2955 Lone Oak Cir - Heating Test RecordsM
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HOUSE NEATING TEST REtORD •
ADDRESS Z APT. _ FLOCR __-CITY SUBURS
OCCUPAN? OWNER ? ------
HEAT 1055. OATE M7G. INS
SOID BY u ?L; ?j, C- _ IHSTALLEO BY
Eleenicof Wwk By Goa Line Br
TYPE OF HE6.T GA FA HW _ STEAM _SPACE HTR. -UNIT MTR. OTMER -
? GAS DESIGN
MAKE MAKE OF BURNER _
Mad•I ?OAl3?j' Z0 Abd.l
Sriol 340Z?q 37 IAar. BTU RaNnp -
INPUT ZZa 0Go MAKE OF FURNACE
Mbd0l
CONTROLS
THERMOSTAT - Flwl Pluy Vent Sls•
Vo1Yo KIND OF LINER_ SIZE NONE_ Z
I?+^"t Droh Nood ? Rpulator
limif Ssttinp A?l? Fi1Nrs Sise wumber
Fon Seeriny 4 L p,tmn.r Loeoelon Inside Owsido
Pilof Trpo i?-?A- ft,4 Qimner Consfrvdion _
Piloe Mok• ?
Piiw Mode) Swoke Bemb Wiriny
Pilot TiminQ + C? Draff T.sl Top
L.W. Cur OF( Dsx Preaave Li tino Inst.
Pressw? ???? ??,?- t- Percont COZOa1e Testsd
Input CFH`7?(1 '_PNe9nt OZ ° Componr Teafinp
Stoek Tomp. -ir"y Psrcont CO ? Name ef Test«
CON Y E RSION
4
•HOUSE HEATING tEST RECORQ
ApORE55 ? `??? Zdl?i ?^ C+? APT. -FLOC'R __ -CITY - SUBURB
OCGUPANT . A_&Lx..-- _OWNER - ----
NFAT lOSS._ _DATE HTG. INST.
SOLD BY _ INSTALLED BY
EI•ehieei Work By Ga• Lin• Br
.
57
TYPE OF HEA7 GA _ FA NIY __STEAM _SPACE HTR. _UNIT MTR. O7MER _
GAS OESIGH CONVERSION
MAKE MAKE OF BURNER
Moa.i f5o L066> d;FsV --
Seriol
G ?j
/kff
0 ?aos.i
-+
! l
__
_
z Ma¦. BTU Rotiep .
INPUT MAKE OF FURNACE
Model
CONTROLS
THERMOSTAT 7?Ze?
Hwf Plwp Vont Sis•
Vv1vi --?°? KIND OF LINER- SIZE NONE
??'""t ? Droh Hood ? ?
q
- R? ulator
Limit Settinq - Y'(7 1LdV 1?
?G
Fil»rs Sie? /NUmber
Fon SeMin9 ahnner Leeerlen tnside Outsid• ?
PiIoe Trp.
a. Chimn.r Const.venon
-
Pilo? A4ek.
/
Pila Medel Sawk• Bomb Wirinp
Pilot Tfminp D?oh •st Tap ?
L.W. Cut OFf
,1 Dex Preaaure liphtlnq (nal.
P
w
S C
° _a ?
reswn
Pereenf COZ - Deh Tesbd
Input CFM _P.re•n? 02 °
Co?ony T•snny ?
/r •
w Stack Temp. Pa?eenf CO Nanr e! Testw 44 0-r-
?''
??-
HOUSE HEATING TEST RECOR6
ADORESS Z?_1-?,,_, ?PJlC?!3Xr- C+'e- APT.-FLOQR___CITY- SUBURB??
OCCUPANi _??•.•?-_1SdG_- ---OWNER ?.-----
MF_AT LQSS __ DATE NTG. INST.
SOLD BY INSTALLED BY
Electricaf Wwk &y . Gas L{no By
TYPE OF HEAT GA __ FA' HW _ STEAM _SPACE HTR. _UNIT MTR. OTHER
Gj15 DESIGH CONVERSION
MAKE ?^ MAKE OF BURNER
M"".i a cs ?- ?aoa.i
Sriol Max. BTU Ratlny --
INPUT MAKE OF FURNACE
Msdel -
/'? CONTROLS
THERMOS?T_A Hwt Plup Vene Si:•
Valr• KIND OF LINER- SIZE NONE
I.imir .-,61jXXGi? Drah Hood _ ulawr
Limit Sotlin9 Filtws Sisn um6er c5t?
Fen SoHiny T= ChimMr Leeot{on insido Outsido
Pilot Type ChImner Censhudion _
Pilof Glak• ?
Pila Medel Smolce Bomb ? Wirinp
Pilor T{minp ' D?aN Teat Tay
L.W. Cut O(f Dex Pressure Li tinO Inst.
Pnssun ? Pereent CO2 DoN Tested
Inqut CFH Z57 / P«a•nt OZ ° Coaqionr Testioy
51oek Temp. a?L _pKeont CO C' G Name sf TasHr
]n5 S HOUSE HEATING TEST RECORD ?i?fL? ?i-?%/Z, -?? a•
' 0c:.3 Ga, "
ADDRESS APT. -FLOOR CITY "u SUBURB
OCCUPANT OWNER
HEAT LOSS Dl-TE HTG. INST.
SOLD BY INSTALLED BY
Eleetrical Work BY Gas Line By GC, 4-
TYPE OF HEAT GA FA HW ?STEAM SPACE HTR. UNIT HTR. OTHER
\
G GAS DE IGN ,I
?
? ` CONVERSION
1 CS Ih?
MAKE a
? r ? r "tP ? MAKE OF BURNER
Model PL4 ' -1`4 A. °' pN Model
Serial z- 0 d Max. BTU Rating
INPUT _ 1 ?Fj i h a0 MAKE OF FURNACE
Model
CONTROLS
THERMOSTAT Heat Plug Vent Size UEnt
Valve KIND OF LINER SIZE NONE
Limit Draft Hood Re
ularor
g
Limif Setting Filters Size Number
Fan SeTting •-
-
- Chimney Location Inside ? Outside
`
,?
Pilot Type ^T?'c`,A!4S ?a7k Chimney Construction
Pilof Make
Pilot Model $moke Bomb Wiring
Pilot Timing Draft ? v? Tesi Tag
L.W. Cut Off Door Pres Li
hti
I
st
T
h`% sure .
g
ng
n
}4
??7
P P 9
rossuro ercentC02 Date Tested
Input CFH 1-753 Percent OZ ? Company Tes*i.+g ?
Staek Temp. ?o ?cs Percent CO ? Name of (Tester
Form 235
HOUSE HEATING 1'EST RECORD '??- ?-?'• a'? ?y? ?6 y/
ADDRESS ,_L?, APT. ?FLOp R CITY SUBURB T?
OCCUPANT 01NNER
HEAT LOSS DATE HTG. INST.
SOLD BY -? INSTALLED BY
Elechieol Wak Br Goa Line By
TYPE OP MEAT GA _ FA _HW _STEAM ____SPACE HTR. _UHIT HTR. OTHER
p GAS DESICN CONVERSION
MAKE ?2??MAKE OF BURNER
Moe.i _S' v.o/aod?3 Moe.i._
Seriol ?U?Jv7S _ Aba, BTU Rotlnq
INPUT _? ?? ?? MAKE OF FUftNACE
Model
?Q CONTROLS
THERMOSTAT _L_(1 3'_/ Heat plup
Velv, 74 /-y46 R
----
Limir 5e»inq
Fan Ssrring ?J
Pilor Typs
Pilee A{oke =?-J.2n,4Z?o
Pilot Modsl
Pilot Timiny Lr.
L.W. Cut Ofl
Pressura -3,
5--?=_a.L??! _ Po roent CO?
Inpuf CFH_.??_,Percent 02 ?tL_6
Slack Temp. ? PsrcoM Cp O ry ! 2
Vont Si:a
KIND OF LINER' SIZE NONE -
Drah Hood -_ R ulotor ????5
Filtirs Sit?l??S ???dr•?? ?umber
ChimMy Loeatlon n
•
I
iid
e Outside -
Qhimrisy'Conahudion ?
?
?
/J ?
w/
1CI? .
Smob Bomb -Wirinq v ..
Drah T?a1 Tup.
Deor Proswn LipbHny Ins
Dor. T•sesd -----
Tsstie
Comyon i
---
9
y,
Name ef"Tesesr ?'? -- -
.I
ADDRESS ?? n e-
OCNPAHT r-4-t JS04 i
HEAT LOSS DATE HI?T
SOLD BY CD.I1 i,I'L TY'?
Eloehieal Mak Bp
TYPE Of MEAT GA _ FA _
HOUSE HEATING TEST RECORD
?OJO`? le?,_ APT._FLOOR CITY SUBURB?
AG/C __ OMMER
:,. INS .
? IMSTALLEO 8Y
_ Gas Line Br
-_MW _STEAM-_.SPAGE HTR. _UNIT MTR. ? OTMER
A( F
? GA?pE51GN
??t /d . , CONVERSION
MAKE Q c ?u ?• MAKE OF BURNER
Alod.l ? Mod?l._
5«ial BTU Rarlny
INPUT MAKE OF FURNACE
Abdel
COIVTROL 5
(
,
u
\
THERMOSTAT ?*at plug aj=
Px
aa(
Vonr Si:•
?
Val•o ---_w KIND OF LINER SI E NONE
LiTit Droh Mood Repuloror
Llmir Seninp Ar
FilNts Siae NO Nu
r
? r?`i ?
Fon $eninp ?
/
Ulmney Locotlon Inside " Ovlaide
Pilot Trpo --- --- Chimney CoeNtueffon --
Pilet A{o4e
V
Pilo Med.l Smok* Bomb Wiriny
Piloe Timinq Droh TeH Tey
--
L.W.
Cut OH Doer Pr••¦ut• lioh}iny In•f.
P..asore
P.rcent C0
- -p?. Date Tni•d .
?
?
Inpur CFH.iJc6?ti?_?^n_P*.e*nt o2_ 4 _ c,,,,P,,,y T..t;,,o r
Y,
$rock Temp. P,rt,nl CO ?.pr ?
B'T_LNowo, e( Tas1e. r(L/("r_- L--i
NOUSE HEATING TEST RECORD
ADORESS APT. - FLOOR _
OCQ/PAN? 01YNER
NEAT LOSS OATE MTG, INj?` jd
SOLD BY ?Li.t,/?. f ? INSTALLEO BY _
El.ctrical Werk gr Gas Line 8y
TYPE OF HEAT GA _ FA `_HM _STEAM ___SPACE HTR. UNIT MTR. OTMER
e GA DESIGH COHVERSION
MAKE ? MAKE OF BURNER
Mod•I '- " Sn ---?d?l
S«iel Moa. BTU Rorlny
tNPUT MAKE OF FURNACE
Abdd
CONTROLS
THERMOSTAT H.at Pluy Vons Siz.
Vel.. KIND OF LINER SIZE NONE
Drah Hoed Reoularor
Limit S.ninp ? ? Qr _ Filleis Siao? Number
Fao Settinp 'r ChimMr Locotfon Inside Ou?side V
Pilnr TYa Chimney Constnuefion --
P;let A4oko ?._. ?
Srock Tsmp. ePerceM CO --Xhp? Nones eI Teoirer CCITY SUBURB ?
Pila Mod•I e? Smoks Bo-b . Wiriey
Pilo1 Timinp Dro11 TeN Teo --
L.W. Cut Ofi Dow Prossa• Liyhllny Insf.
Pressur• Percenf C0? Date Teated Inpur CFM_ ? Poraent 0 2?n Componr Toorinq
tl
ADDRESS ?? n e-
OCNPAHT r-4-t JS04 i
HEAT LOSS DATE HI?T
SOLD BY CD.I1 i,I'L TY'?
Eloehieal Mak Bp
TYPE Of MEAT GA _ FA _
HOUSE HEATING TEST RECORD
?OJO`? le?,_ APT._FLOOR CITY SUBURB?
AG/C __ OMMER
:,. INS .
? IMSTALLEO 8Y
_ Gas Line Br
-_MW _STEAM-_.SPAGE HTR. _UNIT MTR. ? OTMER
A( F
? GA?pE51GN
??t /d . , CONVERSION
MAKE Q c ?u ?• MAKE OF BURNER
Alod.l ? Mod?l._
5«ial BTU Rarlny
INPUT MAKE OF FURNACE
Abdel
COIVTROL 5
(
,
u
\
THERMOSTAT ?*at plug aj=
Px
aa(
Vonr Si:•
?
Val•o ---_w KIND OF LINER SI E NONE
LiTit Droh Mood Repuloror
Llmir Seninp Ar
FilNts Siae NO Nu
r
? r?`i ?
Fon $eninp ?
/
Ulmney Locotlon Inside " Ovlaide
Pilot Trpo --- --- Chimney CoeNtueffon --
Pilet A{o4e
V
Pilo Med.l Smok* Bomb Wiriny
Piloe Timinq Droh TeH Tey
--
L.W.
Cut OH Doer Pr••¦ut• lioh}iny In•f.
P..asore
P.rcent C0
- -p?. Date Tni•d .
?
?
Inpur CFH.iJc6?ti?_?^n_P*.e*nt o2_ 4 _ c,,,,P,,,y T..t;,,o r
Y,
$rock Temp. P,rt,nl CO ?.pr ?
B'T_LNowo, e( Tas1e. r(L/("r_- L--i
NOUSE HEATING TEST RECORD
ADORESS APT. - FLOOR _
OCQ/PAN? 01YNER
NEAT LOSS OATE MTG, INj?` jd
SOLD BY ?Li.t,/?. f ? INSTALLEO BY _
El.ctrical Werk gr Gas Line 8y
TYPE OF HEAT GA _ FA `_HM _STEAM ___SPACE HTR. UNIT MTR. OTMER
e GA DESIGH COHVERSION
MAKE ? MAKE OF BURNER
Mod•I '- " Sn ---?d?l
S«iel Moa. BTU Rorlny
tNPUT MAKE OF FURNACE
Abdd
CONTROLS
THERMOSTAT H.at Pluy Vons Siz.
Vel.. KIND OF LINER SIZE NONE
Drah Hoed Reoularor
Limit S.ninp ? ? Qr _ Filleis Siao? Number
Fao Settinp 'r ChimMr Locotfon Inside Ou?side V
Pilnr TYa Chimney Constnuefion --
P;let A4oko ?._. ?
Srock Tsmp. ePerceM CO --Xhp? Nones eI Teoirer CCITY SUBURB ?
Pila Mod•I e? Smoks Bo-b . Wiriey
Pilo1 Timinp Dro11 TeN Teo --
L.W. Cut Ofi Dow Prossa• Liyhllny Insf.
Pressur• Percenf C0? Date Teated Inpur CFM_ ? Poraent 0 2?n Componr Toorinq
tl
4
HOUSE HEATING TEST RECORD
AODRE55 -a-q5?5 J-onE kt l-r. APT._FLOOR CITY
OCCLPANT (-er Cl cS A C'i LFR ,_ OM?IER -
HEAT LOSS DATE MT?.} JNST?
SOLD BY tNSTALLED BY
Eloetrieel Mwk By Gas Line By
TYPE OF HEAT GA _ FA __H1Y _STEAM -_,SPACE HTR. UHIT MTR. OTMER
M?? GAS SIGN CONVERSION
MAKE !?? ?" ???KE OF BURHER
+?e.i Pb O Moa.i._
S«ial I I 10 570,2_ "76 -_ µoi. 8TU Roflny
INPUT MAKE OF FURNACE
Model
SUBURB ? AN
CONTROLS
? !? ,
/
a
THERAIOSTAT f{
aai pl,p
Vonr Sis•
a
f/'
-
Velro KIND OF LINER SIZE2 NONE
LiTii D.ah Moed Ropulaqr
Limit Soncn9 _ Filt«s Sia•
Fan Settinp Chfmner Lecatien Inside Oulsid•
Pilot Tyq - -- -- O+imrny Construdion --
Piler Moke
?
Pilot Mod.l Sinoke Bomb . " 1Yirinp
-
Pilot Timiny Drah _ Tes1 Toy
--
Cut Ofl
L.W. Dow Pn..ur. LiybNny In.t.
1
r
Prus
P
.
u
t ..c•n/ C0? Dal* Toat.d .
Input CFH. _Pve?n? OZ C,omponr Te?einp ?R ?
Srock Telnp.
Pvune CO --?
; Heme el Tear.. 13 d 1-
tS?r,(e ?
(.%'/'v??
IKE6111M ALL CONTRACTORS MUST BE LICENSED WITH THE CITY OF EAGAN
INCLUDE Q SETS OF PLANS,
CERTIFICATES OF SURVEY
? SET OF ENERGY CALCULATIONS
To Se Used For: ? _ Valuation:?? -Date-
--,. . . .. - ?- - - -- -
Site Addresska,,,f DAk 61RG1_E
Lot : 6 Block : 0 Sect/Sub :???ti Erect :
Parcel #: 10 ZZ5DI c?(o3 2`?Remodel:
Repair:
Owner : ?(??r?i.1 Enlarge:
Move:
Address: -'/? JQ(fT? c?Q, "cQ n? yj/TE//d Demolish:
City/Zip Code: -rj7, 4Ca)?(? MtfK22?a6 Grade:
Phone # : S-7y- W61
Contractor:,5//f), ?pt) Coo
Address : lkv S?'j7'/? np, Pp
City/Zip Code:?jt?(Y$ Fhj?k1 6S'-Id4?
Phone #: AFIZI(7ee014!?Ly?
Arch. /Eng : _cMef6
Address:
City/Zip Code:
Phone#=
Occupancy: g-2
? Zoning: L?
Type Of Const:
# Stories:
Length:
Depth:
_ Sq. Ft.:
Assessments:
Water/Sewer:
Police:
Fire:
Engr..
Planner:
Council:
Bldg. Off.:
APC:
Variance:
Permit: ?I D,2?
Surcharge : 1. ?!2
Plan Rev. -
SAC:
Water Conn:
Water Meter
Road Unit:
Parks:
? /73, a.s