HomeMy WebLinkAboutMechanical 03-0255
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CITY OF PRIOR LAKE
INSPECTION NOTICE
'.
SCHEDULED
ADDRESS
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
P _INSULATION
KFINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
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DATE
TIME
3-~5~
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
aIr 4-
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o WORK SATISFACTORY, PROCEED
~RRECT ACTION AND PROCEED
o CORRECT ~~R~)7LL FOR REINSPECTION BEFORE COVERING
Inspector: -l.!!I./ ~,- 't,/-O?owner/contr:
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INS/</OTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
ADDRESS M %7
OCCUPANT
HEAT LOSS
SOLO BY
'.
TEST RECORD
HOUSE H EA*T 'I'<IG
fiJRI W 6 /UE 1<1JJlD
DATE HTC. INST.
EI.c";c,,1 Wo,k By
TYPE OF HEA T GA _ FA _HW .
GAS DESIGN
MAK E J;flR1?IER..
Mod.1 Sf' (fJ lJ P Dft:D
Serial .--S;.J!l..bP. A 133lPtI
fib 1000 .
INPUT
THERMOSTAT
Valve
Lirr.il
lim;I .Se";ng _
Fon s..etring
Pilat Typ"
Pilar Mak.
P il 01 Madel
Pilat Timing
L. W. CuI 011
Pfelsur~
36
Input C FH
S,,,C" Temp. J #.J1'
CONTROLS
H~al Plug _
Percent CO]
- Percen' 0]
_ P~rce"' CO
7'/
-? ,f)
o
_APT. _FLOOR
.OWNER
CITY
STEAM
_"~STALLED BY
_ Go. line By
SPACE HTR.
UNIT HTR.
CONVERSION
/.lAKE OF BURNER
/.Iodel
/.lox. (lTU Roling
/.lAKE OF FURNACE
Mod"l
Yent Site
KINO OF lIr~ER.
. Sill'
Droll Hood
Fillers
Regula,or
Number.
Sire
ChimrJ4!ty Loco.ion
ChimrH"Y Con,'rucfion
In. ide .
Smok~ Bomb _
Drol,
_ Wiring
_T..ITol1
Door Pr'C:l55Ur",
_ Ligh.inQ In,1.
Dale Te.led _ .3 -/'7-03 A',
Company Tes'ing /IJ;tI/YMtfE n /".e
Nom," or T"5ler ~
SUBURB
OTHER
NON E_
Ou',ide _
/ A" C.
#&;0/
Date Rec'd
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
(Please type or print and sign at bottom)
ADDRESS
Z~~1 s?~\n~ L0--\h~ fQ..c1
LEGAL DESCRU'uON (office use only)
LOT
BLOCK
ADDITION
OWNER
(Name)
~ V\ ~\ '<...:>
~~ ~\~
(Address)
G""w~\~~
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APPLICANT
(Name)
(Address)
~
I. Pink File
2. Green City
3. Yellow Applicant
PERMIT NO./) 'J
//..J -
;? S- 5'
ZONING (office use)
PID
(Phone) 0(2::> d - '& ').q - 8.0 ~)
(Phone)
(City)
(Phone)
DATE
TYPE OF SYSTEM
~rm Air Plants
o Gravity
o Mechanical
~Conditioning
OVent. System
HEATING OR POWER PLANT
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
ADVANTAGE AIR IHe
315 130TH ST. W.
C;JU~nPfE ~~ 5~379
(Wre(sg S Z ) 4 4 5 - 1 9 0 0
(Contact person)1)~~ ~
APPLICANT SIGNATURE ~ ~
U
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION ~PLACEMENT [] AL TERA TIONS
FURNACEMAKEANDMODELr~ b~yv\\j~ <::::>(s.O FUEL ~~
FLUE SIZE RE'~JRN OPENINGS INPUT ~\. ~~ OUTPUT 0 ~ 'f~
He,
...pI~PT ArF MAKE AND MODEL
"\ lC>--f\.L --r'f-A 0 ~
d-\~
(Zip Code)
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PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
Ai c:....,
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 & AIC (New Construction)
Residential, Heating Only (New Construction)
Estimated Cost $
Building Pennit #
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
$
$
$
(":? 9. S-O
.50
, / ('\ _ oQ
7
Paid t:/& / 00
Date?_ 1-3
$39.50
~
$39.50
Reclill605
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