HomeMy WebLinkAboutMech Permit 05-0625
CITY OF PRIOR LAKE
HEATINl:/ATR CONDITIONINGlFlREPLACE PERMIT
REQUEST FOR FINAL
INSPECTION SENT TO
HOMEOWNER 11/05
(Please type or print and sign at b.. ... 'N.)
ADDRESS
S13~ C,rPf'ii-t R\v...ev .Rd
LEGAL DESCRIr uON (office use only)
LOT 3 lR-OCK I ADDITION ~IUJ/JI1J1L
OWNER
(Name) laWY"€V\Ce SchvnLd 5\ ~
(Address) 5.B~ CV'pdt-\- R\V..-v RJ
APPLICANT
(Name) \--\-cMe.. €n~" ~+eY'
(Address) -Lc..,? I"\n ? ~;4, A.J4> N ~ \2.<6
(Address)
(Contact Person)
r "PLICANT SIGNATURE (1" .
Date Rec'd
tJ, ,:SO, ()~
. ~ EiClllt I PERMIT NO. tJ5. O~ 2~1
ZONING (office use)
l!;U~ IS7PID:X ---OI=t-003'-6
~+afll<~t- (phone)
(phone) llo?". 4~ .lqq 0
P \~W\DU. 'tv) .c;sq4. -,
· (City) (Zip Code)
0-
(phone)
DATE --1tZ., .I'tl!=>
\M
\..}J
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION ~REPLACEMENT 0 AL TERA TIONS
FURNACE MAKE AND MODEL "J:c.? Q fY\ f'\I\ S FUEL f....n ~
FLUE SIZE RETURN OPENINGS INPUT ~D('\n OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
OWarm Air Plants
OGravity
o Mechanical
@,ir Conditioning
OVent. 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
FIREPLACE MAKE AND MODEL
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
Industrial, Commercial & Multi-Family
Residential, Heating & A/C (New Construction)
Residential, Heating Only (New Construction)
Estimated Cost $ :3"' . 5"D
.~
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
, Alice Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
$39.50
$39.50
$39.50
Building Pennit #
$
$
$
eFt _50
.50
40 .oD
Paid -I-d . fI ()
Datev. 3d. Or
Receipt No. H7 Z.-?
By ~/
/
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372
He' , HEATING TEST RECORD
ADDRESS S\?J~ CfA;ii\- R\\/pv Rei _APT. FLOOR CITY R\or La.~
OCCUPANTlnw'feN'p, "5c.hvnA S. ~\'d\"~ S1n(\~~OWNER "Sr"Y\l'\'\ld~. &fztn~ a.\
HEAT LOSe:: DATE HTG. INST .......J
SOLD BY HOME ENERGY CENTER . INSTAllED BY HOME ENERGY CENTER
Electrical Work By HARRISON ELECTRIC _ Gas Line By
TYPE OF HEAT GA _ FAX HW STEAM SPACE HTR. _ UNIT HTR. OTHER
MAKE
Model
Serial
INPUT
c':{
"LS--
iT- t:>/ 'S f!Cf I ( q (
~ <. _"'XA
.
~... _ Heat Plug
J_)-
I Y--e>
. t; .
I-J 't-=/::;t""L*~_-_
.. -
Valve
Limit
Limit Setting _
Fan Setting
Pilot Type
Pilot Make
Pilot Model
Pilot Timing
L.W. Cut Off _ ,-
Pressure ~. ~
Input CFH 7-1r
Stack Temp. ~)
.----, ~---
Percent CO2
Percent O2-
Percent CO
,
rt)
b
Form 235
MAKE OF BURNER
Model
Max. BTU Rating _
I MAKE OF FURNArl=
I
Model
l' r
Vent Size ~ yq ~ ~
KIND OF LINER _ SIZE
Draft Hood Regulator
Filters Si~~X 5 ~ber_
Chimney location Inside .......-- Outside
Chimney Construction. A '" ~
Smoke Bomb _ ~ Wiring r----;
Draft ----- Test Tag _ ,,---,
Door Pressure ~ Lighting InsL ~
( '\.
HOME ENERG~
L-JP
"'"
"
, \---'
..........,
~
---.......
'"
~
...........
-
V7:;r03-
NONE'
Date Tester1
I Company Testing _
I Name of Tester
I
DATE TillE
~~5
S/3 f O~~,/ ve':,."" /2/
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
os - 6..:z.s-
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
C~~ENTj): /' - aL /
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............ ----
~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~ L- Owner/Contr:
"""'"
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
/N$NOTI
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
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