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4530 Villa Dr SEDGWICK HEATING & AIR CONDITIONING CO. "EaTI"G ~oerPo 8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 •(952) 881-9000 TEST RECORD ADDRESS r 5 3 O CITY ~e7 . OCCUPANT YQ'r1Q~ SOYlS OWNER SOLD BY INSTALLEn av SY ~ C MAKE 13 r~All ~ MODEL /~4l~VV l 6070 SERIALNO. INPUT `-0 4~721 1 THERMOSTA S~P l~9C~` VEN7 SIZE VALVE TVPEOFLINER LIMIT LINER SIZE LIMIT SETTMG~~ G FILTERS: SIZE NUMBER I i' FAN SETTING WIRING PILOT7YPE 7 1G1~ 671 TESTTAG ' . IGNITION MODEL LIGHTING INST. PILOTTIMING DATETESTED 3--Og PRESSURE -31~ ~ PERCENTCOz INPUTCFH v(/ PERCENTOz COMPANYTESTING STACK TEMP. D)i PERCENT CO NAME OF TESTER ,1:w . FORM 235 (REV. Hle9) FORM DISTRIBUTION: WHftE COFY - JOB FlLE VELLOW CAPY-CITY SEDGWICK HEATING & AIR CONDITIONING CO. HEATING Jog N~)-~D~ 8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 •(952) 881-9000 TEST RECORD ADDRESS l5-2D V lllC7 /.Jr ,~(~n~ I3~ CITY li_G'~q6lf OCWPANT "e 4,I OWNER SOLD BY ~ eZ~~ ( INSTALLEO BY MAKE MODEL 310/.4,4Va3&070 SERIALN O.~ INPUT I P L~ OOU /7~v I THERMOSTAT VENT SIZE VALVE `O TVPEOFLINER LIMIT LINER SRE ~ 1 / LIMIT SETTING G FILTERS: SIZE X'a NUMBER FAN SETTING ~ f WIRING PILOTTYPE TESTTAG IGNITION MODEL LIGH7ING INST. PILOTTIMING /-)-3-~J y 3~ i~?, C ~ ~ DATE TESTED PRESSURE~./ ~ PERCENTCOa n INPUTCFH- PERCENTOz COMPANYTESTING S ~ . STACK TEMP. ~2 0~ PERCENT CO NAME OF TESTER FORM 235 (REV. 11/89) FOflMDISTRIBUTION: WHITECOPY -JOBFILE YELLOWCOPY -CITY SEDGWICK HEATING & AIR CONDITIONING CO. HEariNC J09NO.`~b~ gs 8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 •(952) 881-9000 TEST RECORD ADDRESS L'I ~3O U 1 A-,! ly - GJ CITY L' i ~ OCCUPANT -EF^02? 4 S71 r- OWNER /l r /nJ SOLD BYJ~ INSTALLEn av SyNA c... ~/r MAKE YlI CI~'I MODEL I~VOJ(OO/O SERIALN INPUT64 ~ THERMOSTAT Q VENTSRE VALVE 4-"~ TYPE OF ~MER ~ S~ LIMIT LINER SIZE LIMIT SETTING GO ~ FILTERS: SIZE NUMBEFi / FAN SETTING 41 WIRING - PILOTTVPE ~ TESTTAG IGNITION MODEL LIGHTING INS7. PILOT TIMING J-~ 3-C y DATETESTED-PRESSURE PERCENT COz COMPANYTESTING ~ K INPUTCFH PERCENTOi ^ i STACK TEMP. PERCENT CO NAME.OF 7ESTER , FORM2%(REV.N/89) FORMOISTRIBIJrION: WHITECOPY - JOBFILE VEU.OWCOPY - GTV ' SEDGWICK HEATING & AIR CONDITIONING CO. ?+EariNG ~oB D-~3`btv g5 8910 WENTWORTH AVENUE SOVTH • MINNEAPOLIS, MN 55420 •(952) 881-9000 TEST RECORD ADDRESS _tI S30 V I G[,( ~U/}I CITV EQ OCCUPANT :541-7 S OWNER SOLD BYINSTALLED BY MAKE-'% MODEL "Xoj"(/03 &o `7a SERIAL NO. J y03 ~7& INPUT [ > ` ~ ~ ~Ol~ g7v f THERMOSTAT VENT SIZE n VALVE ~L C NPEOFLWEF LIMIT - ~ LINER SRE ~S ~v , LIMIT SETTING- FILTERS: SIZE / G y~~ NUMBER FAN SETTING F ~ WIRING -l PILOTTYPE r~G~v C~GI1 TESTTAG IGNITION MODEL LIGHTING INST. PILOT7IMING DATETESTED~ L/ PFESSURE PERCENTCOz ~ /J _ / 5- COMPANY TESTING _ d ~ INPUT CFH PERGENT Oz ~/J - STACK TEMR )=/L_Lr PERCENT CO - NAME OF TESTER , FORM235(flEV11/89) FORMOISIAIBUTION:WHITECOPV - JOBFILE YELLOWCOPV - CITY SEDGWICK HEATING & AIR CONDITIONING CO. HEariNG JOBNd 6910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 •(952) 881-9000 TEST RECORD ADDRESS y~30 V,. "Lv I?r, ~V/7 ~iL) an E7U OCCUPANT py O 4 M S OWNER SOLD BY T v k" INSTALLEo gY 1~/ MAKE~/ MODEL ~/d~~ " O~6 07O SERIALNO. I r0_3 a~all/ INPUT r i THERMOSTAT VENT SIZE / VALVE ~L 7VPE OF LINER LIMIT LINER SIZE c/ LIMIT SEfTING 0U!I FILTERS: SIZE `~"X 2 Tx/ NUMBEA FANSETTING 77, WIRING r- PILOTTYPE L`1.WJ TESTTAG IGNITION MODEL LIGHTING INST. PILO7TIMING 3-~y oaa/~llDATETESTED PFiESSURE-31 S pERCENTCOz INPUTCFH 6G PERCENTOz GOMPANYTESTING f ~ STACK TEMR ~ PERCENT CO NAME OF TESTER ~ ~ FORM235(FEV.11I88) FOFMDISTRIBUTION: WHITECOPV - JOBFILE VELLOWCOPV - CITY SEDGWICK HEATING & AIR CONDITIONING CO. Hearuvc JoB,~ B~(f~S 8910 WENTWORTH AVENUE SOUTH • MINNEAPOL/ISN 55420 (9 881-9000 TEST RECORD ADDFESS l ~ V / ?L~d 1~ \ ? , CIN 4 i OCCUPANT OWNER / SOLDBYINS7ALLEDBY J-~ A"~~ ` MAKE MODEL 310A,409/376o70 SERIAL Nn INPUT THERMOSTAT - VEN7SIZE VALVE TVPE OF LINER LIMIT Pl~`el LINERSIZE LIMITSETTING FILTERS: SIZE NUMBEFi ~ FANSE771NG WIRING ~ PILOTTYPE! - c-a-I TESTTAG IGNITION MODEL l- LIGHTING INST. PILOTTIMING ~ DATE TESTED PRESSURE 5 4~• PERCENT COz COMPANVTESTING Sr" / \ INPUT CFH PERCENT Oz STACK TEMP. PERCENT CO NAME OF TESTER FORM235(REV.H/89) FOFMDISTRIBUTION: WHITECOPY - JOBFILE YELLOWCOPY - qTY . ..._i~ .:>.,.!...i.. v:ln-.,... o~-_.v. « r . . ~_gaCa $S SEDGWICK HEATING & AIR CONDITIONING CO. HE^riNG JOBNO. 6910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 •(952) 881-9000 TEST RECORD ADDRESS v /J I ~ / ? i~ i ' ~ ~ / CIN AQ 4w OCCUPANT OWNER n SOLD BY S~' INSTALLEo BY MAKE ~~QF~~ T MODEI 3//4~AVO3~Q70 SERIALNINPUT THERMOSTA r~// N/ uG(/ VENT SIZE / n J VALVE Z' TVPE OF LINER LIMIT LINER512E I ` LIMIT SEl71NG FILTERS: SIZE K NUMBER FANSETTING~ WIRWG ~ PILOT TYPE TEST TAG IGNITION MODEL LIGHTING INST. PILOTTIMING / - I)L 3-C' y DATE TESTED PRESSURE L I pERCENT COz ~ j G COMPANY TESTING INPUT CFH PERCENT ~ Oz STACK TEMP. I-) o F PERCENT CO NAME OF TESTER J FORM 235 (REV. 11I89) FORM DISTRIBtITION: WHITE COPY JOB FILE VELLOW COPY -CITY SEDGWICK HEATING & AIR CONDITIONING CO. HEAnNG I-~~ ~S TE$T RECORD J~B ~ 8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 •(952 681-9000 ADDRESS " I GITY l °c19 i~ OCCUPAN7-~4 -94' -51-1 OWNER SOLD BY INSTALLEn RV ~ MAKE MODEL 36070 SERIAL NO. INPUT ~f (-i ~~OO /`jT? THERMOSTAT C ' VENTSIZE ~ VALVE TYPEOFUNER LIMIT 1 LINER SIZE ~ LIMIT SETTING G o FILTERS: SIZE NUMBER FAN SETiING WIRING ~ PILOTTYPE r-7 Z16-~ TESTTAG IGNITION MODEL LIGHTING INST. PILOTTIMING - -(/y ~ DATE TESTED 2- 3 PRESSURE ~ C PERCENT Wp -7 ~ INPUT CFH (16 PERCENT Oz COMPANV TESTING STACK TEMP.~~ ~U pERCENT CO NAME OF TESTER FORM235(FEV.Hl89) FORMDISTPIBUTION: WHITECOPV-J08FILE YELLOWCOPV - Cltt SEDGWICK HEATING & AIR CONDITIONING CO. r+eariNC JOe ~-$0~' 8910 WENTWOFiTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 •(9^5g~\881-9000 TEST RECORD ADDRESS y5 -3l ~ ~ L lo D r. CITY r-o'dcyn OCCUPANT "?'10q'P'- S~'I S OWNER SOLD r ` INSTALLEo eY ~ MAKE / ~ f -1014 p' MODEL SERIALNO. INPUT 1 (o, Oa U i T THERMOSTA/ P -1C VENTSIZE VALVE~s 7VPEOFLINER ~ LIMIT '~K 'P/ LINERSIZE ~ LIMIT SETTING FILTERS: SIZE /(n K aT X~ NUMeER / ~ FAN SETTING- ~ Q WIRING PILOT7YPE ;51T? TESTTAG ~ IGNITION MODEL LIGHTING INST. PILOT TIMING (r L f ? ! i I DATETESTEO PRESSURE J ~ / PERCEN7C0z p~/// INPUTCFH0 PERCENTOz COMPANVTESTING 5'~< A~ 3]~ ['F STACK TEMP. J" J PERCENT CO NAME OF TESTER z v FORM235(REV.fl/89) FORMDISTPIBIITION: WHITECOPY - JOBiILE YELLOWCOPY-CITV SEDGWICK HEATING & AIR CONDITIONING CO. HEAriNG JQBNU20-gd 6g6 8910 WENTWOFiTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 •(952) 681-9000 TEST RECORD ADDRESS `/5'(3' V I td v/r, t /n 14- - J-6-) CITV - ~~ah OCCUPANT ` r ¢ 5A9 S OWNER SOLD BY- G,ty Ir . WSTALLEn aY l MAKE ah MODEL~~ vL 3 (p ~f ~O SERIAL NO. ~ P., r~' riG ~~v J INPUT THERMOSTAT VENTSIZE ly VALVE ~ 7YPEOFLINEP LIMIT LINER SIZE ~ LIMIT SETTING FILTERS: SI2E X 2 rh I NUMBER / FANSETTING P^ WIRING ~ PILO7TVPE TESTTAG c---- IGNITION MODEL LIGHTING INST. PILOTTIMING DATETES7EO PRESSURE PERCENT COz " / S G/v, COMPANVTESTWG ToOGa.~ INPUTCFH PERCENTOz , STACK TEMP. PERCENT CO NAME OF TESTER FORM 235 (flEV. 11le9) . FORM OISTFIBUTION: WHITE COPY-JOB FILE YELLOW COPY - CITV SEDGWICK HEATING & AIR CONDITIONING CO. HeanNG JQgNpf~-8G~ R(, 8910 WENTWOFTH AVENUE SOUTH • MINNEAPOLI , MN 55420 •(952) 881-9000 TEST RECORD ADDRESS ~V nl ~ ~ c\ L CITV 5 ~ OCCUPANT ~ '~4¢ / OWNER SOLD BV S WS7ALLED BY MAKE MODEL VU~(j,(J 7(~J SERIALNO. ~~~0 3! L-3, S-3 3 S INPUT el v / I y„ THERMOSTAT Q VENT SIZE - - ~ VALVE TVPE OF LINER LIMIT LMEfl SIZE LIMIT SETTING ~ FILTERS: SRE ~ ~ / NUMBER / FAN SETTING WIRING PILOTTYPE,4'~ ~d~ TES7TAG IGNITION MODEL LIGHTING INST. PILOT TIMING DATE TESTED PRESSURE -3' J l • PERCENT COz ~ INPUT CFH ,f pERCENT Oz ~ COMPANYTESTING ~ - STACK TEMP. ~ PERCENT CO NAME OF TESTER . / FORM235(REV.H/89) FORMOISTPIBUTION: WHITECAPV - JOBFILE YELLOWCOPV - CITV SEDGWICK HEATING & AIR CONDITIONING CO. HF-nri"G 6910 yVENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 •(952) 881-9000 TEST RECORD ADDRESS ZI !F-3/ VI ~ lO 191-1 1 V ~I I ~ - IJ~ CIN ~ i OCCUPANT 4 OWNER SOLD BY i~ INSTALLEn av /~'-~I iC / -7 MAKET MODEL SERIALNp. 3/ v/ 3-7v INPUT L~~d~ L f THERMOSTAT VENTSIZE L VAIVE NPE OF LINFR l~ ~LrT h LIMIT LINERS2E ~ LIMIT SETTING 77- FILTERS: SIZE l1 ~ y2 ~X l NUMBER FANSETTING Y WIRING PILOTTVPE TESTTAG IGNITION MODEL LIGHTING INST. PILOTTIMING - 2 ~r C DATETESTED PRESSURE ~ ~ PERCENT COz INPUTCFH PERCENTOi ~MPANVTESTING - L C ' STACK TEMP. PERCENT CO NAME OF TESTER . FORM 235 (REV. 11/89) FORM DISTRIBUTION: WHITE COPY - JOB FILE VELLOW COPY - CffV SEDGWICK HEATING & AIR CONDITIONING CZ HEATING JOBNP 8910 WENTWORTLi AVENUE SOUTH • MINNEAPOLIS, MN 55420 •(952) 881-9000 TEST RECORD ADDRE55 ~/J 35 Vl I ?4 CITY f d~9l~ OCCUPAN7 ~r4i'l LZ OWNER ` SOLD BY SP d u I C INSTALLEn BY MAKE I J I~l An / MODEL ~ i v4A VU36o 70 SERIALN~~U INPUT(2 QaU THERMOSTAT S~ QG VENT SIZE VALVE ~ TVPE OF LINER LIMIT 'r LINER SIZE ~ LIMITSETTING-~LGG FILTERS: SIZE °~j~l NUMBER I FAN SETTING --rlmY WIRING ~ PILOTTYPE ,"l TESTTAG IGNITION MODEL LIGHTING INST. PILOT7IMING ~/J DATETESTED o y PRESSURE L , PEFCENT COz ~ ~ i+ ~ w/ S /Q COMPANYTESTWG INPUT CFH PERCENT Oi ^ STACK TEMP. 3';t! PERCENT CO NAME OF TESTER /A FORM235(REV.H/B9) FOFMOISTFIBUTION:NMITECAPY - JOBFILE YELLOWCOPY - CITY SEDGWICK HEATING & AIR CONDITIONING CO HEaTiN~ JOBNb. go~'g ~ 8910 WENTVJORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 •(952) 681-9000 TEST RECORD ADDRESS I f 3-5- V"0r, v nl CITV L~~on OCCUPANT Qnd ~ ~ S OWNER SOLD BV WSTALL€D AY Sr ~J WI MAKE P> rYT~/ ~ MODEL 4/T /V7 d/(O SERIALNO. INPUT ~t THERMOSTAT VENT SIZE VALVE !TVPE OF LINER i LIMIT `+~i 4 LWERSIZE 5' ` ~~~zSX i I LIMITSETTINGFILTERS: SIZE NUMBER FANSE7TING T m> WIRING PILOT TYPE I•z TES7 TAG IGNITION MODEL IIGHTING INS7. PILOTTIMWG o ~ DATETESTED PRESSURE Cl pERGENTCOz V C~ ~ INPUTCFH 1-6 PERCENTOz ~ Q COMPANYTES7ING STACK TEMP. ]!~5' 77- PERCENT CO NAME OF 7ESTER . FORM235(flEV.tLB9) FORMDISTFIBUTION: WHRECOPV - JOBFILE VELLOWCOPY- CITV SEDGWICK HEATING & AIR CONDITIONING CZ 'HEATING ~QBN~~5o~S7 8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 •(952) 881-9000 TEST RECORD ADDFESS y7 37 V JLQ 1~Tl AI C qTY OCCUPANT OWNER SOLO eYT INSTALLEn av / MAKE MODEL -3lO~~ ~lz' 7U SERIALNO. SI D3,421 3oZ~ INPUT 4104""'C/ THERMOSTVENT SIZE VALVE ~ TYPEOFLINER LIMIT LINER SIZE J LIMIT SETTING 'gvD - FILTERS: 512E NUMeER I FAN SETTING ~ r~l Y WIRING ~ PILOTTYPE TESTTAG ~ IGNITION MODEL LIGHTING INST. PILOTTIMING 3' S O DATETESTED PRESSURE ~PERCENTCOz ~~~777 INPUTCFH PERCENTOz COMPANYTESTING d STACKTEMP. ~ PERCENTCO NAMEOFTESTEF FOFM235(REV.1ll89) FOFMDISTRIBUTON: WHITEGOPY - JOBFILE YELLOWCOPY - GITY SEDGWICK HEATING & AIR CONDITIONING CO. 7 HEaTING JosNO. -$OC°8' 8910 WENTWORT7i RVENUE SOUTH • MINNEAPOL15, MN 55420 •(952) 881-90D0 TEST RECORD ADDRESS ti5.7 J V11 IRr /JL, JJ GITY ~Q A OCCUPANT OWNER SOLD BV INSTALL€D BY W/ / MAKE MODEL ~ UO ~ D f SERIAL NO. 510314 -'-S 3IO INPUT THERMOSTAT 'r l d VENT SIZE . VALVE ~ TYPE OF LINER S- V-eh LIMIT LINER SIZE S a LIMITSETTING e FILTERS: SIZE /G.r~ rk / NUM6ER FAN SETfING ~ r WIRING ~PILOTTYPE "/~e Q) TESTTAG ~ IGNITION MODEL. LIGHTING INST. PILOT TIMING ~ DATETESTED PRESSURE pERCENTCOZ INPUTCFH PERCENTOz S//J COMPANYTESTING STACK TEMP. 3~~ PERCENT CO NAME OF 7ESTER ~ . FORM 235 (REV. 11/89) FORM DISTRIBUTION: WHITE COPY - JOB FILE YELLAW CAPV -CITY SEDGWICK HEATING & AIR CONDITIONING CO. HEanNG JOBNOp-g06~y 8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, /MN 55420 •(952) 881-9000 TEST RECORD ADDRESS ~-5- 3 U ~ ~~4~~ 1 yI r~ - CITY ~ OCWPANT R r 4 p¢ / S OWNER SOLD BY INSTALLEb BV MAKE ~?r~Q~1 / MODEL SERIALNO.~,%03~7..V )I~ INPUT 2P~Y1 K / THERMOSTA VENT SIZE VALVE i7 TYPE OF LINER LIMIT LINER SIZE ~ LIMIT SETTING ~ FILTERS: SIZE NUM6ER FAN SEffING 7' WIRING PILOT TYPE 1 7 L°7/~ ~ dl ` TEST TAG IGNITION MODEL LIGHTING INST. PILOT TIMING i- DATE TESTED l-~ PRESSURE -3 '7 pERCENTCOz / COMPANY TESTING INPUTCFH /aC0 PERCENTOz 5- D C-- c STACK TEMP. o/ PERCENT CO NAME OF TESTEF FOPM2%(REV.11/89) FORMDISTRIBUTION: WHrtECOPV-J09FILE VELLOWCAPV-QTY SEDGWICK HEATING & AIR CONDITIONING CO. HEAriNG J08N0- 8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 •(952) 881-9000 TEST RECORD AOORESS y5739 VI11H /JI" qTY ~YN9'VI OCGUPANT OWNER SOLD BY ~ C W~ G INSTALLEO BY ) -e gTti ~ C I~ ~ MAKE Lr4/a'0 ~ MODEL 311I . t/o36v ~D SERIALN~ya3,/, (9,~ua INPUT v ~ ~~G ~T? ~ THERMOSTA ( / ° VENTSIZE / VALVE ~ TVPE OF LINER ~r LIMIT LINER SIZE ~ e / LIMITSETfING FILTERS: SIZE Gx~rX~ NUMBER ~ FAN SETTMG -1-1 WIRING ~PILOTTVPE TESTTAG IGNITION MODEL LIGHTING INST. --PILOTTIMING y Ol--- DATE TESTED PRESSURE S pEFCENT C0z C COMPANY TEST W G INPUT CFH~ PERCENT Oz STACK TEMP. ~PERCENT CO NAME OF TESTER FORlA235(REV.1N89) FORMDISTRIBUTION: WHITECOPV - JOBFILE VELLOWCOPY-CITV SEDGWICK HEATING & AIR CONDITIONING CO. HEaTiNG JOBN~ 8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 •(952) 881-9000 TEST RECORD ADDFESS LI J J 0 V ' l~ t4 Or. ~f/~~ ~ qTV- r ~d~1 ~ OCCUPANT ~?4~)q T OWNER / SOLD BY INSTALLED BV w~ MAKE MODEL ~lOO~~O7O / SERIALNO. N0314-3LINPUT 4,~v~ THERMOSTA7 5'p 7~4 Ck VENT SIZE y'r VALVE TYPE OF LINER C F i/ LIMI7 ~ LINERSIZE ~ LIMIT SETTING 2av FILTERS: SIZE ~ 2~~ / NUMBER FAN SETTING WIRING PILOTTVPE ~ CGJ L TESTTAG IGNITION MODEL LIGHTING INST. PILOTTIMING DATETESTED ~ PRESSURE PERCENTCOz / ) COMPANYTESTING L INPUT GFH PERCENT Op STACKTEMP. ~IV PERCENTCO NAMEOFTESTERT FOflM235(REV.t1/B9) FOfiMDiSTFIBUTION: WHITECOPV - JOBFILE VELLOWCOPV - CITV t SEDGWfCK HEATING & AIR CONDITIONING CO. HEATING JOed~ ~U~ g 8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 •(952) 8 1-9000 TEST RECORD AODRE55 q ~ ~ U U~ 147 D I~ I 1 Ui! )CTY C 4 ~Y•/ ' OCCUPANT ~nq OWNER SOLD BY INSTALLEn av A- MAKE )~v a/J MODEL ?/Iv11~4Uo36O 70 SEflIAL NO. I I o3`1'r 27 q(y 7 r INPUT f S• OW 43Tv 5 THERMOSTAT VENT SIZE VAIVE ~ TYPE OF LINER LIMIT ~ LINER S2E l LIMIT SETiWG ~ FILTERS: SIZE NUMBER / r WIRING FAN SETTING ~ C07- C- G 1 L TEST TAG l~ PILOT NPE/ -i IGNffION MODEL LIGHTING INST. PIL07 TIMING 1/ • 2 C DATE TESTED /J PRESSURE J~ Z~l 4~" PERCENT COz 6 C ~ COMPANYTESTING INPUT CFH PERGENT Oz ~U • G{L-- STACK TEMP. J~ PERCENT CO NAME OF TESTER, FORM 235 (REV. 11/89) . FORM DISTRIBUTION: WHITE COPY -JOB FILE VELLOW COPY - GTV . . . ::...,.s' s _ m.__. ..._..v.~._ . , . SEDGWICK HEATING & AIR CONDITIONING CO. "EaTiNG JOBNdo gd ~ g 8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, /MN 55420 Z(952) 1-9 000 TEST RECORD ADDRESS 7 3 e GTY ~Oi1G7{7 OCCUPANT Y N ~~~'NJ OWNER i SOLD BY~7 L", ~ INSTALLEn av ~?f -ll G?, C. MAKE MODEL ~0~40 3~rni i~ SERIAL NO. INPUT / THERMOSTAT VENTSIZE L VAWE rv TVPEOFLINEF T~r LIMIT LINER SIZE 7 LIMIT SETTING e~ FILTERS: SIZE K a~X I NUMBER / FAN SETTING Yl WIRING PILOTTYPE TESTTAG IGNITION MODEL LIGHTING INS7. PILOT TIMING ~ r 3.tiy L' DATE TESTED PRESSUflE e" 5 PERCENT COz ~ ~ S~~ l?• ~ INPUTCFH PERCENTOz J ~ COMPANYTESTING STACK TEMP. 3!0 77 PERCENT CO NAME OF TESTER FORM 295 (REV. 11/09) FORM OISTRIBUTION: WHITE COPV -JOB FILE VELLOW COPY-Clrv . . , . . _ . SEDGWICK HEATING & AIR CONDITIONING CO. TES"TaecoRO Jog~'~6C~ 8910 WENTVJORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 •(952) 881-9000 AODRESS Ll~~ A U i Lz4 L- 1 CITY C- Q~ ~ OCCl1PANT DWNER ~ SOLD BV '~l~"~ G INSTALLED BY n / MAKE~ MODEL -*OwVo 3k) 70 SERIAL NO. INPUT < O( 4//'D i'~~TU r THERMOSTAT VENTSIZE ` / VALVE f t TVPE OF LINER - / i LIMIT LINER SIZE S LIMIT SETTWG ~ o FILTERS: SIZE ;2 7! NUMeER ~ FAN SETTING Nl Y WIRING PILOTNPE ( l ) L TESTTAG IGNITION MODEL LIGHTING INST. PILOT TIMING DA7E TESTED Z- PRESSURE 31 PERCENTCOz INPUTCFH PERCENTOz COMPANYTESTING STACKTEMP. ~ S PERCENT CO NAME OP TESTER._/~~,. / FORM235(REV.flI89) FORMDISTRIBUTIIXJ: WHITECOPY-J06FllE YELLOWCOPY - CfTV . v . . ~ ..y. , . . . . , ' SEDGWICK HEATING & AIR CONDITIONING CO. HE^Ti"c TEST RECORD ~OB NO. 8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, M//N 55420 J (9 881-9000 ADDRESS q7 3~ Jf' 7~ pTY L!r OCCUPANT OWNER SOLD BY INSTALLEn RY S_/ w~ C / O MAKE gr~lAi/ ~ MODEL lO ~VV/ 3y ~w.~O~7 SERIAL NO 3~~O ~S INPUT ~ 6 ~ao'~ / v , THERMOSTAT ~ ! la VENTSIZE ~ VALVE NPE OF LINER ~.i LIMIT LINER SIZE LIMIT SEffING Q c FILTERS: SIZE NUMBER ~ ~ FAN SETTING h r WIFING PILOTTYPE ~ ~ lo~ 62 / 7ESTTAG ~IGNITION MODEL LIGHTING INST. PILOTTIMING DATETESTED ~ PRESSUREPERCENT COz ~ COMPANYTESTING INPUT CFH PERCENT Os ~ n STACK TEMP. PERCENT CO NAME OF TESTE ~ FORM235JREV.H/99) FORMDISTRI9lJrION: WHITECOPV - JOBFILE YELLOWCOPY - QTV SEDGWICK HEATING & AIR CONDITIONING CO. HEanNG JOBN~ 06 g~ 8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 5542 •(952) 861-9000 TEST RECORD ADDRESS -/S l(J U31d d( , l I/JI CITY rI OCCUPANT ~1G SI~~ r OWNER SOLD BY INSTALLED BV MAKE 9 N-I MODEL 3/UA1T V03&0 7D SERIAL NO. l t103 430301 INPUT~G~~ l ~luc ~ ~i THERMOSTAT VENT SIZE L/ VALVE TYPE OF LINER (J LIMIT ~X LINER SIZE LIMIT SETTING FILTERS: SIZE b X~ r X / NUMBER FANSEffING WIRING PILOTTYPE TESTTAG IGNITION MODEL LIGHTING INST. PILO7TIMING L- DATETESTED PRESSURE PERCENTCOz G / S r~ LG~ INPUT CFH PEFiCENT Oz COMPANY TESTING STACK TEMP. PERCENT CO NAME OF TES7ER FORM235(REV.1llB9) FORMDISTFIBl1TION: WHITECAPY - JOBFlLE YELLOWCOPV -CITV SEDGWICK HEATING & AIR CONDITIONING CO. HEariNG JOBN~ 7L)e~y 8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 •(952) 881-9000 TEST RECORU ADORESS r,~v 1~ I~i LT} CITV ca q / OCCUPANT Q ~ OWNER SOLD BY INSTALLEO eV MAKE MODEL J 7V1~ 3 66 O SERIAL NO. al INPUT THERMOSTAT VENT SIZE Ll VALVE TYPE OF LINEF ~ ~n~ IIMIT LINER SIZE LIMIT SETTING U~ FILTERS: SIZE NUMBER ~ FAN SETTING v nl/ WIRING PILOTTYPE .7 GGI.C- `-~1 L TESTTAG IGNITION MODEL --'LIGHTING INST. PILOTTIMING ~ ^ ~ DATE TESTED PRESSURE ~ l { PERCENT Wp ~ d • / INPUT CFH PERCENT Os COMPANV TESTING ~ y- STACKTEMP. PERCENTCO NAME DFTESTER / FORM235(PEV.11/99) FOFMOISTRIBUTION: WHITECAPY - JOBFIIE YELLOWCOPV - CItV SEDGWICK HEATING & AIR CONDITIONING CO. r+EarIwG JoBNO. gy 8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 •(952) 881-9000 TEST RECORD nooaESS q 5-3f- Vi cirv LA An OCCUPANT o'~-- d1'7 S , OWNER SOLD BY INSTALLED eY MAKE ~r v11V03100 A~) + 2 MODEL 3/oyF~¢~i03(~o 70 SERIAL NO. J INPUT 6,`s ~ d~ ~ 1 THERMOSTAT 'O a VENT SIZE VALVE TYPE OF LINER , LIMIT LINER SIZE q LIMITSETTING FILTERS: SIZE ~6x NUMBER FAN SETTING WIRING PILOTTYPE TEST7AG - IGNITION MODEL LIGHTING INST. PILOTTIMING '(J ~j ~i C, DATE TESTE~ PRESSURE > 15 ~ PERCENT COz O ~C INPUTCFH PERCENTOZ COMPANYTESTWG T~~ STACK TEMP. PERCENT CO NAME OF TESTER FOPM2%(REVN/89) FORMOISTRIBUTION:WHITECOPY -JOBFILE YELLOWCOW-CITY . , . _ . SEDGWICK HEATING & AIR CONDITIONING CO. HeanNC JOBNO. 8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 •(952) 881-9000 TE5T RECORD ADDRESS dY cm~4r7 OCCUPANT _ S OWNER SOLD BY INSTALLED av % MAKE MOIEL 310,¢A-Up3~a70 SERIALNO. J~~D3~3~~~'0 ,NPUT ev G U r q// TNERM057A7 VENT SIZE ~ VALVE TYPE OF LINER ~ C r~ LIMIT f LINERSRE ~ LIMIT SETTING FILTERS: SIZE NUMBER FAN SETTWG 1' F7~ !i WIRINGPILOT TVPE ~GGi~ TEST TAG IGNITION,MODEL _-UGHTINGINST.~ PILOTTIMMG PRESSURE ~ 1 C' 7 DATE TESTED PERCENT COz INPUTCFH 661 PERCENTOz COMPANYTESTING STACK TEMP. PERGENT CO NAME OF TESTER FORM235(REV.11I89) . FORMDISTRIBUTION:'WHRECOPV•J08FILE VELLOWCOPV-CITY SEDGWICK HEATING & AIR CONDITIONING CO. HEATING JOeNO. 8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 \•(952) 881-9000 TEST RECORD ADDRE55 15-39 l/ l LZ" CIN ` q 9h OCCUPANT ~~qn 4 '0G 5V1 I OWNER q SOIO eY N d(.c. ( Gk INSTALLED BY % MAKE MODEL "3(1DAA03l007a SERIAL NO.ua3A3a ~ gS INPUT & THERMOSTAT ~ ~~`rL C VENTSIZE VAWE lV / TVPE OF LINER 13yell LIMIT ~"Y'Y' LINER SIZE LIMITSETTING- FILTERS: SIZE NUMBER FAN SETTING WIFING PILOTNPE TESTTAG IGNITION MODEL LIGHTING INST. ~ PILOTTIMING DATETESTED PFESSURE pERCENT COz INPUT CFH PERCENT Oz COMPANY TESTING S7ACK TEMP. - L PERCENT CO NAME OF TESTER !&JLA, FORM235(REV.11/99) FORMOISTFIBUTION: WHITECAPY - JOBFILE YELLOWCOPV - CITY SEDGWICK HEATING & AIR CONDITIONING CO. ~ HEATING TEST RECORD ~OB NO. 8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 •(952) 881-9000 ADDRESS /J V IVld qTY Ld7W7 / OCCUPANT OWNER SOLD BV YP & ~ INSTALLEn RY S4 MAKE 4r//'~ MODEL 3/1DUa360 70 . SERIAL NO. 117033,4,-iV ~~Ya INPUT u" '°'~BdG ~Z.-~ , THERMOST VENT SIZE VALVE ~ NPE OF LINER LIMIT_~ LINER SIZE LIMITSETTING FILTERS: SIZE ~(n NUMBEF FANSETTING -1-1 W'tll-/ WIRING PILOTTYPE TESTTAG ~ IGNITION MODEL LIGHTING INST. PILOT TIMING ~ ~i ay DATE TESTED PRESSURE 3, PERCENT COi INPUTCFH PERCENTOs COMPANYTESTING _ STACK TEMP. 29 5 PERCENT CO NAME OF TES7ER -FORM 235 (PEV. fl/89) FOflM DISTRIBIITION: WHITE COPV -JOB FILE VELLOW COPV - GITV SEDGWICK HEATING & AIR CONDITIONING CO. " HEATiNC JOeNA Sb' 8910 WENTWORTH AVENVE SOUTH • MINNEAPOLIS, MN 55420 •(952) 881-9000 TEST RECORD ADDRESS y5--I / V 1bL9 CITY OCCUPAN7 OWNER SOLD BY~ 14" ~ INSTALLED BY MAKE 4I MODEL 70 SERIAL NO ~7~3 ~lJO~dD INPUT T1! / v f ~ „ THERMOSTAT ~ VENT SIZE VALVE TYPE OF LINER / LIMIT LINER SIZE , LIMIT SETTING a) FILTERS: SIZE NUMBEFi FAN SETTING - WIRING - PILOTTVPE 'v/ ~ ~OIZ TEST7AG - - IGNITION MODEL LIGHTING INST. PILOT7IMING 2 DATE TESTED PRESSURE -l pERGENT COMPANYTESTING INPUT CFH ~ PERCENT Oz STACK TEMP. PERCENT CO NAME OF TESTER FOPM235(REV 11189) ' FOflM01STRI8UTION: WHITECOPY - JOBFILE YELLOWCOPY-qTY SEDGWICK HEATING & AIR CONDITIONING CO. ~ HEArING JoBN-j 8Ul'g~ 8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 5542 •(952) 881-9000 TEST RECORD ADDRESS CITY i OCCUPANT OWNER J SOLD BY INSTALLED BY MAKE MODEL SERIALNO./ z/#oJ aVO 3 INPUT137dtJ THERMOSTAT VENT SIZE VALVE ~ NPE OF LINFR J~ V'Ph LIMIT LINER SIZE ~ LIMIT SEffING Gv G FILTERS: SIZE d- I ~ I NUMBER ~ FAN SETTING ` WIRING PILOTNPE TESTTAG IGNITION MODEL LIGHTING INST. PILOTTIMING - DATE TESTED PRESSURE PERCENTCOi ~ INPUT CFH PERCENT Oz S G COMPANY TESTING / c STACK TEMP 1;1-] ~ PERCENT CO NAME OF TESTER FORM235(REV.11/BB) , FORMDISTRIBUTION: WHITECOPY - JOBFILE VELLOWCOPY-CrtV SEDGWICK HEATING & AIR CONDITIONING CO. ~ HEaTiNG JoBNV'gU7M 8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 •(952) 881-9000 TEST RECORD ~ l G14 r//1`r V~l ~CITY L a99~ ADDRESS I OCCUPANT lQr 4d OWNER r- SOLD BY INSTALLEn AV t~ dL-n r / MAKE Q~/`~ ~ MODEL V0 3~070 SERIAL NO. ~(OJ aga3o INPUT 419 L " THEFMOSTAT VENT SIZE VALVE rl NPE OF LINER N LIMIT LINER SIZE LIMIT SETTING v4Q C FILTERS: SIZE NUMeEP \ FAN SETTING WIRING PILOT TYPE TEST TAG r- IGNITION MODEL LIGHTING INST. • PILOTTIMWG DATE TESTED PRESSURE pERCENT COz INPUTCFH PERCENTOz J COMPANYTESTING STACK TEMP. PERCENT CO NAME OF TESTER r ` FORM 235 (REV. 1189) FORM DISTRIBUTION: WHRE COPV - JOB PILE VELLOW COPY - CIN . . . SEDGWICK HEATING & AIR CONDITIONING CO. HeariNG ~QBN1) g0(o8`3 8970 WENTWORTH AVENUE SOUTH • MINNEAPOL , MN 55420 •(952) 691-9000 TEST RECORD - t/n /1 ADDRESS I lO V It L-lI~q /J t' I/n I~ f~~ CITY _OCCUPANT rQnO T~~17,5 , OWNER SOLDBV INSTALLEOev S-~ MAKE (22V Q J MODEL '31e V036' 7O SERIALNO. .q2U31 9°Tv/I . INPUT C/4/~GU~j~(/~ , THERMOSTAT VENT SIZE , VALVE w~~ NPE OF LINEF LIMIT ~ Xf • LINER SI2E ~ LIMIT SETiING 00 ~ FILTERS: SRE NUMBER r FAN SETTING +WIRING PILOT TYPE ~ / TEST TAG IGNITION MODEL LIGHTING INST. PILOTTIMING `3--(JL, , PRESSURE J L'"• PERCENTCOz DATE TESTED S ~ COMPANYTESTING INPUTCFH~ PERCENTOz , f STACK TEMP.~~ ~ PERCENT CO -NAME OF TESTER ~ FORM235(REV.11/88) FORMDISTHIBLITION:WHfiECOPV-JOBFILE YELLOWCAPY-CITY SEDGWICK HEATING & AIR CONDITIONING CO. HEanNC JOB N'o-~~` g3 8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, N 55420 •(952) 881-9000 TEST RECORD ADDRESS r S ~6 V![liG . 6(I I14CIN ~Q d Q~ OCCUPANT ~ OWNER SOLD BY INSTALLED eV TSf ~'I~~1 r / MAKE ~r'lcf ~/y~0~~ MODEL ~~~~~Vt 3(~a76 SERIALNO. 77 S~ INPUT(J7v' THERMOSTAT VENTSIZE VALVE ~ ryPEOFLWER / LIMIT 1 t LINER SIZE LIMIT SETTING c FILTERS: SIZE :2 5-x l NUMBER ~ FAN SETTING WIRING PILO7TYPE-~ TESTTAG IGNI710N MODEL LIGHTING INST. -PILOTTIMING L DATE 7ESTED PRESSURE ~ << PERCENT COz COMPANYTESTING INPUT GPH ~v C PERCENT Oz ~~!l STACKTEMP.. PERCENT CO NAME OFTESTER ~ ' FORM235JFEV.flIgB) FOqMDISTFIBUTION: WHITEGOPV-J08FILE VELLOWCOPY - CIN SEDGWICK HEATING & AIR CONDITIONING CO. HEAriNC JoB NO. g~Og3 8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS MN 55420 •(952 881-9000 TEST RECORD ADDRESS V U i GLq C ciiy C 4' 9 OCCtlPANT d~74d S OWNER SOLD BY INSTALLED BV ~ I' -t ~ MAKE MODEL 3 lO g/4 VO 3 6C 7O SERIAL NO. / LI o-3 11_3 I S ~ ~ INPUT THERMOSTAT VENTSIZE VALVE itIlk TYPE OF LINER i/ LIMIT i f LINER SIZE S LIMITSETTING FILTERS: SIZE NUMBER~- FAN SETTING ~ WIRING CCI ~PILOTNPE TEST TAG 7 . IGNITIONMODEL LIGHTING INST. PILOT TIMING ~ 11 - DATE TESTED PRESSURE PERCENTCOz INPUT CFH PERCENT Oz COMPANY 7ES71NG 112 STACK TEMP. PERCENT CO NAME OF TESTER FORM235(REV.11/99) FORMDISTRIBUTION: WHITECOPY - JOBFILE YELLOWCOPY-CIN SEDGWICK HEATING & AIR CONDITIONING CO. HEanNC ~OBN4$o6 73 8910 WENT4JORTH AVENUE SOUTH • MINNEAPOLIS, MN 5420 •(952) 8 1-9000 TEST RECORD nooaess v(Lzv - -0) cin OCCUPANT OWNER SOLD BY INSTALLED RV lP /c7 I.~- i~ / A MAKE r~f MODEL ~/IO/74yO3~pO7o SERIALNO. UyD3/9 ~ IS7O INPU7 L"~ Oeli!~1 04I, L THERMOSTAT VENTSIZE / VALVE TVPE OF LINER L{i rri LIMIT ~ LINER SIZE LIMITSETTWG FILTERS: SIZENUMBER~ FAN SETTING ~ "di r WIRING PILOTTVPE TESTTAG ~ IGNITION MODEL LIGHTING INST. PILOT7IMING - /?-!J Ll OATETESTED PRESSURE S/I G-'• (PERCENT COz INPUT CFH ( p V PERCENT Oz COMPANY TESTING STACK TEMR ~LLL PERCENT CO NAME OF TESTER S FOPM 235 (REV. 11/&9) FORM DISTRIBIITION: WHITE COPY - JOB FILE VELLOW COPV - CITV ~ 'go (og3 SEDGWICK HEATING & AIR CONDITIONING CO. HEATING JoeNO. 8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, /MN 554 •(952) 881-9000 TEST RECORD ADDRESS ! l / 6 V I ~ ~q ,VY. / U~) CITY OCCUPANT ~Y d_~ dSL ~C17 S OWNER / SOLD BY INSTALLEn RVT y~ r~/ • MAKE 'a~/~ MODEL 3l0 o 3 607O5 SERIAL NO. I O"z,4 -3 INPUT 6' n L/ THEFMOSTAT VENT SIZE VALVE `v TYPE OF LINER LIMI7 LINER SIZE ~ LIMIT SETTING FILTERS: SIZE /~r ?l ~ S~ ~ NUMBER FAN SETfING ~ ~•~y~ T WIRWG PILOTTVPE TESTTAG IGNITION MODEL LIGHTING INST. r- PILOTTIMING r- -/~-U y DATE TESTED PRESSURE pERCENTCOi /COMPANVTESTING INPUT CFH r r;, PERCENT Oz ~ ~ STACK TEMP..~ PERCENT CO NAME OF TESTER~ FORM235(REV.11/B9) FOFMDISTRIBUTION: WHITECOPY-J09FILE YELLOWCOPY - pTV SEDGWICK HEATING &AIR CONDITIONING CO. HEAri"c JOBNu'~ 8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 •(952) 881-9000 TEST RECORD ADDRESS - / ~ / l D V I ut cirv OCCUPANT ll' S OWNEfi SOLO eY INSTALLFn av MAKE~ MODEL 3/ 0'44~U3 CO07b, SERIAL Np. =~yV 3 r'~ I~O 57 INPUT 6711' THERMOSTAT VENTSIZE L VALVE l~ NPE OF LINER z?, LIMIT LINER SIZE LIMIT SETTING FILTERS: SIZE /rP- NUMeEF / FANSETTWG /TWIRING PILOT'fYPE TESTTAG ^IGNITION MODEL LIGHTING INST. ` PILOTTIMWG DATETESTED --e'~ PRESSl1RE PERCENTCOp COMPANY TESTING INPUTCFH~ PERCENTOz STACK TEMP. ~ Z) ~ PERCENT CO - NAME OF TESTEP FOflM235(REV.11I89) FORMDISTRIBUTION: WHITECOPY-J08FILE YELLOWCOPY - CITY SE'DGVUICK HEATING & AIR CONDITIONING CO. HEATING JOBNO. 6970 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 •(952) 881-9000 TEST RECORD ADDRESS of , CITY ~AF'I ~ OCCUPANT ~r OWNER / SOLD BY INSTALLED RV MAKE ~ ~~4~(l I MODEL -3 IDX/,4G/O3 6070 SERIAL NO. qVD 314! 63O INPUT THERMOSTAT SP ~Y/O . C VENT SIZE ~ VALVE ~U NPE OF LINER LIMI7 ? LINER SIZE LIMIT SETTING ` V FILTERS: SIZE NUMBER FAN SETfING I' m WIRING PILOTTVPE ~ TESTTAG IGNITION MOOEL LIGHTING INST. PILOT TIM WG I 3 ZJ y DATETESTED./ PRESSURE PERCENTCOz INPUT CFH PERCENT Oz COMPANY TES7ING STACK TEMP. ~ L- PERCENT CD NAME OF TESTER FORM 235 (REV. 11189) FORM OISTPIBUTION: NMITE COPV - J08 FILE YELLOW COPV - CITY SEflGWICK HEATING & AIR CONDITIONING CO. HE^TiNC JoeN'~ gG6aj' 8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 - (9 ) 881-9000 TEST RECORD ADDRESS 4 CITy ~~7 OCCUPANT ?d S 5 OWNER ~ SOLD BY INSTALLED RY MAKE af, MODEL 31011,4UO3&an2o - SERIALNO. ~ F yQ3APKa77 INPUT ( 0`( ~~Q ~U J S G THERMOST G VENT S2E VALVE NPE OF LINER U LIMIT ± i,kT LINER SIZE S~ LIMI7 SETTMG FILTERS: S2E 2 J NUMBER FAN SETTING ' VY7WIRING ` PILOT NPE TEST TAG IGNITION MODEL LIGHTING INST. PILOTTIMING / DATETESTED PRESSUFE PERCENTCOz ~ S .~I ~ ~ r l~ INPUT CFH ~ PERCENT Oz COMPANVTESTING ~ STACK TEMP. ~ PERCENT CO NAME OF TESTEii /Q-! ~ i FOPM235(REV.11/88) FORMDISTRIBUTION: WHITECOPV - JOBFILE VELLOWCOPV-CITY SEDGWICK HEATING & AIR CONDITIONING CO. / HEaTING Jos Nd0 3910 VJENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 •(9 2) 881-9000 TEST RECORD ~ 4 r~ V ///J' C4~wr! ADDRESS YL ~/7 ? 1/,~)~ h~ CITY OCCUPANT ' OWNER SOLD BY INS7ALLED RY SY a? Lvl f ~ MAKE MODEL 3SO/v/ VU-3GUCOo SERIAL NO. / ? I u'' J Z INPUT THERMOSTAT VENTSIZE PUG, VALVE !T q TVPE OF LINER LIMIT y ~v LINER SIZE O LIMIT SETTING FILTERS: SIZE -/(X X a~ ~ NUMBER FANSETTING ~n7Y WIRING ~ PILOTTYPE ~ `zw TESTTAG ~ IGNITION MODEL LIGHTING INST. PILOTTIMING --n ~i DATETESTED PRESSURE 3 t~~ PERCENTCOi ~ l n// U COMPANYTESTING INPUT CFH _U=- PERCENT Oz c STACK TEMP. ~ n = %5ERCENT CO NAME OF TESTER FOFM2%(REV.i(4uvtp FORMOISTRIBUTION: WHRECOPV - JOBFILE YELLOWCOPY - CITY , ° J ~ . , , , . . , . . SEDGWICK HEATING & AIR CONDITIONING C0.7 HEATING JogN~-~oGS7 $910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN.55420J•(952) 681-9000 TEST RECORD ADDRESS ys y 7 V. LJ f. V n I/ _!1 qTY L Q' OCCUPANT ' Yla OWNEFi SOLDBY C INSTALLEDBV MAKE /J MODEL 301¢.~V03 &070 SERIAL NqO3 3 is a a INPUT THERMOSTAT ~ ! V VENT SIZE VAIVE/A,I.~ _ NPE OF LfNEF ~ i LIMIT ~ LINER SIZE 5 LIMIT SEffING rl FIL7ER5: SIZE ~ K~ rk I NUMBER ~ FAN SETTING Aq T/ / WIRING . pILOTTVPE TESTTAG IGNITION MODEL LIGHTING INST. PILOTTIMING pqTETESTED `i-o JIj PRESSURE pERCENT COz r ) 6 / COMPANYTESTING Ur~ INPUT CFH PERCENT Oz 5TACK TEMP. i1~9 PERCENT CO NAME OF TESTEFI FORM236(REV.11189) . FORMDISTRieJT101YN1HITECQPY-JOBFlLEYELLOWCQPY-0ItY , , . . . . . . : _ ,,.__-.~u . .....e.. SEDGWICK HEATING & AIR CONDITIONING CO. / HEATING ~oBNO~~ ~~~9 8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 •(952) 881-9000 TEST RECORD ADDRESS y5--q/ U41 l_. CITV i OCCl1PANT Ild50'- ~ OWNER SOLD BY INSTALLEn RV ~ 4 LVl C MAKE AO ~ MODEL -3&)A4Vo7`,,.~,c7D SERIALNn D~ R J'j INPUT THERMOSTAT VENT SIZE VALVE w TYPE OF LINER LIMIT ~ LINEfi SIZE ~ -1 LIMIT SETiING O74 FILTERS: SIZE NUMBER FAN SETTING WIRING ~ PILOTTYPE 7ESTTAG IGNITION MODEL LIGHTING INST. PILOTTIMING DATE TESTED //0 -0 PRESSURE el pERCENT COz ~ COMPANYTESTING INPUTCFHIPERCENT Oz S STACK TEMP. ~ PERCENT CO NAME OF TESTER FORM235(flEV.11/89) FORMDISTRIBUTION: Nh1RECAPV-JOBFILE YELLOWCOPY - CITY SEDGWICK HEATING & AIR CONDITIONING CO. ~ TEST HEATING JosN6! ~~89 6910 VJENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 •(952) 881-9000 ADDRESS `15 V l Y LO ~Cl/ . V rI I~ ~C./ CITY LF!56117 OCCUPANT d ¢ ~ S OWNER i SOLD BV u- INSTALLED BY MAKE br!~1Q~~ ~ MODEL V03 O&0 SERIALNq2-O3X I `9'3 o INPUT A7'4, ' THERMOSTAT VENT SIZE VALVE ~ TVPE OF LWER LIMIT LINERSIZE ~ / LIMIT SETTING 0 O FILTERS: SIZE T~X a rx ! NUMBER FAN SETTING WIRING PILOT7VPE~ww ::2~O / TESTTAG IGNITION MODEL LIGHTING INST. PILOT TIMING DATE TESTED PRESSURE 3'r cIPERCENTCOz 6 INPUTCFH(";o PERCENTDz ~j COMPANYTESTING STACKTEMP. IO PERCENTCO NAME OFTESTER ~ FOFM235(REV.1,j~9)T FORMDISTRIeUTION: WHITEGUPY - JOBFILE YELLOWCOPY - CITY / CLAIM VOUCHER - REFUND REQUEST qX3 o CITY OF EAGAN MAKE CHECK PAYABLE TO: VALLEY PLUMBING ADDRESS: 860 QUAKER AVE JORDAN MN 55352 RECEIPT #/DATE: 50926 7/10/03 51203 7115l03 52185 7/31/03 52788 8/13/03 REASON FOR REFUND: INCORRECTLY CHARGED PERMIT 60180, 60183, 66271, 60272 60273, 60561, 60562, 60563 60564,60769 TYPE OF REFUND: Plumbing Petmit 9001.4087 $ Mechanical Pernvt 9001.4088 s Building Pemut Fee 9001.4085 $ Plan Review Fee 9001.4222 $ SAC (MC/WS) 9220.2275 $ SAC (City) 9379.4681 $ SAC (Admin) 9001.4246 $ Water Connection 92203865 $ Sewer Pernut 9220.4532 $ WaterPercnit 9220.4507 $ Account Deposit 9220.2252 $ Water Meter 9220.4509 $ WaterTrearinent 9220.4685 $ Water Supply & Storage 9220.4680 $ Surcharge 9001.2195 $ 26.50 Overpayment 90012250 $ Club Box Deposit Refund 92202253 $ Construction Meter Dep Refund 92202254 $ Other - Fire Pernut 9001.4096 $ TOTAL $ 26.50 I declar under Ihe penalries of law that [his account, claim, or demand is just and [hat no part of it has been paid. .M~: 8/19/03 b.-A~ R"4 SIGNATURE DATE PLUMBING (RESIDENTIAL) Permit Application City OfEagan 3830 Pilot Knob Road, Eagan Mn 55122 Telephone # 651-675-5675 FAX # 651-675-5694 Please complete for. Single Family Dwellings Townhomes and Condos when permits are required for each unit -~6 ~ Date 7 q / 03 Site Address yJ~3 ~ V: »A Dl;v2 V'vrd4' E7v'rldu+5 ~ S Uni[ # _ Property Owner )76ana 'j- -Son S Telephone # ( ) Contractor L4 do, Ph?M6i1Gi Address ;F& 0 (~.?a~-? IQ?C City JoPdan _ State /'iirlpLS04--, Zip °S-3-.3Sv) Telephone# (4~ y9Vdld/ The Applicant is _ Owner f Contractor _ Other Septic System New _ Refurbished Submit 2 sets of plans and MPC license $ 100.00 Includes Counry fee. Additional consultant fees may apply. - Alterations To Existing Dwelling Unit,lncluding $ 50.00 _ Adding fixtures to lower levels or room additions, excluding water softener and water heater _ Abandonment of septic system _ Water turnaround 5/8" meter if needed -$121.00) Other: _ RPZ _ new installation _ repair _ rebuild $ 30.00 _ Lawn irrigation system _ Water softener _ Water heater $ 15.00 _ replacement _ additional , $ 50 Statc Surcharge ~'i; • Total ; $ U, I hereby apply for a Residential Plumbing Permit and acknowledge that the information is complete and accurate; that the work will be in conformance with the ordinances and codes of the Ciry of Eagan and with the Plumbing Codes; that I understand this is n(a ,i permit, but only an application for a permit, and work is no[ to start without a permit; that the work will be in accordance wiih ihc approved plan in the case of work which requires a review and approval of plans. .1a5l.,/A kc11-i ~I~,/~ Applicant's Printed Name Applicant's Signature RESIDENTIAL MECHANICAL Permit Application City Of Eagan 3830 Pilot Knob Road, Eagan Mn 55122 Telephone # 651-675-5675 ,s ~ o ll ~S~ '-7 '-4 Piease complete for. Single Family Dwellings & Townhomes and Condos when permits are required for each unit Date Site Address Unit # S Property Owner Telephone # Contractor r--- , --•.;::~:i:c.y~ iRC?,"71T1 ; ~ WenMjor;h :;~~a. Street Address S - City Yuill 2aO~S~ f41N J.74~ state (952) 881•9onQ ziP TelePnone a( ) Bond Eapires: The Applicant is _ Owner ? Contractor _ Other Add-on, modit'ication or alteration to existing dwelling unit $ 30.00 furnace replacement air exchanger air conditioner _ New _ Replacement other . ~ State Surcharge $ .50 i t~l i Total Si $ ~ i I hereby apply for a Residenrial Mechanical Pemut and aclaowledge that the informarion is complete and accurate; that the work will be in confonnance with the ordinances and codes of the City of Eagan and with the MecLanical Codes; that I understand this is not a permit, but only an applicarion for a pemvt, and work is not ro start without a permit; that the work will be in accordance with the approved plauMWsye,~of~v,4rk vKhic}r~requi~sbre}(i,esw and approval of plans. HII'4 riU19 L^U Applicant's-PYi4iteii'Name" `Applicant's Signature ~~j' COMMERCIAL MECHANICAL Permit Application City Of Eagan 3830 Pilot Knob Road, Eagan Mn 55122 Telephone # 651-675-5675 Please complete for: corrvnerciaUindustriat buildings multi-family buildings when sepazate permiu are not required for each dwelling unit Date Site Street Address Unit # Tenant Name (if applicable) Previous Tenant Name Property Owner Telephone # ( ) Contractor Street Address City State Zip Telephone # ( ) Bond Eapires: The Applicant is Owner Conhactor Other Work Type New construction _ Install _ Remove Underground Tank Interior Improvement Schedule inspection during installation or removal of tank Processed Piping Nature of Work: Permit Fee $50.50 Minimum Fee (includes Sffite Surcharge) Contract Value $ x 1% _ $ Permit Fee • If pernut fee is $1,000 or less, add $.50 $ State Surcharge If permit fee is over $1,000, add $.50 per $1,000 Permit Fee $ Totai Fee I herehy apply for a Commercial Mechanical Pernrit and acknowledge that the information is complete and accurate; that the work wID be in conformance with the ordinances and codes of the Ciry of Eagan and with the Mechanical Codes; that I understand tlris is not a pernut, but only an applicarion for a permit, and work is not to start without a permit; that the work will be in accardance with the approved plan in the case of work which requires a review and approval of plans. Applicant's Printed Name ApplicanYs Signature Approved By: , Inspector Date: c'-- 1j V-~ conu+aERCinr. 2002 BUILDING PERffiIT APPLICATION a~ q 1 CITY OF EAQAN ~ ~ 651-681-4675 [ c, '6 Foundation Onl New Construction Interior Im rovement • SWCWraI Plans (2) sets . Arc:hitecWral Pians (2) sefs . ArchitecWral Plans (2) sets . C'rvA Plans (2) . Strudural Plans (2) • Code Analysis (1) . CertifiwleofSurvey (1) . CivilPlans (2) • ProjectSpecs (1) , CodeAnalysis (1)•• . LarMscapGgPlans (2) • KeyPlan (1) . Projea Speca (1) . Code Malysis (1) " . Master Exit Plan (1) • Spec. Insp. & Testlng Schedule " • Certifipte M Survey (1) • Energy Calculadons (1) not ahvays" • Sofls Report (1) • Spec. Insp.d TesBng Schedule (1) " • Elec. Power & Lighting Form (1) not always" • Meter size must be esfablished . Meter s¢e must be esta6lished • Meter size must be established - if applicable . ProjectSpecs (1) 1 " 1 • EneFgyCalculatiwns (1) 1 • ElecMc Poxrer & LlghUng Form (1) 1 • Mester Exit Plan (1) 1 j • Emerpency Response Site Plan (1)'"" 1 1 • SoilsReport (1) i • MC/ES SAC detertnination let[er • MCJES SAC detertnination IeUer • MC/ES SAC determinatan letter ta11657602-7000 ce11651-802-1000 ca11.651-602-1000 Food 8 beverage or lodging facllides - submR plan M MN Oepartment of Health. CaU 651-215-0700 for details. Contad Building Inspectians for sample. PermitturnewbuildingsoradditlonswillnrofbeprocessedwiThoutEmerg.ency ponse,~itePlan k6uiidingingpe~~forrequirements. ~l DATE: 02 WORKTYPE: X EW _ RE DEL CONST CTION~.~COST: 9/S~ •D~ ~ l la Y ~ SITE ADDRESS: ~ - - A" TENANTNAME: Cedar Villas Housing SUITE#: FORMER TENANT NAME, IF APPLICABLE: DESCRIPTION OF WORK ;rzon,Vr96~ L>Jrr~S'Y2~~1~ /~0~^ Name; Cedar Vi11as, LLP. Phone#: 6( 12 ) 341-7800 PROPERTY Iast Fust OWNER StreetAddress: 900 Second Avenue South, Suite 880 CiW Minneapolis gtate_ MN - ZqP; 55402 oDmpany: Frana and Sons, Inc. Phone#: ( 952 ) 935-8600 CONTRACfOR StreetAddress: 633 Second Avenue South ~ T4 City: Hopkins Sffite: MN IIIIN ZipM ~5~ IIInxcIUMcri N-~'1 2 1 2v32 ENGINEER Company: Elness Swenson Graham ArchitectsPhone#: I 612 339-5508 Name: David Graham Registrafion#: 14808 Strect Addresy: 700 Third Street South ~ity. Minneapolis 5tate: MN Z;p: 55415 JcenaedplumberinstallingnewsewerJwaterservica: Imperial Developers Phone#: 6L 51 1 454-3338 a hereby acknovvledge that 1 have read tliis applkotlon, state fhat ttie irrfortnatbn Is correct, 4- greeJ~ com ty wf all appllcable State of NinneaoTa Statutes and Cily of Eagan Ordinances. ~i, Sfgnature of Applicant• -~G~ Updated 7/02 OFFICE USE ONLY 5UBTYPE ? Ol Foundarion ? 26 Public Facility ? 30 Accessory Bldg. ? 14 Apartments ? 27 CommerciaUfnduslrial ? 32 Ext Alt - Apts. ? 15 Lodging ? 28 Greenhouse ? 34 Ext Alt - Comm. ? 25 Miscellaneous ? 29 Antennae ? 35 Ext Alt - PF ? 37 Nail Salon WORK TYPE D 31 New ? 35 Tenant Impr ? 42 Demolish (Foundation) ? 46 WindowslDoors ? 32 Addition ? 36 Move Bldg ? 43 Reroof ? 47 Repair , . ? 33 Alterations ? 37 Demolish (Bldg) ? 44 Siding ? 48 Authorization ? 34 Replacement ? 38 Demolish (Int) ? 45 Fire Repair GENERAL INFORMATION Gensus Code 7.oning sq. ft. SAC Code # of Stories sq. ft: No. ofUnits Length sq. fL , • . No.ofBldgs. Width Sq f}, ConsG (Actual) Basement sq. ft. MC/ES System _ (Allowabie) Fust Floor sq. ft City Water UBC Occupancy sq. ft. Fue Sprinklered MISCELLANEOUS INSPECTIONS ? Gac Service Test ? Heating ? Insularion Q Plumbing ? Stucco/SWne APPROVALS PWmiing Building Engineering Variance VALUATION $ ~7 5'~ ~ 0 0 0 Permk Fee 5urcharge ~,lan Review u1C/ES SAC % SAC :iry SAC SAC Units Nater Supply & 5torage Meter Size i/W Pertnit iM/ Surcharge 'reatment Plant 'ark Dedication 'raiis Dedication Vater Quality )ther :opies ) " c90e. o f+ "otai , ? s s , .g~ Use BLUE or BLACK Ink r - - - - - - - - - - - - - - - - I For Office Use Permit l 15 ©I l City of Eaoa~ J b I Permit Fee: q>04 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Date Received: Fax: (651) 675-5694 Staff: j I t-----------------I 2013 COMMERCIAL BUILDING APPLICATION Date: qljq) j 3 Site Address: 753 0 /~i V~ Tenant Name: elle d a r IIhla S (Tenant is: New / Existing) Suite Former Tenant: / i Name: Phone: r:7 Property Owner Address / City / Zip: ®e) l `°ekj o.i tro y rov' A Applicant is: Owner Contractor Type of Work Description of work: k0o ili g r i 1 h Construction Cost: l3 Name: ~~.Sf °1 V ~ • License i Contractor Address: 9p l City: 6-o l d e,, t `a l` ~ ,7 ' - l State: M n Zip: s5t`l) Phone: 363300 , f t'~' .Sf'rt~® t4 Contact: 06Vj\ v1l Email: diul; Name: Registration Architect/Engineer Address: City: s State: Zip: Phone: Contact Person: Email: Licensed plumber installing new sewer/water service: Phone NOTE: Plans and supportingdocuments that you submit are considered to be public information. Portions of the information may be classified as non-public if you provide specific reasons that would permit the City to conclude that they are trade secrets. CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.org 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; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. x ~7/v/~ x Applicant's Printed Name Applica is Signature Page 1 of 3 PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA172970 Date Issued:10/25/2021 Permit Category:ePermit Site Address: 4530 Villa Dr E Lot:2 Block: 01 Addition: Cedar Villas PID:10-16900-01-020 Use: Description: Sub Type:Residential Work Type:Replace Description:Standard Water Heater Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Building Code). Please call Building Inspections at (651) 675-5675 to schedule a final inspection. Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087 Surcharge-Fixed $1.00 9001.2195 $60.00 Total: 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. Contractor:Owner:- Applicant - Cedar Villas Lp 1600 Hopkins Crossroads Minneapolis MN 55305 (952) 941-1044 Centraire Heating & Air Conditioning 6811 Washington Ave S Minneapolis MN 55439 (952) 941-1044 Applicant/Permitee: Signature Issued By: Signature