HomeMy WebLinkAboutMech Permit 04-0639
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CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
,. Z3.(J4-
~: ~ ~:~ I PERMIT NO. M . 0 fR ?(j
3. Yellow Apphcant ....> 71
(Please type or print and sijpl at bottom)
ADDRESS
/~S&O t:>A}Mftd ~/1ch. ,M SE
. ZONING (office
use) K-ISD
LEGAL DESCRIPTION (office use only)
LOT4-- BLOCK 6" ADDITION Cl/lu/tAl 0 Lfc71t!J1
PIDz5". lIS: 003.0
OWNER (" /l. ~
(N~ klb4/~ ~Lh
~ . . '1Y7.c,~
(Address) 1t/!5&O CIi#/ln j be-#c Ie
APPLICANT -r= ~
(Name) ,/@4;f1 ///I!Fe.~/~'-
(phone)
#t/tF 5 c--
..J/ijc..
(Phone) c;,/~ ~~ -5Ct?c.JG?
('
(Address) -"2Ln a C' # . /.J. /1 ./1/7 )
~OC/ c;:?'/f6////I~ /-/ve"/fJ ~ ntH S5~ob
(Address) . (City) (Zip Code)
(ContactPen;on) tJ~i$ ~_ (Phone) (:,1.;).- 7;.'7-sr..'fc,
APPLICANT SIGNATURE ~ DATE t,-;lI-01
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION ~MENT 0 ALTERATIONS )
FURNACE MAKE AND MODEL AU/JHAAI11 hot/' FUEL /'II fa
FLUE SIZE ---.5 1/ RETURN OPENINGS INPUT %.lPtJO OUTPUT ~,,';i)
TYPE OF SYSTEM HEATINGORPOWERPLANT )H,t.,j ~/J~o 1JfV}'
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
OWarm Air Plants
OGravity
o Mechanical
OAir Conditioning
OVent. System
gSte~
~ater
o Radiation
o Special Devices
o Other Devices
FIREPLACE MAKE AND MODEL
FEE SCHEDULE
Industrial, Commercial & Multi-Family 1% of job cost Residential, Gas Fireplace $39.50
$39.50 minimum
Residential, Heating & AlC (New Construction) $99.50 Residential, Additions & Alterations $39.50
Residential, Heating Only (New Construction) $64.50 Residential, AC Only $39.50
Estimated Cost $ 3~0b0, ~ Building Permit # {/4-. tJ ~ 37
HEATING PERMIT FEE $ 3 , , >z:>
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ ~r:J, ~
,"'--
(Omee Use Only)
This Application Becomes Your Building Permit When Approved
Bulldlnl! Omelal
Date
. Paid 40 .00
Date t" z,:!. d4-
. Receipt No. 47ZZ.s-' .
By ,J...
(J
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
DATE TIllE
CITY OF PRIOR LAKE ~ h /. /
INSPECTION NOTICE SCHEDULED o/~,...
ADDRESS /~S-6 ~ a~~~/ ~..aL
OWNER CONTR.
PHONE NO.
PERMIT NO.
f ,(PIt!
a FOOTING
a FOUNDATION
a FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
a PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
a MECH FINAL
[J EXIGRAD/fILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
a
COMM~TS: # I."., /
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AWORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT~~:i' FOR REINSPECTION BEFORE COVERING
Inspector: _/~ Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECnON 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
HOUSE HEATING, TEST RECORD
AooIESS J#~t,f) (JAil flln/') &~c.J,~ ~lpT." FLOOR
oCQJPANT L6J~' q' . C 2.. r: r Y . .OWNER (AI"'1I'
HEAT L~ .DAn HTG. INST~ ~-~ ,-~ '
'OLD BY .. CUlS"" _INSTALLEDBY~ ~ h
Electrlcol Work By yrl'bt"\ t;J:::.,.. .Ga. Lino 8y. ~,...
TYPE OP HEAt .~ FA HW -t/ STEAM SPACE HTR. ..,. UNIT HTR. _OTHER.
. fj' h GA. S DESIGN CONVERSION
MAK! rV\.:.\.taA MAKE OF BURNER
Mo4.1 ~"'"" Modol .V.,.... I
&.101 () '-I V , (, tJ J: ~ Max. 8TU Rating
,~J~~T "f1*,DO~li>Tf( :::OF FURNAcel~
.~" P..t:,hlV''''''' CONTROLS 1'1 V'
THERAtOSl'AT ~~ ()tcJ Hoa. Plug Von. Size
Val".*'ytI1'&..Jf/."J/ KINOOFLINEj~/It<5' 15 slzeJ'1
Limit . '1;~ I ( Draft Hood _<' Rogula,or
Limit ""in, I ? If ,. Fi Itor. Sizo. - . ~ber --
".'. on "ttln,- Chlmnoy Location In.lde-V'". .Out.ldo
iRJi.. TY,,~ Y .a't K... Chlmn.y Conatruction -P) - V~/\ ..f
Pilo' Make
Pilot Model-
Pilot Tlmln,-
L.W. Cu. Off .,'
j'~:;~;H < .~~-
t',tack T.rJl9~
r "~~. 235
'-
.P.rcont CO2 ~
. Porcon' 02-+"7J'
,Porcent CO I
.~
(J!j/059
~
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I-l4te
.CITY.
SUBURB
"
_NONF .....
Smoke Bomb ,Wiring _
Draft .To.t Tal.
Door Pro.."ro~' _ Lighting Inat.
Ooto Tutod (' -;; 1- 0 t/ .
Company Testing ::1)'14 ~ m~-;j?
Nome of Teste, -::ro. ~ _ .,/4 /' r
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