HomeMy WebLinkAboutMech Permit 05-0808
CITY OF PRIOR LAKE -
HEA TING/ AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
]).... J{,f 11
~.~~ ~!~. I PERMIT NO. OS-.cJt;ot:h
3. YeHow Applicant C/
(Please type or print and si2ll at bottom)
ADDRESS
ZONING (office use)
/(; "9r
;::r~ rt//"';.I /"~ yc Ie..
Jb
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
/-1 t' 4: 1), " ~
J> ~/ /
(Phone)~\) 1.,. j'y u - ...JY/ '"
/
(Address)
J ~ra -C-
~~;~~ANT . SEDGWICK HEATING & AIR CONDITION!NG LLC J
tS~lU vventwonn Ave :;'0
(Address) Minneaoolis, MN 55420
(952Jatt.9000
(Phone)
(City)
(Zip Code)
(Phone)
/-~PPLICANTSIGNATURE r~ /J-~
. ,T
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION f}lREPLACEMENT 0 AL TERA TIONS
FURNACE MAKE AND MODEL L 1"''1 n u y ~ b u (..(//-:3 t {j IJ 9 ... FUEL J:: ~ J
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
(Contact Person)
DATE
Jhf/ur
TYPE OF SYSTEM
HEATING OR POWER PLANT
DWarm Air Plants
DGravity
)lMechanical
, JAir Conditioning
DVent. System
D Steam
D Hot Water
D Radiation
D 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 SC",EDULE
I % of job cost ,Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
$39.50
Residential, Heating & AlC (New Construction)
Residential, Heating Only (New Construction)
$39.50
$39.50
Estimated Cost $ 6) J 6
Building Permit #
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
] 't r'1
.50
vu~ 0 U
,
iDee Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
I Paid ?--(). 00
Datee. 'Zz,. Or
Receipt No. ~89..s;-
"
BYj'& _ _
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372
DATE TIME
-.. r OF PRIOR LAKE '-' .L .. /
INSPECTION NOTICE SCHEDULED /9'W<.t>""'
ADDRESS /b" 29- S- ~..., ~ C J-
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
as--J"CJY
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
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......
/
~A
OCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL F REINSPECTION BEFORE COVERING
Inspector: ~ '"
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
INSNOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY I
SEDGWICK HEATING & AIR CONDITIONING CO.
8910 WENTWORTH AVENUE SOUTH. MINNEAPOLIS, MN 55420 . (952) 881-9000
ADDRESS I Ct, 2.. qs fY-tlf'\t.h'^ u'r SF
OCCUPANT _
SOLD BY
M~~
MAK'"
/ -e-tA"" 0-1-
SJa5C 0!.fl-27
........-
SERIAL NO. .
THERMOSTA~ Me 3 fa 3
VALVE J -\- - t J
LIMIT l.r:.ri.~
liD
FAN SETTING IA ,^,,-e-) J I .--.
P!LOTTYPE ~ I~ t~ J= 1-1- S 1--
IGNITION MODEL e cc-+-n:> ~<:.-
PILOT TIMING 7l.A.- c..j- ~
PRESSURE -7 ,. ~ ~(~CENT CO2 8 ~
INPUT CFH -B 9)- _ PERCENT O2 (p ~
STACK TEM~ ~~o 0 PERCENT CO () ~
LIMIT SETTINr.
FORM 235 (REV. 11/89)
HEATING
TEST RECORD
CITY Pno-r LNLt..
OWNER Pa.1Yi6k:..- D6 \ \
INSTALLED BY
MODEL -.010 () l~ ~ 09 (')
INPUT rB~ /{)OU
VENT SI71= c;'tr
TYPE OF LINE: p~tJ ~
~ /'(
LINER SIZE Ih
FILTERS: SIZE Jf oc)
WIRING ----.&~_P
-
TEST TAG
,--
JOB NO. 5fo 3 S I
o~
fl' -
_ NUMBER
LIGHTING INST.
DATE TESTED -.B -l -os
COMPANYTESTING/5~ ( ^'w ('" Jc...
,..~-~,
NAMEOFTEST~ ~- . ~
FORM DISTRIBUTION: WHITE COPY - JOB FI~ v~" ~COPY - CITY