HomeMy WebLinkAboutMech Permit 05-0783
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
~.~.:. ~~~ PERMIT NO. 05. 0 7~ 3
3. Yellow Applicant -u
(Please type or print and silm at bottom)
ADDRESS ZONING (office use)
3W- 1- / W-d eN c/J-. Nt 14<
OWNER 0 'L' 1- ~ .. I J t
(Name) ---p I I- I JJL1j _'5 tb.) M
(Address) .~ / ~ if ~ / AJ d e IV t'~ I' r~ W, W..
APPLICA~ _L ·
(Name) .'::>OCli-n fob I J eH+!J. ~ A/ t:
(Address)jtJRl10 }/d h Mt(..v)~ /r.Jl 8/.-, vd
- (Address)
(Contact Person) ---/l.o .b
. "'PPLICANTSIGNATURE .4ff~jp~J
C/
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION II REPLACEMENT 0 AL TERA TlONS
FURNACE MAKE AND MODEL R li qJ l{ (; fJ(t') cf ~ .AM ~ f{ FUEL
FLUE SIZE tJ. II RETURN OPENINGS INPUT I J.5;g/J I) OUTPUT IQl}tJ tJ c)
TYPE OF SYSTEM HEATING OR POWER PLANT
LEGAL DESCRl.t'uON (office use only)
LOT
BLOCK
ADDITION
PID -p~. I tfl . 01 r. ()
(Phone)
'f LJ 7.. ~h 43
(Phone) 3./L*J.. -SJ R.!i - ~ 'I ~ ~
}~ LM 6-,)c+.'-s 7'
-. - (City) (Zip. Code)
(Phone) 9 S'J - e d' If.-;) L/ S:~
DATE.51 -/d r(!) S-
DWarm Air Plants
DGravity
II Mechanical
DAir Conditioning
DVent. 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
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$39.50 minimum
Residential, Heating & AIC (New Construction) $99.50
Residential, Heating Only (New Construction) $64.50
Estimated Cost $.3 7 g 1/
FIREPLACE MAKE AND MODEL
Industrial, Commercial & Multi-Family
$39.50
Residential, Additions & Alterations
Residential, AC Only
$39.50
$39.50
Building Permit #
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
lice Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
$-
$
$
3'7r 5:tJ
. .50
LJ61 () (J
Paid 40. W
Date ~ .f (" AI!/'
Receipt No. t}ff:"~
By j,.
o
~;II ~.:>-7 83
, HOUSE HEATING TEST RECORD o. ~k.c;.
ADDRESS ),~tf t-:.'^;'~ C1/C\C. /U W ,APT. FLOOR_ _CITYfJ\OJ SUBURB
OCCUPANT 6A.tf.,.~d('~ OWNER $6-.. ~
:"':AT LOSS _ OAjE Hfb. INST. -5L:::..f/~ O~ .
$\:LD BY ~~l~. '- INSTALl.EO BY ""~~,rfLE. -H+;: ..H{~
E I.ctrical Work By.s _ 1.-, ;r..t'7;.d';"...vIV T ~-- Ga. Lin. By .:;5-c-
r'Y?~ OF HEA T GA r....... _ FA +-HW .STEAM .S?ACE HTR. UHlr HTR. OTHER
GAS CESIGN CONVERSION
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CONTROLS
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MAKE OF BURNER,
_ Mod.' .
_ Max_ BTU Ratinv_
MAKE OF FURNACE
Mod.l,
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CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
7~r-
/ l<-
eI-
ADDRESS
J/,z~ L/:-cl:.-.
OWNER
CONTR.
PERMIT NO. ~'- ,- ?d:J
PHONE NO.
o FOOTING 0 PLUMBING RI 0 EXIGAADIFILLING
o FOUNDATION 0 MECH RI 0 COMPLAINT
o FRAMING 0 WATER HOOKUP 0 FIREPLACE Rl
o INSULA liON 0 SEWER HOOKUP 0 FIREPLACE FINAL
o FINAL 0 PLUMBING FINAL 0 GASLINE AIR 1ST
D SITE INSPEcnON ~CH FINAL 0
COMMENTS: /~qC r"'. / ~_~,-
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o WORK SATISFACTORY, PROCEED
~RRECT ACTION AND PROCEED
/~~CTWORK' CALL F~PECTION BEFORE COVERING
lnspe"o,,)%1' OwnedContr:
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETY!
/11h G? H~ 9?<S}/
Job Address ~
Souths~~~tiZJ ~~A~C;:~i~:ing
Name of Tesler Ir""r...
Date -.!l::Jl;O ~
~.'f
Percent 02
Percent CO
tb
Percent C02
-::z ~ ~
3<<>ep:.
Stack Temp.
Combustion air is adequately supplied per
UMC Seer. 606 "
Input i U, t.taS 6'IlAi