HomeMy WebLinkAboutHeating Permit 09-0239
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS ..~~(g
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
DATE
SCHEDULED ~/~
LJ~~ ~tVJ/
f
q - 23'r
CONTR.
PERMIT NO.
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
}ll MECH FINAL
TIME
o EXIGRAD/FILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
~WORK SATISFACTORY. PROCEED
o CORRECT ~ AND PROCEED
o CORREa w~ti CALL FOR REINSPECTION BEFORE COVERING
Inspector: I LV / Owner/Contr:
CALL 447-9~R THE NEXT INSPECTION 24 HOURS IN ADVANCE.
~IREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTI
HOUSE
ADDRESS ?-~;tt p i i ~ \, uJau.
OCCUPANT DA.\'~ \'V\J \ \,e.f ..J
HEAT LOSS . D~ HJG. IH.ST.
SOLD BY. C-en.-\-et- t-b I ~ 1" ~l{
Elec~ical Work By "~\.A' ~ hr~ \ ~ - .-J
TYPE OF HEAT GA _ FA ~W. STEAM
MAKE ~€>c... \J 4010S DESIGN
Model. f~~ er
Serial ~~Cf/4 \J'3~C)
INPUT q(j .tDOt)
CONTROLS
THERMOSTAT
Valve.
Limit _
Heat Plug _
r-:
'\..---
- '\
I-!-e(~
Limit Setting
Fan Setting
Pilot Type
Pilot Make
Pilot Model
Pilot Timing _
L. W. Cut Off
~~D
Pre..ure .... . '"-'
Input CFH~.Lla.1 ()
Stack Temp. '~":3 - 3
H EATING TEST RECORD
Aw
CIT~+>' L. .SUBURB
.FLOOR
APT.
OWNER.
INSTALLED BY ::Eon ~
rv\~ch~.,C0{
Ga. Line By
SPACE HTR. _
UNIT HTR.
.OTHER
CONVERSION
MAKE OF BURNER _
_ Model _
_ Mox, BTU Rating
_ MAKE OF fJ.lIlt!ACE (' ~ ~er
Model _ S ~G VA <..-,q () ,- -
-( - - ! {"
(I
Vent Size 4
NONE -
_ KIND OF LINER. . SIZF
_ Draft Hood - . Regulator
. Fi Ite,. Size ~..{c9S~ '-t.-~,?,ber
. Chimney Location . Insidis ^- Outside -
, ,,, . ~
_ Chimney Construction: - ,-",,,,,,-,
r
. Smoke Bomb _ Wiring
_ Draft T..t Tag
_ Door Pre..ure Lighting Inst. _
PercentC02 1-77"0_ Date T..ted _ S-\<;--~9 ,(
Percent 02~ 90 _ Compony Te.ting ~r)(\~ ~...e('Yh. ~', ("(\
Percent co ~ Name of Te.ter - ~ ~ \" 3--\::JS-
Form 235
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
s: I~ P!
I. Pink
2. Green
3. Yellow
File
City
Applicant
I PERMIT NO'09. 02.391
I
ZONING (office use)
(Please type or print and sign at bottom)
ADDRESS
2526 Waterfall Way
NW
Prior Lake
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name) Dave Muller
(Address) 2526 Waterfall Way NW Prior Lake 55372
(Phone) 9 5 2 - 9 3 5 - 6 1 5 5
APPLICANT Ron I s Mechanical Inc
(Name)
(Address)
12010 Old Brick Yard Road
(Address)
(Phone) 952-445-8585
Shakopee 55379
(City)
(Zip Code)
(Contact Person) Linda
APPLICANT SIGNATURE ~~ CQJr..~
~-
APPLICANT PLEASj: COMPLETE BELOW
DNEW CONSTRUCTION ~REPLACEMENT D AL TERA TIONS
FURNACE MAKE AND MODEL C11Vyjw FUEL ;Vb
FLUE SIZE RETURN OPENINGS INPUT !ll100b. OUTPUT -::tal ()fX)
TYPE OF SYSTEM HEATING OR POWER PLANT
(Phone)
952-445-8585
DATE
6.-:-/812'1
DWarm Air Plants
o Gravity
o Mechanical
DAir Conditioning
DVent. System
o Steam
o Hot Water
o Radiation
o 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
$49.50 minimum
$149.50
$64.50
$49.50
Residential, Heating & AIC (New Construction)
Residential, Heating Only (New Construction)
Residential, Additions & Alterations
Residential, AC Only
$49.50
$49.50
Estimated Cost $
Building Permit #
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$ Lf1.r;v
$ .50
$ S7).r:;U
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Buildinl! Official
Date
Paid C;V.. {/2J
Date r ~ ~ (/ 7
. Rec~o. S7ftty'
~,
o
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S,E., Prior Lake, Minnesota 55372