HomeMy WebLinkAboutMech Permit 02-1423
CITY OF PRIOR LAKE MC
16200 Eagle Creek Av. S.E. Permit No. 12). - ) l!;;3
Prior Lake, MN 55372
Date
l b,"2.. ~-o-:2-
HEATING APPLICATION I PERMIT
PID# ~- /31- OOI-D
S~e Address
'&1 ,
\2...~ "T\. Co-
Lot
Block
Addition
t-\ ~(t.. ~
O~N
Owner's Name
~AQ
S-c-
Address
t..~~'
~u ~i\ L '"i...o~~ _,_~
Heating Contractor _'"l.l-~.....Tt '"' L
Address I J, be:- '-\. \ S T ..~,.
Telephone # 6 l2.. -12- "1....1 a"t<t
Furnace Make & Model ~~ c:,.<.....
Model Size ~ t"'\ ~^ 6 P, c;:. " ~ ~ b
Conn. Load
Fuel .1:Ut"".~fr!!:> Flue Size
Supply Openings
Return Openings
Input KO. 000 Output ,""',... 00
Edr.
Cfm.
A~erations
TYPE OF WORK
Replacement /
}...'~T'I ~c_ + A \ cz-
~ V''1<:: -4
TYPE OF SYSTEM
Warm Air Plants
Gravity
Mechanical
Air Conditioning
Vent. System
HEATING OR POWER PLANT
Steam
Hot Water
Radiation
Special Devices
Other Devices
New Construction
Repair Est. Comp. Date I () -;z, \ - C> "-
Est. Cost $ ~ , \ I .00 . . Building Permit #
HEATING PERMIT FEE $_ ~~q' 5 D
STATE SURCHARGE $ .50
TOTALPERMITFEES $ 4n.. 0 Receipt # !td-q ~5
~
TYPE OF STRUCTURE
1. Pink
2. Green
3. Yellow
File
Oty
Q.~-".."-
Single Family
Commercial
/
Two-Family
Multi-Family
Public . Other
Industrial
Fee Schedule
Industrial, Commercial & Multi-Family
Residential, Heating & AC
Residential, Heating Only
Residential, Gas Fireplace
Residential, Additions & Alterations
Residential, AC Only
1 % of job cost ($39.50 minimum)
$99.50
$64.50 PLEASE NOTE:
$39.50 Air Conditioner Units Cannot
$39.50 Encroach Into Required Side-
$39.50 Yard Setback.
Remember to add the State Surcharge on the bottom of this application.
The price of your heating permit includes one rough-in and one final inspection.
Additional inspections will be billed at $35.00 each.
House Heating Test Record must be submitted with buildinq permi\ number before build-
ing certificate of occupancy will be issued.
t1EAT CALCULATIONS REQUIRED with number of supply and return openings listed per
room with CFM's per opening. New structures or additions send floor plan with supply
and return locations shown. HEAT LOSS CALCULATIONS, PAYMENT AND
APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 16200 EAGLE
CREEK AVE. S.E. PRIOR LAKE, MN 55372.
City Hall business hours are 8 a.m. - 4:30 p.m.
ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
447-9850
I hereby apply for a mechanical systems permit and I acknowledge that the
information above is complete and accurate; that the work will be in conformance
with the ordinances and codes of the city and with the state building/mechanical
codes; that this form does not become a permit until signed by the BUILDING
OFFICIAL; that the work will be in accordance with the approved plan in the
case of all work which requires review and approval of plans.
Applicant's Signature
rv
Building Offical's WQnature
io-Z3-~<-
Date
lj;~~~7
Date
ADD~SS(' S II
OC~UPANT
IIi HEAT LOSS
;.. SOLD BY
Electrical Work By
TYPE OF HEAT
')
V "",,,~ ,,(
(II
HOUSE H EA TING TEST RECORD
11c~ ~~. <-
_CITY, . SUBURB
l(>'
'.APT..
OWNER
FLOOR.
DA TE HTG. INST./fI 2 0/
GA _
FA ~HW
GAS DESIGN
MAK E _
Model =:LV'.muVf)O - ( -/6//1
Serial ~ sO) f\ I; > 3/
~"'-'---':",""""
INPUT '-C.J>'
THERMOSTAT (/I ,
lll0
I .I V-
I /
1;<(/
Valve
Limit
Limit S.tting
Fan Setting
Pilot Type (...,
Pilot Make
.;.. (' .";~
I'~-'
~/-
"7IPI/l'c.! ~i(lr;
C"","l C:., (
Pilot Model
Pilot Timing
L. W. Cut Off
Pressure '.:)--< uVl L
Input CFH.>~'
Stack Temp./ / of
Form 235
CONTROLS
Heat Plug
( '.
Percent CO2
Percent 0
i.
Percent CO .
STEAM
INSTALLED By/~-." J.~ .,J I.
Gos'Line By.
SPACE HTR. UNIT HTR.
-:Y
/'.
'"
I Ii
rf/
OTHER
CONVERSION
MAKE OF BURNER
Model ~"-
Max. BTU Rating //
MAKE OF FURNACE //
Model
Vent Size L :J " (
\
KIND OF LINER
f. ,<'.
,-,.' I--/~' 'r-
NONF
"I t''''''''1
SIZE
Draft Hood.
Fi Iters
RegulaTor
Si~rj "-/.So " / _Number t:
Chimney Location Inside ,.....--'. Outside
Chimney Construction (i _ r..... ,..... ./
Smoke Bomb
Draft
/ Door Pre~~~r~
(:> ./ -i:Tci,'-t;:ted
a~~ Company Testing
l' Name of Tester
Wiring
_Test Tag , ~
. Lighting Ins..k-~
/ (/ . l ~I . l
~.-:-'
,0'
<,.,J-r -<-..
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
CDI
I2VJ~ P2cL
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
o MECH FINAL
COMMENTS:
Fvvvr ltV(
- I'
/ I IrS-( t0lc...-
L,../\ ~- ,
DATE TIME
4 - 7-clJ
'- -/(.,12.. 3
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
(1)
P--WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT ~O" CALL FOR REINSPEcTION BEFORE COVERING
Inspector: Y vr /Lt-7- 0) Owner/Contr:
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INS/iOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!