HomeMy WebLinkAboutMechanical Permit 04-0272
of
_ .!!!J
LII idF PRIOR LAKE
I1~AIING/AIR CONDIIIONlNGIFIREPLALE PERMII
Date Reetd
.~~ ~Jf . or print and sip at bottom)
ADDRBSS
Jt, I If- tlJ.tIUw ,8f' A e4.iJ
~~:L
~~
l. PiftIt File PEn...~ NO ,.,
~: =- ~icant ~Tll. M- ~/)~
ZONING (ofIke use)
J<ISD
LEGAL DESCR.I.r llON (oflice use ou1y) ... J
LOT BLOC~~ ADDITION I / J~ c9 /..I
g;~:~:K Ihu J) /rJ I; n
(Address) ~L
(phone)
PIDcX 6-/ lfi- 60& 1.?
~- '-IL/1- /L/Id;
APPLICANT
(Name)
f.';l:Dc~'~'~qf'l: ~:"~ 'T"~)'.l.r,:, ~O~,!f":~.,. '. .. l(Ehone) ~J- U /-'1~tJtJ
89iO ~Ventworth Ave. So.
(A'U-'-"~18apalis. MN 56420
UUldS (952) 881-9000
(Contact Person) _ / (Phone)
~PLICANT SIGNA'TI1Rlf-1' ~ 8 ~i:ti~ DATE 1/--1" 1!!z/
APPLICANT PL~S~ COMPLETE BELOW
- DNEW CO!~CTION efREPLACEMENT D ALlhKATIONS
FURNACEMAKEANDMODEL'-l~ ..!:(thl/l1{)V '~1bG,"''''7t) FUEL 'fj&h
FLUE SIZE RETURN OPENINGS INPUT ~() OUfPUT ~~
n.t'h OF SYSTEM HEATING OR POWER PLANT
~aim Air Plants 0 Steam
o Gravity 0 Hot Water
l2J1v1echanical 0 Radiation
C2f7\ir Conditioning 0 Special Devices
LJ.iA DVent. System 0 Other Devices
~CEMAKEANDMODEL~ /.1/kLlJJ..t{'
(Address)
(City)
(Zip Code)
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
. Required Side Yard
Setbacks
~l-hJ
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
$39.50
4J9.5~
$39.50
Residential, Heating & AlC (New Construction)
Residential, Heating Only (New Construction)
Estimated Cost $ t:, 7~ -
Building Permit #
~
lice Use Only)
This Application Becomes Your Building Permit When Approved
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PEAAll. FEE
$
$
$
J4.---0
.50
~ .t!J~
Building Official
Date
Paid L(t;................-
Date L/ ~ 16'-4
Recei~: .~'lf lo "
By C
~
J ,
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372
. DATE nMe
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED 5" ... Ll.::a....'(
ADDRESS ~. '_J.'I kz>~
OWNER CONTR.
PHONE NO.
PERMIT NO.
j - ;lrrJ_
o FOOTING
o FOUNDA rlON
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
XMECH FINAL
o EXIGRADIFILLING
IJ COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASlINE AIR TST
o
COMMENTS:
~~
)(WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORR7!lEO . CALL FOR REINSPECTION BEFORE COVERING
Inspector Owner/Contr:
CAl 44",9 0 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
~UlREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
L.l,j l..j.
SEDGWICK HEATING & AIR CONDITIONING CO. HEATING JOBN;;?~ 613
8910 WENTWORTH AVENUE SOUTH · MINNEAPOLIS, MN 55420 · (952) 891-9000 TEST RECORD , "(j 'J--.
ADDRESS 3'tl( W.l( OLV 0..eA~ - (r- CITY. Jf"l (J Y' ~Pr~c:..< 0 '-',"- (}
OCCUPANT :\~ OWNER ')01'- Y \J left 0.0
SOlD BY S' e.c\ ~ w, c/r;e INSTAllED BY ~~ --S;"'" ~
MAKI= ~ 0\-.:> I\J Cf 'ftC.
SERIAL NO. 59 D Ll e ~31 ~I
THER~OSTAT g 363 /1
VALVF? }~J
", 1'/
UMIT ~~_
V' 0"
UMITSETTING~ -3QC>~
FAN SETTING +tih\~
Vl v---(
IGNITION MODEL - //S {
PILOT TIMING ~ 3Qr .Qr1\..J,..]
'< C"i' ~ t\
PRESSURF -..:>..,0 ..., PERCENT CO2
INPUT CFH ., iJ PERCENT O2,
STACK TEMP. I do ~ F PERCENT CO
PILOT TYPF?
FORM 235 (REV. 11189)
MODEL. G b{ fV\-pV Sb~ 0'70
INPUT ltJ oCJO
(')'.
VENT SIZE. 01
TYPE OF LINER ) \I L..
UNER SI]I= ;;J' ·
FILTERS: SIZE ~
NUMBER
WIRING,..-
TEST TAG
---
LIGHTING INST
~~
to ~
{J~
DATE TESTED.
COMPANY TESTING
\~
NAME OF TESTER
sOOF
YELLOW COPY - CITY