HomeMy WebLinkAboutMechanical Permit #01-0006
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Date
CITY OF PRIOR LAKE MC
16200 Eagle Creek Av. S.E. Permit No.
Prior Lake, MN 55372
HEATING APPLICATION I PERMIT
.
PID# 25-/Zd> - 01-3 - 0
'USS C:.L~"""DAL"=- AvE;,. s...(.,
Site Address
Lot
. Block
Addition
Owner's Name .S \-\ A (t...o N ~rt... QS~ \ ~
Address \ ~,f:J S (::> L.. ~ N D ~ LC:;. A vr:: S ~
Heating Contractor~c::...." 'C ~~'\\. '"" \- \-\~~ "' .... ~ ~ A" ~
Su,,~ f\
Address
~ .. tot,S'-
~YO . 89A5
ST
l ~ \5
Telephone #
Furnace Make & Model CA.~... ~ <<...
M d I S. ".5 ~ \..) ~" 8 0 .. 1 ~
o e Ize ~ C:> -r 6
TYPE OF SYSTEM
Warm Air Plants
Gravity
Mechanical X
Air Conditioning
Vent. System
HEATING OR POWER PLANT
Steam
Hot Water
Radiation
Special Devices
Conn. Load
Fuel ~ ~T . L f\SFlue Size
Supply Openings
Return Openings
Input 8011 (/'.:'0 Output J c...., . 0 0 u
Edr.
Cfm.
Other Devices
TYPE OF WORK
A~erations
<
New Construction
Replacement
Repair Est. Comp. Date
Est. Cost $ '1 0 y ().' C?" Building Permit # 0/ - 0 0 O(P
HEATING PERMIT FEE $ ,""') ~ . S 0
STATE SURCHARGE $ .50
TOTALPERMITFEES $ Y () .60 Receipt # 32;6~7
TYPE OF STRUCTURE
1. Pink ' File
2. Green ' City
3. Yellow ' Contractor
Single Family
Commercial
'<
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 PLEASE NOTE:
$39.50 Air Conditioner Units Cannot
$39.50 Encroach Into Required Side-
$39.50 Yard Setback.
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 buildinq 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 ttte work will brein ccordance with the approved plan in the
case of all work ~hich requirt; r ew and approval of plans.
~ ~ {L _ I z.. - J ~ - 00
re Dme
(- B. 0 I
Date
CITY OF PRIOR LAKE
ltU~PECTlOtl NOTICE
SCHEDULED
DATE TIME
2/e% (
;
10,' ~t:J
A.DDRESS
/Lf755
G~~,
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING 0 WATER HOOKUP
o INSULATION I@ 0 SEWER HOOKUP
lZl FINAL 0 PLUMBING FINAL
o SITE INSPECTIO flt MECH FINAL
COMMENTS:
Or- OOc::>>~
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
...'.........;
~)l
,.J(JwORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~ (
I
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
Owner/Contr:
INSNOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
~~. .....~~.......'7"~~_~,~....'''''.'''''''~'''. _::.'._":",,.r..~lf1l'. ,:,'~'f:~,?<;".,~~ .' '~::"'t:,;~,",%..r,';~~r.'!~r'~T~~'. ~,.'''!''~ It. :';:"""".'~_~
MAKE
Model
Serial
INPUT
C... i GAS. DESIGN
t;;tiH iI ~O'
- L..I 4 DO I}Jt'5 3 q?
~,/ tT1N)
I "eCOHTROLS_ .
tiiERMOSTA T-.W .... He~tPi'~;
.VtJlve'. t-.1 I 1.-/ ~,.
Limit J...I/ t.Y'
Limit Setting _ " -; 0
Fan Setting " ()
Pilot Type f> I If-t,,:--,
Pi lot Malee IVI/t.
Pilot Model fT ''? I l>:C V I h
7 S-~~
r
I,
Pilot Timing
L. W. Cut Off ,
A "
"3,J
<to
/15
Pressure
Input CFH
Stack Temp.
Form 235
f~
~'~.;~'.~\.,C02 .
. Pere.."t O2
. Pereer\t CO
, \
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,<.~:: ~ .,>.....':."1D~.:;~.~'~ ,~.-,',;-"~~;',.' ., . .~~>"..';......;.,.:'i-. ';,'''''i'
RECORD
Pt<' ~ r
.CITY LA:/J. +'.SUBURB
'r?~
\.... ~.,
~. ~
"< /':-' HOUSE HEATING TI=ST
ADDRESS 14 7 5'5...: -. It.' .1.1 I.-7t1 ~ /~, ;Jt'::'~.:{;~~;J.'..'.~,:,
OCCUPANT PI I s J", /l ,,~,",I., "t1Wfiil!:~'
HEAT LOSS tJ/J/!l.t'tl .~TE HTG. INST. () ~ I ~ - 0 "
SOLD BY 1"1 ,~~. _. ,.!U;~
/ . ."';; ~ . . /.
Electrical Work By . 1/J'{~
TYPE OF HEAT GA . FA . Y _HW
FLOOR.
STEAM
INSTALLED BY
Gos Line By
SPACE HTR. _
I
.II! . ,.
.~ ~ /L-h('1' .
~ ~ .
UNIT HTR. .OTMER ! .
I \~
CONVERSIO~
Vent Size .1
KIND OF LfNER B - I/'.....tt ...;to> ~IZE~ N
Draft Hood . RegulaTor _
Fi Iten Size ~ 0 ~;- .;y I .Number
Chimney Location Inside V O~tside .
Chimney Construction
MAKE OF BURNER _
~ Model
. Max. BTURating
, /
. MAKE OF FURNACE
Model
:A:~'---" ---. ~>
Smoke Bomb. .
Draft
Door Pressure
t i'o
-? 4jti
'D
Date Tested.
Company Testing.
Name of Tester
, .,
\
.... ~
." '"
r
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f"
NONF
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4--... .-"
x: Wiring
)( Test Tag
)< Lighting Inst.
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