HomeMy WebLinkAboutHeating Permit 07-0241
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
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ADDRESS
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CONTR.
OWNER
PHONE NO.
PERMIT NO.
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COMMENTS:
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
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o EXlGRAD/FILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
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I' WORK SATISFACTORY. PROCEED
o CORRECT ACTION AND PR~D
o CORRECT WOIiaC. Gf.LuroKREINSPECTION BEFORE COVERING
Inspector:
Owner/Contr:
I
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETYI
INSNOTI
HEATING
TEST RECORD
5" SGf )6
SEDGWICK HEATING & AIR CONDITIONING CO.
8910 WENTWORTH AVENUE SOUTH' MINNEAPOLIS, MN 55420 . (952) 881-9000
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1900 '-2D"r
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PILOT TIMING <is S ( CD rJ..S<..
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PRESSURE . ,\,,<:> I ~ ~. PERCENT CO2
-10
INPUT CFH . LV PERCENT 0.0
1J I " ,oF
STACK TEMP. -/ (). )" . PERCENT CO
ADDRESS
OCCUPANT.
SOLD BY
MAKF
SERIAL NO. .
THERMOSTAT
VALVF
LIMIT
LIMIT SETTIN(.l
FAN SETTING
PILOT TYPE
IGNITION Mon!"1
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FORM 235 (REV. 11/89)
JOB NO.
CITY.
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-
OWNER
INSTALLED BY ~ IYJ~.'/ jYIJ r1/k,J,Jru-
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MODFI
INPUT
VENT SIZF
TYPE OF LINER
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LINER SIZF '0 I
FILTERS: SIZE~)( d S
NUMBER.
F\oo
WIRING _
;
TEST TAG
.-
LIGHTING INST.
DATE TESTFn L/ /; U /07
COMPANY TESTING j 4i'~' ~~ /;, fl" /'C
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NAME OF TESTER ~ h/M,A "LIJ I
FORM DI~~ITE COPY. JOB FILE
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YELLOW COPY. CITY
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'1- bS . 00
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING!' (REPLACE PERMIT
Date Rec'd
~. ~~~~w Jl~icant I PERMIT NO. 07. D2~/1
(Please type or print and si~ at bottom)
ADDRESS
I'-\OS S SVlLA-cAj ~~O-.Ch \rl,
ZONING (office
use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID u I). (I 4- () () z. . ~\
OWNER '
(Name) j CLt'Y\ ~ s- M--e_ \ ~."\
CfS?-YYS-3z..sg
(Phone)
(Address) i'-1 0 '3 S
2::, ho..c.0J ~'\',J2._~'""\.,..-'-
APPLICANT
(Name)
(Address)
...,. -liCK HEATING & AIR CONDITIONING llC
. -10 Wentworth Ave.
~~jjnneC1poljs, MN 55420
'Ql=\?~.Ba1 QQI)Q
(Address)
(Phone)
(City)
(Zip Code)
(Contact Person) l::'-l, (Phone)
I APPLICANTSIGNATU~DVu'1_~~Q...Lv-.(s-,. DATE '-1\ \\ lot
\J APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION 'gREPLACEMENT 0 ALTERATIONS
FURNACE MAKE AND MODEL 'v--nn "x. 660 LAri 31.0 m, 0 FUEL bCJ.... 'S-
....
FLUE SIZE b RETURN OPENINGS INPUT (0 000 OUTPUT Slc ,ee:. C)
TYPE OF SYSTEM HEATING OR POWER PLANT
~arm Air Plants
DGravity
D Mechanical
DAir Conditioning
DVent. System
D Steam
D Hot Water
D Radiation
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 % of job 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 $ 6'~ 10 D. 00
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
Building Permit #
$_ 39. S7J
$ ...so
$_ 10,00
(Office Use Only)
Buildinl! Official
Date
Paid 1-0/ (/t)
I Date l' . ;;;V. J)
(
Re~No'5 '!1V3
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This Application Becomes Your Building Permit When Approved
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245