HomeMy WebLinkAboutMechanical Permit 03-0639
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED'
ADDRESS
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OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
CONTR.
PERMIT NO.
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
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,)A TE TillE
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o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
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I1 WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: fV(? r;. J)- u3 Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH .& SAFETY!
INSNOn
.....,,-" .
HOUSE HEATING TEST RECORD
Iii j..~ OJ j.../ . ( - r ,1 ttr r:-
ADDRESS _ I . J 7 /llt) . ( ! r. .-', L . APT.
OCCUPANT /-I",{, "I/_OWNER
HEAT lOSS I.~n..lf' (f .9ATE_HT):;. IN~J"( ~.;J -;. 0 -~.
SOLD BY r kl.-.; (,{'I..f<".J,...1Zt. _INSTALLED BY_
Electrical Work By ILL...:,.;..,.l.s_,., II'". f / _Gos line By
GA FAX HW STEAM SPACE HTR.
~YPf; OF HEA T
. ./ '-..A'" '. GAS DESIGN
M.\i<E - t///C ~
MoJel C?l?tl (t-I {I- 3' t,,?
Seria I 5' F C' ?~ e; ~ ;15.1'0
INPUT _ ';J .1'; ('-;;'.0
I
(90
~ / CONTROL S
THERMOSTAT, /,1,;/ Heot Plug
Volve .t--//t/
4-/1 i/
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9c
,e (t~J~'" .
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It..// K'
57 Ci/CiC (/0/(0
--.? S' nee .
limit
Limit Setting
Fan Setting
Pilot Type
Pilot Make.
Pilot Model
Pilot Timing
L. W. Cut Off
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c-/ 0"'
X ?I
S <'1 1;' (l
P\l:essure
Input CFH
Stock Temp.
"Form" 235
(;, CZ
" ~.
~
Percent CO2
Percent 02~Y-
Percent CO .. ~
FLOOR
. l cike
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CITY _ SUBURB.
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.l.:J (...I (~d, ,. 4 11,;/ /-..,'-0
J/ W(,-1 t-:J'
_UNIT HTR. _OTHER
CONVERSION
MAKE OF BURNER
Model
Max. BTU Rating
MAKE OF FURNACE
Model
Vent Size
KIND OF LINER ..c.cr-1J-J
5""" ",'
NON~
c.
SIZE
Draft Hood
Fi Iter.
ReguloTor
Size;IC, ':/ / 't( 5".Number. I
Chimney Locotion Inside
Chimney Construction ..
v
Outside
Smoke Bomb
Dr oft
V'
y
V'
Door Pressure_
Wiring
Test Tag
).'/ y
lighting Inst. ..
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",,2.J2.d-- .~<d."../ ...~~ I-t-y
C If t_iJ k ..
'K""
Date Tested
Company Testing
Name of Tester
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CITY OF PRIOR LAKE MC fb h 39
16200 Eagle Creek Av. S.E. Permit No. V,::) -
Prior Lake, MN 55372
TYPE OF STRUCTURE
L Pink
2. Green
3. Yellow -
File
City
Contractor
Date
HEATING APPLICATION I PERMIT
S - 2-3 -03 PID#~t;-I:3f-()/7-6
/4.~ q '2 HAP L. {:.. '\ ~A, L- S.. C
Site Address
Lot
Owner's Name
Address
Heating Contractor
Add1ess
Telephone # .
Block
Addition
(' /'In. \~Tuf> I-H~-\<......
\ '-I 'Q~ "2..
M AP LC-
KG::.s l \) C-A. ,'"r, '" \.
Industrial, Commercial & Multi-Family 1 % of job cost ($39.50 minimum)
Residential, Heating & AC $99.50
Residential, Heating Only $64.50 PLEASE NOTE:
Residential, Gas Fireplace $39.50 Air Conditioner U its C t
Residential, Additions & Alterations $39.50E hIt R n. d anuS'do
'" A ...~ _ Residential, AC Only $39.5C ncroac n 0 eqmre 1 e-
J M//7 /S Yard Setback.
~ 5LjO? Remember to add the State Surcharge on the bottom of this application.
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C-.. _ i-tl S"7" S 1', .~ u l~G::.
1'5 2-~I..jO - ~51S
A
Furnace Make & Model he,.N f'-.) C -,<
Model Size G(.., u U 1-\ " a c, () is 0 /6
Conn. Load
Fuel rJlli. GIt S Flue Size
Supply Openings
Return Openings
Input ~ 'is ~ 000 Output 70. 't 0 j)
Edr. .
Cfm..
Alterations
Repair
Est. Cost $
TYPE OF SYSTEM /
Warm Air Plants. 1/
Gravity
Mechanical
Air Conditioning . v
Vent. System
Single Family
Commercial
~o-FamiIY
Industrial
Public
Multi-Family
Other
Fee Schedule
The price of your heating permit includes one rough-in and one final inspection.
Additional inspections will be billed at $35.00 each.
2-1"'0...1
House Heating Test Record must be submitted with Quildina oermit number before build-
HS)( DIS-Q2.-Lf ing certificate of occupancy will be issued.
r 0 S(;U7-:
HEAT CALCULATION& REOUIRED with number of supply and return openings listed per
room with CFM's per opening. New structures or additions send floor plan with supply
and return locations shown. HEAT LOSS CALCULATIONS, PAYMENT AND
APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 16200 EAGLE
CREEK AVE. S.E. PRIOR LAKE, MN 55372.
HEATING OR POWER PLANT
Steam
Hot Water
Radiation
Special Devices
Other Devices
TYPE OF WORK
Replacement ~ew Construction
Est. Comp. Date
STATE SURCHARGE $
TOTAL PERMIT '-"='=S $
~a ,6 .0<,;, Building Permit #
HEATING PERMIT FEE $ 3,\ - S Q
.50
'fo,~<0
Receipt #
L/LI'760
City Hall business hours are 8 a.m. - 4:30 p.m.
ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
447-9850
I hereby apply for a mechanical systems permit and I acknowledge that the
information above is complete and accurate; that the work will be in conformance
with the ordinances and codes of the city and with the state building/mechanical
codes; tha.. t this form does n~t . ecome a permit until signed by the BUILDING
OFFICIALln:; hat the. WR:ill e n accordance with the approved plan in the
case of alII rk whic r quO e review and approval of plans.
t(-. ~""' 5 23-~5
f Applicanl's Signature Date
~f_ a-8f-1J3
'ate
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