HomeMy WebLinkAboutMechanical 03-1111
DATE TIME
CITY OF PRIOR LAKE
INS~TION NonCE
SCHEDULED
((,.J .c;-;/
ADDRESS
If, 74,~ !r-rtl1rd
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PHONE NO,
PERMIT NO.
03- 11/ I
1/,- ~ cO
OWNER
CONTR,
o FOOTING
o FOUNDA TJON
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
o PLUMBING RJ 0 EXIGRADIFILLlNG
o MECH RJ 0 COMPlAINT
o WATER HOOKUP 0 FIREPLACE RI
o SEWER HOOKUP 0 FIREPLACE FINAL
o PLUMBING FINAL 0 GASLlNE AIR TST
o MECH FINAL 0
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~RK SATISFACTORY. PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT ~O~K. C~FOR REINSPECTlON BEFORE COVERING
Inspector: Vl1"' Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
lNSNOTJ
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BVftN~"ILLE
Heating & Air Conditioning, L.L.c.
12481 Rhode Island Ave S, Savage, MN 55378 · 952-894-0rfJ 3 - // / I
Orstat Test Report for JObl~ '( dY
f
Address / t, 7 Y <.. .~. ~c. I f( City!~, '00 L ~
Occupant fV'\ '-'=> I 1 '1 Y"Vv:", r- '-" IC" <'~:n-
Date of Install <j - ~ ;2- <::) -:.;
v ~
Type of HT. F/A V HW Space HT _ Unit HT
Other /
Make
Model
Serial
Input
Pilot Type
Pressure
Input CFH
Stack Temp
( -f Y\^O~
G.<;, J ~ P' ()t-j 'j--OL~~
~<?~.3 ~ "2 7f~/
IA,(' 0 ex)
, ,
HOT SURFACE IGNITOR
"1" ~.;- C02
(7t)/ ~7 0 0 02
/ Ie:; 0 CO
yrJ
, -
t" 1
I( prr--..
Date Tested <7S - dd -03:.,
Company _ BURNSVILLE HEATING & AIR CONDITIONING
Technician /! /(-~ ""'~-_
f ' - ...
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
8.2/.tg
I. Pink File PERMIT NO
2. Green City . /'l:::> _-/11 /
3. Yellow Applicant u.::>
(Please type or print and sign at bottom)
ADDRESS
1t.P7L/3 f}n~ Trull
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID 2.5. (j() 7. 002. (L
OWNER .
(Name) (no/ly
(Address) I 1.R7'-l ~
mare/) e:, ~ ,a J/-
.an/1~ Tyu...;/
(Phone) C]5;;J. - U 35 --t.R&{p,;;).
APPLICANT
(Name)
(Address)
Burns'Iillc Hcatir.;3 S. :\.'0, In~.
12481 Rhode Island Ave, So.
Javayc, rvtN(;~~s~-1122
(Phone) 9cCS;)- fCtl./ ~ OCOs
(City)
(Zip Code)
(Contact Person) (Phone)
PPLICANT SIGNATUR~ ~rMn// DATE d" -/9 -03
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION !S1REPLACEMENT 0 AL TERA TIONS
FURNACE MAKE AND MODEL (Qnnlix f1.r;;f..nGd -SO -10 FUErAJt1.-f e{IS
FLUE SIZE RETURN OPENINGS INPUT ~J ()OO OUTPUT .L/lo, roO
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
1 % 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
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
Building Permit # 03 - / / / /
$ 3Cj ,SO
$ .50
$ LlO,CO
Estimated Cost $
.fice Use Only)
Building Official
Date
Paid A /l
~.() ()
Date
8 .2-/. OJ
Receipt ~of5Z4-0
By 1.
U
"his Application Becomes Your Building Permit When Approved
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372