ^ MAKE OF BURNER Model Model Serial Max. BTU Rating 10 INPUT )S! MAKE OF FURNACE Model THERMI T T _ at Plug Vent Size i Vales KIND OF LIN2 SIZE NONE Limit Draft Hood l Uh R g I to Limit Setting Filters Size(0)(7-0)( l Number I Fan Setting _ Chimney Location Inside utaide J -Pilo-Ty pe -- - - Chimney Construction FcS?S Pilot Make Pilot Model 5 ' Smoke Bomb / Wiring I Pilot Timing Draft - - Test Tag L.W. Cut Off Door Pressure ?? Lighting Inst. % Pressure Percent COZ-y_ ( Date Tested - (?-?? Input CFH Percent OZ6 Company Testing -Rouse Mechanical, Inc. Stack Temp. Percent CO Col 11348 K-Tel Dr. Minnetonka, MN 55343 Name of Tester _? 14 ,, ?1I ADDRESS /U , ?/dcJ t t'?YYIC'.a11 ?./?L- HEATING ¢_. /Q6 ' TEST RECORD APT. LOOR ?Cl SUB?IRN OCCUPANT ` OWNER IVY I /1?v+ ?(Lyl HEAT LOS AT TG. INST. SOLD BY 4 - INSTALLED BY f71A.QSL. cP Electrical Work By J..UQ - XAaA / s^ Gus Line By ( ? TYPE OF HEAT GA -L---FA i?-HW STEAM SPACE HTR. UNIT HT-R. OTHER 5 DESIGN MAKE _ MAKE OF BURNER_ Model +<04)Q 09 Model Serial N3 Max. BTU Rating - INPUT 72Z, OOH MAKE OF FURNACE Model THERM T Va lre L Limit Setting Fan Setting _ ---Pilot Type Pilot Make _ Pilot Model _ ERSION JTROLS Heat Plug Vent Size UJ KIND OF LI R SIZE NONE Draft Hood Regulator 5--? _ Filters Size l(OX78YI Number Chimney Location I ode utside -- --- Chimney Construction Pilot Timing L.W. Cut Off Pressure c J«C41t?- Percent COQ 00 Input CFH i(X0 Percent OZ O Stack Temp. :tw Percent CO Q Smoke Bomb Wiring v Draft ? Test Tag Door Pressure ?f Lighting Inst. T Date Tested Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. ?/Mitnnnetonka, MN 55343 Name of Tester _ ' ??/? /?//p?ATING TEST (RECORD _ ADDRESS '?/SL-I 'd???D /- ?' APL `03,OOR / CIT SUBUR? ^ OCCUPANT ?? GG OWNER _(eYLI?!C-?J(l r ! HEAT LOSS ?D?TEJTG. INST. SOLD BY I??P7/Lf O,i??//CC((_vrX' _n INSTALLED By ?ILLQ_1 -Pr __ Electrical Work By 44.r-44?„ -Gas Line By ZQ r TYPE OF HEAT GAHW STEAM SPACE HTR. UNIT HTR.A_OTHER GAS DESIGN MAKE MAKE OF BURNER_ Model Model Serial Max. BTU Rating - INPUT MAKE OF FURNACE Model Valve Limit Limit Setting Fen Setting _ Pilot Type s Pilot Make Pilot Model _ TROLS !r z/ " leat Plug Vent Size KIND OF LIN Si Draft Hood Regulator Filters Size ' Number II,, C? Chimney Location /y?j?d Mr Chimney Construction %w C,6 Smoke Bomb Wiring l/ Pilot Timing Draft Test Tag - L.W. Cut Off c? Door Pressure Lighting Inst. Pressure Percent C02 Date Tested O -7 2 Input CFH d Percent 02 Company Testing -Rouse Mechanical, Inc. Stack Temp. Percent CO 11348 KTel Dr. Mlnne nka, MN 55343 Name of Tester _'4cfl- '` '`CC H1ATING TEST RECORD ' S I/ R! ADDRESS` 1 ?7t APT. FLOOR U CljJl?_ U t1 ? OCCUPANT clr'Y?l OWNER u Y? v n I M <-tXjYLC /' HEAT LOSS INST ATE TG ? . . SOLD BY INSTALLED BY A3 O- .00 - X t Electrical Work B -4 a I fl) 9 -I - Gos Line By t6 aL D L ..21P_ _ y TYPE OF HEAT GA_L--FA_ HW- STEAM-SPACE HTR.-UN IT HTR. -OTHER GAS DESIGN MAKE MAKE OF BURNER _ Model Model M Serial V K Max. BTU Rating - INPUT MAKE OF FURNACE Model ve--'/'7nLrLLimit vo Ive THERMqqTj Limit Setting Fan Setting _ Pilot Type _ Pilot Make _ ROLS pt Plug ?+ / Pilot Model -11 r Le, Pilot Timing Lj L.W. Cut Off /t? . 1 Pressure •S (N?-- Percent C02 Input CFH Percent OZ Stack Temp.dF Percent CO Cp% rf _ _ v Vent Size KIND OF L ER SI Draft Hood Reguloror Filters Size' (IX70)C I Number Chimney Location rlnside?? Chimney Constru etion LI'l-l6 Smoke Bomb Wiring Draft Test Tag Door Pressure Lighting Inst. / -7-p-7 ?- Date Tested L Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. Minnetonka, MN 55343 ? Name of Tester hMil/ HEATING TEST RECORD ` ADDRESS .J `? ) y,?/ 'l?,[fY3na2LLI `/-L'?.( APT. 1661 ?)OR CIT SUBPRB OCCUPANT ? OWNER j yL?Y1C?. - lN1 S 'L?Y HEAT LOS AT HTG. INST. , -X7 SOLD BY INSTALLED BY Electrical Work Ry Gas Line By `Qr TYPE OF HEAT GA 1W STEAM SPACE HTR. UNIT HTR. OTHER 0 G DESIGN CONV RSION MAKE MAKE OF BURNER Model i 1+ DO ?C- Model Serial 7 - 7_ 7 _31 Max. BTU Rating INPUT C70v MAKE OF FURNACE Model Valve Limit Limit Setting Fan Setting _ Pilot Type Pilot Make . Pilot Model _ Pilot Timing L.W. Cut Off VTROLS L Heat Plug Vent Size L_ KIND OF LI(/gR SIZE NONE Draft Hood ?/ U" CTV'? Regulator 7 S -3 f Filters Size I Number f - Chimney Location do utside -Chimney Construction Ip?s/?'J-.loLld?S Pressure ::i'sj Percent COg ?,,o Input CFHAS5/ZXb Percent Op j9 Stack Tem. . Percent CO O Smoke Bomb Wiring Draft e _ Test Ta Door Pressure Lighting Inst. Date Tested Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. Minnetonka, MN 55343 Name of Tester f • ' HEA ING TEST RECORD ^'? ' .- C 0 ?? ? . ADDRESS OOR X CjjTY R B OCCUPANT Q OWNER L,_ (j{M ?t7t-t-CiMT HEAT LOSS E H G. INST. - SOLD BY INSTALLED BY !? Vt-? ?'> Electrical Work By MA OL °^ Gos Line By VO TYPE OF HEAT GA ?FA- L-HW STEAM SPACE HTR. -UN IT HTR. OTHER GAS ESIGN CO VERSION MAKE MAKE OF BURNER Model 6 Model Serial 3 Max. BTU Rating INPUT 4Srmo MAKE OF FURNACE Model Valve L Limit Setting Fan Setting _ Pilot Type - Pilot Make - Pilot Model _ Pilot Timing t Plug Vent Size KIND OF Lir _ ' SIZE__- _S "NONE ?- Draft Hood _ ?'y`? Re_gula.nr Fi Iters Size ) 19kWX I Number Chimney Location Insid OutO?utside Chimney Construction L.W. Cut Off Cif Pressure J Percent C02 Input CFH Percent 0 Stack Temp. Percent CO2 09, Smoke Bomb Wiring f Drab Test Tag Door Pressure _1r Lighting Inst. Date Tested Company Testing -Rouse Mechanical, Inc. 11348 KTel Dr. Minnetonka, MN 55343 Name of Tester ..?/ / ?HEATING TEST RECORD ADDRESS ?Z.a / /7ClYYrir? L,G7 o f?j` APT.. Z OOR C ,- lJ ,C OCCUPANT OWNER M CjrYl-LC'?Cr'r HEAT LOSS DATF7/ HTG. INST. ` SOLD BY aQCt?+_-' n INSTALLED BY '-er Electrical Work By Gas Line By TYPE OF HEAT GA 7/FA 'HW-STEAM -SPACE HTR. UNIT HTR. OTHERf AS DESIGN OERSION MAKE MAKE OF BURNER Model 6 - yEC. Model Serial Max. BTU Rating INPUT MAKE OF FURNACE Model THERMQ$TA Valve -//'?} Limit Limit Setting Fan Setting _ -Pilot Type Pilot Make Pilot Model _ Pilot Timing L.W. Cut Off CONTROLS ? !!_ j ,/ - Heat Plug - Vent Size _ ) - 6 1 KIND OF Lf ER SIZE NONE 12 Draft Hood t L41 Regulator G ?• ? r ^` Filters Size Numb Chimney Location Inside -?j-0 aside Chimney Construction Pressure Percent CO 2 O 2 Input CFH!=Percent ,pO? Stack Temp. Percent CO 4f::2% Smoke Bomb„ f Wiring C? Draft C.:' Test Tag Door Pressure ?i Lighting Inst. Date Tested Company Testing -Rouse Mechanical, Inc. 11348 KTel Dr. Minnetonka, MN 55343 Name of Tester klk- TING TEST RECORD ? IJ?? ' t" -? r t'?1 VIAIf cY: _ i??? ?, CX aLlk I V I ADDRESS APT. OO R C2Y +51J)3URB Lfd = ) OCCUPANT ' , ? OWNER L.v rrvu?.'t ?((?.4'+"?lI['hD'Yl I HEAT LOS !/ D TE pq G. INST. -7 SOLD BY 61 ' 100 INSTALLED BYA tnAZO C ?+ - Electrical Work By LA01 p- Gas Line By in4A o_ .O(' TYPE OF HEAT GA -4-,PA ??HW STEAM -SPACE HTR. UNIT HTR. OTHER DESIGN CO VERSION MAKE MAKE OF BURNER Model " 04 eFy! & Model Serial ?? e1 z?g 7 Max. BTU Rating INPUT !15104D MAKE OF FURNACE Model CO NTROLS cl THERMO Hea Plug Vent Size S Valve KIND OF LI R SIZENONE "OPW Limit Draft Hood Regularor ?-? i Limit Setting L " Filters Size Number Fan Setting 10 R) -FF Chimney Location d0utsida Pilot Type _ Chimney Construction Pilot Make Pilot Model Smoke Bomb Wiring Pilot Timing Draft Test ?? Tag - L.W. Cut Off Door Pressure Lighting Inst. Q r? p Pressure Percent CO 9D Date Tested C Input CFH Percent OZ ompany Testing -Rouse Mechanical, Inc. Stock Temp.__I_? Percent CO ©,?O 11348 K-Tel Dr. Mi nnetonka, MN 55343 ?/ A- Name of Tester 7? ? HEATING TEST RECORD c ,Q ADDRESS I5? f A-C>1'h4.0 ?-?^? r y' J L APT.' FLOOR y TY UBURB OCCUPANT OWNE (h.A f -? HEAT LOSS DATE HT?j INST. _ SOLD BY n? l2 QA?J?'W..W _ INSTALLED BY 'Q - Electrical Work By 1 _ !Ll/?( Luz , -Gas Line By Bf TYPE OF HEAT GAF, STEAM SPACE HTR. UNIT HTR. -OTHER GAS D IGN C ERSION ^ MAKE MAKE OF BURNER Model ' 1 t__ a Model Serial ^ r 7(')S7 C, Max. BTU Rating INPUT ?l C `1F? MAKE OF FURNACE Model , 9f THERMO T _ eat Plug Vent Size 11 /7 Valve ,t KIND OF LIR SIZE NONE Limit _ C 7 Draft Hood. Ul n Regularor s3 Limit Setting , - y Filters Si.. Number Fan Setting d Chimney Location nside utside Pilot Type - - Chimney Construction ?_?_ p-, D _ Pilot Make 13 ! Pilot Model ` Smoke Bomb Wiring I Pilot Timing Draft Test Tag L.W. Cut Off r? Door Pressure Lighting Inst. Pressure Percent COZ Date Tested Input CFH ?_- Percent OZ Company Testing -Rouse Mechanical, Inc. Stack Temp. ? Percent CO D 11348 K-Tel Dr. Minnetonka. MN 55343 Name of Tester HEATING TEST R E CORD 4, ADDRESS S ??, ??//// ??? APT. ?L(1?LOOR ?i IT?YJ SUBU B ? OCCUPANT OWNER (?Z HEAT LOSS AT HTG. INST. $??J SOLD BY INSTALLED BY1'(OLf..O? .cl` Electrical Work By Qt( ?°? Gas Line By CAAA--Q_. -0 TYPE OF HEAT GA ?A HW STEAM SPACE HTR. UNIT HTR. ,OTHER _G S DESIGN MAKE MAKE OF BURNER_ Model - Model Serial - Max. BTU Rating_ INPUT S! MAKE OF FURNACE TH E RM(?Tp Va Ive-r-lr YY j??'_ L Limit Setting Fan Setting _ Pilot Type Pilot Make - Pilot Model _ Pilot Timing L.W. Cut Off CONTROLS Heat Plug Pressure R.S rr(A P Percent CO r Z 5 / Input CFH -??rOm?D Percent OZ D Stack Temp. ?`f?y Percent CO !n Model Vent Size KIND OF LIN R Draft Hood ON a SIZE r NONE ularor _ Zf v--!) Filters Size Number Chimney Location n ide Chimney Construction Smoke Bomb Wiring Draft ??Y7 Test Tog Door Pressure Lighting Inst. Date Tested '6 -t Company Testing -Rouse Mechanical, Inc. 11348 K -Tel Dr, Minnetonka, MN 55343 Name of Tester v t `1,, H TING TEST RECORD yt ADDRESS 570 t''?A? APT. JIL ItoP,O,R_?J r'ITY SUBUR OCCUPANT OWNER .J?OV?TL _nn Q(`s HEAT LOS ? r DAT HTG. INST. 77-7 SOLD BY Q?6,1,?, `Q INSTALLED BY Llp Electrical Work By F 1w And tGAC Goa Line By L ?Pf TYPE OF HEAT GA -I-FA f -STEAM SPACE HTR. UNIT HTR. OTHER GAS DESIGN MAKE q 2 -? MAKE OF BURNER _ Model 1 O{P 04? .?f0?,p _ Model Serial OA.03D)OZ/ F2Gt87 GGzIZ Max. BTU Rating_ INPUT '4"C? MAKE OF FURNACE Model THER Valve Limit Limit Setting Fan Setting _ Pilot Type Pilot Make - Pilot Model _ VTROLS ' c/ v Heat Plug Vent Size KIND OF LIN R SIZE NONE Draft Hood tRegulamr Filters Size Number Chimney Location Isii 0 tside ?'LL1 -Chimney Construction- t'/ / r=/?55 Pilot Timing "4- 1 L.W. Cut Off Pressure ?? -S trC"t, Percent CO2 ®?Q Input CFH !?/?n?Q Percent 02 Stack Tamp.J'!_?Percent CO Smoke Bomb Wiring Draft Test Tager Door Pressure Lighting Inst. Date Tested Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. Minnetonka, MN 55343 Name of Tester KA ?f I? I j ? ? mle //??HEATING TEST RECORD ? ADDRESS C- - - APT. 00 R CI ??UBURB OCCUPANT OWNER HEAT LOSS ATE VTG. INST. !71 -- SOLD BY _Y INSTALLED BYE? ^^ Electrical Work By AUA ?' Gas Line By Fii -- II o?(..? TYPE OF HEAT GA -4.,GFA'_?HW STEAM SPACE HTR. UNIT HTR. -OTHER ) S DESIGN C ERSION - MAKE MAKE OF BURNER Model Model Serial Max. BTU Rating INPUT MAKE OF FURNACE Model THERMO AT tt He Plug Vent Size v Valve ISUW KIND OF LI R t NONE IZE Limit Draft Hood ! ? ?- Regulator Limit Setting Filters Size Jxwx Number t Fan Setting Chimney Location Inside Outside -Pilot Type_ Chimney Construction Pilot Make 5p7ls Pilot Model ' Smoke Bomb Wiring ^ Pilot Timing r/ Draft Test Tag L.W. Cut Off Door Pressure -^ Lighting Inst. re_ Pro P c nt C02 Dote Tested I P' Input nput CFH t Percent 0 S 0 Company Testing -Rouse Mechan ical, Inc. Stack Temp. 2 Percent CO 0 7 11348 K-Tel Dr. Minnetonka, M N 55343 / 4A Name of Tester //?,y //? H TING TEST RECORD ADDRESS ?"'?•' _e_ ' APT. LOOR ICIT SUB R! j OCCUPANT OWNER HEAT LOSS A E H G. INST. -F? 2 Qn SOLD BY INSTALLED BY ITOI/nn ", Electrical Work By Ic- Gas Line By ??l+t'Q.? 10 (' - / TYPE OF HEAT GA ?_S_HW STEAM -SPACE HTR. -UNIT HTR. -OTHER G DESIGN MAKE pp MAKE OF BURNER- Model - Lce L Model Serial - Max. BTU Rating - INPUT ?J1CX? MAKE OF FURNACE Model THERMO AT f Hea Plug Valve Li i t f" JtL Limit Setting Fan Setting tl Pilot Type_ Pilot Make Pilot Modal Pilot Timing L.W. Cut Off Vent Size KIND OF LI R Draft Hood Filters Size L? Chimney Location I Chimney Construction _ u n Pressure Percent COZ .60L Input CFH _ Percent OZ N Stock Temp. /P5yIC Percent CO RSION &5-- SIZE7 -NONE Regularor Smoke Bomb Wiring il? Draft cn'z' _ -- Test Tag Door Pressure ?s Lighting Inst. a/? Date Tested '?d- -4 y- 7 Company Testing -Rouse Mechanical, Inc. 11348 KTel Dr. Minnetonka, MN 55343 Name of Tester ,i / - H ING TEST )?RECORD 5? ADDRESS 1520 Q? ®//G? APT.' -"FF?LLOOOR-,_7+? /vI TAY -) -S BURG OCCUPANT OWNED l?'''-"-1pC-?L HEAT LO ATE TG. INST. SOLD BY SOX " INSTALLED BY /L1Q /? Electrical Work By uQ - Gas Line By riya-R- ,,e TYPE OF HEAT GA ?L?A _HW -STEAM SPACE HTR. -UNIT HTR. OTHER GAS DESIGN MAKE MAKE OF BURNER_ Model - t? Model Serial Max. BTU Rating INPUT MAKE OF FURNACE Model THERM Volvo Limit Limit Setting Fan Setting _ Pilot Type _-? Pilot Make . Pilot Model _ Pilot Timing L.W. Cut Off -? Cm Pressure ?'? ttf Percent C02 Input CFH 46-110CD Percent 0 ? 2 •S? Stack Temp. .?6eF Percent CO 0% VERSION ,. Vent Size q KIND OF LINER IZE. NONE Draft Hood Regularor A Filters Size 164 07) Number_ Chimney Location I`?s? Xside Chimney Construction t'I a Smoke Bomb r? Wiring v Draft Test Tog / Door Pressure Lighting Inst. p? Date Tested Company Testing -Rouse Mechanical, Inc. 11348 KTel Dr. Minnetonka, MN 55343 Name of Tester k H HEATING TEST RECORD .- ADDRESS I?? t/ 147Y10 /0r ,• APT. C5' LOOR I COY +_?SUBURB OCCUPANT OWNER AM M -CA,(CfS a HEAT LOSS AT?E, /y?TG. INST. SOLD BY - ?C-h = INSTALLED BY jC a' Electrical Work By VIA A"4 6P- - Gos Line By MAl-Le M?EC TYPE OF HEAT GA FA-_HW -STEAM SPACE HTR. -UNIT HTR. -OTHER S DESIGN MAKE MAKE OF Model 6 - 9E Model _ Serial Max. BTU INPUT St(?OC] MAKE OF Model Valve Limi t t L Limit Setting Fan Setting _ Pilot Type . Pilot Make Rating - FURNACE CONTROLS ' t s- H at Plug --------- Vent Size KIND OF LI R SIZ _ ONE pt 0- - t5 6( 1 1,' Draft Hood Re S gularor J Filters Size /6x Z1)X/Number Chimney Location I sid ??iside Chimney Construction ?SQ=,.5 Pilot Model T' Pilot Timing L.W. Cut Off i Pressure 3' Percent CO2 Input CFH Percent 02 A? Stack Temp. ? Percent CO C Smoke Bomb ? Wiring Draft (,GY-g/°F Test Tog 11 Door Pressure Lighting Inst. Dote Tested cd- / -R-- r ? 6 Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. Minnetonka, MN 55343 Name of Tester _ ?/?lfi- BURNER ING TEST RECORD ,?. ADDRESS ',-7LO APT. V? FLOOR ?SJlcfrT?Y,,??f? BURB OCCUPANT OWNERS-?'? L-??•t?'i7ucY-S HEAT LOSS TE TG. INST. SOLD BY INSTALLED BY 2034/10 Electrical Work By I Line 8y hs44- C - TYPE OF HEAT GA CFA _HW STEAM SPACE HTR. -UNIT HTR. -OTHER S DESIGN C V RSION MAKE MAKE OF BURNER Model 0:2 Me Model Max. BTU Rating Serial - O_Z INPUT ?S?D (9a MAKE OF FURNACE Model r ONTROL$ . rf _? rr V THERMO T Heat Plug Vent Size Valve V KIND OF LI SIZE -NONE Limit Draft Hood Regularor 3r-? _3 Limit Setting ?Jclklyqil Filters Size Number III Fan Setting Chimney Location Inside a_Tsidf Pilot Type _ Chimney Construction ?M't T YiJ TGU Pilot MakeQ Pilot Model - r' r °-r Smoke Bomb Wiring? / Pilot Timing ." Draft 711r?Test Tog y L.W. Cut Off Door Pressure ry Lighting Inst. r d Pressure Percent CO, Z Dote Tested ?? a ?7 Input CFH ?5Z00() Percent OZ Company Testing -Rouse Mechanical, Inc. Stack Temp.-dr r Percent CO 11348 K-Tel Dr. Minetonka, MN 55343 Name of Tester U `y???? ING TEST RECORD [4 ADDRESS Nlt?/??%V(^ f r• Urt'r n QAP OORCIT i/SU BURB OCCUPANT OWNER aYY1 /?-- HEAT LOSS D TE TG. INST. 7`7y SOLD BY r^ INSTALLED BY Electrical Work By 4A.G" EIZZ& Gas Line By mA'? _,?,r TYPE OF HEAT GA-1LF??W-STEAM -SPACE HTR. UNIT HTR. OTHER DESIGN CON SON MAKE _ MAKE OF BURNER Model EACA_ 072" CA=, - Model 1077 Max. BTU Rating Serial ?-zr INPUT /`mar P??G? MAKE OF FURNACE Model Valve 44* Limit Limit Setting Fan Setting _ --Pilot Type Pilot Make - Pilot Model _ VTROLS rt _6 rr Heat Plug Vent Size r AJ? KIND OF LINER 7F NONE Pilot Timing L.W. Cut Off r Pressure ? fU ??1?' Percent CO2 [ Input CFH 7 Percent OZ Stock Temp J ?Percent CO Draft Hood Regulator Filters Size Number Chimney Location Inside -Chimney Construction Smoke Bomb Draft Outside Wiring - Test Tag Door Pressure ?i Lighting Inst. Date Tested Company Testing - Rouse Mechanical, Inc. 11348 K-Tel Dr. Minnetonka, MN 55343 Name of Tester HEATING TEST RECORD ADDRESS _ OCCUPANT HEAT LO DA 771E HTG. INST. -/-1f" SOLD BY _ 01.1.[101!4 P?I, ' INSTALLED BY Pri -/, g Electrical Work By _ OP ^ Gas Line By KL)3&a.8 r" 4Or /tom TYPE OF HEAT GA -4,--rA I?n?_HW -STEAM -SPACE HTR. UNIT HTR. -OTHER AS DESIGN MAKE MAKE OF BURNER Model (0 DL9 en P, Model Serinl Max. BTU Rating _ INPUT MAKE OF FURNACE THER Valve L Limit Setting Fan Setting Pilot Type _ Pilot Make - Pilot Model _ Pilot Timing L.W. Cut Off ON Model CONTROLS it `` rr at Plug Vent Size 1 i KIND OF L ER A4 adw SIZ ONE Draft Hood wit Lf rM Regalaror 75Z_ -__:r Filters Size f 1 Number Chimney Location si 7 ^O?ut ode ?? Chimney Construction Pressure Percent CO 2 -706 Input CFH r tl'? Percent 02 1470 Stack Temp. Percent CO 0 Smoke Bomb Wiring Draft Test Tog Door Pressure ?fLighting Inst. Date Tested R-11-61 Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Or. Minnetonka, MN 55343 Name of Tester `' 1 n HEATING TEST RECORD ? ADDRESS NTI ? ICJ l R APT 'LOOR`'_ ` M Clyj m5'+!l V OCCUPA -OWNER. HEAT LOS DAT HTG. INST. ` {a'Ll C Nn ?7_ Y-1 20 ryylict }-1 SOLD BY ?(.AO c.20 INSTALLED BY w Electrical Work By 1 A Gas Line By TYPE OF HEAT GA VFA HW -STEAM SPACE HTR. UNIT HTR. -OTHER S DESIGN MAKE MAKE OF BURNER _ Model (<& 8 W604 Model Ssrial 04 Max. BTU Rating - INPUT MAKE OF FURNACE Model THERMDVT? V_.1_ Limit Limit Setting Fan Setting _ - Pilot Type _ Pilot Make - TROLS 411_ leat Plug Vent Size KIND OF LI ER SIZE -45-" NONE Draft Hood Ov\ Regulator Filters Size X Number / 0 Chimney Location (y/Side -/p-utside !J - Chimney Construction Pilot Model Z? 1-cI I y " Pilot Timing L.W. Cut Off -;? Pressure 'tPercent CO2 `O Input Percent 02 IO Stack Temp. Percent CO ? Smoke Bomb Wiring L/ Draft 4 Test Tag Door Pressure Lighting Inst. Date Tested ?-/-7- Q Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. e#- Minnnetonka, MN 55343 Name of Tester f EATING TEST RECORD H ?!?- ? ??y'.? ? t ( H? __ ?7` ADDRESS 1 v1?YY?-? -' hit. ' APT LOOR CITY\ SUBURB k OCCUPANT -bpy CIj2f t.? /1 OWNER ?1 /rf r)Q fM HEAT LO DATHTG. INST. SOLD BY INSTALLED BY ?-AJ -? tOr Electrical Work Ay /??t IPA D/?. Gas Line By mAIQ.,l -e C III TYPE OF HEAT GA CFA HW STEAM SPACE HTR. -UNIT HTR. -OTHER GAS DESIGN CONVERSION MAKE MAKE OF BURNER Model r li H Model Serial 9 p? O Max. BTU Rating INPUT MAKE OF FURNACE. Model g CONTROLS G? _ rt_ t/ J THERM q A Heat Plug Vent Size % ? Valve 7[L t ] C O Kn-k A r- KIND OF LI ] 3 0 SIZE ??r NONE 1 ' Limit P ? CP'-A 0. I 1 %Y Ltj OV•\ Draft Hood Regulator ?rG'-l Limit Setting , 196cr Filters Size Number Fan Setting t o Chimney Location I ide Outside Pilot Type _ Chimney Construction ??-' ?y 't? Pilot Make 4ad 14 r 6 Pilot Model Smoke Bom6. Wiring y Pilot Timing Draft Test Tag L.W. Cut Off Door Pressure Lighting Inst. T , `/Q r 5-1') -S-'? Pressure Percent COZ Date Tested 0 Input CFFI 6nIAn Percent 02 ?0 - - Company Testing -Rouse Mechanical, Inc. Stack Temp. 70 6F'1= Percent CO p 11348 K-Tel Dr. Minnetonka, MN 55343 Name of Tester ?^ HEATING TEST RECORD t ADDRESS w? ?M(A L0 ` ? N , APT. LOOR"Z/ CIT UBURB OCCUPANT OWNER flY\ a A/VN'tr){ _A91 6 -? HEAT LOS$d„ fJ.ATE NTG. INST. SOLD BY 'VdLLQ-A n'••(•'P-n?,.• INSTALLED 8Y,' CT1? i ? Electrical Work By L-r-OA - Gas Line By -- TYPE OF HEAT GA '1L?_FA-HW -STEAM SPACE HTR. UNIT HTR. -OTHER GAS DESIGN C NVERSION MAKE MAKE OF BURNER Model - Model Serial I ?? 74 7 Max. BTU Rating INPUT ?-?t0? MAKE OF FURNACE Model THERMO T T t g Heat Plug Valya Limit . Limit Setting Fan Setting o Pilot Type _ Pilot Make V_(5IQLA_&SjhA?D Pilot Model 11,2 11 S? Pilot Timing L W Cut Off . . It Pressure u? Percent CO2 Input CFH ? Stack Temp. Percent Oz Percent CO C1 t Vent Size f 5" KIND OF LI R ES C) SIZE NONE Draft Hood Regularor 3 Filters Size /- V/XZIOx ( Number Chimney Location In uiside Chimney Construction Smoke Bomb _ Wiring Draft Test Tag Door Pressure Lighting Inst. Date Tested Company Testing - Rouse Mechanical, Inc. 11348 K-Tel Dr. M in n tonka, MN 55343 e / , ? (? i Name of Tester \ HEATING TEST RECORD '520 `t t T CTYVI( t.4 I0 le P .P? .. ADDRESS ` APT. OOR - CITY/_?-rSUBURI_B ` OCCUPANT OWNER M'Yt ?M (- J1rr/t .l HEAT LOSyS?? ATE HTG. INST. SOLD BY "d"?_ y'4U_ rLC Z? ' INSTALLED BY V, Electrical Work By lef& O I toA Gas Line By k,Av ?'• TYPE OF HEAT GA ?rA W STEAM SPACE HTR. -UNIT HTR. -OTHER GAS- ESIGN MAKE ?? - MAKE OF BURNER_ Model }-0 G-e J Model Serial 1? V Max. BTU Rating - INPUT MAKE OF FURNACE Valve Limit Limit Setting Fan Setting _ --Pilot-Type Pilot Make - Model Ls Plug Vent Size IS KIND OF LI R SIZE I r? NONE Draft Hood Q- 0-?_Regularor ?'iEl"F!P 3 Filters Size (9X2DXt Number andy-?? Chimney Location y lq_s Outside J WOT - Chimney Construction Pilot Model Pilot Timing _:?)_S LC - L.W. Cut Off '5?- 541D Pressure ?'S( Percent C02 Input CFH 4000 00 ?? Percent 02 00 Stock Temp. Percent CO Smoke Bomb Wiring Draft Test Tog Door Pressure Lighting Inst. Date Tested W - (?? ^0^/ Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. Name of Tester miiin?netgnka, MN 55343 /_41L/1 HEATING TEST RECORD k ADDRESS OOR CITY ?SUBUR? ? OCCUPANT OWNER ' S HEAT LOS D TE 7yf TG. INST. SOLD BY `pC_J?- INSTALLED BY Electrical Work By E _DA 3AA0'4 Fpee- Gas Line By TYPE OF HEAT GA L?A A=T?'_HW -STEAM -SPACE HTR. UNIT HTR. -OTHER GAS DESIGN CONVTRSION MAKE MAKE OF BURNER Model 6 Model Serial 1 -7 Z Max. BTU Rating INPUT MAKE OF FURNACE Model Valve h!Ur Limit Limit Setting Fan Setting _ Pilot Type Pilot Make Pilot Model _ T???CONTROLS R _5 y -111- Heat Plug Vent Size 19 5.1/1Q / A r- KIND OF LINER 04 /(AkW Draft Hood (1 Allfw- Pilot Timing ?L a-KK ' L.W. Cut Off !(y? Pressure • l.-- Percent COZ 'SD Input CFH ?I?DM? Percent O2 b Stock Temp. 477,5"''C«t? P Percent CO Filters Size Chimney Location I Chimney Construction - Smoke Bomb Wiring Draft I Tag- Door Pressure ?T Lighting Inst. Date Tested g? '(? 9-) Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. Ma, MN 55343MN 55343 Name of Tester pV? l ? HEATING TEST RECORD t / ? Z C( Q ADDRESS t/ - PT ' , - A LOORQ?CI ? ?UBURB ( OCCUPANT O'YYY[,(M ?iQ]?j-1tyC OWNER HEAT LOS (y/?f_?A T E 1?{TG. INST. , ,, ,, SOLD BY INSTALLED BY Electrical Wert By p8 - Gas Line By r AQAQ g- Seif TYPE OF HEAT GA __bFA r/ STEAM-SPACE HTR. -UNIT HTR. -OTHER -G-AS DESIGN C NVERSION MAKE MAKE OF BURNER Model Model Serial Max. BTU Rating INPUT MAKE OF FURNACE Model CONTROLS sir y THERM T T Heat Plug ? r Vent Size Valve KIND OF LI ER IZE NONE Limit Draft Hood aNf? Regulator -37 5-- 3 Limit Setting Filters Size 164ZDX I Num6er- Fan Setting Chimney Location 17 a /tom tside L? _ Pilot Type -- a.lt - Chimney Construction `E?'F+ rlt?s Pilot Make Pilot Model Smoke Bomb Wiring Pilot Timing Draft Nest Tag L.W. Cut Off Door Pressure- s Pressure Percent COZ 'S Date Tested -0 Input CFH S Percent OZ Company Testing Stack Temp Percent CO Name of Tester -(? -O Lighting Inst. - Rouse Mechanical, Inc. 11348 KTel Dr. MinrV?tonkaI MN 55343 I 1- n/ HEATING TEST ?}R'EECORD ADDRESS ?Za Le P( APT. LLB Cry UB RB OCCUPANT OWNER ;(,J II?L\ f I.L__E rj HEAT LOSS L? D?A p7E HTG. INST. - SOLD BY INSTALLED BY _Pn&A Electrical Work By EtA ,,w Pe Gas Line By - - TYPE OF HEAT GA L---FA 2----HW STEAM -SPACE HTR. -UNIT HTR. -OTHER S DESIGN IT RSION MAKE - A MAKE OF BURNER Model lt?GJDII Model Serial 'z S7- Z7-43 Max. BTU Rating INPUT S/aX? MAKE OF FURNACE Model THERMO ?-????..--???? CONTROLS T t? Heat Plug Va Ive Limit Limit Setting a Fan Setting C1 CD _y ----Pilot Type- - "e Pilot Make v Pilot Model C !5P74J-!5P_745 Pilot Timing ° NtrC L.W. Cut Off I m Pressure 315' , w s- Percent CO2 Input CFH 4qS'C:04D Percent 02 Stock Temp, Per cent CO 0 !! sr/ Vent Size KIND OF LI R_ ?`?' SIZE NONE DraN Hood Regulator Filters Size 10?,?0x0 Number Chimney Location II side Outside Chimney Construction- !"r E ?, Smoke Bomb Wiring Draft Test Tag Door Pressure ? / Lighting Inst. Date Tested Gr-/-l6 Company Testing -Rouse Mechanical, Inc. 11348 KTel Dr. Minnetonka, MN 55343 Name of Tester KA / HEATING TEST RECORD 'A_ 4A ADDRESS ?Jt.JC/ 1 r ` ?1 ( ? APTQMOFI)OOR '. OCCUPANT OWNER HEAT LOSS DACE HTG. INST. -7 SOLD BY INSTALLED BY Electrical Work By Pe? Gos Line By d1ta-2 ec 1 TYPE OF HEAT GA LLFA?W -STEAM-SPACE HTR. -UNIT HTR. -OTHER MAKE Model_ Serial . INPUT Vo Iver Limit DESIGN CO VERSION MAKE OF BURNER Model ?- Max. BTU Rating MAKE OF FURNACE Model rCONTROLS _- Heat?Plug Limit Setting t ZV / Fan Setting Pilot Type Pilot Make Pilot Model Pilot Timing L. W. Cut Off Q Pressure ys'/Percent C02? Input CFH Percent OZ Stack Temp, _ Percent Vent Size T_ KIND OF LIN _ Draft Hood -LU Filters Srz Chimney Location Chimney Construc Regulator Smoke Bomb Wiring y Draft Test Tager Door Pressure Lighting Inst. Date Tested Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. Minetpnka, MN 55343 Nome of Tester ,YYLL?f?? IIr? /HEATING TEST RECORD ADDRESS fOZnn v fNYIf?.e I.(A ?ro P't. APT.0+-FLOORt 1tc Y& --,,,-SUBURB OCCUPANT OWNER (Q _ r.r? ?,,V`n4 tr HEAT LOSS DATE HTG. INST. -7 7 SOLD BY 9??'P I • ? INSTALLED BY - -? 'e- - Electrical Work By rtk*fJC1.f°? Gos Line By O\A? TYPE OF HEAT GA L-FA !E?HW -STEAM SPACE HTR. UNIT HTR. -OTHER ' ?AS DESIGN MAKE -?- MAKE OF BURNER_ Model 0?' T7/Jr-f 0 e P Model Serial f %) A ?"?7 ZZ(oz Max. BTU Rating INPUT 4s?no1? MAKE OF FURNACE Model CONTROLS THER STAT a I r- Heat Plug Valve Limit 0499 V Limit Setting Fan Setting _ Pilot Type - Pilot Make _ Pilot Model _ Pilot Timing L.W. Cut Off Vent Size KIND OF LIR SIZE sy NONE Draft Hood l?\ Regularor 7 3 Filters Size 16nX7l1X k Number Chimney Location . Irnside ?Outside Chimney Construction Pressure ?5-S ct4-r Percent CO2 Input CFH _4_4 Percent OZ - 6&11170 Stack Temp. 4'100F Percent CO Smoke Bomb Wiring Draft &W4 v Test Tag Door Pressure Lighting Inst. Dote Tested Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr, Minnetonka, MN 55343 Name of Tester HEATING TEST RECORD '?ny ` ' Ti,0>1 L AC P 1 L? a S ADDRESS - • APT` f;L0 0R Z CI i SU UR OCCUPANT OWNER J }3y , y?rP?+-? HEAT LOS y ATE„HTG. INST. ? ?,,?? SOLD BY vwL1E` INSTALLED BY Electrical Work By e - ! A 0 A g P' _ Gas Line By ,,,•????...• 000G?'?'Q-? 614,C, I ' TYPE OF HEAT GA ? / ? ?HW -STEAM -SPACE HTR. - UNIT HTR. -OTHER - AS DESIGN 0 (VERSION MAKE MAKE OF BURNER Model 7 U2 (I V__ Model Serial e l 8-) ZS0 Max. BTU Rating INPUT MAKE OF FURNACE Model Va Iva Limit Limit Setting Fan Setting -- Pilot Type - Pilot Make _ Pilot Model _ Pilot Timing L.W. Cut Off CONTROLS -Meat Plug if ^1 S I Z Regularor _ E Pressure Percent CO2 9.510 Input CFH Percent 02?R-e Stack Temp Percent CO _ /WJ?I0 - Vent Size KIND OF LIN Draft Hood Filters Size Chimney Location Chimney Construction Smoke Bomb Wiring Draft Test Toy Door Pressure Date Tested Lighting Inst. Company Testing -Rouse Mechanical, Inc. 11348 KTel Dr. M in netonka, MN 55343 n Name of Tester ' / `y I T J - /? EAT ING TEST RECORD y/??',,?, ., 1 F" ? / ADDRESS . ?zo ?yl2 ( / - SUBUF2 ( v APT OOR ? CIT ?a _ . . ?} ? " ? ' OCCUPANT R ' .f3?.d X ? Jl'Y14??- ` OWN yy ?? ?? ?? HEAT LOS ETG. INST. ?`E7 AT y ,? , ?- , SOLD BY Ryl.ut- ? ['?tt=C'?+ - -INSTALLED 8Y?L4Jdlt - Electrical Work By - Gas Line By TYPE OF HEAT GA ?? _HW STEAM -SPACE HTR. UNIT HTR. -OTHER GAS DESIGN C NVERSION MAKE MAKE OF BURNER W Model Model 44 Serial Max. BTU Rating INPUT MAKE OF FURNACE Model e-f CONTROLS rt _ ` ri THER T T Heat Plug Vent Size J Valve 0 KIND OF LI R _ SIZE 1:V' NONE Limit Draft Hood ETA Regular-, Limit Setting !!,, lJ Filters Size Number Fan Setting ar Chimney Location Inside utside y? -Pilot Type- alt - Chimney Construction ?l•( Q??' Pilot Make C> _. ? Pilot Model ??`? Smoke Bomb Wiring j Pilot Timing i ?- Draft Test T-g L.W. Cut Off Door Pressure Lighting Inst. S'r? t p1 K 6"7C?0 ? 1/3 ?2 Pressure • - Percent COZ ' Input CFH Percent O rr ' r" Date Tested Company Testing -Rouse Mechanical Inc Stack Temp. Z Percent CO d?m , . 11348 KTel Dr. M, patonka, MN 55343 I??/Art2 ^-7? / Name of Tester ,, / HEATING TEST RECORD ADDRESS -??? ' rW?"T g,t:C) LGU"LP APT LOOR ITY UBURB OCCUPANT OWNELIY1'lll?? iztdt,n HEAT LOSS DATE HTG. INST. -7 - S 7 SOLD BY '?'Ja - - INSTALLED BY Q = / Electrical Work By J?e 'tw'd ddtt''""1('Q /"to i Gas Line By /L(.? 0 TYPE OF HEAT GA LFri 4W -STEAM SPACE HTR. -UNIT HTR. -OTHER -GAS DESIGN N gERSION MAKE MAKE OF BURNER Model - cc - Model Serial vZ_ _ <f Z-3 y Moz. BTU Rating INPUT MAKE OF FURNACE Model Vent Size KIND OF LI i? IZE NONE Draft Hood _ay\- Regulator Filters Size J i 7LX ( Number Chimney Location ??n/6id -Outside Chimney Construction /-"t 5 Pilot Model Smoke Bomb, ,t Wiring Pilot Timing Draft y tea' Test Tog L? L.W. Cut Off Door Pressure Lighting last. Pressure Percent CO2 `90/0 Date Tested Input CFH Percent 02 ??qqw Company Testing -Rouse Mechanical, Inc. Stack Temp. Percent CO 6? 11348 KTel Dr. Minnetonka, MN 55343 Name of Tester ADDRESS r 2/? OCCUPANT HEAT LOSS AT HTG. SOLD BY '2 CL Electrical Work By ked TYPE OF HEAT GA _Z.Lf-A c! nHEATING TEST RECORD PB -/. APT `r LOOR ITY SUBI'RB ry% OWNER Q J ?-?{>? UL' A 41 INST. INSTALLED BylnIwo l 0d` Gas Line By 7SIL( AA .P C? - H -STEAM -SPACE HTR. -UNIT HTRLJ_OTHER G S DESIGN MAKE MAKE OF BURNER_ Model Model Serial "' Max. BTU Rating INPUT C? MAKE OF FURNACE Model CONTROLS Heat Plug Valve I Limit Limit Setting Fan Setting - Pilot Type Pilot Make Pilot Model r ° t Pilot Timing _ L.W. Cut Off ?r Pressure7 Percent C02 -796 Input CFH ?? Percent 02 Stack Temp?Percent CO 1;>17P Vent Size -r 1' r KIND OF LI R 0\ SIZENj2jlE Draft Hood Regularor ?? Filters Size Number Chimney Location s' Chimney Construction ?r?' -? Smoke Bomb Wiring Draft ?-Test Tags/ Door Pressure Lighting Inst. Date Tested Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. Minnetonka, MN 55343 Name of Tester' ' / ADDRESS I(5w t_f ^ wfp?-tU C.L¢ ka- t.ATING STRECORD TEAPT ?? OCCUPANT ! OWN HEAT LOSgy /pATE RG. INST. ?? SOLD BY 7L1J1?..??L` 9 i7 INSTALLED BY Electrical Work By ?y K-'? Gam - Gas Line By TYPE OF HEAT GA _ FA _HW STEAM - SPACE HTR. -UN IT HTR. -OTHER f./ i1GAS DESIGN MAKE {?/?? MAKE Model Model Serial Ito Z Max. INPUT MAKE TH E RMOSITA Valve yJ Limit Limit Setting Fan Setting _ Pilot Type Pilot Make - /D /F CONTROLS Pilot Model r / t Pilot Timing L.W. Cut Off r? Pressure ?- ??r?Percent CO2 OZ O Input CFH-? J! Percent Stock Temp. (® ? Percent CO ?_6 OF BURNER BTU Rating _ OF FURNACE Model i/ `ri Vent Size J _ KIND OF LIN U&Iwl w SIZ Draft Hood tf el Regulator _ Filters Siz?XZO•e Number_ Chimney Location 'IInnp id Chimney Construction- Smoke Bomb Wiring Draft Test Tog Door Pressure Lighting Inst. Dote Tested 'j ?-2 Company Testin g -Rouse Mechanical, Inc. 11348 KTel Dr. in to a, MN 55343 Name of Tester HEATING TEST RECORD ADDRESS 1SZ_0 w ?- - APTLOOR ? CNY - SU URB? OCCUPANT OWNER' ` ?TY?O-}'A /?_^-T?O HEAT LOSS DAT HTG. INST. 7`7 SOLD BY INSTALLED BYrlA01? Electrical Work By _ C Gas Line By ??-?- '? aA'A I TYPE OF HEAT GA _ FA ?HW STEAM -SPACE HTR. -UNIT HTR. -OTHER GAS DESIGN CONV R SON MAKE MAKE OF BURNER Model Model Serial Max. BTU Rating INPUT ?SrcAO MAKE OF FURNACE Model THERMOOT, Valve K L Limit Setting Fan Setting _ Pilot Type Pilot Make - Pilot Model _ Pilot Timing L.W. Cut Off CONTROLS Q./( r. Heat Plug Vent Size KIND OF LI R, < SIZE Sri NONE Draft Hood PE2N Regularor ?iZS'3 - Filters Size TLOX?nX f Number Chimney Location I p?utside Chimney Construction'Pt+t' tt Pressure?2-' t(JX- Percent CO2 5.5% Input CFH 5 (? -Percent 02 -7 O Stack Temp. ? Percent CO d?? ® -J Smoke Bomb Wiring !l Draft ??Test Tog Door Pressure Lighting Inst. Date Tested t9-( 3-e:? Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Or, Minnetonka, MN 55343 Name of Tester ? R /??/? HEATING TEST RECORD ADDRESS 1,57Zo w?mQ? ! f? APT. LOOK ?CIT?SUBU_IjBs OCCUPANT ?7 OWNER HEAT LOS AT HTG. INST. SOLD BY MA °C - INSTALLED BY Electrical Work By ?/ ? Gas Line By --Q Ad`P / TYPE OF HEAT GA -L--fA-HW-STEAM -SPACE HTR. -UNIT HTR. -OTHER GAS DESIGN CO VERSION P J, MAKE / MAKE OF BURNER Model TT l9??7 C Model Serial \ 1(?? f?l/, ?P ?? g / S Ma:. BTU Rating INPUT ??rOOr? MAKE OF FURNACE CONTROLS THERMO T T 1 1? Heat Plug Valve 0 L Limit Setting _T( Setting Pilot -Type - u<-?- - -- - - Pilot Make Pilot Model Pilot Timing' L.W. Cut Off `- Pressure 3-S rr Percent C02 Input CFH 6rPercent 02 n-"j Stock Temp. 4430E Percent CO Model ??r r Vent Si:e KIND OF LItG47? R rLC K1_ SIZE NONE Draft I P)?AOp C<Yt Re_gula.or ZS _3 Filters Size I&A 70 k ( Number Chimney Location IPSi a Outside - -- Chimney Construction Smoke Bomb `-? Wiring Z/ Draft Test Tag Z? Door Pressure Lighting Inst. ly -1 Date Tested .?- Company Testing -Rouse Mechanical, Inc. 11348 KTel Dr. Minnetonka, MN 55343 Name of Tester HEATING TEST RECORD ADDRESS APT..%w/0FL??yp,R,, CITY',,, ` 5 BU,,RAg_ OCCUPANT OWNER. ?iy'y'-'A '?/y'?^a- -? 1 HEAT LOSS RATE _IT G. INST. -?? SOLD BY ?????- ?' INSTALLED BY FMAV- tO - Electrical Work By toZO Q Gas Line By n - TYPE OF HEAT GA A HW STEAM SPACE HTR. UNIT HT-R. -OTHER GAS DESIGN CONVE ION MAKE MAKE OF BURNER Model P-6 A }-Iry'F?q Model Serial C9/ 7- ?? Max. BTU Rating INPUT 6001 WC MAKE OF FURNACE Model Valve Limit Limit Setting Fan Setting -Pilot-Type - Pilot Make - Pilot Model _ C( CONTROLS rr , T Heat Plug Vent Size 2eQaUr KIND OF LIµ; V SIZE S`t NONE Draft Hood _Regulator S-7 Filters Size ?ZO9' 1 Number ' 3(] U Chimney Location ,Igsid9 utside 4?/ - - - -- - Chimney-Construction-- ?f Pilot Timing L.W, Cut Off ?ArO Pressure ??Per<ent C02 /I. q Input CFH ? Percent OZ ? ? C6 Stack Temp. Percent CO -7U< -----'7 Smoke Bomb Wiring le? Draft Test Tag Door Pressure Lighting Inst. Date Tested - t 3- Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. Minnetonka, MN 55343 Name of Tester I? ` , ? HEATING TEST RECORD OCCUADDRESS 7O 1 OWNER ???y` OOR ,,C?yy?-SUBURB? HEAT LOSS AT HTG. INST. -5-7 BY INSTALLED BY 2 9= - ?' - Electrical Work By - Gas Line By '0-KA 9_ LLect_ TYPE OF HEAT GA 4--?A HW STEAM -SPACE HTR. UNIT HTR. OTHER MAKE GAS DESIGN CO VE SION J ? I no 7 MAKE OF BURNER Model 014 -QOC'A -C Model Max. BTU Rating INPUT ?? C)?y MAKE OF FURNACE Model THERMg3 Valve ??OO L Limit Setting Fan Setting - Pilot Type - Pilot Make _ Pilot Model _ Pilot Timing CONTROLS / (I - Heat .? - Heat Plug Vent Size `t _ KIND OF IL R SIZE J NONE Draft Hood ?? Regularor ?Z7 ?3 Filters Size'?x ZOX I Number Q? Chimney Location [ Ipsi e?_tS utside _ , - Chimney Construction L.W. Cut Off ?+p1 Pressure 3r1?tr Percent COZ Input CFH ?I1 --Percent 0 Stack Temp. yZ Percent CO Z Ob• 7 V Smoke Bomb Wiring Draft Cam! Test Tog Door Pressure Lighting Inst. f Date Tested e -I -S -Y--) Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. Minnetonka, MN 55343 Name of Tester y HEATING TEST RECORD ADDRESS APT. 3?,,C LOOR r? ?, CISUB•URB OCCUPANT OWNER 1,lJYti'?CLLC tL m/1 HEAT LOS D TE TG. INST. 7 SOLD BY ?- INSTALLED BY QIAJU- r - Electrical Work By 0 .LAOir / OO - Gas Line By ry'0-0 `en :_L TYPE OF HEAT GA-STEAM SPACE HTR. -UNIT HTR. -OTHER GA DESIGN CONVERSION MAKE MAKE OF BURNER Model C ' Model Serial A Q ?e 7 ,37 Max. BTU Rating INPUT 0 MAK E OF FURNACE Model THERMO TA Valve Limit Limit Setting - Fan Setting _ -- -Pilot Type Pilot Make _ Pilot Model _ Pilot Timing L.W. Cut Off YIRVLJ ` rtl?l? Heat Plug Vent Size 4 KIND OF LI R SIZENONE Draft Hood AAU 6r Regulator > Filters Size IL1x ?.OX I Number D Chimney Location }).n ?d OOutside C'2 - -- -Chimney-Construction / "'L'am Smoke Bomb Wiring •/ Draft (Test Tag Door Pressure Lighting Inst. -7 r! Pressure S' S ?G Percent COQ ' (% Date Tested ?- 13 -? 7 Input CFHPercent OZ Company Testing -Rouse Mechanical, Inc. Stack Temp. Percent CO 11348 K-Tel Dr. Minnetonka, MN 55343 AG J,4 Name of Tester JN+ `y'- I /' EATING TEST RECORD l) / ' 'JC? 1 ADDRESS -^,,,, /U Otto ? I ,n APT. LOOR ITY UBURB - = OCCUPANT OWNE R .(lYY1( 2.C„n A1/-lt?tn 1 HEAT OS`Z?3 ? _, D A HTG. INST. P SOLD B ?QL(,(Ij). ?` ` ? ? 1..? INSTALLED BY m?e Electrical Work By Gas Line By ^ uit4. £ (,Pr TYPE OF HEAT GA f/? STEAM -SPACE HTR. -UNIT HTR. OTHER HW ?GAS DESIGN CONVERSION q ,?y? MAKE k?r" ? MAKE OF BURNER Model Model Serial 3? ?? >C? ZZZ6 Max. BTU Rating INPUT 1600 MAKE OF FURNACE Model THERM Valve Limit Limit Setting Fan Setting _ Pilot Type - Pilot Make - Pilot Model Pilot Timing L.W. Cut Off CONTROLS - q,?•/ Heat Plug Vent Size ? KIND OF LI R _ SIZE NONE Draft Hood Regulator ?3 p Filters Size Number I /Q Chimney Location 1 idl Outside Chimney Construction m s C } r? Pressure 2.4Percent C02 71? 20 Input CFH y? Percent 02 Stack Temp. Percent CO O Aq. -) Smoke Bomb Wiring Draft -Test Tag L Door Pressure c'-- -7 Lighting Inst. 1/ Date Tested Company Testing -Rouse Mechanical, Inc. 11348 KTel Dr. Minnetonka, MN 55343 Name of Tester t 0 D HEATING TEST RECORD 9 ADDRESS 1SZ0 0)14M ?'?-•r APT. L/f00R LCI SUBU B ? OCCUPANT OWNER HEAT LOS? DAy7?F- HTG. INST. SOLD BY INSTALLED BY RinklQ A_G `P Electrical Wort Fly /C -(0V (Ca-t ADd 1° Gas Line By TYPE OF HEAT GA Z/A' ?:n'_HW STEAM SPACE HTR. -UNIT HTR.-OTHER GAS DESIGN C 1 VE 510N MAKE MAKE OF BURNER . _LA 01110 - Model Model Serial $ Z3 Max. BTU Rating INPUT MAKE OF FURNACE Model CONTROLS [ 4[t _5 THERM O T T Heat Plug Vent Size Volvo KIND OF LInR 65 SIZE S4 NONE Limit Draft Hood 1 6 Regularor 32c? Limit Setting Filters Size ?(oXZOX I. Number Fan Setting Chimney Location Insid side Pilot Type Chimney Construction Pilot Make O Pilot Model ? I ? Smoke Bomb Wiring Pilot Timing ?'?-- Draft &e1w Test Tog L.W. Cut Off Door Pressure ?- Lighting Inst. ? Z - J Date Tested 13 -f" / Pressure `S ["J ? Percent CO C Input CFH Percent OZ Company Testing -Rouse Mechanical, Inc. Stock Temp. Lt 6cyt- Percent CO 11348 K-Tel Dr. y'l nnetonka, MN 55343 .77 3 Name of Tester t`"•' HEATING TEST RECORD J/?/? ADDRESS APT. ) LOOR jITY SUBURB _C: OCCUPANT OWNER HEAT LOSS ME TG. INST. 7 -`37 SOLD BY INSTALLED BY 014JO 9--)El' '. - Electrical Work By Q - Gos Line By mzA = TYPE OF HEAT GA __L,-rA _HW-STEAM -SPACE HTR. -UNIT HTR. -OTHER GAS DESIGN MAKE MAKE OF Model 6 Y?i L- Model - Serial G.fJ3!)/o4- F7n87- ZzZ Max. BTU INPUT MAKE OF Model - BURNER Rating FURNACE RSION 1 ONTROLS -I ^ (1-5.1 7 ?T T float Plug Vent Size Volvo ?'Q Valve ^ i ( KIND OF LIN r IZE.??NONE Limit r -k Draft Hood Q? Regulator ?... S-? Limit Setting 1130 Filters Size - x 0x I Number Fan Setting _ cry\ Chimney Location Ipsi d Oy?ar'de -- - -Pilot-Type-_ - - Chimney Construction '??-5' Pilot Make c Pilot Model ?? 7 S Smoke Bomb - ? ?- Pilot Timing r ", ? ar??? Draft (d_ Test Tog -/ L.W. Cut Off Door Pressure Lighting Inst. ! 2 f( P r c/ Pressure ' 4 /A - Percent CO2 5: Date Tested Input CFH- , Percent 02 Company Testing -Rouse Mechan ical, Inc. Stock Temp. & .?---- of Percent CO 11348 K-Tel Dr. Minnetonka, M N 55343 " {y ? I, Name of Tester 1r?p ?y ,/y,, HEATING TEST RECORD -71r, ADDRESS r JZC? r ? uyYK,_4 2h " APT ?FLOOR '3 TY SUB RB A"?? OCCUPANT OWNER 177n HEAT LOS DA IE HTG. INST. SOLD BY INSTALLED BY Electrical Work By d' - Gas Line By ate- TYPE OF HEAT GA J?W_. Le<HW -STEAM -SPACE HTR. -UNIT HTR. -OTHER AS DESIGN C VERSION MAKE MAKE OF BURNER Model .6 cc _ Model Serial 3 U- - Zzr15 Max. BTU Rating INPUT MAKE OF FURNACE Model Volvo THERIMR Valve Limit Limit Setting Fon Setting _ Pilot Type _ Pilot Make - CONTROLS ^ 1, r y Heat Plug Vent Size l ??-?- KIND OF LItR _ SIZE rr NONE Draft Hoad Reg le.,.. z s_-3 d Filters sI Number Chimney Location I si a Outsgid?e ?? ti Chimney Construction Pilot Model r Z1 13n Pilot Timing L.W. Cut Off Pressure Percent CO 7 q^o Input CFH oL? Percent 02 0 Stack Temp. Percent CO n /a R6.Z Smoke Bomb Wiring Draft Test Tag 1- Door Pressure Lighting Inst. Date Tested Company Testing -Rouse Mechanical, Inc. 11348 KTel Dr. Minnet nka, MN 55343 Name of Tester HEATING TEST RECORD 5-70 J ? l C1 [ (IYt'll' ^? '' \J (L/Ct 30 ADDRESS - i, /11 -APT. SU URB - LOORC?TY F_ OCCUPANT ^ OWNER .ALrn'1?'tm /'G/L4 00 - HEAT LOS E HTG. T ?7 DA INST. 7- SOLD BY ? r M'?(.% I INSTALLED BY 1` 'e Electrical Work By _Gos Line By ?'?? 'e TYPE OF HEAT / GA _a, FA _ HW -STEAM SPACE HTR. -UNIT HTR. -OTHER e? G DESIGN CONV RSION MAKE i MAKE OF BURNER Model 6 Model Serial ` N3D IO4^ FZ(1 7 Z Max. BTU Rating INPUTJOOd MAKE OF FURNACE Model CONTROLS THERMf T - ._ Heat Plug Vent Size S Valre KO KIND OF LIN R SIZE S1f` NONE '-? Limit _ J'f Draft Hood ,F 071"t Regularor Limit Setting Filters Size 1G?,Y7t7X? Number Fan Setting Chimney Location utside ?? Pilot Type - lK Chimney Construction Pilot Make D Pilot Model Smoke Bomb Wiring Pilot Timing ' Draft (?it7(1Lt Test Tag / L.W. Cut Off Door Pressure Lighting Inst. 2 ?mod Pressure / •C? LtJCr.__ Percent COZ Date Tested) Input CFH ?-Y-? Percent OZ , R6 Company Testing -Rouse Mechanical, Inc. Stack Temp. / 50? Percent CO 11348 KTel Dr. Minnetonka, MN 55343 Q 7-? Name of Tester ,7in6- r/ ?HEATING TEST RECORD r ADDRESS Isz? / ?"+CNI'??l? L?IJ''/G?/`Z' APT. FLOOR ?QITY?SUBURB OCCUPANT OWNER HEAT LOSS SOLD B _ //?? INSTALLED BY `g' Electrical Work By Gas Line By TYPE OF HEAT GA FK-??HW -STEAM -SPACE HTR. UNIT HTR. -OTHER AS DESIGN MAKE MAKE OF Model 611 Q Model Serial tia6/? - 00,?;_7 Max. BTU INPUT L? MAKE OF Model - THERMOS AT ? Volvo Limit Limit Setting Fan Setting P' lot Type Pilot Make Pilot Model Pilot Timing ----7's a L.W. Cut Off TROLS at Plug Vent Size KIND OF LIN R SIZE NONE 3 Draft Hood _Regularor Filters Size Number © Chimney Location Iq ido utd. 0 Chimney Construction L/ Pressure Percent C02? Input CFH S Percent 02 fy ^L/ b Stack Ten '. AWN ent CO 49 ?/) L/]- Smoke Smoke Bomb ?-, J- Wiring Draft Test Tag Door Pressure Lighting Inst. Date Tested 8-I?__ ? Company Testing -Rouse Mechanical, Inc. 11348 KTel Dr. Minnetonka, MN 55343 Name of Tester BURNER Rating _ FURNACE ADDRESS /0 ! !//?17/? zq_ OCCUPANT HEAT LOS DATE TG. INST. SOLD BY Electrical Work By flll?, 16,_6 AP-4 tj TYPE OF HEAT GA FA ?HW HEATING TEST RE 0RD IZ 'j1' j? APT. OORCITY, SSI -RURR Lam- ---v- OWNER (' -t ,tO/' 7.[.t!n INSTALLED BY / '`P Gas Line By )Vd'T?4 /u-,P STEAM -SPACE HTR. UNIT HTR. -OTHER - S DESIGN MAKE MAKE OF BURNER _ Model Gfzl?`DY/GC' -Model Serial ?? ??1(]? /=7nR7 Zz? Max. BTU Rating INPUT QS?GY?? MAKE OF FURNACE Model THERMITt VaIv Vave Limit Limit Setting Fan Setting _ -- --Pilot Type= Pilot Make . Pilot Model _ CONTROLS -r Heat Plug Vent Sixe KIND OF LI SIZE 5" NONE ?- Draft Hood R Regularor ?75 3 Filters Size Xl Number Chimney Location ??I/ps?id/e / ^7puts ida Chimney Construction _S_fY( ap4 - Smoke Bomb Wiring Draft Test Tay Door Pressure c Lighting Inst. Date Tested (? ?o Pilot Timing L.W. Cut Off cv? Pressure Percent COz Input CFH 1r Percent OZ n Stack Temp. =,(M a/::- Percent CO ?rs ' / Company Testing -Rouse Mechanical, Inc. 11348 KTel Dr. Minnetonka, MN 55343 Name of Tester - 1 7 ADDRESS 576 ?A-? 1 t 'U/? l ?I AII (?//y)1EATING TEST RECORD L t/ (_. - APT. LOOR y C ? -- SUBU-? g- OCCUPANT OWNER ^ r / y? HEAT S DT E,?i TG. INST. 7 /-2? SOLD BY ' INSTALLED BY ^ Electrical Work By Q--? - Gas Line By Cr1A-,2-e ?e n? TYPE OF HEAT GA -"---FA _HW STEAM SPACE HTR. UNIT HTR.A--OTHER S DESIGN MAKE '?' MAK Model b? ,tQ0e ? ?- Model Serial .fJ3 t)/09- n,/'7 -2CJi? Max. INPUT ?r MAKE TH E RMQ$,T/fl Valve j- Limit Limit Setting _ Fan Setting - -- Pilot-Type Pilot Make - Pilot Model - Pilot Timing L.W. Cut Off ?c Pressure -S L? Percent CO2 input CFH A-jlU67_0 Percent OZ? Staek Temp. Percent CO 77 c/ CONTROLS E OF BURNER OF FURNACE Model BTU Rating 6cr _t 'r Vent Size ___7_ KIND OF LI R_ Draft Hood Filters Size Chimney Location Chimney Construction aror E Smoke Bomb Wiring (! Draft Test Tag Door Pressure Lighting Inst. Date Tested 'FK-(3-0 y Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. Min ngtonka, MN 55343 Name of Tester HEATING TEST RECORD ADDRESS JSZD !ttl ervnCl.? -/?--APT.' LOOR2CI Y-? SUBU OCCUPANT OWNER svv®lCs= tip-! ?° AR^ HEAT SOLD BOSS.LcD,/tT?HT .INST. ?? INSTALLED BY Electrical Work By ((??(( - Gos Line By _ (),?a_g / .? .-. TYPE OF HEAT GA L! 4--FrW STEAM SPACE HTR. -UNIT HTR. -OTHER S DESIGN MAKE MAKE Model'Q - Model Serial - ?.z 14 Me X. INPUT MAKE Model `r i OF BURNER _ BTU Rating OF FURNACE CONTROLS THERM TAT F- Plug Vent Size - Valve obr>=E' KIND OF L Limit TYI• Draft Hood Limit Setting 1- Fan Setting Pilot Type - a-C - - Pilot Make Pilot Model / - Pilot Timing-,-',) L.W. Cut Off Pressure ?.l Percent C02 Input ? nput CFH 4(5JOL-o ??,?L??, Percent Oz Stack Temp. o -)O Percent CO d T(, - 3 Filters Size _? Chimney Location -Chimney Construction ide Smoke Bomb Wiring r/ Draft 6 Test Tag Door Pressure y?7 Lighting Inst. Date Tested Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. Minnetonka, MN 55343 Name of Tester -4e A- 1_2tEZ?SIZ Regulator - 7 / n "Iy_ EATING TEST RECORD 2 ADDRESS bzoo hmyym L-??' APT.3 OOR y CITY SUBU ?n(',ft, ,,n \) OCCUPANT -` OWNER u`fY1O.? C.(?n?n HEAT LOSS D TE TG. INST. 7-?7 SOLD BY INSTALLED BY y?RQ1-l-QJL Y Q Electrical Work By Gas Line By 1912 TYPE OF HEAT GA __L,_F'A HW STEAM SPACE HTR. -UNIT HTR. -OTHER ,n / GAS ESIGN CO VE ION MAKE J?(?,(1 MAKE OF BURNER Model Model Serial V?3 ?lU ?" ??p g7? 45 Max. BTU Rating INPUT 5/y? MAKE OF FURNACE Model CONTROLS _ THERM T/LT r Hgat Plug Valve ( C --?J Limit Limit Setting Fan Setting Pilot Type Pilot Make Pilot Model Pilot Timing Ci.1l'X L.W. Cut Off C, Pressure 2• S«c.jc_ Percent CO2 Q ?D Input CFH- Sr Parcent O2 Stack Temp. Is'sulir CO n r0 V-3 q 11 Vent Size KIND OF LlgSR Draft Hood I?X Filters Size Chimney Location Chimney Construction Smoke Bomb -^ Wiring v Draft Test Tog Door Pressure -?? Lighting Inst. / Date Tested Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. M netgnl?, MN 55343 Name of Tester/ / 'H'I tQz9Qj4aJ SIZ CYr ' Regularor _ Y70Y I „ , HEA ING TEST RECORD ? ?? v ? Lq 6? ADDRESS R (- 0 APT. LL0 SUBURB OCCUPANT ?p g OWNEFJ S HEAT LOS TE H G. INST. - - )L S r-7 SOLD BY INSTALLED BY ? e- Electrical Work By f` ? S Gas Line By ' TYPE OF HEAT GA ?A -HW STEAM SPACE HTR. -UNIT HTR. -OTHER Or /I ?iAS DESIGN MAKE v' ?" MAKE OF BURNER _ Model - Model Serial 7 - /? Max. BTU Rating _ INPUT - / MAKE OF FURNACE Model TH E Rl? Va Ive Limit Limit Setting Fan Setting _ Pilot Type Pilot Make - Pilot Model Vent Size _ t S" c , KIND OF R IZE.?N E Draft Hood Regularor ? ?.5 ue Filters Size X QX I Number Chimney Location ide Outside Chimney Construction Smoke Bomb Wiring Pilot Timing r-t DICE- Draft ??Test Tag L.W. Cut Off Door Pressure ?/?? ''?Lighting Inst. Pressure !e Percent C02 Date Tested S-_ 13 -?j/ Input CFH Percent OZ Company Testing -Rouse Mechanical, Inc. Stack Temp. Percent CO iPj 7h Name of Tester 11348 K-Tel Dr. etgfrka, MN 55343 11 - L(IJ?(?.. ?IEATING TEST RR - -7 ADDRESS 157D??? rJJIL APT. I LOOR AMSU URA) OCCUPANT OWNER HEAT LO55 A TE INST. SOLD BY `¢??, ` INSTALLED BY0 Electrical Work By DD /? or Gas Line By n?l`-f'-`C>• TYPE OF HEAT GA _ FA HW -STEAM-SPACE HTR. -UNIT HTR. -OTHER GAS DESIGN /) - MAKE r MAKE OF BURNER_ Model Model Serial - - Max. BTU Rating - INPUT MAKE OF FURNACE Model 110 THEe ?6 Valve [ Limit i Limit Setting Fan Setting _ Pilot Type - Pilot Make Pilot Model Pilot Timing L.W. Cut Off Pressure _-t?Percent CO2 Input CFH-? r CPercent OZ___?LlLJ Stack Temp Percent CO CONTROLS Vent Size ? KIND OF LINER SIZES NONE Draft Hood Regularor SZS 3 Filters Size Number Chimney Location In ode O .id. Chimney Construction ? 92 Smoke Bomb , Wiring , Draft L ?-? ? °- Test Tag Door Pressure Lighting Inst. Date Tested A ?Qp W 7J:? Company Testing -Rouse Mechanical, Inc. 11348 K-Tel Dr. Min et?MN 5534355343 Name of Tester ? /??IL HEATING TEST REi 0 D y/? ADDRESS . 1 1 l W//?? APT. LO OR C}tTT??SJJBURB F/J OCCUPANT OWNER L L(YY1(I1 (' YTt? HEAT LOSS D TE TG. INST. {/?/ SOLD BY `Q INSTALLED BY ?0 - Electrical Work By Gas Line By t ,v, TYPE OF HEAT GA _00K A' HTR. UNIT HTR. -OTHER - SAS DESIGN MAKE MAKE OF BURNER _ Model _ Model Serial y Max. BTU Rating _ INPUT 6") MAKE OF FURNACE Model CONTROLS yt ?Cr? THER T T He t plug Vent Size J Valve KIND OF LI R SIZE 5 N NE Limit i C Draft Hood Regulator ?ZS Limit Setting Filters Size Number Fan Setting Chimney Location In ide O aside x1-- e - ybd? ----Pil t -T Chimne Construction?'? - . yp o y Pilot Make U del Pil t M Smoke Bomb Wiring o o Pilot Timin Draft 2?? Test Tag g ?? L.W. Cut Off Door Pressure Lighting Inst. i? Percent C0 P Data Tested Y0 2 ressure 1,50 , Percent 0 Input CFH ? Company Testing -Rouse Mechanical, Inc. 2 Stack Temp. - 31 r Percent CO 11348 K-Tel Dr. Minn et ka, M N 55343 Name of Tester ` , ? H ATING TEST R ORD n -1 ? 1 T/ L g ?- ADDRESS / ` ?? / APT. LOOR U BJURB PTY r OCCUPANT -^ , _ OWNER =U;f n C ctT_ iii HEAT LOS TE HTi G. INST. SOLD BY . - 19 INSTALLED BY Electrical Work By V, d V4 41 aA If, Gas Line By TYPE OF HEAT GA FA _HW STEAM -SPACE HTR. -UNIT HTR. OTHER GAS DESIGN C VERSION MAKE MAKE OF BURNER Model Model Serial Max. BTU Rating INPUT MAKE OF FURNACE Model ?q CONTROLS THERMOS T Heat Plug Vent Size Valve KIND OF LINER WF-11-h1ni_ SIZE NONE _ Limit Draft Hood Regularor 3 Limit Setting Filters Size Number Fan Setting Chimney Location In side Pilot T pe Chimney Construction ?•.? w/ ?•5'?-] - y Pilot Make Pilot Model Smoke Bomb Wiring Pilot Timing , Draft Tezt Tag L.W. Cut Off Door Pressure Lighting Inst. Date Tested 'T0 7 Pressure Percent CO2 Input CFH v 000 Percent OZ --- O Company Testing -Rouse Mechanical, Inc. ? Stack Temp. Percent CO O- 11348 K-Tel Dr. Minnetonka, MN 55343 .04 Name of Tester HEATING TEST R COLD ?.p ADDRESS APT. u?L00R 1?-cnr? Y SUBURB OCCUPANT - _?OWNER I UIyXeZ/n L.01J-NT7"ZAk--[" I HEAT LOS?pATFt HTG. INST. - SOLD BY rt?(/.It MFi(-1 INSTALLED BY Electrical Work By vex-i i 1)E/C_ Gas Line By dQ_e TYPE OF HEAT GA .CFA ?W -STEAM -SPACE HTR. -UNIT HTR. OTHER AS DESIGN MAKE -MAKE OF BURNER _ Model - Model Serial (Z - 2__)Q Max. BTU Rating _ INPUT I no f Ono MAKE OF FURNACE Model THERMQ$Tt Valve Limit- I Limit Setting Fan Setting _ Pilot Type Pi lot Make Pilot Model _ Pilot Timing CON li_ (t Vent Size 4 f, //-- KIND OF LIN SIZE C)" NONE Draft Hood Regulator Filters Size dX Number Chimney Location I([I^^sJJ de utside Chimney Construction Smoke Bomb) Wiring Draft Test Tag i W r- nrr n___ Li hti I t Pressure 'C-?'Loa' nput C02 I Date Tested -0") nput CF Percent OZ Company Testing -Rouse Mechanical, Inc. I Stack Temp. Percent CO 1 11348 K-Tel Dr. Minneto X MN 55343 Name of Tester g mg ns . .48 UNIT - RENTAL CITY OF EAGAN Co N 3068 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, M N 55121 PHONE: 454-8100 ? / ?/ BUILDING PERMIT Receipt tt ?1? ?O Tobeusedfor APT. BLDG Est.Value $1,375,000Date DECEMBER 30 1A6 Site Address 1520 THOMAS LAKE POINTE Erect 1:1 Occupancy R1/B1 Lot 2 Block 1 Sec/Sub THOMAS LAKE POIItMEdel ? Zoning PD . Repair ? Type of Const. V 1HR/I IN SPR Parcel No. Addition ? No. Stories 3 Q Name THOMAS LAKE HOUSING ASSOCIATESe ? Length z1 n 3140 HARBOR Address LN Demolish ? I I ? t Depth 67 Ft S o mpr. n . City MPLS Phone 559-1711 install ? q. 83, 00 `o I Name DOMAIN CONSTRUCTORS INC $ a Address SAME. a ? City Phone rw Name JOHNSON, SHELDON & SORENSEN Address 10249 YELLOW CIR DR u a W City MTKA Phone 935-6337 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 Cj1y..Qf Eagan Ordinarces. Signature of Permittee v v v A Building Permit is issued to: DOMAIN CON TRL all work shall be done in accordance with all applicabl State of Building Official 4-Z- Assessment - Water & Sew. Police - Fire Planner Council 81dg. Off? ?T$? APC Var. Date Permit '? ., , u c v ..,' Surcharge 650.01 Plan Review 1,810 .21. SAC 22,540.01 Water Con42, 200. 01 Water Meter- N/A Road Unit 11,136-01 Tr. PI. 6,125.01 Parks Copies Total $65,081.7. on the express condition that and City of Eagan Ordinances. CITY OF EAGAN 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 N2 12947 PHONE: 454-8100 BUItDING ERMIT Receipt If (Dd ?7 Tobeusedtor FOUNDATION Est value Date DECEMBER 5 7986 Site Address 1520 THOMAS LAKE POINTE Erect Occupancy Lot 2 Block 1 Sec/Sub THOMAS LK POINTH3emodel ? zoning Parcel No Repair ? Type of Const. Addition ? No Stories Name THOMAS LAKE HOUSING ASSOC Move ? Length w 3140 HARBOR LN Demolish El Depth o Address Int. Impr. ? Sq. Ft. City PLYMOUTAone 559-1711 Install ? o Name DOMAIN CONSTRUCTORS INC Approvais z0 SAME Q Address Assessment City Phone Water & Sew. Police F w Name Fire c0i Address Eng. w a City Phone Planner Council I hereby acknowledge that l have read this application and state that the 12/5/86 Bld 077 information is correct and agree to comply with all applicable State of . g. Minnesota Statutes and City of Eagan Ordinan APC Var. Date Signature of Permitte Fees Permit Yi?evv Surcharge Plan Review SAC Water Conn. Water Meter - - Road Unit Tr. PI. Parks Copies Total A Building Permit is issued to. DOMAI'R CONSTRUCTORS INC on the express condition that all work shall be done in accordance with all a able State o Minn Statutes and City of Eagan Ordinances. Building Official F , y 1 13 Z) L r 1986 BUILDING PERMIT APPLICATION - 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 48 FOR SALE UNITS INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SURVEY - CHECK WITH BLDG. DEPT., 1 SET OF ENERGY CALCULATIONS COMMERCIAL INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS, 1 SET OF SPECIFICATIONS AND 1 SET OF ENERGY CALCULATIONS, $2,000 LANDSCAPE BOND 49 ufri I, I To Be Used For: APT-- BCDCa, F7 Valuation: $ 1,375,000 Date: 11/18/86 Site Address 1520 Thomas Lake Pointe Lot 2 Block 1 Parcel/Sub 'r(- /%5 LA4.,fF-= 'PpIF4TE Owner Thomas Lake Housing Associates. L. Address 3140 Harbor Lane City/Zip Code Minneapolis. NIN 55441 Phone (612) 559-1711 Contractor Domain Constructors Inc. Address 3140 Harbor Lane City/Zip Code Minneapolis, NIN 55441 Phone (612) 559-1711 Arch./Engr. Johnson. Sheldon & Sorensen Address 10249 Yellow Circle Drive City/Zip Code Minnetonka. MN 55343 Phone # (612) 935-6337 Erect ? Occupancy R• 1 /5.1 Remodel Zoning FD Repair Type of Const 1 hl P- Addition - # of Stories -5 Move Length 31 C> Demolish Depth c.'7 Int.Impr. Sq Ft d33,ICo Install APPROVALS FEES Assessments Permit 3(aZ0.? Water/Sewer Surcharge 605o. Police Plan Review a(0.Zs Fire SAC 22,540, Engr Water Conn 11, zoo, Planner Water Meter N/A Council Road Unit 11,136, Bldg Off ? 2,,. Treatment Pl 6,125. APC Parks N /< Variance Copies TOTAL 105 CeA ?s 6 0 5PRINK NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED- Z -.) E: C- (1 1 5 1 -94o M Y ti 1 2004 COMMERCIAL BUILDING PERMIT APPLICATION City Of Eagan 3830 Pilot Knob Road, Eagan Mn 55122 J ??? Telephone # 651-675-5675 FAX # 651-675-5694 . Structural Plans (2) sets • Architectural Plans (2) sets • Architectural Plans (2) sets • Civil Plans (2) . Structural Plans (2) . Code Analysis (1) " • Certificate of Survey (1) • Civil Plans (2) Project Specs (1) . Code Analysis (1) " • Landscaping Plans (2) • Key Plan (1) • Project Specs (1) . Code Analysis (1) • Master Exit Plan (1) • Spec. Insp. & Testing Schedule " • Certificate of Survey (1) • Energy Calculations (1) not always" • Soils Report (1) • Spec. Insp. & Testing Schedule (1) • Elec. Power & Lighting Form (1) not always- • Meter size must be established • Meter size must be established . Meter size must be established-if applicable 1 Project Specs (1) 1 Energy Calculations (1) 1 Electric Power & Lighting Form (1) ' l l Master Exit Plan (1) y 1 . Emergency Response Site Plan (1) " * d 1 Soils Report (1) 1 SAC determination - call 651-602-1000 SAC determination - call 651-602-1000 SAC determination -call 651-602-1000 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 C D ? C - ate Constr uction ost ?( 90 G Site Address i-S ?U //?G^2tnS ?12 ?ZG ?P 7- ICl Unit/Ste # _ Tenant Name (? ?+y., S G Po r QO Former T enant Name Description of Work )e-,-r 6'Y 1&,_60f G s' Property Owner pyp l?l'l,r cry Telephone # Contractor ?? S ?6 CG r s l` . G Address gp, V C? fZ d Sr. i ?? g0? City L `???? C? ^ o a State M tJ Zip Telephone # 00 762 .-tom 1_r? # o3av3r? Arch/Engr Registration # i Address City State Zip Telephone # ( ) Licensed plumber installing new sewer/waterserviv Phone #: O I hereby apply for a Commercial Building Permit and acknowledge that the work will be in conformance with the ordinances and cod Statutes-, I understand this is not a permit, but only an application f permit; that the work will be in accordance with the approv tan it a 7ral of plans. it,vrd ?USri?r? hat the information is complete and accurate s of the City of Eagan and the State of NlI r a permit, and work is not to start without 1 the case gFpvork which qui es a review ant Applicant's Printed Name Applicant's Signatur OFFICE USE ONLY Sub Types ? 01 Foundation ? 14 Apartments ? 15 Lodging ? 25 Miscellaneous Work Types ? 31 New ? 32 Addition ? 33 Alteration ? 34 Replacement Valuation L0,00,9 Census Code SAC Units Nbr. of Units Nbr. of Bldgs Type of Const ? 26 Public Facility ? 27 Commercial/Industrial ? 28 Greenhouse ? 29 Antennae ? 30 Accessory Building 32 Ext Alt-Apartments ? 34 Ext Alt-Commercial ? 35 Ext Alt-Public Facility ? 37 Nail Salon ? 35 Int Improvement ? 38 Demolish (Interior) ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 37 Demolish (Bldg)' R-?43 Reroof 'Demolition (Entire Bldg only) - Give PCA handout to applicant n. Occupancy Zoning_ Stories Sq. Ft. Length Width Required Inspections Footings (new bldg) Footings (deck) Footings (addition) _ Foundation Drain Tile ?Roof ?Ice Pr _ Decking Insul Framing Fireplace - R.I. _ Air Test - Final Approved By: Base Fee Surcharge Plan Review MCES SAC City SAC Water Supply & Storage S/W Permit S/W Surcharge Treatment Plant Park Dedication Trails Dedication Water Quality Copies Other Total Final Planning h f 7l 3, 75 3a.oo MCES System City Water Booster Pump PRV Fire Sprinklered ? 44 Siding ? 45 Fire Repair ? 46 Windows/Doors _ Insulation _ Final/C.O. _? Final/No C.O. Other Pool _ Ftgs _ Air/Gas Tests -Final Siding _ Stucco - Stone Windows Building Inspector r 9v) 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 RENTAL UNITS FOR SALE UNITS INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SURVEY - CHECK WITH BLDG. DEPT., 1 SET OF ENERGY CALCULATIONS COMMERCIAL 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: r-- i.ior.r. Valuation: Site Address 15'L0 TNnm. Lv-. PT"rW Lot Z Block I Parcel/Sub T f bMAS LK rO1,,TL= OwnerC6as (ay, i sinr A, L. Address 3 t q c7 IT' ?.' (-6- City/Zip CC/ode rM nL W/C// Phone 6/,2 S5 n Contractor 6ro r+t + l '6y AfyUJi?r C Address 3)V(> t4r[z(XrC L,< City/Zip Code Phone (O( x - S's;) - i7 1 Arch./Engr. S(An rn - ern -C yPr t 1 Address IbL?(A5'' ?/rllu , Circle ?r City/Zip Code ?nrnn< c? /hN Phone # 9 15- (0 337 NOTE: ADDRESSES FOR CORNER LOTS - IS DESIRED. NO CHANGES WILL Date: l k- 13-63 - Erect ? Occupancy Remodel I Zoning Repair Type of Const Addition I # of Stories Move Length Demolish Depth Int.Impr. ! Sq Ft Install APPROVALS FEES Assessments Permit Water/Sewer; Surcharge Police _ Fire _ Engr Planner- Council- Bldg Off APC Variance Plan Review SAC Water Conn Water Meter Road Unit Treatment Pl Parks Copies TOTAL 15 S MUST DESIGNATE WHICH ADDRESS PERMIT IS ISSUED. 1993 PLUMBING PERMIT (COMMERCIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN MN S5122 (612) 681-4675 PLEASE COMPLETE FOR ALL COMMERCIAUINDUSTRIAL BUILDINGS. ALSO FOR MULTI- FAMILY BUP_DINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH DWELLING U ?:T. NEW CONSTRUCTION ADD ON REPAIR WORK DESCRIPTION: CONTRACT PRICE: $ /, SO C) FEE: 1% OF CONTRACT FEE. STATE SURCHARGE: $.50 FOR EACH $1,000 OF PERMIT FEE MINIMUM FEE: $ 25.00 ^? 4 CONTRACT PRICE X 1% $ (X STATE SURCHARGE $ TOTAL $ Gf SITE ADDRESS: /S A D TENANT NAME: ! oiM-fo' LA(a- STE. # OWNER NAME: INSTALLER: ADDRESS: '? CITY: IfiAn(e (9 R o or STATE: ftl . VO ZIP CODE: S 5 3 6 I PHONE #: `7 3- 6 33J"' FOR: ! i CITY OF FAGAN APPLICANT f ?? PLEASE COMPLETE FOR SINGLE FAMILY DWELLINGS. ALSO, FOR TOWNHOMES AND CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT. NO. FIXTURES EACH SHOWER 3.00 WATER CLOSET 3.00 BATH TUB 3.00 LAVATORY 3.00 KITCHEN SINK 3.00 LAUNDRY TRAY 3.00 HOT TUB/SPA 3.00 WATER HEATER 3.00 FLOOR DRAIN 3.00 GAS PIPING OUTLET • minimum - 1 3.00 ROUGH OPENINGS 1.50 WATER SOFTENER 5.00 PRIVATE DISP. •DakQy.iic. 15.00 U.G. SPRINKLER • home under mnsi. 3.00 ALTERATIONS • io acisting 15.00 WATER TURN AROUND 15.00 STATE SURCHARGE TOTAL: .50 SITE ADDRESS: OWNER NAME: INSTALLER: ADDRESS: CITY: PHONE #: ( STATE: ZIP CODE: SIGNATURE OF PERMITTEE 1993 PLUMBING PERMIT (RESIDENTIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN MN SS122 (612) 681-4675 CITY OF EAGAN NOTP: PAYMBNT OF FEE AT TIME OF LDDT.TrnTTrm mFC TSw [nxic rry7m IF EXISTING STRUCTURE, DATE OF ORIGINAL BUILDING PERMIT ISSUANCE: PRESENT ZONING/PROPOSED USE: (Mm Year) CC1VERCIAL/1RETAIL/0FFICE R-1 SINGLE FAMILY INDUSTRIAL 0 R-2 DUPLEX (Two Units) c INSTITUTIONAL/G0VERIZ0,Tr -R-3 TOWNHOUSE (Three + Units) ( Units) Cr-4 APARTMENT/CONDOMINIUM (-5:'_Anits) 2) NAME: ADDRESS: CITY, STATE, ZIP: PHONE: I 3) a ?. 7• _ US NAME: , ?? For City Use ? Plumbers License: ADDRESS: Active CITY, STATE, ZIP: ? t red N t - o o recorded PHONE: oo 573"_-3 MASTER LICENSE# : / 2 Stoma initial 4) .. . 7- NAME. Z ADDRESS: CITY, STATE, ZIP: PHONE: -5) 1 Y• 1 M: • 7 • 7 71 U .?47i ??CONNECTION TO CITY SEWER Q CONNECTION TO CITY WATER Q OTHER 6) 1 PLEASE HOLD APPROVED PERMIT FOR PICK-UP BY ONE OF ABOVE PLEASE MAIL APPROVED PERMIT TO 1, 2, 3, 4, ABOVE ?? ?? _ (Circle one) FOR CITY USE ONLY i. 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 I9"7- o'O D $ WAC ? $b $ SAC D $ $ TRUNK WATER ASSESSMENT $ $ TRUNK SEWER ASSESSMENT $ $ LATERAL BENEFIT/TRUNK SEWER $ LATERAL BENEFIT/TRUNK WATER D I $? ' ( Y S •O 0 $ WATER TREATMENT PLANT SURCHARGE $ $ OTHER: $ 4 -7 ?' "d Z) $ TOTAL .S? 7332 RECEIPT RECEIPT DO ES UTILITY CONNECTION REQUIRE EXCA VATION 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. SU BJECT TO THE FOLL OWING CONDITIONS: APPROVED BY: Al -zl,Lc, TITLE: DATE: ?j?// C CITY OF EAGAN APPLICATION FOR PERMIT SEWER AND/OR WATER CONNECTION MOTS: PAYWNT 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. i ii Ziil S] i1] F1 F] if FwiwlififwiFw ZwwiSil (Please Print 1) PROPERTY ADDRESS: _ LEGAL DESCRIPTION: - IF EXISTING STRUCTURE, DATE OF ORIGINAL BUILDING PERMIT ISSUANCE: PRESENT ZONING/PROPOSED USE: (Month/Year) C0mmERCIAL/REPAIL/OFFICE u INDUSTP.LAT INSTITU"TIONAL/GOVII2fA'IE'NT R-1 SINGLt FAMILY R-2 DUP=L (Tuv Units) R-3 TOWNHOUSE (Three + Units) ( Units) I li R-4 APARTt+ENr/CONDOMINIUM (Units) 2) f1? NAME: ADDRESS: CITY, STATE, ZIP: PHONE: ?7?H - 5 (UW 3) =?']II For City Use NAME: LSD/. [ ()?/??/ (p(? Plumbers License: ADDRESS: L' C?_ecl Active CITY, STATE, ZIP: Expired Not recorded PHONE: YfjCG - ?2 MASTER LICENSE#' --r-- St Initial 4) •• • is n NAME: 6A 010 /R j? ADDRESS: CITY, STATE, ZIP: Fill PHONE: / CONNECTION TO CITY SEWER CONNECTION TO CITY WATER OTHER ,Ea 6) • PLEASE HOLD APPROVED PERMIT FOR IPICK-LIP BY ONE OF ABOVE - PLEASE MAIL APPROVED PERMIT TO 1, 2, 3 4, ABOVE (Circe one) p 7) r r• x/ ILI/?/Ih ! h7 f FOR CITY USE ONLY PERMIT # ISSUED Pd w/Bldg. Permit FEES: f $ $ SEWER PERMIT (INCLUDE SURCHARGE) $ $ /( S T WATER PERMIT (INCLUDE SURCHARGE) $ •-? $ WATER METER/COPPERHORN/OUTSIDE READER $ $ WATER TAP (INCLUDE CORPORATION STOP) $ $ SEWER TAP $ $ ACCOUNT DEPOSIT - SEWER (j$a $ ACCOUNT DEPOSIT - WATER ( ? $ S-IfD • 61-o $ SAC $ $ TRUNK WATER ASSESSMENT $ $ TRUNK SEWER ASSESSMENT $ $ LATERAL BENEFIT/TRUNK SEWER C $ LATERAL BENEFIT/TRUNK WATER DL $6 Z S' • C` D $ WATER TREATMENT PLANT SURCHARGE $ $ OTHER: $ a $ TOTAL RECEIPT if 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 Q DIVISION. LIST AS A CONDITION. SUBJECT TO THE FOLL OWING CONDITIONS: APPROVED BY: ?Jti?L 7r. ?4 zr? TITLE: / ?G /Q DATE: > o,- Z 'B I k i Thlom AS LAKt P&WI CONTRACTOR'S MATERIAL & TEST CERTIFICATE PART "A" GENERAL 15-20 PROCEDURE UPON COMPLETION OF WORK INSPECTION AND TESTS SHALL BE MADE BY THE CONTRACTOR'S REPRESENTATIVE AND WITNESSED BY AN OWNER'S IthPRESENTATIVE. ALL DEFECTS SHALL BE CORRECTED AND SYSTEM LEFT W SERVICE BEFORE CONTRACTOR'S MIEN FINALLY LEAVE THE Im. A CERTIFICATE SHALL BE FILLED OUT AND SIGNED BY BOTH REPRESENTATIVES COPIES SHALL BE PREPARED FOR APPROVING AUTHORITIES- OWNERS AND CONTRAC. TOR. IT IS UNDERSTOOD THE OWNER'S REPRESENTATIVES 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. r-..... -wit DATH ? .-Th 2m AS r L,ac c K ` J ' 3 c? -$ T i3 1 c T PROPERTY ADDRESS wd L K Q 7 n.ve QcI nr AJ C bca E AU EPT ED BY A PPROVING HORI7Y( 'SJ NAMES 1 r V (?DLI?-KA4lL ADDRESS .Ly 9 jo 6'' K' - ssu. ,ear. Ct A, . PLANS 9CGY_.,?, S J 5?3,l-" 1NSTALLATI C ONE RMS TO ACCEPTED PLANS ? Ytl No D TQUIPMENT USE IS APPROVED IF NO. STATE DEVIATIONS YES (I!-- NO C] SPAS PERSON IN CMARGE OF FI-aE EQUIPMENT BEEN INSTRUCTED AS TO LOCATtOFi OF CONTROL VALVES AND CARE OF THIS NEW EQUIPMENTt YES 0-- No 0 INSTRUC- IF NO. EXPLAIN TIONS HAS A COPY OF INSTRGCTION AND MAINTENANCE CHART BEEN LEFT AT PLANTI -YES NO IF NO. EXPLAIN "I.I"FHI\u" Fbne the n'yuu cd rllr nmd realer Ix deer tw Indli.ited CP nA collection of foreign malerlM In burl&p bags at outleU Each AS rant, an blow off[. Plneh It Haw- not I.. them an GI'H fur Gdlull III" atM -mane, ]000 OTIM for F-Inch pipe. I400 GPM for IOJneh pipe, and 2000 GPM fee I:- 11" It pile Nlwu -a l'10 ,.mart piaduce Auphl'..Ied Onw It.N, obtain alaxiv in Available. TEST Hl' OROSI'AT'IC- H)drn[tnllc little shall be .,,ad, it not lea than TOO PSI for [Imo huurs nr 5OPS1 Shove static repare In aseeu Of 160 PSI . p Differential dn-Plpe aall'e hipp,,r. -ball be left upon during la.t W Dreveril damage. All abovegroaad piping tentage [hell be [topped. DESCRIP- LEAF AG P: sew pipe ELM with : uhher elakeled )uln: ve.ll, If the warknumNhip Is milisfaalur), have little or an leakage at the jolnlL The n( leuL.ure It the Juinla xhall nut exceed 2 ,..... Is pet hunr Per IN Pont. Irreapeclt,.J, of pips dlsmeler. The leak.[, xhall IN d1.- trlbo«a e ,111 Joints If Narh Ie.iknKe 4-arm at A few Flints the Installation Alwll W considereE unptlefnctite, and aecexlen'Y I.Pah. TION nnlde. New ninr laid with caulked lead ,,lead-subHlAlc 1'.Iata Nh,til. If the worknnlnshlp Ir Aa UNfaelm'Y, hltve little or no lenknge at the J..un. An)' Iuo.I mum, leakn[c .., a lhpn a "s1lpu di ill' nr "weeping" xhall he repnired. Leak.90 -ball net exceed I A ID.... III eIa- ti'0 ,-I hunr per Inch of pipe diameter per Jo nt The leakage shall be distributed oIer all Joints. If Euch leakage Iaeurs .Manual en. leely at n few joint., the InsbtHntlon Shall be cupldered annallxhuquO" and-neresxary repairs made. 1'] IR-HATIP E.ti l ah 10 PSI Air pressure and it drtm which shell not exceed IM PSI In 24 he... Teat preEEUp lamb at narmal w:ner laid and air Drepure and measure air Prepure drop which Shall not exceed Im Pill In 21 hours. . PART "B" - UNDERGROUND PIPING Peeps BLOCS. LOCATION PIPE TYPES AND CLASS TYPE JOINT UNDER- GROUND CONFORMS TO sTANDARD Yu ? No ? - IF NO. EXPLAIN - PIPES AND JOINTS NEEDING ANCHORAGE CLAMPED. STRAPPED. OR HD IN Yu ? No ? ACCORDANCE WITH STAND t ORM IF NO. EXPLAIN REQUIRED FLU G HYDROSTATIC LEAKAGE - NEW UNDERGROUND PIN •LUSH ED ACCORDING TO STANDARD Yu ? - BY ICOMPANY) HOW FLUSHING OW WAS OBTAINED: , IWLIC WATER ? TANK ON [tluO1[ ? win run, 0 THR III H WHAT TYPE OPENING: IrLUSI •t NYO. Sun, ? MIN mra C) LEAD-1115 FLUSHED ACCORDING TO STANDARD YES, [3 BY (COMPANY) HOW FLUSHING PLOW WAS OBTAINED: PUM.IC IYA}U I] TANK 00 MUYOIN ? no pomp ? 7A4OUGH N'HAT TYPE OPENING Y CONN. TO PLAN" A SPIGOT ? I m rim I] Few Me. M ? - - P.MtA V I.L.S.A. t_ HYDROSTATIC psi MR Rau" TOTAL AMOUNT OP LEAKAGE MEASURED LEAKAGE .- GALS' HOURS TEST I1-- ALLOWABLE LEAKAGE --_ I GALS. HOURS . NUMBER INSTALLED TYPE AND MAKE HYDRANTS ALL OPERATE SATISFACTORILY Yp ? NO 0 WATER CONTROL VALVES LEFT WIDE OPEN: YU 0 No 0 CONTROL IF NO. STATE REASON VALVES HOSE THREADS OF FIRE DEPARTMENT CONNECTIONS AND HYDRANTS INTERCHANGEABLE WITH THOSE OF FIRE DEPARTMENT ANSWERING ALARM! YU ? n0 0 DATE LEFT IN SERVICE REMARKS _?.._ PARTS A & B I NAME OF SPRINKLER CONTRACTOR MR PROPERTY OWNER ISIGNEDI TITLE FOR SPRINKLER CONTRACTOR (SIGNED) DATE SIGNATURES : 'PESTS WITNESSED BY TITLE DATE ' PART "C" - SPRINKLER & WATER SPRAY ABOVEGROUND PIPING (PILL OUT SEPARATE PART 'C' FOR EACH RISERI LOCATION I SERVES BLDGI,: TESTS ALL PIPING. r 7 ' PNEUMATICIC: : DRY PIPING. DRAIN:.. ...._.p PNEUMATIC: REQUIRED . EQUIPMENT OPERATION: ALL. SPRINKLERS TEMPERATURE. MAKE MODEL SIZE. OGANTITY RATING ___._.___. vZ Aif ? OR #-I d- qGs IA F -__1'a_. 1 a SPRAY q rr r yZ $ ?6 NOZZLES r / PIPE AND RD _ - MATERIAL AND KING CONFORMS TOE{ STAND EXPLAIN IF NONE FITTINGS . ? A L A A M D E V I C E MAXIMUM TIME TO OPERATE THROUGH TEST PIPE ALARM VALVE OR FLOW INDICATOR __ _ - -- TYPE MAKE. MUUEL MIN. SEC. ?fC-O' LAJ -?- 4% ?xi C7 -? II -' ` . O P ER ATI NLA TESTS RESULTS: TIME TO TRIP 1 TRIP TIME DRY MAKE MODEL SEA, TIIROUGH TEST PIPE WATER I AIR ! POINT WATER ALARM NO. _ WITHOUT WITH PRESS. I PRESS. AIR REACHED TEST EST OPERA'TD PROPERLY PIPE O. D. O. O. D. PRESS. OUTLET IN. SEC. MIN. SEC. ° P.S.I. P.S.I. P.S.I. IN. SEC MIN.. SRC. . YES NO VALVES F ; PLAIN // /f NOl L G .- OPERATION: PNIUMATIC ? uFmiC ? NYMAULIC ? PIPING SUPERVISED: YU 0 No ? DETECTING MEDIA SUPERVISED: TU 0 NO 0 DELUGE DOES VALVE OPERATE FROM THE MANUAL TRIP AND/OR REMOTE CONTROL STATIONSI Yu 0 No 0 & 15 THERE AN ACCESSIBLE FACILTCY IN EACH CIRCUIT MR TESTINGI TIP 0 NO 0 IF NO. EXPLAIN PRERCTION VALVES DOES EACH CIRCUIT OPERATE SUPERVISION LOSS ALARM DOES EACH CIRCUIT OPERATE VALV BPI RAB MAXIMUM TIME TO LEAS& MAKE MODEL I E BI OPERATE ¢E YES NO YES NO MIN. SEC. ALL PIPING HYDROSTATICALLY TESTED AT 3450 PSI PO¢ HOURS DRY PIPING PNEUMATICALLY TESTED: TU 0 No 0 TESTS EQUIPMENT OPERATES PROPERLY: YU 0 NO 0 IF NO. STATE REASON DRAIN TEST: READING OF GAGE LOCATED N WATER SUPPLY TEST PIPE, RESIDUAL PRESSURE WITH VALVE IN T P OPEN WIDE STATIC PRESSURE P51 PSI NUMBER USED LOCATIONS NUMBER REMOVED BLANK TESTING WELDED OR BRAZED PIPING Yu 0 No C IF YEP, DO YOU CERTIFY AN THE NPRINKI.ER CYISTRAcTDR THAT THF. WELDF,HH DR RRAZERB ARE QUALI PIED FOR M I GASKETS LNG OR BRAZING IN ACCORDANCE WITH THE RE(kjlREMENTB OF ARNE HOILRR AND PRESSURE VFSREI. CODE, SECTION' M, LIFICA ION STANDARD ? FOR WELDING AND B LI NO PROCEDURES, WELDERS, HRAZERR. AND WELDINO AND BRAZING Q ' II F I Yo C3 NO 0 DATE L IN SERVICE WITH ALL CONTROL VALVES OPEN. EFT REMARKS _ _ 7 NAME OF SPRINKLER CONTRACTOR OWN SI ED) TLE PART "C" <-? u 1-.4- SIGNATURES POP SPRINKLER CONTR OR ISIGNB p TESTS WITNESSED BY TITLB DATE I Ma I 7 ®_o"l 12/10/2011 04:22 7634447106 D&D ANDERSON H & P PAGE 02/04 Use BLUE or BLACK Ink For Office-Use j Permit City of Eap I ' 05.05 3830*Pfbt-Knob Road i '1 I Permit Faa: I Eagan MN 55122 I Date Received: > I Phone: (651) 675-5675 t I Fax: (651) 675.6694 Staff: I i 2014 COMMERCIAL PLU BING PERMIT APPLICATION Tease submit two (2) sets of,plans with all commercial appliFatlons,, Date: 5- 00 L/ SltaAddoess; Tenant: i Suite t yyL1' J;.: Name: Phone: . T . 'CJJ: Nil ' L r Name / J / ' -O Snse c In 216 ~lL Address: J S 175,"Cai try w City rt /~f Statey"w Zip: 5 Cid T t,.. Phone:- 3 ° 111-x`7 -5,W-Er aif: do .0 64 q • q ° ~1a ".P" New Replacement _ Repair i Rebuild _ Modify Space Work in R.O.W. Description of work: -S ,ts 'COMMERCIAL _ New-Con ruction Modify Space y ti Z° IrrigationSystem es 1 no PZ 1 fie'V a 9ry~ ~Y - )_..FVt3) • Rain sensom required on Irrtgatlon systems Avg. GPM (2° turbo required u less smaller size allowed by Public Works) Meters Call (651) 675-5646 to verity that t is passed prior to Dickina up meter. i~aP;`; r,,•,•.. , R" Domestic; SI2e & Type Fire: 1 Avg. OPM High demand devices? Yes _No Flushometers Yes ~J~lo COMMERCIAL FEES Contract Value $O X.01 i $55.00 Permil Fee Minimum 5 $ ~ ~•f'p__ Permit Fee I *If contract value is LESS than $10,010, Surcharge = $5.00 = $ Surcharge- "if contract value is GREATER Phan $10,010, Surcharge = Co act Value x $0.0005 l0 7 TOTAL FEE If the project valuation is over $1 million, please call for Surcharge Following fees apply when installing a new lawn irrigations stem I $ Water Permit Contact the City's Engineering Department, (651) 675-5646, for required ee amounte. $ Treatment Plant $ Water Supply & Storage $ State Surcharge TOTAL FEE t CALL B FO" YOU DIG. Call Gopher State One Call at (651) 454-00 for protection against underground utllity damage. 1 I hereby acknowledge that this information fe 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 IN a permit, land work Is not to start without a permit; that the work will be In accordance,vrith the.approved.plan in the ease.ofwork ..which requires a.review and approval.of plans. x DGUI 2-tG~P~:SOt~ x Applicant's Printed Name A plieant's signature~-~ .rv+~.,~y~~p~.,.~,~~~m ;,i•C.~J' ` ",Is)'~{F~1? ,S a~,'~'~`,R,, ~„E ~ ,a~ ~••e,.. ~ \ ~~'c7~2yo.'r?~.. 1 ^1'~ a ~,'~Ya ~r-, .r • ' , Z \ . vt . ~ M~j ' ~ ' J;.,~;, J e ~ 11 ^ M .\p c,. A\ * <T y[ +~,~~.`1~'`\ .^''lSr. P. ~,1•`fl,'1 ,1 ~ ~"7 °da ~.q. s, ~ k •e ,'r„ .~`~.y~, S ° 1y' a 1 1 t ~Y ~ d ~ h ,.~V v 1 to v~~W.W1~1' , w \ J v Q~~~L , Page 1 of 3 12/10/2011 04:22 7634447106 D&D ANDERSON H & P PAGE 03/04 Use BLUE or BLACK Ink _ _ _ For Office I I ~ I Permit f3; L2A1 I I My of Eap 1 3830 Pilot Knob Road I Permit Fee: Eagan MIN $5122 1 Date Received: a~ I Phone: (651) 675-6675 t I Fax: (651) 675-5694 I Staff: ^ I 2014 COMMERCIAL PLU BIND PERMIT APPLICATION ❑ Please subrtllttwo (2) sets of plans with all commer ial applications, Date• 57- a~ ( Site Address• 1,51q o ornc e Tenant: Suite ' ;~.7 % Name: Phone: ,AF's t 1 ~~ayA ,r z 4: Name: I 5l License: PCCO 1 q9S rX Address: ~S~ iry: I 1V/ / 1ate~~Zip:~ ~,Y.. ""•~%q"?t~~ ~ / Q~"K~~~~~~ ~ Ali: ~v` ////!//~1~~'r.~/~ (c... ' New Replacement Repair Rebuild Modify Space Work in R.O.W. Description of work: e -C Z-2 16~ LMT <r a, ,x COMMERCIAL New Con ruction Modify Space Irrigation System yes / _ no) PZ /`VB) ~x„k• I~ia,„ .'.u;~~'s Raln sensors I requited on irrlgatlan s ma F?E ;:X P ' r Avg. GPM (2" turbo required less smaller size allowed by Public Works) Meters Call (651) 6755646 to verity that tests. passed!Rti4C l52 gioking up meter. t; 1s+x 'r Domestic: Size 8 Type Fire: 1 y, Avg. GPM High demand devices? Yes --N6, Flushometers Yes _ J11o COMMERCIAL FEES Contract Value $ 6; • DD x .o1 $55.00 Permit Fee Mlnl!MMM J1 ~j ~ = $ Permit Fee 1t contract value is LESS than $10,010, Surcharge = $5.00 Surcharge' i "if contract value is GREATER than $10,010, Sur&args = Co ct Vaiur x $0,0005 -if the project valuation is over $1 million, please call for Surcha ge $ TOTAL FEE I Following fees apply when installing a new lawn irrigations stem $ Water Permit Contact the City's Engineering Department, (661) 675.5646, for required ee amounts' $ Treatment Plant $ Water Supply 8 Storage P $ State Surcharge ( K . $ 3 TOTAL FEE CALL BEFO You DIG. Call Gopher Stata One Call at (651) 454.004 for protection against underground utility damage. 1 I hereby acknowledge that this Information is complete and accurate; that the work 41 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 permit that the work v✓til be In accordance with the approved plan In the case of work which requires a rg iew and approval of plans, x bode d~~5c7r~ x, Applicant's Printad Name A' plieanrs Signature ...d,r :1 .1: :r~.Ar..:. AJ~.. ,r'~•ti.i ~'M„{'f' \ ECv;•1~u.~A t'~ _ •a. n.~.SS :At."A\:Y,,:n+1"~: "K~~"~~~i' I~)1 11 ~Je' 'W16 , i, L 3.~Z;~'~+s,~ f MAGJ~ ~~,~aC r rX,F" I 1 r 1 s~' r1'.J 'AflA^s :'i Ferttet;nstion&.. UMdei`a~SulDj":,,i R4,►!9 .,Air a'a;'___.Gd¢es',;':> . `r,'yrr[}~ f•~r ,hNK(~~+~~p,ar,' q~'f ~O, -~~r d~1~p,1r C 3z~~1 ~~4.y!.~'yMW '<f d * ~ ~ lla~:+.. In {~,~TY ~'•A~4 v ~~,o - ;7 I" .r.Y. .t~~WGr~ R!r~.l~Pi•°R~ pr ;~(~~`~i!•!~I,:V'. . ~ , 1 \ .Sr ~'~~d~~OrS ;;iA'A ~rt~11~~~''r "•;':?s t'< f ~ \'E ~ . j Page 1 of 3 i i • r , RE For Office Usetoc) , �� litfog, '• r �� $ Permit#: • •: . MAR 1 D 2020 (QCr Permit Fee: 3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 Date Received: (651)675-5675 I TDD: (651)454-8535 I FAX: (651)675-5694 buildinginsoections aC�.citvofeagan.com Staff: L CROSS CONNECTION CONTROL PROGRAM INSPECTIONS R L ,.�_ 8o�f PERMIT APPLICATION ictk, Date: 3/10/2020 Site Address: 1520 Thomas PointeRre7R, Eagan, MN 55122 Tenant: THomas Lake Pointe Apartments Suite#: Property Owner Name: Nationwide Housing Corporation 763-512-7720 Phone: Name: Jayhawk Mechanical Inc PC644834 License#: Contractor Address: 3307 N 2nd St City: Minneapolis MN 55412 State: Zip: Phone: 612-522-3499 Email: flee©jayhawkmechanical.corn New .✓ Replacement _Repair _Rebuild Type of Work Description of work: Replace backflow device with new RPZ. COMMERCIAL Irrigation System( yes/I no)(1 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 permit; e w will be in accordance with the approved plan in the case of work which requires a review and approval of plans. Applicant's Printed Nameplic M ghature