HomeMy WebLinkAboutMechanical 99-1435
CITY OF PRIOR LAKE MC
16200 Eagle CreekAv. S.E. pe-mitNo:--9Q -1tj.3~
Prior Lake, MN 55372 '
Date
Site Address
Heating Contractor
Address
,hA.'O~\(t! r~ 1,1"<, f'''" '
41f1tol~"'-" L~,
MI!'!.:.~~~;:;:r~, /' i
t
Telephone #
Furnace Make & Model b (l/\ d' S 3~PE OF SYSTEM
. ,'^ ~ \ Warm Air Plants X
Model Size ~V ) Gravity
Mechanical
Air Conditioning
Vent. System
Conn. Loap J
(lq~,.otiJ
Fuel _.- <. Flue Size
"0'-
Supply Openings
HEATING OR POWER PLANT
Steam
Hot Water
Radiation
Special Devices
Return Openings
Input ~ ~ ~utPut
Edr.
Other Devices
Cfm.
TYPE OF WORK
Alterations Replacement X. ~ I,Ne~nstruction
Repair Est. Comp. Date /,.51 ci()
Est. Cost $ ~,7 g ~ Building Permit #
HEATING PER~IT FEE $3q , SO
STATE SURCHARGE $ .50
TOTALPERMITFEES $ ~ ~~=-~ Receipt# 3070 I
'/0 i Or)
L Pink
2. Green
3, Yellow
File
City
Contractor
TYPE OF STRUCTURE
Single Family
Commercial.
~
Two-Family.
Industrial
Fee Schedule
Industrial, Commercial & Multi-Family
Residential, Heating & AC
Residential, Heating Only
Residential, Gas Fireplace
Residential, Additions & Alterations
Residential, AC Only
Public
Multi-Family
Other
1 % of job cost ($39.50 minimum)
~~/
~./' DEG 2 7 '999
~ I
$39.50
Remember to add the State Surcharge on the bottom of this application.
The price of your heating permit includes one rough-in and one final inspection.
Additional inspections will be billed at $35.00 each.
House Heating Test Record must be submitted with puildinq oermit number before build-
ing certificate of occupancy will be issued.
HEAT CALCULATIONS REQUIRED 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.
City Hall business hours are 8 a.m. - 4:30 p.m.
ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
447-4230
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; that this form does not become a permit until signed by the BUILDING
OFFICIAL; that the wo,k will DO'dance with the approved plan in the
case oW~~Uire . :::al of Planj ~ -Yl ( 1C
. - A. PP..li~a"/n.t.'.~." ~a.t.. ur. e.... . Date I 1
krk^V!A )"'"/-.,, ,"~!_'~ 12./27/qq
Building Offical's,Sfgnature . Date' I
1072 Payne Ave.
St. Paul, MN 55101
651/772-2449
""c., ,_ , t
GAS WORK\(jkoER L
STAN'E:lARC
....,. HEATING 0..
& AIR CONDITIONING
A Blue~of: Serv;ice CO. EQUIPMENT INFORMATION
FIRSTG)OA(\, 5 ,TYPE
Dv. (C 'S "\ l S, C . MAKE f1Jt 'c~
ZIP S t:7 '!f7:) MODEL3'33.8/k) <1c/2t".??o fI t2J J1
,SERIAL .3 '-/19 ;tJ J S;) 90
INPUT SO CJoo
\
LAST 62 I .0 IAJ.(>
ADDR~S - ( S \ 1 L t? I, -'U ('I
CITY P ~ , n ~ (Ie-
HM PH)!'f 'J -- Att[... ~/j!J~
TECH /I, ^^ ?
'-J
,Q9-/'-I-35
'.., ;'
410 W. Lake St.
Minneapolis, MN 55408
6127824-2656
WKPH
, DATE ( )- I) () ( c; 9
ORSATTESTRECORD .
C02 /,0 % METERED INPUT 9/) I cfh CHIMNEY TYPE ~_ 1)(7 /'- (
02 g. S % LIMIT SETTING ;) o::t 0 FLUE SIZE _. (.., in.
CO 7) % PILOT OUTAGE ;;~;:r see CONNECTOR SIZE <(in.
NET STACK TEMP 3 5 L 0 TOTAL CHIMNEY INPUT (/ g occ..> btuh
"
I /)
/..'......~
.".... ""....... Inr::lIt"'e