HomeMy WebLinkAboutMech Permit 03-0774
CITY OF PRIOR LAKE
I
HEATING/AIR CONDITIONING/FIREPLACE PERMl..
REQUEST FOR FINAL
INSPECTION SENT TO
HOMEOWNER 8/03
,Please type or print and siRD al
ADDRESS
& 3? 0 - eon r (J y' ~T AI. t,
t
LEGAL DESCR1r uON (office use only)
LOT BLOCK
ADDITION K
OWNER
(Name)
J{1 e. 5 (!, IJ If
(,37() - e. (J 11 to f Sr /1/[.
(Address)
Date Rec'd
L Pink File
2. Green City
3 . Yellow AppliCllll
PERMIT NO. 03-771
ZONING (ofticeuse)
1<1 Sf)
PID ;)5'//1./; tJO/'(~
(phone) ~;1 - ~4f.$"- ~~:J- $I'
Ir/b'r kk~ IYtn <<37:J-
APPLICANT ~ )J../; If J
(Name) ..:::;)(1u:[j SJ)p, 91 I<L- ~
(Address) IO%() ~- Alb'r;na.4,-j~ /~ tiff/...-
(Address)
(Contact Person) /f..J}fl.." l-- t fi. 5 "e- r;: e.,.. t
APPLICANT SIGNATURE M~ K ~
{J
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION . ~ REPLACEMENT 0 AL TERA TIONS
FURNACE MAKE AND MODEL ~ tL~rD/o E 2 f-M FUEL /l/d i'~
FLUE SIZE 3 II RETURN OPENINGS INPUT /OS"'.A'1 OUTPUT ?7~5lJ
~
I
(Phone) 9.{?- - %K </. .;z q'S,3
l>/6 0 WI ,~~ 7"bJ....)/h.J s-rzl37
ity) (Zip Code)
(Phone) -2s;;...... ITY- dl ~ - .3
DATE ~ -/0 ... 0 3
HEATINGORPO~RPLANT
lYPE OF SYSTEM
IXlWarm Air Plants
OGravity
~ Mechanical
Air Conditioning
Vent. System
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices ~,~ P(1,,_ LJ V-
~ t-Uh,,{
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
FIREPLACE MAKE AN[ REQUEST FOR FINAL
INSPECTION SENT TO
Industrial, Commercial & Mul HOMEOWNER 11/03
Residential, Heating & AlC (1'
Residential, Heating Only (NCVi ~u.."...JctlOn) $64.50
4.
Estimated Cost $ ggn
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
~ce Use Only)
I 'his Application Becomes Your Building Permit When Approved
Building Oftlclal
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
LE
sidential, Gas Fireplace
$39.50
Jsidential, Additions & Alterations
Residential, AC Only
$39.50
$39.50
Building Pennit #
$
$
$
..59.. sO
.50
.yO ~ In)
Paid t; l/ t; ~..-/ Receritt:/5C? t(
Date .tJ -I'd -:3 By Cf-/
1~1J. lJ?' - 77 t/
HOUSE HEA ilNG rEST RECORD
ADORESS III 3 7D - ~ ~ T IV. E ,APT. FLOOR. _~JTY
OCCUPANT ~ ~c) (1A1;C (} OWNER ~. 5~
HEAT LOSS. ,CATE HTG. I~ST.
SOLD BY So u./.n... f'I" ~ tJt;v AI L- ..}r-<:....- INSTALLED BY 5" t1-nv- -
Electrical Work By It'1J1. P ~'1 Ga. Line 8y S ~, ~ to< IJ- I e... ~
TYPE OF HEAT GA --X- FAX HW STEAM SPACE HTR. UNIT HTR. 'OTHER
^ ~ GAS DESIGN CONVERSION
MAK:: ~ MAKE OF BURNER
Model. 11./ .If F:J) I tJ C 2. e.. M .$ Mod.l
Serial. F I( 5'070 I F0WQ3029/~' Max. BTU Rating.
INPUT fr1S',Od:::J hTv..... MAKE OF FURNACE
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CITY OF PRJOR LAKE
INSPECTION NOTICE
ADDRESS
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
OA TE TIME
SCHEDULED 0,;2 - () j- ()~
b'3 70 ~/LJr6LI 5r-
CONTR.
PERMIT NO.
CJ3 - 7~~1
o PLUMBING RI
o MECH Rl
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXIGRAD/FILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
SENT T .STS EOR-
iN ~y EL'il"ONLE'Ii'IERS OU"r-
REC~IVElLNO RF,5.PONSFJ
CL
1NA. CTIVlIY
o WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector:
Owner/Contr:
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEAL TH ~ SAFETY!
I/iVIOTl