HomeMy WebLinkAboutMechanical Permit #01-0137
CITY OF PRIOR LAKE MC
16200 Eagle..Creek Av. S.E. Permit No.
Prior Lake, MN 55372
HEATING APPLICATION I PERMIT
Date ~-~-~\ PID#--Z5-124--0
Site Address \ l-\ \ \ ~ ~~ \-tA.. \\ €. ~ ~. E .
Lot Block 1- Addition 60 U 01 tJS t1 A NO t2-
Owner's Name ~~ t fC-~ ~OQ.~\-\-
UV
Address ~Q\"\\C6 ~b ~\~
Heating Contractor M \.D..rl~ .~ V"' \ \ ~ , .
Address 'bd~ \ ~~ ~\, ~. ~'nCll.o~
Telephone # lq~~) ~~~- \C\tj2) .
Furnacelli~~~l i ~del .::~: l J/\ l.) 0 70 TYPE OF SYSTEM
Warm Air Plants
Model Size Gravity
Conn. Load
Fuel k I ~ +
M&Gha"ieal J (' fl.rr\p r
A........ .... . I..."" JI'l""~_~' ^ J#f"~ ,~t \
Air \,;onaruonln9{ ....,~ \ ~I-\.Uol.""""'\
~9Rt. SYEit8~ \ '2 ~ \ ~ ~<2C..~
HEATING OR POWER PLANT
Steam
Hot Water
Radiation
Special Devices
Flue Size
~ ..
Supply Openings .
Return Openings
Input 10 6ffl)
I -?, ,
Output Ie.). C U V
,
Edr.
Cfm.
Other Devices
TYPE OF WORK
Alterations
Replacement ~
New Construction
Repair. Est. Comp. Date
Est. Cost $ df1:r) t:P Building Permit #
HEATING PERMIT FEE $ 2:t1 ,~
01-0/37
STATE SURCHARGE $
TOTAL PERMIT FEES $
.50
L\D,c0
Receipt #
:J10h4-
TYPE OF STRUCTURE
1. Pink ,f .2 99
2. Green City
3. Yellow Contractor
Single Family
Commercial
K
Multi-Family
Other
Two-Family
Industrial
Public
Fee Schedule
Industrial, Commercial & Multi-Family
Residential, Heating & AC
Residential, Heating Only
Residential, Gas Fireplace
Residential, Additions & Alterations
Residential, AC Only
1 % of job cost ($39.50 minimum)
$99.50
$64.50
$39.50 --,
--.... J'\ "'" r -
_ $39.50 . ~ Fu t<)v;r~ ~
~ A{d/
Remember to add the State Surcharge on the bottom of this application.
The price of your heating permit includes one rough-in and one final inspection.
Additional inspections will be billed at $35.00 each.
House Heating Test Record must be submitted with building permit number before build-
ing certificate of occupancy will be issued.
HEAT CALCULATIONS REQUIRED. with number of supply and return openings listed per
room with CFM's per opening. New structures or additions send floor plan with supply
and return locations shown. HEAT LOSS CALCULATIONS, PAYMENT AND
APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 16200 EAGLE
CREEK AVE. S.E. PRIOR LAKE, MN 55372.
City Hall business hours are 8 a.m. - 4:30 p.m.
ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
447-9850
I hereby apply for a mechanical systems permit and I acknowledge that the
information above is complete and accurate; that the work will be in conformance
with the ordinances and codes of the city and with the state building/mechanical
codes; that this form does not become a permit until signed by the BUILDING
OFFICIAL; that the work will be in accordance with the approved plan in the
case of all work which requires review and approval of plans.
~ Vccx...-V ~.....L ~ :)-\ ~ ,(J \
~ APPI~J1Y1iJJ?)~ Date
3-5-0/
Buildinll Offical's Sianature Date
HOUSE HEATING TEST RECORD
AOOR ESS / L-LJJ:.3 ,/7~ ;,L~~' ('#c/d ..c
OCCUPANT _ /l&>5c7 C~~ -~7"""/
HEAT LOSS _ DATE HTG. lNST. .-'3--7-0/
SOLO BY ,/J1//?/J~2' 4'.:5"a::P
EI.Cfrical Work By /A-2
TYPE OF HEAT GA FA)( HW STEAM
GAS DESIGr-.:
MAKE
Mod.1
~///~/-
<r3.wAoC/ ?.c/ ... /A
-'3 /~O ~ ?/ 3..3.-r-
7a::> An
S.rio I
INPUT ..
CONTROLS
THERMOSTAT
Heof Plug
Valve
L i rr.i t
L i m i t 5.." i" <,)
Fan ~ttjng
Pilof Type
Pilot Make
Pilot Model _
Pilot Timing
L. W. Cut Off
Pre s sure
1,~
Percent CO2
Percent 0)
Percent CO
Input CFH
Stock Temp. 9~/
Form 23S
~. 1../
~
~
APT.. FLOOR
OWNE R ..
CI TY I?t::.. - _ SUBURB
INSTALLED BY
,4h/J/~fi .#//->~~~
Gos Lin. By
SPACE HTR.
UNIT HTR.
OTHER
CONVERSION
MAKE OF BURNER
Mod..1 _
MOJ(. B TU Rotin~
MAKE OF FURNACE _
Mode I
Vent SiH'
KIND OF LINER
SIIF
NONF
Droh Ho,~d
Filter I
Rogulotor
Si:xe
Number _
Ch imnoy Location
Chimney Construction
Insido _
Outside
Smoke 8o'mb
Dr oft
Wiring
Tost Tog
L ighf;ng Ins l.
Door Pr"~; sure
Dole Tesled..
Compony Tasting
Nam.. of Tesler
1-7.-0/ /
~~~>>/~/_~J/' ~.
_<C~~./
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDUL&D
? · 2. 2-. tJ I Z ~ 3 0
ADDRESS
/4/13 N~uG
OWNER
CONTR.
PHONE NO.
PERMIT NO.
J - tJlS /
I
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBINlG RI 0 EX/GRAD/FILLING
o MECH RI 0 COMPLAINT
o WATER HOOKUP 0 FIREPLACE RI
o SEWER HOOKUP f) 0 FIREPLACE FINAL
o PLUMBING FINAL(" ~ 0 GAS LINE AIR TST
o MECH FINAL , ~ I=U ~A1l.E.L
I ' It/~
COMMENTS:
-~-,: -~~:.~~~..----
II
-
~.~ ~~.
*ORK SATISFACTORY, PROCEED
. 0 CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPEC'TION BEFORE COVERING
~
I
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
Inspector:
OWnE~r/Contr:
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl