HomeMy WebLinkAboutHeating Permit 07-0245
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
fJ1(J'7f7
ADDRESS
S7~ r<.-.,l..lA/1J7fd
OWNER
CONTR.
PHONE NO.
PERMIT NO.
7-~
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COMMENTS:
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
r-<lYVLa.~ / A-1~
/
o EXIGRADfFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
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~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WOR~. CA"R REINSPECTION BEFORE COVERING
Inspector: fillY / Owner/Contr:
V -.J'
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTI
SEDGWICK HEATING & AIR CONDITIONING CO.
8910 WENTWORTH AVENUE SOUTH. MINNEAPOLIS. MN 55420 . (952) 881-9000
ADDRESS 57(Jj~CHWJaA. AVE /liE
OCCUPANT -Lf}.. liJiLfEL -5.or\t-It..l:AL5.
SOLD BY J -XJ)JTlJNflV
L&JJ.JDX
SERIAL NO. )70 6 1<:. (7 ,-( /9 t
THERMOSTAT V ~ ~6()()
/-10 I/J -c \~ t.J~ II
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INPUT CFH _ {p
{ J '8" PERCENT CO
MAK<=
VALVF
LIMIT
LIMIT SETTING
FAN SETTING
PILOT TYPE
IGNITION MODEl
PILOT TIMING
PRESSURE
5?
C;
o
PERCENT CO2 .
PERCENT On
STACK TEMP.
FORM 235 (REV. 11/89)
JOB NO 5870lt
HEATING
TEST RECORD
b.[f)~ LAKE
CITY
OWNER ~
INSTALLED BY (1,4 '1..
MODEL
INPUT
VENT SIZE
TYPE OF LINER
LINER SI71=
FILTERS: SIZE
WIRING
TEST TAG.
LIGHTING INST.
DATE TEST<=n
/
GO(/
.{I (j '/
c Y J
GAlL- ~
$'0 ~CJr J?4'\ /
-- ---- ---
G~l/l1~{36
'600G
-
v-,//( 4
lj, q.. 0 I
S'~J
'2~
COMPANY TESTING
NAME OF TESTER_
. ~ WI CY<....-.-
~
FORM DISTRIBUTION: WHITE COpy - JOB FILE YELLOW COPY - CITY
1~'SSct2B
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
; ~::n ~~~. I PERMIT NO. 07. 0 ~" r-t
3. Yellow Applicant ~ I
(Please type or print and si~ at bottom)
ADDRESS
S 70 S bir ch LDoool ftvc Nt
ZONING (office
use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID L<; _ 'L0\ DC; 2. ()
. -
OWNER . ^ I" . C'
(Name) m~GV'(~\ 2>imp~h.~
7<,. Z - i.-/ t-{ S . b ( 7 b
(Address) 'St-~
(Phone)
(Address)
:d);:',VICf( HEATING & AIR CONDITIONING LLC
2:]10 Wentwar.~ .",,'e.
r,~,nne()polis, MN 55420
(952) 881 .9000
(Phone)
APPLICANT
(Name)
(Address)
(City)
(Zip Code)
(Contact Person) (Phone)
I APPLICANT SIGNATUR~V~~ILJ\UL- Ug, DATE y) I 10,
APPLICANT ptEASE COMPLETE BELOW
DNEW CONSTRUCTION -,glREPLACEMENT 0 AL TERA TIONS
FURNACE MAKE AND MODEL (Ont1DX hhl M PI! ~ 10 e, Of I FUEL G,Q...3
FLUE SIZE RETURN OPENINGS INPUT 70,000 OUTPUT lo G, So 0
TYPE OF SYSTEM HEATING OR POWER PLANT
DWarm Air Plants
DGravity
&1 Mechanical
@.ir Conditioning
DVent. System
D Steam
D Hot Water
D RadiatiDn
D Special Devices
D Other Devices
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
FIREPLACE MAKE AND MODEL
Residential, Heating & AlC (New Construction)
Residential, Heating Only (New Construction)
FEE SCHEDULE
1% Dfjob cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
$39.50
Industrial, Commercial & Multi-Family
$39.50
$39.50
Estimated Cost $
HEATING PERMIT FEE
STATE SURCHARGE
TOT AL PERMIT FEE
Building Permit #
$ ;'1. $ 0
$ .50
$ Y Q. DO
(Office Use Only)
J:F JtJ/11/
Receint No. ~ J --( ~ J
By ,
), .
U
Buildin!! Official
paidtfo . uV
Dat~
Date {j, .,rJ , r1
24 hour notice for all inspections (952) 447-9850, f~X (952) 44/-4245
This Application Becomes Your Building Permit When Approved