HomeMy WebLinkAboutMech Permit 02-0953
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CITY OF PRIOR LAKE
hEATING/AIR CONDlII0NING/~1.KEPLACE PEMul
t'II.-IY\ b (J"Jc1-p C ('
LEGAL DESCRIPTION (office use only)
P.AtWtJA~~vtL.
fv:,f r' (Phone) 1.<:::2 - 'IlfJ -Ij ~ S
C!.-o..m6r;ri(ft' Cir sf'
mec..h(JJ1iul -1-n(1... (Phone) 952 - c.;~S - ~S- 8'S'
/~()/O (JfJ ~j fiarLfJ
(Address)
(Contact Person) f.-J n ;/ d.
APPLICANT SIGNATURE ~ ~ tJur~
U
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION !:SJREPLACEMENT D AL TERA TIONS
FURNACE MAKE AND MODEL 'Q. UJJ.:n UJ'1 PllO -=r FUEL IJ b
FLUE SIZE RETURN OPENINGS INPUT ~DD OUTPUT UD:"rj)
TYPE OF SYSTEM HEATING OR POWER PLANT
~Wann Air Plants 0 Steam
OGravity 0 Hot Water
~echanical 0 Radiation
ir Conditioning 0 Special Devices
Vent. System 0 Other Devices
(Please type or print and siJ!ll atL~"__)
ADDRESS
UOl '3
LOT ~ BLOCK ~ADDITION
- " -
OWNER
(Name)
(Address)
JirlMJ
/1;;073
rz6aS
APPLICANT
(Name)
(Address)
FIREPLACE MAKE AND MODEL
~ate Rec'd
"{',
J. Pink File
2. Green City
3. Vellow Applicant
sf
Z G (office use)
RI
PI~ - a:JCf -O::XI-,()
(~e( 5iI:!2i
C?Sd--7"~S- ~X'S
p-I-ot...
(Phone)
DATE
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
Industrial, Commercial & Multi-Family
Residential, Heating & AIC (New Construction)
Residential, Heating Only (New Construction)
Estimated Cost $
4 bOD
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
(Office 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
$39.50
$39.50
$39.50
Building Permit #
$
$
$
(~Q /:n
. .50
I.fl2.1ll)
Paid , -^rl "\
lI~ ,U LJ
Date
R <t; ... (l
.
Rece~s q ~
By ae/
(J
HOUSE HEATING TEST RECORD
ADDRESS I 60 \~.> L4. Y"'\.b\-~~~ APT. _FLOOR
OCCUPANT ~ \\ 0... V'.... __ K ~ ~ f:'~ ~ -. \. ~'~~ER.
HEAT LOSS , ~ATE T~. IN~. C)- ~ ~. /),
SOLD BY .ff'1 f n.r'- c.. U - INSTALLED BY n"" V\
Electrical Work By r, _I\.!.>~ V Gas Line By -
TYPE OF HEAT GA _ FAX"'" .HW / STEAM SPACE HTR. _ UNIT HTR. OTHER
^ GAS DESIGN CONVERSION
MAKE ~ . _ ~AKE OF BURNER _
Model '1':. ~ - 0 -I' EA- U~ --. ~
Serial f-~C';U' l.x. TU Rating -::><....
INPUT r--n.. . ,_ MAKE OF FURNACE ./ -----
, ~~\' \A/ Model_
&/C' (};QM\TRO S /f I' ~
THERMOST~ ' ~eat Plug -- Vent Sin ~ IJ I' __ '-
Val"e. .. () KINDOFLlNER.ry---\R.V'\._"T---..1ZF
-~...... \~ \ ;>
Limit _ ~ - ,,. ,..-, V" Draft Hood - ~ ....:n~a'or
Limit Setting. ~,t'- Co- Y Filters Size 1f1.X ~-.S/'. I umber
Fan Setting _ ~ Chimney Location InsiAe _...... ~
Pilot Type ~:' ~- '. ,~/ ----- . Chimney Construction ~r- ~ Y '- \
Pilot Make .,
Pilot Model j ~r _ "' "'-- . Smoke Bomb ./'....... _ Wiring
Pilot Timing _ ~ \ '- . Draft / ~ Te;t-"'cijj.
L.W. Cut Off / - - . Door Pressure ~ ....---- Lightingln.t.
Pre..ure ~, ~~ d Percent CO2 7~. o.M T"Md ~-A- I" ,0. ~
Input CFH /1fj~b c> Percent O2 ~.- Company T..~y\ 5. d1
Stack Temp. "'%"'Ql- - Percent CO . No.... of Tester ,f2!1-. ~ --'
Form 235
CITY
'\
.SUBURB
R(~
';J',t
NONE
. CrrrOF PRIOR LAKE
INSPECTION NOTICE
~DDRE~S , ~ () 7 ~
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
Jl. FINAL
o SITE INSPECTION
"'--L;, .
.~-/~
~.
DATE TIME
SCHEDULED rf1R/ 4?.. /41T7
~CW
o
CONTR.
PERMIT NO.
112- 953
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
COMMENTS: Fw ,~ t}!-p,~ .iJ ,+, e I
ID ~ (J~aitA~::J1 - ~ -:n-
~ ~ ~-T'
,) nJj / _ ,.. {-I n _..i'" .&
(~ ~ ld-4--tlC~
~~.
o WORK SATISFACTORY. PROCEED
o CORRECT ACTION AND PROCEED
)lQcORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
'",peelo" ~ Ow"e'~
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl
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