HomeMy WebLinkAboutMechanical 00-0866
DATE TIME
crry' OF PRIOR LAKE jq/(5"kD
INSPECTION NOTicE ICHEDULED 7,'eJO
ADDRESS / 388~ ~~ ~.
d
OWNER :ONTR.
PHONE NO. 'ERMIT NO. 0-8100
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION ~
~FINAL ~
o SITE INSPECTION
o PLUIIBING RI 0 EX/GRAD/FILLING
o MEC I RI 0 COMPLAINT
o WAr ,R HOOKUP 0 FIREPLACE RI
o SEW;R HOOKUP 0 FIREPLACE FINAL
o PLur IBING FINAL o":ili'" 0 GASLlNE AIR TST
o MEC'i FINAL A/Iff 0
COMMENTS: fU.r2.NI4.c'~-r~
~....._-~
rf::M ~)
-. . . f---- . I..., . ti.~ I _ 11
(.7"""""'" ~~0 0..<~,
~ WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REIN! PECTION BEFORE COVERING
Inspector: ~.
)wner/Contr:
CALL 447-9850 FOR THE NEXT NSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOJ YOUR PERSONAL HEALTH & SAFETY!
/NSNOTl
HOUSE HEATING TEST RECORD
ADDRESS / J Rtf J> c..~,?-.~ - A:J..fJ
OCCUPANT /lJaJ>.f' ~ . ~ "ku ./.:'l0::...
HEAT LOSS DATE HTG INST.
SOLD BY _p".__ _' ....~ Z; INSTALLED BY
-J!.j "
Electrical Work By -"-~1 I;" ~. -.- Gos line By
TYPE OF HEAT GA _ FA K-tiw _STEAM _SPACE HTR. _UNIT HTR. _OTHER
APT. _FLOOR
OWNER /n-- P'L___
CIT~' SUBURB
,
-/ GAS DESIGN
MAKE~
Modol,V;;t '3 4:J.S7~-J.Q~C;--c,
s..;.1 ~~99L J I sC: c'/
INPUT /:;),("',000
CONVERSION
MAKE OF BURNER
Modol
. Max. BTU Rating
, MAKE OF FURNACE,
Mod.1
CONTROLS
THERMOST~,r . Ho.' Plu.
V.lvo '"' .<AI/i'~
Limit <: f'lt' A.- ~ /)J ( (7 -
Umlt So";n. ' :l 3 0
Fan Setting ')-; /r? e .tJ
P;1.. Type P...-r <: t.J~;:::.4C' e
Pi lot Make
Pilot Model
Pilot Timing
L.W. Cu. Off /"
e~ h!:.'q,;.s r-
Pressure /0 . ~;cent CO ..-2. ~
Inpu' CFHL~, C:;:,<) q" Po...n' 02 Cj.D
:1 - 2 ...
Stack Temp. ~ D Percent CO _ C/
Form 235
,,-r;-
Vent Size c.:,.
KIND OF LINER 8 t/ e-..::f-
SIZE
?
NONF
Draft Hood RegulaTor
Fi Iten Size _:J (')y~ f))('" LNumber
. Chimney Location Inside k'""
tl..9 u Jrl HAl Chimney Construction h,...-# :t5--4 F
02.,17
Outside
/'
-......"
Oate Tested
Co mpany T u ti ng
Narne of Tester
e; - ::< p-
.f'~.....
c/.,A/
Wiring
Test Tag
1 ighting Inst.
:2'l100
'J.. . ._d. '" _','-'" - - ./
Smoke Bomb
Draft
Door Pressure
.
CITY OF PRIOR LAKE MC
16200 Eagle Creek Av. S.E. Permit No.
Prior Lake, MN 55372
Date
HEATING APPLICATION I PERMIT
q . 20. DO PID # ...:J 5 ~ 9,;}vf'
Stte Address
l1:AAA ~:al..Trp'C'-oOTTOV "01"\
Addttion p.:t d7 QpJ;2 r I Tw j.j III:)
U I' f
MARLENE MUT,r,TN
Lot
Block
Owne(s Name
Address 13888 CAN'I'ERRTTRY Rn
Heating Contractor
RON'S MECHANICAL. TNr
Address ,
12010 OLD BRICK YD RD
Telephone # YCJL./ qq,,-O"O"
Furnace Make & Model II t\ nall
G~')llo-I1.>)
TYPE OF SYSTEM
Warm Air Plants
Gravity
Mechanical
Air Condttioning
Vent. System.
HEATING OR POWER PLANT
Steam
Hot Water
Radiation
Special Devices
Model Size
Conn. Load
Fuel 0l~
Flue Size
Supply Openings
Return Openings
Inpud..'2S,rou Output \W,COO
Edr.
Other Devices
Cfm.
Merations
TYPE OF WORK
Replacement)( New Construction
Repair
Est. Comp. Date q - 29J. DO
2.CCO
Est. Cost $
Building Permtt #
~q.6D
HEATING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEES $
.50
%lD Receipt# ~el.f53
TYPE OF STRUCTURE
1. Pink
2. Green
3. Yellow
File
City
Contractor
Single Family,
Commercial
. Two-Family
Industrial
Multi-Family
Public Other
Fee Schedule
f? .).).Industrial, Commercial & Multi-Family
Residential, Heating & AC
Residential, Heating Only
Residential, Gas Fireplace
Residential, Additions & Alterations
Residential, AC Only
1 % of job cost ($39.50 minimum)
$99.50
$64.50
$39.50
$39.50
$39.50
Remember to add the State Surcharae on the bottom of this aDolication.
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 "ulldlna Q=i! numbAr before build-
ing certificate of occupancy wili be issued,
HEAT CALCULATIONS 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,
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; that this form does not become a permit until signed by the BUILDING
OFFICIAL; that the work will be in accordance with the approved plan in the
case of all work which requires review and approval of plans,
'cJ,wJa~~
a .......
U
t/ Building Offical's Signature
q'2-0 cOO
Date
9-d,S-oO
Date