HomeMy WebLinkAboutMech Permit 03-1519
CITY OF PRIOR LAKE MC
16200 Eagle Creek Av. S.E. Permit No.
Prior Lake, MN 55372 .
( LJO'OO " ')
03./~ ~
TYPE OF STRUCTURE
,.,,--
1. Pink
2. Green
3. Yellow
File
City
Contractor
HEATING APPLICATION I PERMIT
Date I 2- - I 9 - 0 .~ PID #
Site Address i b '-( bo -L ~ -.l f.J. t I ~r-. __ "
REQUEST FOR FINAL
-,.., INSPECTION SENT TO
.:h~ HOMEOWNER 01-05
_ Two-Family
Industrial
Multi-Family
Public. Other.
Lot Block . Addition
Owner's Name U f"'<..-...) ~ U t"_ 1) N r_~
Address 16y.bo .-L' """(:r Ie') t"'!..po --..... ~ G-.r.o.L\-\
Heating Contractor ~€:.~ rOE:,.......,..,..JO. Ie H CfCl\-l'\...._, t~ .,l A .rz
Address
Industrial, Commercial & Multi-Family
Residential, Heating & AC
Residential, Heating Only
Residential, Gas Fireplace
Residential, Additions & Alterations
Residential, AC Only
1% of job cost ($39.50 minimum)
$99.50
$64.50 PLEASE NOTE:
$39.50 Air Conditioner Units Cannot
$39.50 Encroach Into Required Side-
$39.50 Yard Setbacks.
1 ~ 15 G - Lj, $ 1"" .51
h 12... -72.l.f-t8 er
Su \\~ A
Remember to add the State Surcharge on the bottom of this application.
Telephone #
Furnace Make & Model ~,",VD
Conn. Load
Fuel tJp" GPtS Flue Size
Supply Openings
Return Openings
Model Size
gOlo
U(,(f(07€'''N<:L TYPE OF SYSTEM
Warm Air Plants
Gravity
Mechanical
Air Conditioning
Vent. System
.I:iEAI CALCULATIONS REQUIR~ with number of supply and return openings listed per
room with CFM's per opening. New structures or additions send floor plan with supply
and return locations shown. HEAT LOSS CALCULATIONS, PAYMENT AND
APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 16200 EAGLE
CREEK AVE. S.E. PRIOR LAKE, MN 55372.
City Hall business hours are 8 a.m. - 4:30 p.m.
ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
447-9850
The price of your heating permit includes one rough-in and one final inspection.
Additional inspections will be billed at $35.00 each.
,..-.
v- House Heating Test Record must be submitted with buildinq permit number before build-
V 'Kvvc t /h""~~'U~ng certificate of occupancy will be issued.
Input ~ (:) . no cJ Output
Edr.
5 (,.000
HEATING OR POWER PLANT
Steam
Hot Water
Radiation
Special Devices
Cfm.
Alterations
Repair
Est. Cost $
Other Devices
TYPE OF WORK
Replacement ~ New Construction
I hereby apply for a mechanical systems permit and I acknowledge that the
information above is complete and accurate; that the work will be in conformance
with the ordinances and codes of the city and with the state building/mechanical
codes; that thisf orm does not bec~a permit until signed by the BUILDING
OFFICIAL; tha the work Will~: 1" cc rdance with the approved plan in the
case of all work: hich requi /~ev e and approval of plans.
I y,,, 6"""'" '--'"" J 7- -I 9 ~ 0 3
AISP~Ii'caca~n Date
d~ IZ-.ZJ.OJ
Buildin ffical's Signature - , Date
Est. Comp. Date
50 'i z.' 0 v Building Permit #
3tt5D
.50
4<;.Ot)
tJ..3~/SI1
HEATING PERMIT FEE $
STATE SURCHARGE $
TOTAL PEP'''T FEES $
~~
Receipt #
)'
ADDRESS
/~~6"o
DATE TIMe
SCHEDULED ~~--
.'4~q, ~.J<e. ~~~
-
CONTR. 03- /5/9
PERMIT NO. Cfs/- / /
CITY OF PRIOR LAKE
INSPECTION NOTICE
OWNER
PHONE 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
,..I!t1'LUMBING FINAL
Ji!HftECH FINAL
o EXIGRADlFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASlINE AIR TST
o
C~MEN1S: /' / /1: /
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O~
~RK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTlON BEFORE COVERING
Inspector: ~". Owner/contr:
/,--
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
/NSNOTl
ADDRESS /6'/f./J ::r ~;?~sg,;JA~:STR::::D CITY f);:i:sull.ii5/Q
~:~~?~ f1r!~t:~~ /;J. .):.) i7:f!::~~ED BY ) M ~ 4... Jd ;.MJ
Electrical Wark By ~ ~- ,Gas Line By ~~ .
TYPEOFHEAT GA '_FA.X. HW STEAM SPACEHTR. 'UNITHTR. OTHER
/) dl 11 GAS DESIGN
MAKE Kt&[, If' _
Model /" (f-f Ic'" - 07 c;,!:J;ne e.
Serial ~ Ii I> -:?',f2):) ~ l/ i, (! -t;o79i/...2
INPUT _ ('" f/?,J ~J7:J
;
if CONTROLS
THERMOS~-'JT .b/ t" Heat Plug
Valve HI t.-
Limit /...1/ t~,.
Limit Setting I 'Zl
Fan Setting _ ~')
Pilot Type ~
Pilot Make JI,/IR
Pilot Model _ 51""~t:.. </0.//,0
Pilot Timing 7 ~~
L. W. Cut Off ,
-? r"
Pressure:? ,,;./
Input CFH~ 4t
. D
Stack Temp. 7"4-'/)
Percent CO2 0 9":0
Percent O2 ~
Percent CO _ ~
Form 235
CONVERSION
MAKE OF BURNER
Model
Max. BTU Rating
MAKE OF FURNACE
Model
Vent Size ,.,. I::' ~ / /
KIND OF lINER_("~.D SIZEP NONE
Draft Hood RegulaTor
Filter. SiJ~ y$<; V I Number !
Chimney Location Inside V Outside,
Chimney Construction
'v......
v
Smoke Bomb
Draft _
Door Pressure
"'-(
_ Wiring
_Test Tag
""",,'
_ Lighting Inst.
/i#ffj~/ ~
y
......,r
Date Tested
Company Testing
Name of Tester