HomeMy WebLinkAboutMech Permit 02-0454
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
L;' -30 '-()d
L Pink File
2. Green City
3. Yellow Applicant
PERMIT NO.O~ - CJ'It l'
ZONING (office use)
R I Sf) .
(Please type or print and sij!;ll at bottom)
ADDRESS
::; ].. 9 0 he J. r P () . ',v r
c, '12-(., J c...
s'E
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION 7raL-f CO - () (( L S jp ~Cf PID ;;2.5' ot::.J!)'-odkf)
OWNER
(Name) ^'oRmA-N
S~I.I ft3P- r
I
(Phone) 9 s l.. - 'I '( '7 .-.3 S- b 7
(Address) SZ.9o P/l.-oJ,r Po,'.u r C'-tv/v SE
APPLICANT .
(Name) IJeA.fivCj
,
Cv.u.s u ITA-.v r.!
(Address)
/19ft
if.)
J11Al/J
(Address)
(Phone) q.r;.. - 71)"8'- if 11-7
/Vu,.; PI'.A~uu 1)1., 0 7 I
(Cityl (Zip Code)
(Phone) &1 ~].. - 7 S-8 - '11 '2- 7
DATE
(Contact Person)
S'c 0 rr HA JJ
M;r:~
APPLICANT SIGNATURE
c/
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION ~PLACEMENT 0 AL TERA TIONS
FURNACE MAKE AND MODEL24L.Le.tV/VtlX 631- VS -ltJo c;~ Z v~- izS FUEL /V &
~/I 2-if:-Mt:c. /~S" v,.~ /17, e",<.<
FLUE SIZE ;:." RETURN OPENINGS 1NPUT ton' no'~ OUTPUT q-\ n'H)
, -,
DWarm Air Plants
DGravity
[)?Mechanical
DAir Conditioning
DVent. System
HEATING OR POWER PLANT
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
TYPE OF 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
$39.50
Residential, Heating & AIC (New Construction)
Residential, Heating Only (New Construction)
$39,50
$39.50
Estimated Cost $
Building Penn it #
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
39, r 0
.50
1./0. 00
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
pai~ 1.;;7, OU Reci!!J fr; 5' 1
I .
Date ..:J . By /""'~.......-
iJ--;'JO -Od- ~
(J'
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
5 2-/~t'2-
ADDRESS
.::5-290 /1l2OJ. / ~o / NT <!-I.e s C
OWNER
CONTR.
PHONE NO.
PERMIT NO.
02- -04-54-
COMMENTS:
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
~GASLlNE AIR TST
/' W-E{/.e.N'~~
I7P..JHT~~
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
C1-VJ6 P10t=-
&dWORK SATISFACTORY, PROCEED
1;- CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: Th. ~ Owner/Contr:
CALL 447.985~OR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl
e
e.
GAS L1Nr: AND
APPLIANCE PERFORMANCE TEST
(Contractor to complete' items)
(Attach to gas line adjacent to regulator)
'Heating Contractor ..#'~. 6tboftl/~A ~
;1 .
'JobAddress~C/ '''';'-h '~;~.,/ C;:-.c/p f"E"
GAS LINE AND
APPLIANCE PERFORMANCE TEST
(Contractor to complete' items)
(Attach to gas line adjacent to regulator)
'Heating Contractor #~,~tSV~""~-
'Job Address ....?~P F~-:/ft,:.,i~'.;':-rk f'.E
Approved
'Percent C02 ~ 3%
'Percent 02 1jI,~~
'Permit#
'Percent CO CJ 'Z
~
'Stack Temp./ h
Approved
'Percent C02~" / %
'Percent 02 9'~
'Permit#
'Percent CO ~
4!1'
'Stack Temp /.2/
'Permit #
'JobAddress ~~ r.-s=..J-;;:::'.'-~~~~S~-
'Heating Contractor ~ ~~v/~~ >:I
. ~C"'/
'Testers/Signature ~~..:? ~ ~
'Permit #
'Job Address...s:::>;O r -""Jt!PS.~ ~. ~ ,I.. ~:'1!.~.s-~
'Heating Contractor ~, ~~v/"'-:#9;f
'Testers/Signature ~ 5"'.5"-->
Date
Time
Pounds
Pressure
Date
Time
Pounds
Pressure
'Gas Line
Pressurized
'Gas Line
Pressurized
Inspected
Inspected
PERFORMANCE TEST
PERFORMANCE TEST
'Percent C02 b' '5%
'Percent 02 SI,~
'Percent CO t:7 Z
'Stack Temp /9,,"
'Percent C02 6' ,/Z
'Percent 02 9',;,29:>
.Percent CO ~
'Stack Temp /.;i}'~
Final Inspection
Date
Final Inspection
Date