HomeMy WebLinkAboutMechanical 03-0213
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
/4 117 ,A5'fJ-I/I
,~
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
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~ql
CONTR.
PERMIT NO.
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o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
(<./Y;'1 fAt< ./ A / '--
/
ov+r;d ~
~t./+- c.CIk~/M f.rlJ'v't.
J 1-~. ~
Floor,
Cliv-
rJcrr
DA. TE TIME
J -(,-tJ)
() 7- ).17
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
A-IL- LrVl~ <:
sf., frY!-t.,.- <;; a
C ;1+-f"f.~
on
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( / uSe'.-- . ~i' ~
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o WORK SATISFACTORY, PROCEED
II CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: M 3 --(;. - 03 Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
/NS/'IOn
!J . _ . . H~U'SE ~ EATING TEST R.ECORD
1'/371 SPtiv"AIli: . Alt~ APT FLOOR
"'1 - .-
.OWNER.
AOOR ESS
OCCUPANT
HEAT lOSS
SOLD BY
EI.c'ricol Work By
TYPE OFHEA T GA
DATE HTG. lI-1ST.
FA _HW.
GAS DESIGN
MAK E (1RR(~
Mod.1 S PCTA f)?tl. I::J
S.riol ~yU D;)..A.),LliSS
INPUT '701cJt()
THERMOSTAT _
Volv..
lirr.it
limit .S..IIi"9.
Fa" ~"i"g
Pilo. Typ"
Pilol Mok.
Pilol Mod.1
Pilol Timi"9 .
L.W. CuI Oil
Pr8J$urfl_
3.5
I"pul CFH_
S;ock T.mp. ...-3JJ)
CONTROLS
Heo. Plug
Percen' CO]
PerCe"' 0
1
P~rc~n' CO
7,1
(p.~
c9
STEAM
_"~STALLEO BY
.Go. line By
SPACE HTR.
. MAKE OF BURNER
. Model
. Mox. BTU Roli"g
MAKE OF FURNACE
Model
V.."t Sir..
KINO OF ur.JER.
Orolr Hood
Filt.... Sh..
Chimn.,y Loco'ion
Q-.imnf'l'Y Con,,',uc1ion
Smok.. Bomb.
Droll
Door Pre55ur"
CITY
SUBURB
UNIT HTR.
OTHER
CONVERSION
. SIZF
NON E_
. Regulo,or
.Numb..r.
I",id.. ~ Oul.id.. -
_ Wiring
.Tel" Tan
lightinl1 ,".1.
Do'" T..,'ed~'d)-t23
Company T...li"9 . AbulAl'/'??dJ:; AIr1
Nom.. 01 T.."..r ~_
-11597
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONINGIFIREPLACE PERMIT
Date Rec'd
(Please type or print and sign at bottom)
ADDRESS
\ l\Q'l~ '\Q.\*'_l{\ ~~, KJ. S.
I. Pink File PERMIT NO
2. Green City "03-(/'1. ) 3
3. Yellow Applicanl ---::;r
ZONING (office use)
PU()
LEGAL DESCRlPTI. ON (offire ~ only) y
LOTtf' BLOCKL/ ADDITIO:rrnb?1r! :fJ~/ ,~yd
OWNER
(Name)
mx\ Vi r\ deAr'
~VV\.~ ~ ~~~
(Address)
PIQ;75' ~ cJ /11- 01/3 - (,>
(Phone) ClCO 2 - ~ ~o - 2;> ~O~)
(Phone) QCO'ct-44S- \qDO
6Y'O-X\JU~-, \R\0 5~'bM
(City} \ (Zip Code)
(Phone) ~,-5d -4Y.5-lq~
DATE ~- \ q---()~
APPLICANT (\ \ I!\ '
(Name) nd\J(}(\~Cl[~) \.-\\v \ \(~.
~:/~S \CD ~~ ~~ ~.
(Address)
(Contact Person) \)eJo~ . .~... \
APPLICANT SIGNATURE ~r-..-\~
. ()
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION IKl. REPLACEMENT 0 AL TERA nONS
FURNACE MAKE AND MODELeV') l\J\iQA ') S ~ ~ ~ ~D\O - \ ~ . FUEL ~ -
FLUE SIZE 6 ~ RETURN OPENINGS ~ INPUT ~OIOc::(::) OUTPUT5w, 000
(Address)
TYPE OF SYSTEM
HEATINGORPO~RPLANT
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
.EJWarm Air Plants ~-no...Q..-'<...,
DGravity
o Mechanical
EfAir Conditioning
\/1) DVent. System
~~ .
-FIREPLACE MAKE AND MODE~'\J-JLU \QS\ 0 ~'--\
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
~ \-1:)\\ \'b C3::,~e...N~
~\ C..J
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
Industrial, Commercial & Multi-Family
Residential, Heating & ArC (New Construction)
Residential, Heating Only (New Construction)
Estimated Cost $ Q~' I::!:
$39.50
$39.50
$39.50
Building Penn it #
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
$
$
$
2/~ So
.50
1....\0 - 00
paiddJ ~ /. oC>
'IP <-(0 ,,--
Dat~
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Rece~. '7 95'
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