HomeMy WebLinkAboutMechanical Permit #00-0077
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HEATING APPLICATION / PERMIT
. ~'i 1"',,-, 0 Commercial
Date .7 ;',[ 'v<, . PID # 2-5-00\- 032-- .
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Site Address . \ r (~ n, ';'. . -J \ \ .. \, \ p:\~_;,. . \- _ ., -~ ". C.3 Fee Schedule
Lot BI?~k Additior:, ~bT~S AAl.D fiG U/"./L2,r; ,: \, Industrialc;ommer~U!ti-FamiIY
. \ . \ '.1'., ~ -1Yr"' f' ,.:';;',=-, "'~-....... \ ~~ 1 -, ""' (\r,~<; iJ.l !',\ \ Residential, Reatlng & AC
Owner s Name ~ '\ '.- ~ l"",, ! ,k ' ",' \ ,-,j~") i ',' \ \~ ..\, ,( I J . ,-" \ il J,', \ , '2\~\-) ) Residential, Healing Only
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- ,.\ ~ '''- ; Residential, Gas Fireplace
Residential, Additions & Alterations
Residential, AC Only
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Address
Heating Contractor
Address
"'J/L --::; 1..Jv<. is
-j CITY OF PRIOR LAKE MC
16200 Eagle Creek Av. S.E. Permit tic.
Prior Lake', MN 55372
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2. (1m:n
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City
Conlnel'"
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TYPE OF STRUCTURE
Single Family
Two-Family
Multi-Family
Olher
Industrial
Public
_OEPB.ln!RI F IMDOCR AIR OUALfTY. INt
2619 COON RAPIDS BOULEVARD
~OON RAFll)~. Ml't OOIt~,), ,,'\r'.
~,~/~. \ ,~
( 1 % of j~ ($39.50 minimum)
$mr.5t)
$64.50
$39,50
$39.50
$39.50
FEB I I 2JGG
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Remember to add the Slate Surcharge on the bottom of this application.
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Telephone #
Furnace Make & Model' }\\\\:~\\_\ r~.\\\)
Model Size
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The price of your hea~ermil includes one rough-in and one final inspection.
Additional inspe~ will be billed at $35.00 each.
~ouse ~e~g ~t Re~or ~ust b~ submitted with building IlliIIlil D.lJ.!I1.Q.e.r before build-
Ing cer rca~occupa y Will b~ .
H J ';J.L~tiS _~UI~ with number of supply and return openings listed per
r60m~h . M's~r"6penin~ew structures or additions send floor plan with supplJ'
~~~tur 1,10 lions\ show. EAT LOSS CALCULATIONS, PAYMENT AND
"'- \$,6UCA MA ILED TO THE CITY OF PRIOR LAKE, 16200 EAGLE
"J REEK . .E. PIKE, MN 55372.
\. \ ~ Cit~all uSines~r fa 8 a.m. - 4:30 p.m.
( -, . -j}J I'LL ~M~ BE INSPECTED (ROUGH-lN AND FINAL). CALL CITY HALL
\ J \. \\J < ~)' 447-4230
TYPE OF ,ORK \{ \,0'\",J \>> '-.. I hr,re y apply for a mechanical systems permit and I acknowledge that the
,/ . \ \ inf alion above is complete and accurate; that the work will be In conformance
Replacement '. Now Construction (the ordinances and codes of the city and with the state building/mechanical
3/ ~~ i C:.,"",> "\J~odes; that this form does not become a permit ~ntil signed by the BUILDING
, . Est. Comp. Date I I .1\ OFFICIAL; that the work will be in accordance With the approved plan in the
\\C L\ , CC:: Building Perm~ # () 0 ~ () 0 7'7 case of all work which requires review and approval of plans.
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TYPE OF SYSTEM
WarmAir~
Gravity
Mechanical
Air Conditioning
Vent. System
\,
Conn. Load
, .~.. \ ,
\ ' y' -
Fuel.', J'..\ ,.-.(\--- Flue Size
Supply Openings
Return Openings
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Input. _ ;'" .
Edr.
Cfm.
Alterations
Repair
Est. Cost $
it
Output
HEATING OR POWER PLANT
Steam
Hot Water
Radialion
Special Devices
Other Devices
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HEATING PERMIT FEE $ , ,: '\
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STATE SURCHARGE $ .50
TOTAL PERMIT FEES $ ~j .- \ ^-.....,~, 30732-
~ Receipt #
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~ ~~ Offical's Signature
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Date
2 - 2 L{ -2CrlJ
Date
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". .'~..I"J'''' <,,", -f" 'd .. 'lI "(' ,,,~\,,...~,I~" ~I"J"r'''''" ',' . '. '.......11. -.."Wj."'; ',;, ....".,..1:. . "l,j., I ,
1ft, Z Lf WlA~ A-ug;
HOUSE HEATING TEST; RECORD
AOORmf,.l(:)~ " ;.......S:-. t ~T. -'LOOR CITT --k...suau.I
OCCUPANT . 'lQO ..:. .-..'_-!WHfR
HEAT lOSS _DATE HTC. INST. -z..- ~-~ .
SOLD IT p"',tJ(,.rtl'i.I,.J~ ~~ J~~.14bl)HSTALLEO IT ~bh t'il~ "fL'r,
EI.cfricol w.,. "ST _~/"'A~!" ~z.,~ n-1" ,Goa. Lilt. By,' ~... ~~...- .A.I;:
TYPE OF HEA TGA FA:A;-HW STfAW SPACE HTR. UNIT HTR. OTHeR
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;,:.:. t ~ l;,A,S DESIGN
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horn y-~c:::> .....~
CONTROLS
THERMOS'!;A T~#""'l' ~_, PI
Voly. -l/oJ..... ~ ...
Lim" IJJ- !!)V:VS
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."'b!-e}oo III ,.pLL
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MAKE
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INPUT
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Limil 5.",n,
Fan Selfin, .
Pil., Typo
Pil., Mo...
Pilot Modol
P iI., Ti mint
L. W. C.., Off
5f1!Dy.,
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ItU:ll
1~'
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. P,...",. 1.. Porc.n, C01
1""", CFH~ s."./~P.,.c.n' 01
S",ck T.m,. ~ I~ () P.,cenr CO
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.MAKE OF BURNER
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MAKE OF FURH~CE.
Mod.'
CONVfRSION
V.n, Size
'5 /'
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. KINO OF LINER .SIZF
, 0,." Hoeel --1!"'H ~l/:.'t!d _ R.....I.,.,
Fill.,. Si..~~'l:'S ~........
o..;m_y L.co'ion ' 1...ieN ,tJ:::.flid.
o..imn.y Conlfrvcti.n ~ {A ~s:'
Spillage _1",-./
Sm.... B.mb '-' -" ,.-Witin.
Orolt ./ .T.., T.,
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0..,. T..,.., -Z... -4'. BO
CO"'....ny T..tin. P:;rAA~b'; :;jY/Jr/ VJ{)lIJ';",
N._ .f T ..,., , 1"'1- rA. ~ _
Certificate ofCompentency _ # AlL:q.fJ'W
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NONE
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CITY OF PRIOR LAKE
INSPECTION NOTICE
DATE TIME
SCHEOOLED ~162 a / n. '30...
fY'aJ n A Y'€ #- ant)
ADDRESS / {.., 'd;) x--
OWNER
PHONE NO.
CONTR.
PERMIT NO. (J{)- on 7 7
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING 0 WATER HOOKUP
o INSULATION 0 SEWER HOOKUP
o FINAL ~ '\&:.~UMBING FINAL
o SITE INSPECTION ~ECH FINAL
COMMENTS:
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
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)6 woRKsAnSFACTORy.PROCEED~ ~ ~ ~
/0" CORRECT ACTION AND PROCEED ~Yf..., .~ _____
o CORRECT WORK, gA:L FOR REINSPECTION BEFORE C~VERING
Inspector: ?f") I Owner/Contr: ~s, e 1)
, I
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!