HomeMy WebLinkAboutMechanical 06-1071
DATE TIME
CITY OF PRIOR LAKE .3Icr/q
INSPECTION NOTICE SCHEDULED
, ,
ADDRESS L)~ I Qua.W \f
OWNER CONTR.
PHONE NO. PERMIT NO. tn-tO?!
o FOOTING o PLUMBING RI o EXIGRAD/FILLlNG
o FOUNDATION o MECH RI o COMPLAINT
o FRAMING o WATER HOOKUP o FIREPLACE RI
o INSULATION o SEWER HOOKUP o FIREPLACE FINAL
o FINAL ~ PLUMBING FINAL o GASLlNE AIR TST
o SITE INSPECTION MECH FINAL 0
COMMENTS:
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~~
~
JJ) It" L.t>
I ~-. . \...
)t WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
.......
RK, CALL FOR REINSPECTION BEFORE COVERING
Owner/Contr:
\..., ..../
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
HEATING
TEST RECORD
JOB No,5"'8t.f ( /
ADDRESS L12..5 I & LA a. ~ Y" T l
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L. tn n l> Y .
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lERMOSTAT V P ~ D 0 0
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LIMIT ~~S-).N ) " "\
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FAN SETTING ~4
PILOTTYPE 'ff'.'-)--k:'-
IGNITION MODEL~ (/"A'
PILOTTIMING -:J:1/.1fi p....... I
PRESSURE ~ .5. PERCENT CO2 '
INPUT CFH ~ PERCENT O2
STACK TEMP. ~ PERCENT CO _
V v
FORM 235 (REV, 11/89)
OCCUPANT
SOLD BY
MAKF
:;ERIAL NO,
LIMIT SETTING
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J~ff 1et-er-s- 0 V\
INSTALLED BY. ~ \1\ I) tr.....
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VENT SIZE I"
TYPE OF LINER Jl vtJV 1
LINER ~'71= )J)\"fi
FILTERS: SIZE / ~ 54 NUMBER _ J
WIRING r::;-~ ~ I
ti
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COMPANY TESTING ~
4 ',f ,
NAME OF TESTER Itk---I-
FORM DISTRIB ~! '~~ COpy . J~B F:L YELLOW COPY. CITY
CITY
OWNER
MODEL
INPUT.
TEST TAG _
LIGHTING INST.
DATE TESTFn
,
1) S5~6 \
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
1. Pink File PERMIT NO b /
2, Green City . . /07
}, Yellow Applicant
(Please type or print and sij(n at bottom)
ADDRESS
ZONING (office use)
~1.S\
Q \All\, V oA'""' I or 1
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER 1)-
(Name) J~F r-e.- -r -e-.r-S6.....
(Address) Y'2-S \ &U.o...u.r T r1
APPLICApU;" , I I .. I ~
(Name) ~-e.d3V\JQt-KocnJ
(Address) ~ ~ J () \AI (~rrt W 0 {--i'h
(Phone) q~2 - '1'17- b~3\.j
(Phone) '15. 2.. BB 1- 9 D6 0
-Ai e- Nt pis (City) S5 LJ 2 (g Code)
(Contact Person) _ _ (Phone) Q<:2. f/A 1- 9 6 tJ6
APPLICANT SIGNATURE V W ,yv~ ~A'JJ,t ~ DATE /I Iw 16 b
APPLICANT PL~A~E COMPLETE BELOW
DNEW CONSTRUCTION ~ REPLACEMENT 0 AL TERA TIONS
FURNACE MAKE AND MODEL i QA'1 VI 0 )( ~ 6 D U. ttv ~lo 6"1 6 FUEL 6 GiL~
FLUE SIZE RETURN OPENINGS INPUT 9 O. 000 OUTPUT /2-,000
(Address)
TYPE OF SYSTEM
~ann Air Plants
DGravity
o Mechanical
DAir Conditioning
OVent. System
HEATING OR POWER PLANT
o Steam
D Hot Water
o Radiation
D Special Devices
o Other Devices
PLEASE NOTE: Air Conditioner
Units and Fireplaces Cannot Encroach
into Required Side Yard Setbacks.
Fireplaces with Box Additions or
Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL
Industrial, Commercial & Multi-Family
FEE SCHEDULE
I % 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 $ -39. '30
Building Permit #
HEA TING PERMIT FEE
STATE SURCHARGE
TOT AL PERMIT FEE
$
$
$
3 '1.5 0
.50
'-1.0.00
'fiee Use Only)
Buildinl! Official
Date
Paid ~(),~ 0
Date /~,~, ~ b
/J
:;:tNO 5u~
U
This Application Becomes Your Building Permit When Approved
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372