HomeMy WebLinkAboutMechanical Permit #03-0782
09/26/02 TBlT 15:52 FAX 6124474245
CITY OF PRIOR LAKE
~003
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONINGJ~IKEPLACE PERMIl'
REQUEST FOR FINAL
INSPECTION SENT TO
HOMEOWNER 8/03
(Please type or 1Xh1t ~ Sian at boIloml
ADDRESS
(47...:~l? ~r?tZ.~ lANG
(Contact Person) ~ () W ~"'f-zet,.
APPLICANT SIGNATURE ~..J
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION ~PLAC~MBNT 0 AL I't.M TIONS
FURNACE MAKE AND MODEL G,t}{L({.,1 e'Yl- c;;0M\I P 060 FUEL WIH . 6A ~
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
~arm Air Plants 0 Steam
C Ore.vity 0 Hot Water
~echanica1 . i1 Radiation
Air Conditioning REQUEST FOR FIN A
Vent. Syscem INSPECTION L
FIREPLACE MAKE AND MODEL ~ HOMEOWNESENT TO
R 11/03
-0
. ~..G/
- .
LEGAL DESCRlr uON (office use only) ')
LOT / t(BLOCK 3ADDITION~i
OWNER
(Name)
~
yf) (}1/p;(L
.
(Address)
PAV\D
t Lt-z...~
~~C;
SH ~ ~f'Jfi
APPUCANT
(Name) MAX
(Address) 1) I
M~N/~
~,H ~T~( ~
(Address)
Industrial. Commercial It Multi-Family 1 % Of JOO CO-"
$39.50 minimum
Residential. HcatiDl &. Ale (Now Construetlon) $99.50
Residentialt Hcatina Only (New Construction) $64.50
Estimated Cost $ ? '7 t; -; .0 ()
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
(omet Use Only)
This AppliC8tion Becomes' Your Building Permit When Approved
Building orndl'
nate
14 hour notice for aU inspeetlon. (952) 441-9850, r.~ (952) 447-4245
Date Rec'd
rtnk rU,
er- City
ytllow AIOlloant
PE~l~~ NO. () '3 -1f~1.,
ZONINO (omce UM)
(JILl]
J-/7X
PIDq5"- ~/'i" 01(0 ,'-d
(phone) Cft;z,- ""'t:th - (Ll' / ,
(Phone) fJ;;J -t, ~I? -77.;2, '-
"'~ /?rl.J6(-f'7r:;,v ~117.-
(Cil.y) (Zip Code)
(Phone)
DATE
t:,11I{n.,
PLEASE NOTE:
Air Conditioner Units
Cannot Bnerolch into
Required Side Yard
. Setbacks
place
$39.50
Residential, Additions & Alterations
Residential. AC Only
$39.50
$39.~0
Building Pennit #
$
$
S
5et · "=' 1/
.50
'to · 00
paiYi Llo I /"
Datek_/~, 3
R~t)PlJ~ (fU
8017/
()
,t,7r; 4CJ,w
ADDRESS I 1../1,. 'Z- ~ ., J...., C' (..,;' 1 u. v-..~ A)r APT.
OCCUPANT (~~,,:'V\..~ y.....-f"::,," '
HEAT LOSS f'i ! .,.'\ .....;.\ "',--Q.,:,",~::(:'C DATE HTG. INST. t::..,. 7(",
SOLD BY -'(Y1~., .. \ ~ ('t ~". 0
~~~t~Fa~::;k B -~A~' . r:: -\ LA....(. '- ';:-w STEAM
J - /,'(.' .
I GAS DESIGN
MAKE /' ~!{ \;'~ loA
Model . 5 ~l) (n \/pd) (::It) \ i./
Serial }~ 4/Y0 ~ ,
INPUT II' /.;. C' C" I .-. .\..,..'
THERMOSTAT
Valve~c
Limit i.,
Limit Setting
Fan Setting
Pilot Type
Pilot Make
Pilot Model
f Pilot Timing
L.w. Cut Off
~C) Ct~>C? /l ; ....., t~
CON'ftOLS
_Heat Plug
("'+4L ~ .......)
.,. .,.- - ...
e.-.i--'
/ 2.~ c'
0'0
(I t....r
I' !'~'
/
I
,
l
\ ..-,..;... l-l
I' Pressure ?, ~. l~; C , Ai~. ' . 'percent C02 C)', (q~
Input CFH c,C r'ty--:> ,Percent 02 / C' ,:;
Stack Temp. / I r; ,c-, . 'percent CO J r ff Vf'
Form 235 ICP9609098
ORSAT TEST RECORD
FLOOR CITY~ ;-,,\ L r- SUBURB
OWNER Uf' \f..,::, ('\\..-.rt_.1tV,kf_~.'
0~
INSTALLED BY ft (1 y'" \ \', ~(C l C\ lA : (' ,\, (
Gas Line By
,SPACE HTR,
UNIT HTR.
OTHER
CONVERSION
MAKE OF BURNER
Model
Max, BTU Rating,
Make of Furnace
Model
Vent Size ? Vc.- ?' I
KIND OF LINER ' (i }.C,Y
Draft Hood
Filters Size /1 ,:'..."'""Z Qy' ( Number
Chimney Loc~tion Inside X
Chimney Construction ? l/...J! -""-- 4-
Smoke Bomb .Wiring . /
",,/ /'
Draft ./ Test Taa ../'
Door Pressure /' _Lightin~ Ins~
/
Date Tested S ..- 79. o~ _
Company Testing try,\!..). 'v X".( c L....c: \^ ~ rc::
Name atTester ~\_'~. ~_~ ( ~r-- ",-...Q...~
-t' 1 ,
-l Q ;J
SIZE 1../ t I t.J I ~ONE
Regulator :: -, C fr'V; ,/. -h- r~ ,
- /' r-C'
Outside
'.
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
b1:lC~3 ~\~Q
ADDRESS t4z..U-- ~.~
CONTR. /' ~
PERMITNO( 3 -?gz..\ 783
o PLUMBING RI "- 0 ~DIFILUNG
o MECH RI 0 COMPLAINT
o WATER HOOKUP 0 FIREPLACE RI
o SEWER HOOKUP 0 FIREPLACE FINAL
~ PLUMBING FINAL 0 GASLINE AIR TST
pt MECH FINAL 0
hw~ ~W~~-tAL
J ~ ~A&e_ vVv.JLe...-vp ~V- Iv\. lJ~
SCHEDULED
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
o !tPRK SATISFACTORY, PROCEED
\B'CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~
Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl