HomeMy WebLinkAboutMech Permit 05-1012
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CITY OF PRIOR LAKE
ilEA TING/ AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
It). 1/. oS
I. Pink
2. Green
3. Yellow
~!~. I PERMIT NO'05/0 12-
ApplIcant .
(Please type or print and sign at bottom)
:u~~ ~J, Jc
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID 25.143. (j oz.. ()
OWNER
(N ame)
~- c1f~fiI
~QA?1L
(Phone)
(Address)
APPLICANT ,
(Name)
I
SEDGWICK HEATING 8. AIR CQNnlTlml'~JG IIC
8910 Wentworth Ave. 0U
(Address) ~hF(~~~~O~:12~
(Contact Person)" - r4 (Phone)
--PPLICANTSIGNATURE-IMmIn A ~P~,_DATE /O-h--cJS
j ---ITJUV
APPLICANT PLEAS ~ COMPLETE BELOW
"
DNEW co~S~CnON e1REPLACEMENT 0 AL TERA nONS
FURNACEMAKEANDMODEL~~ b&'Jmpv~B(J1() FUEL ~
FLUE SIZE RETURN OPENINGS INPUT tdPi/Jt1CJ OJ(PUT bel; ~~()
TYPE OF SYSTEM HEATING OR POWER PLANT
~arm Air Plants 0 Steam PLEASE NOTE:
o Gravity 0 Hot Water Air Conditioner Units
o Mechanical 0 Radiation Cannot Encroach into
OAir Conditioning 0 Special Devices /' - ~ 'S.: "l..) } Required Side Yard
OVent. System 0 Other Devices ~ ~ ('Setbacks
(Phone)
(City)
(Zip Code)
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 & AlC (New Construction)
Residential, Heating Only (New Construction)
$39.50
$39.50
Estimated Cost $
4.l4S'
Building Permit #
REA TING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
..14$ ()
.50
/fIUM
flee Use Only)
Building Official
I
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372
Date
pai~(j .00
Date I O. II. oS
Rec~iPt No. .5lJ;3 0 tJ
B>/,
U-~
This Application Becomes Your Building Permit When Approved
S-IO/~
JOBNO SbJfll
SEDGWICK HEATING & AIR CONDITIONING CO.
8910 WENTWORTH AVENUE SOUTH. MINNEAPOLIS, MN 55420 . (952) 881-9000
ADDRESS ? J/~ ~fL .7f
OCCUPANT ~ '?IbdM-(
SOLD BY r-eJ) W'{ ~ /J4.; t U-.
MAKF ~
SERIAL NO.
\1 P S (J r9 0
\~.t~L(
FN,d
.9 () CJ :- ;:) cJ 0 r
+l~
f\~
l+".(
PILOT TIMING ~ S ( (. (j-f/l)g
PRESSURE.-3. :\ I' kti' (PERCENT CO2 ~ (f) to
INPUT CFH _ 7 0 PERCENT O2 &. (J / ()
STACK TEMP. I a lOp.. PERCENT CO D I
THERMOSTAT
VALVF
LIMIT
LIMIT SETTING
FAN SETTING
PILOT TYPE
IGNITION MODEl
FORM 235 (REV. 11/89)
HEATING
TEST RECORD
moV lAb _ .
OWNER . f~~ ~(
.1/ -
_ INSTALLED BY ... i.JL~ /~ t-~
! " ,
MODEL (, ~ I )1fJ V ~ ZII 07 /)
--r (J () (J CJ
CITY_
INPUT
VENT SI71=
c)c{
PUL
TYPE OF LINER
LINER SIZI=
dY'"
010 'l..d~
NUMBER :5 0<:9 CJ
_ FILTERS: 5171=
WIRING
TEST TAG
LIGHTING INST.
1~/7/t?5
"/~:/ J
COMPANY TESTING ~ ep~
NAME OF TESTER ~~<. r-'\
FORM DISTRIBUTIO~HJ COPY. JOB FILE ~
DATE TESTED
-,~
DATE nME
CITY OF PRIOR LAKE I z/27h}
INSPECTION NOTICE SCHEDULED
..... ,
ADDRESS 3BllD K4r'"," 5+.
OWNER CONTR.
PHONE NO. PERMIT NO. S'- /6 12.
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
8--PLUMBING FINAL
~ MECH FINAL
-
-r Un,.. .. ~--<:.
~~ ~~....lcJ..L.
tJ", t:c:,. -A r ^ - (,. I , ~ : ~.'.' .
+0 CS 1 ~ \ ~~,t; IJ........:::b .
.
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
ft'GASLINE AIR TST
COMMENTS:
L
\ \.\..'S() \~c::;I\.. -+~~
+0 ~11~~
o WORK SATISFACTORY. PROCEED
XCORRECT ACTION AND PROCEED
o CORRfEK' CALL FOR REINSPECTION BEFORE COVERING
Inspector / Owner/Contr:
CAL ~50 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH cl SAFETY!
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