HomeMy WebLinkAboutMech Permit 05-0194
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CITY OF PKlOR LAKE
liEATING/AIR CONDITIONINGlFlREPLACE PERMIT
Date Rec'd
3,2/.05
(Please type or orint and si2ll at bv..~_)
I ADDRESS
/~J51 .Ei.oJ ~ ~IU
~.~ ~:~. I PERMIT NO. 05 olqAJ
3. Yellow Applicant ....,..- I
ZONING (office use)
rc I 50
LEGAL DESCRIPTION (office use only)
LOT & BLOCK
ADDITION
WIIA/OW.s
2~N~
I
PID 2-5. I oq 00 lIP. (.
OWNER
(Name)
(Address)
~6p~
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(Phone) ~d-'" 1./17- 44lJ6
(City) (Zip Code)
(Contact Person) ;J __ (Phone) W - .tfll...q~
'PPLICANTSIGNA1'VRYi~ ,8~tL DATE J. /;~/~.s
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APPLICANT PLEASE'COMPLETE BELOW
SEDGWICK HEATING & AIR cmmmONING LLC
891 Q \o\Ient\Morth .1:. VA ;"'){,
Minneapolis, MN 55420
(A~~ 881-9000
(Phone)
APPLICANT
(Name)
(Address)
DNEW CONS UCnON ~ REPLACEMENT 0 AL TERA nONS
FURNACE MAKE AND MODE '/~~CJ~/) FUEL~
FLUE SIZE 1, If RN OPENINGS \ - INP~T ~A O~UT ~ ~~
TYPE OF SYSTEM HEATING OR POWER PLANT
~ arm Air Plants 0 Steam
[]p:ravity 0 Hot Water
eJ ~echanical 0 Radiation
i01\ir Conditioning 0 Special Devices
tt, R.lLJn J OVent. System _ ~ ... _ _ 0 Other Devices
,=.ElIt61"LALC MAKE AND MODEL ~ I J ItU/J.Jl)
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
~ :6_~
Estimated Cost $
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
Building Permit # OS. 01 C; 4-
$39.50
/$39~5V
$39.50
Industrial, Commercial & Multi-Family
Residential, Heating & AlC (New Construction)
Residential, Heating Only (New Construction)
REA TING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
3'1 StJ
.50
,q tJ -1')0
ffice Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Paid 1'0 . () 0
Dates. 2/.05
Receipt No. -18850
By ctlf2<-
/
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372
SEDGWICK HEATING & AIR CON ONING CO.
8910 WENTWORTH AVENUE SOUTH' MINNEAPOLIS, MN 5t.._J . (952) 881-9000
ADDRESP
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C "oK
OCCUPANT
SOLD BY
MAKF
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ScJt!Lf tJdd 5:17
SERIAL NO.
THERMOSTAT A ~f!~~
VALVF I~
LIMIT ~. JC
~Vr
+'J
1/ JJg (
PILOT TIMING _ ~ 'SeCb 1'I.00S
PRESSURE 3, 5'"/IW~ PERCENTC02
INPUT CFH 90 PERCENT O2 _
STACK TEMP. -1./2.317 F PERCENT CO
LIMIT SETTING.
FAN SETTING
PILOT TYPF
IGNITION MODEL
FORM 235 (REV. 11/89)
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HEATING
TEST RECORD
CITY _
P'f''''~~ LJlltkc--
5
OWNER S 14 VI? ~ .
INSTALLED BY ~,!ff#{JJ
MODEL t7 (j 0" 1-1 - 3 G 8 - (/ 9 (/
eftJ/W
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~::: :I:~INER y
/:let
FILTERS: SIZE ~ xLf
INPUT
_ LINER SIZI=
NUMBER
_ WIRING
---
-
_ TEST TAG
LIGHTING INST.
-
DATE TESTED J;; ( 10 ~
S '... / ~ "- I.
COMPANY TESTING ff::Y~
_ NAME OF TESTER
JOB NO.
,.5J-S
114
p-( (')0
YELLOW COPY. CITY
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o EXIGRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
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
DATE TIME
COMMJ;NTS: ~ / //yC~
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_~KSATIS~"',~~
o CORRECT ACTION AND PROCEED
::CT~NS:~~:FORECOVE~NG
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
lNSNOT!
CODE REQUIREMENTS A.RE FOR YOUR PERSONAL HEALTH & SAFETY!