HomeMy WebLinkAboutHeating Permit 09-0731
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CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
1. /~, OJ
t ~i:w ~l~icant \ PERMIT NO'Oq. o73~
ADDRESS ZONING (office use)
.5q~~ CeehrLDDcxJ 4. Nt
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
(Address)
NeCL)
5q~1o
Z j m mermDf\
Ce~
(Phone)q~.. ~5- b5'1
OWNER
(Name)
e:
APPLICANT
(Name) SEDGWICK HEATINC & AIR CONDITIONING LLC
8910 Wentworth Ave. So
Minneapolis, MNd<664QO
(952) 881-9000
(Phone)
(Address)
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION REPLACEMENT 0 AL TERA TIONS
FURNACE MAKE AND MODEL I pn ()O'X. ~ Coo lJ \i \) 3b A D'1 [) FUEL ~.s
FLUE SIZE ~ r J RETURN OPENINGS INPUT '7 D I nf)D OU~UT .5 bOD 'D
TYPE OF SYSTEM HEATING OR POWER PLANT
(City) (Zip Code)
(Phone) q~ - gg' J - '1 r1.~'1
DATE g - cd.. f? ... c:J. D DLf
(Contact Person)
APPLICANT SIGNATURE
DWarm Air Plants
DGravity
o Mechanical
DAir Conditioning
A ~ent. System
FIRJ!Pl:\C2 MAKE AND MODEL
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.
Residential, Heating & AlC (New Construction)
Residential, Heating Only (New Construction)
FEE SCHEDULE
1 % of job cost Residential, Gas Fireplace
$49.50 minimum
$149.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
$49.50
Industrial, Commercial & Multi-Family
$49.50
$49.50
Estimated Cost $
Building Permit #
REA TING PERMIT FEE
ST ATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
L/q---5D
.50
-5D. DD
(Office Use Only)
Date
o. ~~2.
This Application Becomes Your Building Permit When Approved
Buildin!! Official
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. MINNEAPOLIS, MN 55420 . (952) 881-7739
ADDRESS tii1~ ~()fJf) ~ }.I, t;, I
OCCUPANT
SOLD BY A~ ~(2.Aa
MAKE LwiJD'A
SERIALNO.~~.(, 1\
LIMIT SETTING
FAN SETTING
PILOT TYPE
IGNITION MODEL
PILOT TIMING 5 ~
PRESSURE '!Lt:;" We
INPUT CFH ",(,
STACK TEMP. ;3;)[f
PERCENT CO2
80/0
6%
o (Jlo
PERCENT O2
PERCENT CO
FORM 235 (REV. 6/08)
HEATING
TEST RECORD
JOB No.01aftf11
CITY rfJo~~
OWNER fJ&..At., Z, PnWl fr::I!.J1AA-NIJ
b"
LINER SIZE
FILTERS: SIZE lli;l5 'f. I
WIRING Su!:xJ rbW'\
/
/
DATE TESTED 8 -;A3 .. 0 '}
COMPANYTESTlN~. ~gWI c~
NAME OF TESTER
FORM DISTRIBUTION: WHITE COPY - JOB FILE
INSTALLED BY
MODEL
INPUT
VENT SIZE
TYPE OF LINER
TEST TAG
LIGHTING INST.
NUMBER
. ~/(c,
(t>,
YELLOW COPY - CITY