HomeMy WebLinkAboutMech Permti 05-1016
CITY OF PRIOR LAKE
HEA TING/AIR CONDITIONINGIFIREPLACE PERMIT
Date Rec'd
/fJ.B. tJS-
1. Pink File PERMIT NO
; ~:w ;;~icant 'OS. 101 ~
(Please type or print and sign at bottom)
ADDRESS
15207 FIS/1 paiNT ~
ZONING (office use)
LEGAL DESCRiJ:' lION (office use only)
LOT
BLOCK
ADDITION
PID 2S. I d1.s: 01+. 0
OWNER
(Name)
(Phone)
(Address)
~~;~~ANT < A LM fS M ECI-t A-t-J l,c,A-L
'544-0 ~~ l vcocod t;,
(Address)
(Contact Person) ~ W\ \-\ u.L ~V\......, (Phone)
llPLICANT SIGNATURE c:::::::;..----\ ~ ~ DATE
APPLICANT PLEAS~?MPLETE BELOW
DNEW CONSTRUCTION ~;?,ACEMENT 0 AL TERA TIONS
(~l(RNA~KEANDMODEL LE"~M.)XJG~(1MP ~lo r; tt{) FUEL tJ~+- Grw-
FLUE SIZE 4-(( RETURN OPENINGS INPUT 'lO!ooO OUTPUT 9('1, DOO
TYPE OF SYSTEM HEATING OR POWER PLANT
(Address)
N,WI
CUJ.
(Phoqe) '1 to 3 ~ ~~ I
A,^~ve.r MY 55304-
(City)
(Zip Code)
1 fa3 '?>o() Co~31
CJ c... I, 1 ~ I J..ooS
DWarm Air Plants
DGravity
o Mechanical
DAir 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
1 % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
$39.50
Residential, Heating & NC (New Construction)
Residential, Heating Only (New Construction)
$39.50
$39.50
Estimated Cost $
Building Permit #
REA TING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$ .39.5D
$ .50
$ +O.M
llice Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Paid ~d _
Date
/ D. I.I. tJr'
Re:;;pt No. SO..3 / f-
~.
U
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372
DATE TIME
SCHEDULED ~~~~~
~ '"
~i ~/- /2/
,
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
/S-~CJ 7
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
C FOUNDATION
C FRAMING
C INSULATION
C FINAL
o SITE INSPECTION
o PLUMBING RI
C MECH RI
o WATER HOOKUP
o SEWER HOOKUP
C PLUMBING FINAL
~FINAL
COMMENTS:
.~ I'
~~~, ~(:1'.~
/'
c;:Jy,rt;r-
~ / ,.,(' /'
~,k9'//,yIL
I
,s--/,O/b
o EXlGRADIFILLlNG
C COMPLAINT
o FIREPLACE RI
C FIREPLACE FINAL
C GASLlNE AIR TST
o
~ /
7e/1.r-
~ATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
C CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
,nspector. ~ Qwne,/Conlc
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl
------~-
HOUSE HEATING TEST RECORD
JO 1- R) 5 tJ APT.
9WNER
.....
ADDRESS r~.d-07 h'~"
OCCUPANT
HEAT LOSS
SOLD BY
Electrical Work By
TYPE OF HEAT
DATE HTG. INST.
GA .FAX _HW
GAS DESIGN
MAKE Lp VI II\. U ~
Model --1-r'?D Vl H-- - .~ b L- - )/1)
Serial o::::;q ,) ~ ( ~ 4 /...# 7_ c;--
INPUT -, k>. DOC
.
CONTROLS
THERMOSTAT 1+ W
Valve
Limit
Limit Settinll
Fan Setting '[( /'oJ cI
Pilot Type fJ .5 ~
Pilot Make
Pilot Model
Pilot Timing _
L.w. Cut Oft
'. -
Pressure 3 IJ Percent CO2 7, !
Input CFH Percent O2 ~-
" Stack Temp. JJ3.-~ P Percent CO r)
FLOOR
.CITY
SUBURB
.INSTALLED BY
.Gas Line By
STEAM
OTHER
UNIT HTR.
CONVERSION
~
-~ ------
~
MAKE OF FURNACE _____ ----
Model ~
/'
.SPACE HTR.
MAKe 01- t3t:tRWEB
Model
Max. BTU Rating _
------
.Heat Plug _
.KIND OF LINER
Draft Hood
filters
Chimney Location
Chimney Construction
Vent size~{1
SIZE
Regulator
NONE
Size
Inside
Number
Outside
Smoke Bomb
Draft
Door Pressure
Wiring
Test Tag
Lighting Inst. _
Date Tested /D / 13/Uj--
Company Testing (,/ KAlMES MECHANICAL, INC.
Name of Tester I-~ r~ p ,I-:.4! ~ c::?.