HomeMy WebLinkAboutHeating Permit 15-0147 DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE SCHEDULED 2 j 24i
ADDRESS 3 5-3 /Arl A c I-f- lvic
OWNER CONTR.
PHONE NO. PERMIT NO. /S , i 11
❑ FOOTING 0 PLUMBING RI 0 EX/GRAD/FILLING
❑ FOUNDATION 0 MECH RI 0 COMPLAINT
❑ FRAMING 0 WATER HOOKUP 0 FIREPLACE RI
❑ INSULATION 0 SEWER HOOKUP 0 FIREPLACE FINAL
❑ FINAL 0 PLUMBING FINAL 0 GASLINE AIR TST
❑ SITE INSPECTION ECH FINAL 0
COMMENTS:
Fida/ORK SATISFACTORY,PROCEED
❑ CORRECT ACTION AND PROCEED
❑ CORRECT WORK,CALL FOR REINSPECTION BEFORE COVERING
Inspector:id/A., Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH&SAFETY!
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4 rnjo CITY OF PRIOR LAKE 6� 54-SDDate Rec'd
': ', `k, t HEATING/AIR CONDITIONING/FIREPLACE PERMIT
,y fµ.3y�F1 ''
•V
I.Pink File PERMIT� NO. /�
��NNESD�r 2.Green City
3.Yellow Applicant
7
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
96 3
Tthivuic
C),v N w
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER -
(Name) ,�l0 TUAN1 0 (Phone)
(Address) *53 `--R iyA vu l)1 c 0k lr NI V\I
APPLICANT
(Name) , � t P-
.f I viva__ -ti k (Phone) (31(312,-6 C i-CI nil)
140 J (/1, tat* V�-- JI :Q.(,I; n IM�•1 S, 12..-0
(Contact Person) d \,L, 1 (Ank (Phone) q5 - c 1 -01 orb
APPLICANT SIGNATURE /, ., ,. i lAi't
DATE 2 11 s
1 •
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION REPLACEMENT ❑ALTERATIONS
FURNACE MAKE AND MODEL LtYU'L ty S LP Di -�-I 1 D X V1,0 C FUEL
FLUE SIZE RETURN OPENINGS INPUT I D i LAA) itill&OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE:Air Conditioner
/EWarm Air Plants Ell Steam Units and Fireplaces Cannot Encroach
Gravity ❑Hot Water into Required Side Yard Setbacks.
❑Mechanical ❑Radiation Fireplaces with Box Additions or
DAir Conditioning ❑Special Devices Cantilevers to the Outside of Buildings
ill Vent. System ❑Other Devices Require a Building Permit.
FIREPLACE MAKE AND MODEL
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 $49.50
Residential,Heating Only(New Construction) $64.50 Residential,AC Only $49.50
Cost$ Building Permitil
IEATING PERMIT FEE $ 49 . 5 D
STATE SURCHARGE $ 5.00
TOTAL PERMIT FEE $ 5'-1--. 50
This Application Becomes Your Building Permit When Approved Paid 5-4., 50 Receipt o. 6777
Building Official Date Date l8 ,l By •
24 hour notice for all inspections (952) 447-9850
4646 Dakota Street S.E., Prior Lake,Minnesota 55372
1;247
SEDGWICK HEATING & AIR CONDITIONING CO. HEATING
JOBNO.4 f
1408 NORTHLAND DRIVE,SUITE 310 • MENDOTA HEIGHTS,MN 55120 • (952)881-9000 TEST RECORD
ADDRESS
�4 (71441/ &a , /VW 124CITY ' r / \l0
OCCUPANT .4tAiliagr
OWNER �il
4 SOLD BY > INSTALLED BY
MAKE /1, 10t6C4C- MODEL 5Z1P4 VL/0/0/NeV
SERIAL NO. -97/10/4 G./3 3< Meet9`.' INPUT
sx
VENT SIZE
THERMOSTATS*tL1� 1t( AV/ 1 •"(
VALVE /-62,--17
4,-re---1/
1/ TYPE OF LINER �1
11.
LIMIT - ' " LINER SIZE /
( D-304F /�(/ y2c ) UMBER ..
LIMIT SETTING f/ FILTERS: SIZE r-�
FAN SETTING . WIRING /-. 3
PILOT TYPE C TEST TAG '-...../"'
�//_
IGNITION MODEL N� LIGHTING INST 4✓ "
PILOT TIMING /4 z/2_ I l S
n DATE TESTED
PRESSURE 5^ PERCENT CO2 /- !/ 5...,.. .,4..„,. .'
q� 3 COMPANY TESTING
INPUT CFH I(/�( PERCENT 02
` //
STACK TEMP. /v ` PERCENT CO . a n NAME OF TESTER
FORM 235(REV.10/10) FORM DISTRIBUTION: WHITE COPY-JOB FILE YELLOW COPY-CITY
11