HomeMy WebLinkAboutHeating Permit 08-0933
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CITY OF PRIOR LAKE
HEATING/AIR CONDITIONINGIFIREPLACE PERMIT
Date Rec'd
1. Pink
2. Green
3. Yellow
~~icanl I PERMIT NO. ug, 0;73~
I
ZONING (office use)
(PI<uotype ~....:: bo1toml
I ADDRESS
11D/5J.. L" e.5 i rill J
Aue . ~iE
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
(Address)
(3,enL\LL
1
f30'~\ n
jf1L Aue.
(Phone) '15J.. -L/41-[J~ D3
'--
APPLICANT
(Name)
(Address)
SEDGWICK HEATING & AIR CONDITIONING LLC
8910 Wentworth Ave. So
Minneap~rMN :-;5~20
(95j tlY~~ooo
(Phone)
(City)
(Zip Code)
(Contact Person)
APPLICANT SIGNATURE
DATE
)D.-/=)D ,-D?
APPLICANT PLEASE C LETE BELOW
DNEW CONSTRUCTION REPLACEMENT D ALTERATIONS
FURNACE MAKE AND MODEL L.py\y\~ b-ln Dl \ ~4V3IoBc/1tJ FUEL 4Lt..5
FLUE SIZE RETURN OPENINGS INPUT q ~ [)[\Z) OU7JUT '7.:1. bO-o
TYPE OF SYSTEM HEATING OR POWER PLANT
OWarm Air Plants
OGravity
o Mechanical
OAir Conditioning
OVent. System
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
PLEASE NOTE: Air Conditioner
Units and Fireplaces Cannot Encroach
into Required Side Yard Setbacks.
Fireplaces with Box Additions or
Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL
Industrial. Commercial & Multi-Family
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$49.50 minimum
$149.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
$49.50
Residential, Heating & AlC (New Construction)
Residential, Heating Only (New Construction)
$49.50
$49.50
Estimated Cost $37.;35
Building Permit #
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
LjL1.5D
.50
60. DO
ceipt NO'51 'it(
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Duildinll Official
Date
Paid 5U,
Datel( j~ ,(u~
24 hour notice for all inspections (952) 447.9850, fax (952) 447.4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
SEDGWICK HEATING & AIR CONDITIONING CO.
8910 WENTWORTH AVENUE SOUTH 0 MINNEAPOLIS. MN 55420 0(952) 881-9000
ADDRESS I b { S- 2: [, ~ ".'C S (1__ A u - S'
OCCUPANT ~ J .". f? l\ It ""-
SOLD BY ~ -r J. c:, l..V '( .~
,- t
t;; CITY
OWNER
INSTALLED BY
MAKE
L "-"t ~ It-!
.,10 <2' 1'7 Y"C r.;
v(Jrocd
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p ~j- -c.- ~
t7 a
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r:: I-r: c-
rIsf'
l \.t: S f.4-<... r
/'l ~ y. ".- /
~ _ PERCENT CO2
~'" C/ C
~ 1!1- PERCENT O2
77z.
NAME OF TESTER
MODEL
SERIAL NO.
INPUT
THERMOSTAT
VENT SIZE
VALVE
TYPE OF LINER
LIMIT
LINER SIZE
LIMIT SETTING
FILTERS: SIZE
FAN SETTING
WIRING
PILOT TYPE
TEST TAG
IGNITION MODEL
LIGHTING INST.
PILOT TIMING
DATE TESTED
PRESSURE
COMPANY TESTING
INPUT CFH
STACK TEMP.
(!J
PERCENT CO
FORM 235 (REV. 11/89)
HEATING
TEST RECORD
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FORM DISTRIBUTION: WHITE COPY - JOB FILE YELLOW COPY - CITY