HomeMy WebLinkAboutMechanical 03-0837
DATE TIME
CITY OF PRIOR LAKE 7-1--0:7
INSPECTION NOTICE SCHEDULED
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ADDRESS ~c.t
OWNER CONTR.
PHONE NO. PERMIT NO. :J-g-:J7
o FOOTING o PLUMBING RI o EXIGRADIFILLING
o FOUNDATION o MECH RI o COMPLAINT
o FRAMING o WATER HOOKUP o FIREPLACE RI
o INSULATION o SEWER HOOKUP o FIREPLACE FINAL
o FINAL o PLUMBING FINAL o GASLINE AIR TST
o SITE INSPECTION o MECH FINAL 0
COMMENTS: Fv-~
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~ORK SATISFACTORY. PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: v}r7 7 -1'r!};, Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
INSNOTI
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ADDRESS
OCCUPANT
HEAT LOSS
SOL 0 BY
Electrical Work By
TYPE OF HEAT
MAKE
Model
Seria I
INPUT
THERMOSTAT
Valve
limit
Limit Setting
Fan Setting
Pilot Type
Pi lot Make
Pilot Model
f'
HOUSE HEATING TEST
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RECORD
CITY {) - SUBURB
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APT.
OWNER
F.
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STEAM
INSTALLED BY
Gas Line By
SPACE HTR.
OTHER
UNIT HTR.
L GAS DESIGN
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GS-1M V - "1{.~ '-ol..j~
~..;:. 0 .~ l:. ~(,{) {S 9
)I'? nCP...A1 .
CONVERSION
M\KE OF BURNE~
.)
Max. BTU Rating ./
MAKE OF FURNAQ{'
Model ~.
II. ,'"I
____ CONTROLS
---...... Heat Plug
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,-; )(- "
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--
Ptle-
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--
KIND OF LINER
Draft Hood
Vent Size
SIZE
NONE
4 .J iPJ/egula,or
I . Number
/
,
Outside
F i Ite,.
Size
Chimney Location Inside
Chimney Construction
Wiring
Test Tall
lighting Inst,
I
Smoke Bomb
Draft
Door Pressure
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mJ
,\
J"
Pilot Timing
L. W. Cut Off
Pressure l- t II" WL
Input CFH
Stack Temp.
Form 235
b,Cj
4" .q..
0'
Date Tested
Company Testing
Name of Tester
Percent CO2
Percent O2
Percent CO
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CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
I. Pink File PERMIT NO 'If
2. Green City ''0 ") _ 0"-::2.
3. Yellow Applicant ':J l5 J
(Please type or print and sign at bv..v....)
ADDRESS
ZONING (office use)
16540 Franklin Trail SE
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION X
PID;?S-- qtJ/-oo1-0
"
OWNER
(Name) Susan Cl ipper / Dave Klassen CAP Agency
(Phone)
952-496-2125
(Address) 16540 Frankl in Tra i 1 SE
APPLICANT
(Name) Ron's Mechanical, Inc.
(Phone) 952-445-8585
(Address) 12010 Old arick Yard Road
(Address)
Shakopee
(City)
55379
(Zip Code)
(Contact Person) L i.nd.;:i (Phone)
'''PPLICANT SIGNATURE )d'\~\ciOA (~V (\fLJ/d.L{ DATE U' lq,~
APPLIC'&T PLEASE COMPLETE BELOW
. ,
DNEW CONSTRUCTION . tzl REPLACEMENT D AL TERA TIONS
FURNACE MAKE AND MODEL LL\\-'V\-Oi- (J1 ~ Q 1- sO /hlilrrtP"'3IIA'" {)"S"FUEL N b{
FLUE SIZE RETURN OPENINGS INPUT (~()\mo OUTPUT tt\D fJUU
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TYPE OF SYSTEM REA TING OR POWER PLANT
OWarm Air Plants
o Gravity
o Mechanical
OAir Conditioning
OVent. System
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
FIREPLACE MAKE AND MODEL
Industrial, Commercial & Multi-Family
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
$39.50
Residential, Heating & AlC (New Construction)
Residential, Heating Only (New Construction)
$39.50
$39.50
Estimated Cost $
Building Permit #
''I
HEATING PERMIT 'FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
'~.SD
I. i \ ....so
"1U. W
flce Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
paid.$ LftJ.--
Date 10 - d3~
Receipt t/ Iff:JtJ
By ~
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24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372
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