HomeMy WebLinkAboutMech Permit 05-0081
CITY OF PRIOR LAKE
HEA TING/ AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
/.2..7. oS
~ase type or print and sign at bottom)
rlDDRESS
52)L\S (~o 4 fUJ. I Ir:rt S1
1. Pink File PERMIT NO
2. Green City '05. 00 8/
J. Yellow Applicant
ZONING (office use)
NS
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID z..S. 239. o1-S: 0
OWNER\V~j .. , .~ r<V">'.' I
(Name) ~Q _ ~ '\ Xl
(AddreSS)~..g (~lUJ~ s+ N. '2.-
~:;~~Ati J : nl)( i.LU~ _ ~'t -:::;s f lJ/-C..<PhOne) ,~~i (/ ~0W5 >
(Address)lClLtKJ Rh,)c/v 0lUJvtd i311f S: <SiL.1Jc1{f <.~316
(Address) (City) (Zip Code)
(Contact Person) Ulm; J ~ . (Phone)
APPLICANT SIGNATURE fSU1LJ:-, f3JJ.~.(}/7r:l~~-; DATE /-~-O~)
(PhoneP~-2-Ul~S--' ?::/:l3
APPLICANT PLEASE COMPLETE BELOW
DNEW COZ;;~~~~N JXJ REPLACEMENT 0 AL TERA nONS
FURNACE MAKE AND MODEL 'ry 6- &(J(j /ff/.3{o/:"] rJ'7C.-'J FUEL LYi 190 ~ ./
FLUE SIZE RETURN OPENINGS INPUT -7<-1 (X}() OUTPUT ~. (XX)
TYPE OF SYSTEM HEATING OR POWER PLANT
DWarm Air Plants
DGravity
o Mechanical
~Air Conditioning
:JYent. System
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
FIREPLACE MAKE AND MODEL
Industrial, Commercial & Multi-Family
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64.50 ReiSidential, At Only
$39.50
Residential, Heating & AlC (New Construction)
Residential, Heating Only (New Construction)
$39.50
$39.50
Estimated Cost $ Lj 3 (X) , (X) Building Permit # 05, 00 e I
REA TING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$ ~-iCI, 50
$ .50
$ 4(9. or)
(Office Use Only)
"his Application Becomes Your Building Permit When Approved
Building Official
Date
Paid c)
1-tJ. (J
Date 7 () -
/, z." ~
Receipt No. +1'fl1
BY~
/
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372
,.!}~s- TIME
~S<;lS- a~~:oj sr(
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
OWNER
CONTR,
PHONE NO.
PERMIT NO,
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
~CH FINAL
os-- ?/
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
COM~TS:/ i. ~ uf!. /'
~ ~/qced ~r.n4-c.e ~ /7;7C-
, ~ / - / /
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~ORKSATISF~
a ~ORRECT ACTION AND PROCEED
o CORRECT WOR~. ~:; ~INSPECTION BEFORE COVERING
Inspector: ~ ~/ Owner/Contr:
.~/ -,,~
r/ ( e.. ./
-----
,CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &I SAFETY!
IIiSNOTI
BIJKN~~ILLE
Heating & Air Conditioning, L.L.C.
12481 Rhode lslilnd Ave S, Savage, MN 55378 · 952-894-0005
Ors1at Test Report for Jobl 76.3 <.)
Address S~7Is c pJvf~~ $--"
Occupant p 6 q '1 f( 0(;. c J-...
Date of 1051311 / - ~ ~ -05
Type of HT. F/A V HW Space HT
Other /
City Pr ~ d"" L c, ~.
Unit HT
Make
Model
Serial
Input
f (>" ri);/
6 bou /Iv -"3 bA --i)/O' 0 S
c: CI oC:'A () --; 9'i~ '/
-- 7 ~.'00 .
Pilot Type HOT SURFACE IGNITOR
Pressure ~, ~ C02
Input CFH ? of. ~ 02
Stack Temp '1 31 0 CO
I - ;2 (f, - ex::::
fo,~
9)
laJ?rP r-"'
Date Tested
Company _
Technician
BURNSVILLE HEATING & AIR CONDITIONING
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