HomeMy WebLinkAboutMechanical Permit #01-1378
HOUSE
51 ~,/ Av,.
~/J^--
DATE HTG. INST.
ADDRESS It O?r
OCCUPANT /J in J1.b.
HEAT LOSS_
SOLD BY. d/~ L
EI.ctrical Work By /4 J IJ
TYPE OF HEAT GA
FA:~ HW
j GAS DESIGN
MAKE RI&Jt A
Model -'LilA -C/&f //1/{L>
Serial E /1).0 ?D.2- I':::':~ 9171' I >cff~ /
INPUT....41 (j:?/Y
CONTROLS
THERMOSTAT .fI-v) Heat Plug -.t'
Valve~l
Limit Il k J
Limit Setting ~(YA" /J
Fan Setting ~.~~
Pilot Type .L/v-1'-:
Pilot Make #-/,/
Pilot Model
Pilot Timing J-:J- J;..-
L. W. Cut Off
---
Pre..ure -3 -1\
Input CFHJ 7- S'-
Stack Temp. ' J /7rilP
Form 235
Percent CO2 7
Percent 0 7 ~ ~--
Percent CO'" #
HEATING TEST RECORD
~S~
CITY
SUBURBfrldr ~,1~
STEAM
APT.
OWNER
INSTALLED BY s:;'~ I~J';:~'/;"
Gas Line By
SPACE HTR. .UNIT HTR. OTHER
FLOOR.
CONVERSION
MAKE OF BU."NER
. Mad.1
. Max. BTU Rating
. MAKE OF FURNACE
Model
I(
Vent Size _ .J
KIND OF LINER SIZF NONE~
, Draft Hood R.gulator
, Filters Slz. /~y /,~y ( Number /
, o.imney Location In,.de J/ Outside
, o.imney Construction ~t'/ L.
, Smoke Bo~ . / Wiring %
,Draft h~ Test Tag'j(
. Door Pr.ssur. Lighting Inst. _ )(
, Date T.sted _1J.-/-(J/ ,r--/
. Compony T~.ting ~~~k
. Name of T.ster 't:
ADDRESS
l~,} s
DATE TIME
SCijEDULEf> L..!/..J#O I 2.. / d 0
Jt, fW .Au<,
CITY OF PRIOR LAKE
INSPECTION NOTICE
OWNER
CONTR.
PHONE NO.
PERMIT NO.
() 1- /37rJ
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~ FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
(l.OMMENTS:
&J~
~I
Uud- ~.
/)
~ * ~/G- (tiJ
f q5'z,- ~L{7 - ~.l>~~
\.All ~ i, I~ ~
I (
o WORK SATISFACTORY. PROCEED
o CORRECT ACTION AND PROCEED
~ CORRECT WO~ALL 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 & SAFETYl
INSNOTl
CITY OF PRIOR LAKE
HEATING/AIR eONDITIONING/FIREPLACE PERMIT
Date Rec'd
12- /0 -0/
~: ~:n ~:~ PERMIT NO. o/-/r"'2rta
3. Yellow Applicant --J I ~
(Please type or print and sirot at bottom)
ADDRESS
/lPOqS ~T PfWL A'v6 ~6..
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION
OWNER
(Name) l) I AIV~ }JDe~
ZONING (office use)
PID zI5 - 004 - 028" I .
(Phone) 9S:2 - t.(c...fo -:2 'is 7
(Address)
SA--tvLlS
APPLICANT
(Name) S--ufJe-e(o<
(Address) (;/ /tJ.. (
~()~ I I2A-LTO ~s
(Contact Person)
t/~~ kLl~ 4
~ (Address)
&~y)
Oc'~
(Phone) f){,.~ -'o3?--EVq I
C!.-eVS77k- retJ SJC/.:22
(City) (Zip Code)
(Phone) '7~3 -zS-3? .... ~t{QI
DATE /~-7-{J1
:::]Ik
APPLICANT SIGNATURE
t./"
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION ~REPLACEMENT 0 AL TERA TIONS
FURNACE MAKE AND MODEL l2u-u-b U G If.AO G:, FUEL P A- T
FLUE SIZE RETURN OPENINGS INPUT (p@/f}GU OUTPUT ~, DQ'()
TYPE OF SYSTEM
HEATING OR POWER PLANT
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
DWarm Air Plants
o Gravity
~ Mechanical
rJAir Conditioning
DVent. 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
$ 3'1.50
$ .50
$ l.j. 0 ./ 0 0
,
(Office Use Only)
This APPIlJ;;Al~ Y our BUildin~ ~:~t ;:~ jPprOVed
Building Official Date
paid40. 0 0
Dat~
(,/10 -@I
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
$39.50
$39.50
$39.50
Receipt N21rJ q &;
BY!l