HomeMy WebLinkAboutMechanical Permit #08-0380 � a� �
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Monday, September 16, 2013 ���, �
Current Resident �5�'' a �
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Prior Lake, Minnesota 55372 �U� t
Re: Building Permit Number �� . We request your help
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� In review of the building permit files, it was discovered there is an open permit for
x x. a�the above address. Please call by Monday, September 30, 2013 to set
up an inspection. If there has been no contact from you by this date, the City will
deem the permit abandoned and invalid. (per State Building Code R105.3.2). This
permit abandonment will be recorded in the permanent public record for this
address.
Any new work relative to this type building permit will require a new permit along
with new permit fees.
Please call the Building Department at 952-447-9850 to schedule your inspection
date. �
Thank you for your cooperation,
Sincerely,
Building and Inspections Department
City of Prior Lake
SEDGWICK HEATING & AIR CONDITIONING CO HEATING �ag NQ
8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 •(952) 881-9000 TEST RECORD
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ADDRESS �' � � � ` ` � CITY v � �� � `
OCCUPANT 6 � ` l OWNER � �� �
i ��'Z/
SOLD BY � �� INSTALLED BY � �
MAKE � � � ` � MODEL � I _ ` " � � � V
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SERIAL NO. � � � � ` Z �( INPUT
THERMOSTAT � � VENT SIZE � '
VALVE d� 2 � � M NPE OF LINER �V �
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UMIT `x"" � �� LINER SIZE �
LIMIT SETTING �� FILTERS: SIZE 4 NUMBER
FAN SETTING � � � �' WIRING � � " `� �
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PILOT TYPE � f' L TEST TAG
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IGNITION MODEL _� � l LIGHTING INST. �—
PILOT TIMING ` / � � � � O �
DATE TESTED
PRESSURE �/ PERCENT CO � � � � � C✓�
INPUT CFH � PERCENT 0 � COMPANY TESTING
STACK TEMP. PERCENT�CO —+� NAME OF TESTER �
FORM 235 (REV. itl89) � FORM DISTRIBUTION: WHITE COPY • JOB FILE YEILOW COPY • CITY
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�� � CITY OF PRIOR LAKE Date Rec'd
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HEATING/AIR CONDITIONING/FIREPLACE PERMIT
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j�'NES��� 1. Pi� File pERMIT NO. Q� D3�
2. Green City
3. Yellow Applicant
ease or ' t and si at bottom
ADDRESS ZONING (o�t use)
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LEGAL DESCRIPTION (oflE'ice use only)
LOT BLOCK ADDITION PID
OWNER '
(Name) (Phone) ��1 ��'" �l ��
(Address)
APPLICANT
(Name) SF��y�r;�� �r� ��, �� (Phone)
1
�,,�,. ���;,.�,-.._�� '::1'ii� �+.�!$.
(Address) -. �
' ` ' d .4ctdress) r °', . : `. J �`Y (City) (Zip Code)
�;:;2) ��t1-•9000
(Contact Person) (Phone)
APPLICANT SIGNA � DATE 6J��
APPLICANT PLEASE COMPLETE BELOW
❑NEW CON UCTION PLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL �oL�CO D FUEL
FLUE SIZE RETURN OPENINGS INPUT '� O UT
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TYPE OF SYSTEM � HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
❑Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
❑G�avity ❑ Hot Water into Required Side Yard Setbacks.
�qechanical ❑ Radiation
❑Air Conditioning ❑ Special Devices Fireplaces with Bog Additions or
❑Vent. System ❑ Other Devices Cantilevers to the Outside of Buildings
FI� /�, Require a Building Permit.
KE AND MODEL I� (/ ��
FEE SCHEDULE
Industrial, Commercial & Multi-Family 1% of job cost Residential, Gas Fireplace $49.50
$49.50 minimum
Residential, Heating & A/C (New Construction) $149.50 Residential, Additions & Alterations $49
Residential, Heating Oniy (New Construction) $64.50 Residential, AC Only 50
Estimated Cost $ Building Permit #
HEATING PERMIT FEE $----- ��.� v
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ , �ty .�}
ffice Use Only)
his Application Becomes Your Building Permit When Approved Paid� � Rece� t o. �� U � �/
Y
Date� � � �� Q By
Buildine Official Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
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