HomeMy WebLinkAboutMech Permit 05-0102
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONINGIFIREPLACE PERMIT
Date Rec'd
2,4-, oS'"
I. Pink
2. Green
3. Yellow
~:;y I PERMIT NO. OS: 0/02-
Apphcant .
lJ:'lease type or print and siRD. at bottom)
ADDRESS
/5~a .8hUj# a;/lf .fJMd .s~
LEGAL DESCRIPTION (office use only)
ZONING (office use)
toASt:)
LOT 3 BLOCK4-" ADDITION G~~ .rflon.61
PIDZ-J": dtf/. dZ,+, ()
OWNER
(Name)
(~' tk~
'S441u
(Phonefl~- 'Il/7- //~ 7
(Address)
SEDGWICK HEATING & AIR CONDITIONING Wi
Aa1n Wentworth Ave. So.
Minneapolis. MN 55420
(Address) (Addresf52) 881-9000
(Contact Person) II (Phone)
APPLlCANTSIGNATURE~ Sr:;/;..I1!:it~, DATE //li/~
- c:..- #/lPl- "
APPLICANT PLE SJ: COMPLETE BELOW
DNEWCON~TRU TION ~pPLACEMENT o ALTERATIONS
FURNACE MAKE AND MODEL ~ ~bD ItJI-Ji2/J.../PCjt) FUEL 4k
FLUE SIZE to t( RETU OPENINGS INPUT ~tJ~ OU~UT 1J, M])
TYPE OF SYSTEM HEATING OR POWER PLANT
~arm Air Plants 0 Steam
OGravity 0 Hot Water
0'Mechanical 0 Radiation
g,(ir Conditioning 0 Special Devices
IhR..lb1ld OVent. System ~ 0 Other Devices
f'lREpLACEMAKEANDMODEL~ IJ !ftCIJJt; J'l-l-m
APPLICANT
(Name)
(Phone)
(City)
(Zip Code)
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$39.50 minimum
Residential, Heating & AlC (New Construction) $99.50
Residential, Heating Only (New Construction) $64.50
Estimated Cost $ 5. ?OtJ ,..
$39.50
Industrial, Commercial & Multi-Family
Residential, Additions & Alterations
Residential, AC Only
$39.50
$39.50
Building Permit #
OJ" 010 "Z-
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
~4.S~
,/}. .50
"'--10 .(J~
'Office Use Only)
Building Official
Date
Paid .f().OO
Date Z. 7. ()Q--
Receipt N~13
Byf/ilfR
/
This Application Becomes Your Building Permit When Approved
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372
fl4/t'~ {Nlt
).,0.5-10",;
CtJ..4> ( d.
G&o LA U ~ ~ rJ 0 'lD
~/'DO
/1/
VENT SI71= 0/
{ /"> \ .J
TYPE OF LINER _ ,> 'U e~
-It'
LINER SI71= I
'-'
r' ll'" -.J
FILTERS: SI71= ........ L./ c
WIRING '~\o...... I 0 ~..
SEDGWICK HEATING & AIR CONDITIONING CO.
8910 WENTWORTH AVENUE SOUTH. MINNEAPOLIS, MN 55420 . (952) 881-9000
ADDRESS
(')5 5~ ~.lO P! ~l 5(
~l.trf,,J
G~-n La
INSTALLED BY
CITY
OCCUPANT
_ OWNER.
SOLD BY
MAKF k)..) to! D K
SERIAL NO ~6JO <-i ~ b''10y () ~
THERMOSTY ?5 .~&3
VALVE \-. W.
LIMIT c.; '1...J2 cl
LIMIT SETTING _llO
FAN SETTING:) '1 \I\.A -e ~
PILOTTYPF \ ~. S t
IGNITION MODFI e l e. ,-4 .f Dv0U
PILOT TIMING .'j V\. ~f .-'/J
/7 / ~ If ('J c.7'/
PRESSURE' J. ~ l..- PERCENT CO2 _7) /"
0/ - -
INPUT CFH r) g PERCENT O2 t, ~
-7 L ) C1--;.
STACK TEMP. ../ .7 '-' PERCENT CO ....D /?'
FORM 235 (REV. 11/89)
MODEL.
INPUT
TEST TAG
-----
LIGHTING INST
HEATING
TEST RECORD
JOB NO. S-) Co 2
v
0,0
OS'
_ NUMBER
-
? -- [- 0 'J
DATE TESTEf'l -;;f
COMPANYTESTINGS....) {;?~) __ '.;J /. c Ie .. ) . .
~ -"P It-_J
NAMEOFTESTER j'-'.> J / -> --C b- c';' c/
FOR~~~~TION: WHITE COPY. JOB FILE
YELLOW COpy, CITY
ADDRESS
DATE TIME
uF PRIOR LAKE '7 #d~ _
,nlSPECTlON NOTICE SCHEDULED ~S ~
/S-~?() ;j;et:'cV ff)(f
. CONTR.;r
o ,S- ~ /0...2-
PERMIT NO.
OWNER
PHONE NO.
o FOOTING 0 PLUMBING RI 0 EXlGRADIFILLlNG
o FOUNDATION 0 MECH RI 0 COMPLAINT
o FRAMING 0 WATER HOOKUP 0 FIREPLACE RI
o INSULATION 0 SEWER HOOKUP 0 FIREPLACE FINAL
o FINAL 0 PLUMBING FINAL 0 GASllNE AIR TST
o SITE INSPECTION ~H FINAL 0
CO~NTS: ,/ / /"- / 'A_
4/?/~=C d 7V/~~c~/ PO/C
(r, /, , ( /
/~/ P, " (./ e c1 0;/ Sc;; T- 7-er f /'
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/- , ,/ "-
t=/~se ,/-;. ~e '
WORKSATISFA~
~RRECT ACTI"" AND PROCEED -
o CORRECT WORK'.%~ ~EINSPECTION BEFORE COVERING
Inspector: / u--r ~ Owner/Contr:
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSIiOTl