HomeMy WebLinkAboutMechanical 03-0239
CITY OF PRIOR LAKE
.
HEATINl;/ATR CONnTTTONINGIFIREPLACE PERMIT
REQUEST FOR FINAL
INSPECTION SENT TO
HOMEOWNER 5/03
Date Rec'd
3...S'.,03
(Please type or print and sign at t. '"'. __)
ADDRESS
~: ~ ~:~. I PERMIT NO. /'1? -0 ' ';:Ja
I. Yellow Applicant ~ ~ 1
332- ~
\J '\ l"
...
~lt"
LOT
BLOCK
LEGAL DESCR1r nON (office use only)
ADDITION
OWNER J
(Name) O~
(Address)
APPLICANT
(Name)
(Address)
6ren. n~ r'\
ZONING (office use)
PIDZS-1IJ - OI4'-D
(phone) 9S-l-ZG~-'-lS5 ~
(PC L - fc>1 ~ -'-{ Yl( J
,
(Phone)
(Address)
(City)
(Zip Code)
(Contact Person) ~ (Phone)
~- uPLICANTSIGNATURE( _ 1 -:) DATE ~ --'7- 0 ~
APP{ICA~T PLEASE COMPLETE BELOW
DNEW CONSTRUCTION 0 REPLACEMENT 0 AL TERA TIONS
:tUR~~ACE ~KE AND MODEL . FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM
HEATING OR POWER PLANT
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
OWann Air Plants
DGravity
o Mechanical
OAir Conditioning
OVent. System
~PLAC~KE AND MODEL
Estimated Cost $
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
Building Permit # () .I" () 1,3 _7
Industrial, Commercial & Multi-Family
Residential, Heating & AlC (New Construction)
Residential, Heating Only (New Construction)
Alice Use Only)
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$ 3'" 50
$ .50
$ ~O.oO
This Applic~~io~romes Your Building Permit When Approved
(7J1j t- 1-- ~ -0)
Building Official Date
Paiq
"r() - c/7)
Date
3 - t -( >
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372
T
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
$39.50
$39.50
$39.50
Recei,~o1 r7
By r1-
Q
,.
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
-?-~J
ADDRESS
75J.3 l/l;t l~ .
.:> L- {/L.....~
CONTR.
OWNER
PHONE NO.
"?-- ~ . )..:J ~
PERMIT NO.
F
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI 0 EXIGRADIFILLING
o MECH RI 0 COMPLAINT
o WATER HOOKUP 0 FIREPLACE RI
o SEWER HOOKUP 0 FIREPLACE FINAL
o PLUMBING FINAL 0 GASLINE AIR TST
o MECH FINAL 0
1t),0 I~aitv / ;::;uvu u-I,.,a-
I
COMMENTS:
-- --- -, -.......
~
/ t
/ / / ?t -
! I l ()X
~ ~'-
'-----
~
r: ~ )
f { /
~
6' WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: (lI;f? ~ - U ~ Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
lNSNOTl
"-
"
.____;,i4
.-.-
APPLIANCE
PERFORMANCE TEST
..
Locate near the furnace manual
LP Gas"-- Natural Gas J
Job Address~.3 Y"'~' e (",or. -p{.
,
"
Heating Contractor
Name of Tester ~\ ~ .
Date
0(0- 2:/ - 01)
&,'(D
1:>(
<3%'
Y 7!;o
, Percent O2
Percent CO
Percent CO2
, Stack Temp.
Pressure
White - City Copy Tag. Site Copy
't-. ..
I 83q
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