HomeMy WebLinkAboutMech Permit 05-0787
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APPLIANCE
PERFORMANCE TEST
Attach to gas line adjacent to regulator
Heating Contractor
Name of Tester
Date
AIR .M~'TERS, INC.
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Job Address .Y3~3' 5~ ~
Heating Contractor AIR~. S, INC.
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Name of Tester
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Date
Percent 02
Percent CO
Percent C02
Stack Temp
Combustion air is ad=zeuatelY su plied per
UMC Sec. 606 ..-e.a-
input __ ~ t!;
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CITY OF PRIOR LAKE
HEA TING/ AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
(Please type or print and sign at bottom)
ADDRESS
3~V ,\,~~.
~. ~~n ~~~. I PERMIT NO. 0 3""": 070'7
3. Yellow Applicant (I
ZONING (office use)
LEGAL DESCRir nON (office use only)
LOT
BLOCK
ADDITION
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(Address) 33f'..~, ')~ J..J ~
APPLICANT (). . /Yl JJ
(Name) --I ~ lLt~'o
(Address) Skg S' -- ) ~ c; L 5+ {..,J o/d /
. J (Address)
(Contact Person) -- / ~ -:- ..f r
,,- ~PLICANT SIGNA;~RE L-......C'.w. / f\ h
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APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION Q REPLACEMENT 0 AL TERA TIONS
FURNACE MAKE AND MODEL ~Mln [;.h1V}-~ S FUEL ('}1/jVO
FLUE SIZE RETURN OPENINGS INPUT G,o_ li.i) OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
OWNER
(Name)
(Phone)
tj"-/7 ~ JS 901.,
(Phone)
ij~/ S93~
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J'l.u S5J~t./
(City) (Zip Code)'
(Phone)
DATE
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DWarm Air Plants
DGravity
0:Mechanical
~ir 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
FIREPLACE MAKE AND MODEL
Industrial, Commercial & Multi-Family
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
$39.50
Residential, Heating & AIC (New Construction)
Residential. Heating Only (New Construction)
$39.50
$39.50
Estimated Cost $ IJ( 11 ~
Building Permit #
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HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$ 39/fD
$ .50
$ /.A.7...........
Ilice Use Only)
This Application Becomes Your Building Permit When Approved Paid 1t'. cIl.J
Date ~.) , 'f, DS"
Building Official Date 1 .)
24 hour notice for all inspections (952) 447.9850, fax (952) 4474245
16200 Eagle Creek Avenue, Prior Lake, MN 55372
Receipt No.
By 1
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CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
~cYTWE
77'/
PHONE NO.
~5S?cf yruc<p
CONTR.
PERMIT NO. 0)"-:" 7' f 7'
ADDRESS
OWNER
o FOOTING 0 PLUMBING RI 0 EXIGRADIFILLlNG
o FOUNDATION 0 MECH RI 0 COMPLAINT
o FRAMING 0 WATER HOOKUP 0 FIREPLACE RI
o INSULATION 0 SEWER HOOKUP 0 FIREPLACE FINAL
o FINAL 0 PLUMBING FINAL 0 GASLlNE AIR TST
o SITE INSPECTION ~CH FINAL 0
COMNENTS; j ~ ~ ~
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~ORK SATISFACTORY, PROCEED
Yo ~ORRECT ACTION AND PROCEED
o CORRECT WOR:. ~A:L...F.7EI~SPECTION BEFORE COVERING
. IRSpectoc ftV{./ OW".,JConlc
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl