HomeMy WebLinkAboutMech Permit 05-0988
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONINGIFIREPLACE PERMIT
Date Rec'd
~'~~n ~:~. I PERMIT NO. /J t::".... Of?~
3, Yellow Apphcant , (/..:/ 7 ~ ~
16498 In~uadona Beach
LEGAL DESCRIPTION (office use only)
LOT /q BLOCK ADDITION DOG q aD L/'" ..-.-
OWNER
(Name) Jeanne IT~ns~n
~D O?~- 0/'
ZONING (office use)
(Phone) 951-44 7-l:\q74
(Address) 16498 In..:::uadona Beach
APPLICANT
(Name) 'Ron'", MpC"nrlni("(;ll t TN('
Rd
(Phone) 952-445-6585
(Address)
12010
ShaJ.copee. MN
(City)
(Contact Person)
\'OJV
~hon~ 952-445-8585
DATE
PPLICANT SIGNATURE
55379
(Zip Code)
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION REPLACEMENT 0 AL TERA TIONS
FURNACE MAKE AND MODEL \.).,\'\"\'\..0)( FUEL ubt
FLUE SIZE RETURN OPENINGS INPUT =Tb ,000 OUTPUT (05 , 10 i)
TYPE OF SYSTEM
HEATING OR POWER PLANT
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
DWann Air Plants
(:J$V'avity
[!I"Mechanical
DAir Conditioning
DVent. System
FIREPLACE MAKE AND MODEL
Industrial, Commercial & Multi-Family
FEE SCHEDULE
1 % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
Residential, Heating & AlC (New Construction)
Residential, Heating Only (New Construction)
Estimated Cost $
Building Permit #
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
~.LJO
\.\0.00
.50
flee Use Only)
This Application Becomes Your Building Permit When Approved
---
-~
Building Official
Date
24 hour notice for all inspections (952) 447.9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
$39.50
$39.50
$39.50
DATE TIME
SCHEDULED I~~~S--
~JjV,,<j,HqkO::
CONTR. ,
PERMIT NO. S -- --9 fY
, CITY:aF PRIOR LAKE
INSPECTION NOTICE
.DDRESS
/6rf'rr
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
o PLUMBING FINAL
~CH FINAL
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
~ME~S: /-zr.
, ~ ~~ c( 'u nt2"~-e,
~~ r~I2/...~~<'-
" r oC-~ I-
~~e,~..,_1 LI/<:"'4i.-I- 7i?fJ~
, ,
/~
~~sr:b~ Ar
o~-
z91;i
WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FO EINSPECTION BEFORE COVERING
Inspector:
Owner/Contr:
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
_11
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
H' HEf-TING TEST RECORD /J L.
ADDRESSJJOyqt 'CV1jY'iA cf()Vtl'.1 V-xat.-VI APT._FLooR_efT"
OCCUPANT --:f.l:~v.'\f~'-1.<' ~". ~ OWNER II ,\
HEAT LOSS _ DATE HTG. IINST, I tJ 1<71 t?tJ .
SOLD BY' fI. j!." WJ.(.t \It I (A) INSTALLED BY !l O"~ <" J1-'\.U L-t " ., ,'eC'l f
Electrical Work By _~ t. I fl~...\ ~<,tJ Gas Line By
TYPE OF HEAT GA _ FA -LHW _STEAM _SPACE HTR. _UNIT HTR. _OTHER
GAS DESIGN CONVERSION
SUBURB
MAKE --Le lI\ ~.~
Model
MAKE OF BURNER
Model
Mox. BTU Rating
MAKE OF FURNACE
Model
Serio I U
INPUT 70.00
f
CONTROLS
Heat Plug
Vent Size
t"
KIND OF LINER SIZE
Draft Hood Regula,or
Fi Ite,. Size Number
Chimney Location Inside '>l
Chimney Construction -----/-11 C-
Smoke Bomb
Draft
Door Pressu.e
NONE K
THERMOSTAT
Valve.
Limit
Limit Sa"ing
Fan Setting
Pilot Typo
Pilot Make
Pilot Model
Pilot Timing
L.W. Cut Off
Pressure ~'4 ~
Input CFH {; r"OeD
"10
Stack Temp. [10 .
Form 235
Pereant CO l., .ll'/ 0
Percent O~W~
Percent CO
Date Tested
Company Testing .
Nama of Tnter (? II
Outside
Wiring
Test Tag
Lighting Inst.
'I-