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CITY OF PRIOR LAKE
INSPECTION NOTICE
DATE TIME
SCHEDULED
L()/~~l~ ~
ADDRESS
I L{2-S-S- ;)~~ Lg
OWNER
CONTR.
PHONE NO.
PERMIT NO.
--3 - I 2-Cl. 7
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
11 0 GA LINE AIR TV: '- r
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COMMENTS:
'~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
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Inspector:
Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETY!
lNSNon
) '1~)7 5 Jf.r:J/'fJ t:OUSE HEATING TEST RECORD
ADDRESS
OCCUPANT
HEAT LOSS
SOLD BY /Jrf) Iv 15
Electrical Work By
TYPE OF HEAT
GA
DATE HJG. INST.
tf1!J.C/, .
FA '~ HW
MAKE
Model
_ial
INPUT
/ R. . !}.AS DESIGN
t.- C}JNt!) )(
(5 (;./)() ftv7(;A~7tJ
q-lfo.'7b 7 J 7-~ (p
. 7 () J(~) (f}/J .
. .
CONTROLS
THERMOSTAT Heat Plug
Valve ~... . -e, A
Limit r f K :,jI
Limit Sa"ing t
Fan Setting
Pilot Type I J ~-
Pilot Make /....J.dLJ
Pilot Mod.lTfU!
Pilot Timing
L.W. Cut Off
Pre..ur.
Input CFH
Stack T.mp.
Form 235
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'7 I}"; LLl./ I-
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Percent CO <:; J
Percent 02 J/J., j
Percent CO 2a/tP~
"v
APT.
OWNER
FLOOR
STEAM
INSTALLED BY
Gas Line By
SPACE HTR.
UNIT HTR.
CITY f'Ah/~BURB
OTHER
CONYERSION
MAKE OF BURNER
Madel
Max. BTU Rating 7CJ/O">>
. ~ -
MAKE OF FVRNACE --'=1:. .NN/.? ~
Model G ~/)uH 1/ 'J1AA-07/J
~fj
Vent Size
KIND OF LINER .-
Draft Hood
Filte,. Sin
Chimney Location
Chimney Construction
;) I L F .------,
Kegula,or ::..
~r
InH_de
f7VE:.JuT-
\ /'
,,/
^
Date Te.ted <11;;. ?r/6 '3
Company T..ting . A/JA/ 9-~!'CJf
Na_ of T...., ~ ~ j:'/.n 1\..._---'.....;,
'+-" :.. ,
Smoke Bomb
Draft
Door Pre..ure
Ou..ide
Wiring
Te.t Tag
Lighting In.t.
NOHF'
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CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
I. Pink File PERMIT NO{)3
2. Green City - h. cY r,'
3. Yellow Applicant I~ I
(Please type or print and si~ at bv..v~.)
ADDRESS
14255 SHORE LANE NE
LEGAL DESCRlyuON (office use only) ~
LOT //PBLOCK 3 ADDITION ~~ {JM~ 4~
OWNER
(Name) MARK WEISGRAM
(Address) 14255 SHORE LANE NE
ZONING (office use)
PInc7S-d15-0l/eJ-C,
(Phone) 952-496-1627
APPLICANT
(Name) RON I S MECHANICAL I INC.
(Phone) 952-445-8585
(Address) 12010 OLD BRICK YARD RD SHAKOPEE MN 55379
(Address) (City) (Zip Code)
(Contact Person) L\l'~..:Je V nahder (Phone) ClCC2- q45"~C;
-'\PPLICANTSIGNATURE J:!,rdA- ~ DATE q~23'D?
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION ~REPLACEMENT 0 AL TERA TIONS
FURNACE MAKE AND MODEL Ltnno)G 0 (oOUHV"""3I.1A-D-=tO FUEL
FLUE SIZE RETURN OPENINGS INPUT ~O~ /)DV OUTPUT ~ D
TYPE OF SYSTEM
HEATING OR POWER PLANT
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
DWarm Air Plants
DGravity
,~eChanical
, .onditioning
Vent. System
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
Residential, Heating & AIC (New Construction)
Residential, Heating Only (New Construction)
Estimated Cost $
Building Permit #
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
30,.;1)
_ lrr-- - .50
-rv.UU
lice Use Only)
This Application Becomes Your Building Permit When Approved
Paid II ~
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Date (j_ J-L/- 3
Building Official
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447.4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
$39.50
$39.50
$39.50
Recl!t!t9/7
By 3-