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Mechanical Permit 01-0383
CITY OF PRIOR LAKE Date Rec'd HEATING/AIR C?NDITIONINGIFIREPLACE PERMIT /)---/-0/ PERMIT NO"F- tJ3 g3 ,~" "'ZONING (office use) Rl 1. Pink File 2, Green City 3 . Yellow Applicant (Please type or print and sign at bottom) ADDRESS /7 3'33 Uor/)..OJ../-rr LEGAL DESCRIPTION (office use only) LOTL{ BLOCK 3 ADDITION IJJocrb-,\d~ est ~ NJ PIDOlS -r7'iQ-()cJ-/-G,) , , v~ ~=~R 1( a !JelL! V tl I e" (Phone) ~-if!I2- Cj!L1./S- / (Address) APPLICANT (N ame) ~ (Phone) (Address) (Address) (City) (Contact Person) (Phone) DATE /? ..~.~~ , APPLICANT SIGNATURE (Zip Code) t....f l;2b /0' . - APPLICANT PLEAS:E: COMPLETE BELOW DNEW CONSTRUCTION 0 REPLACEMENT 0 AL TERA TIONS FURNACE MAKE AND MODEL FUEL FLUE SIZE RETURN OPENINGS INPUT OUTPUT TYPE OF SYSTEM HEATING OR POWER PLANT [] Steam [] Hot Water [] Radiation [] Special Devices [] Other Devices S70v~ DWarm Air Plants DGravity o Mechanical DAir Conditioning DVent. System FIREPLACE MAKE AND MODEL ()..tLs U Industrial, Commercial & Multi-Family FEE SCHEDULE 1 % of job cost Residential, Gas Fireplace $39.50 minimum $99.50 Residential, Additions & Alterations $64.50 Residential, AC Orily Residential, Heating & AIC (New Construction) Residential, Heating Only (New Construction) Estimated Cost $ Building Permit # (Office Use <M a;, This ~cffoflf~c ~~I. Building Offi~i;al HEATING PERMIT FEE STATE SURCHARGE TOTAL PERl\1.1T FEE $ $ $ ?Y{ ,SO .50 10.- Paid LfO,~ Da~_I-o) 24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245 PLEASE NOTE: Air Conditioner Units Cannot Encroach into Required Side Yard Setbacks $39.50 $39.50 $39.50 J:i?oV. \O~. {k)5"L.c..At-(~ ~UI~~ OI\J SllG--. ReC~~qs-33 BY~ ..~ National ~valuati APr~30-01 10:56am From- . I Panic;plflns Members: BQC~ .\Rt'....n atmri...ln~ 405, W. F...." RaIa ~~ Ch$ rs.. 1liMii1D47W'115 (701) ....=05 T-621 ,02/05 F-670 ;:'1 Lt j).,l 0 I - .3B3 -Servic nc. ICBO ev4ll".tian Se~h:c. Ine:. SHOW...,.. "'III 'hnncr. ~ aol-2Z&S (sa) -.0543 saccI P&lDrtc 5"f_ T_cing .na EViII~at:ian SIIrvic:e6, "'~ C McnQiIir R'*l. s..,. A iIirrtlI~. ~ S211-,. ('ZDS) 598 1800 . NATIONAL EVALUATION REPORT COPIn;nt c> lll' Nt""'~"" SIMC:N. ".~ - JAaQIltATQRY fOR flR~ & ENVIRDNMENTAL. PLUMSING F1X'tURiS l MATERIA~. ~, ftUCfURAJ.. ASSEMIL!J&. THQCMA&. IMSUI-ATIQN, ~~. NI:AUGAS/OI~ . SOl-I) F\.Is.. FIR~P APP1JANCES . ACCfSSORfI$ AND woaD BASED PRQDUcrS TmlNG ,~. AU at TurING SifMcES NA 1Ne. 70 CODMON hlL-L. RQAP ;ax8QRDUGH.~ 01719 aranch OffiCII: Ell. WHI (WARNOCK HJRSEV) ATLANTA 4317-A Pafk Pri". NW Norcto.~. Gdorgil 30093 C:ORTLAND 393] US RQ~il1 Co"IDI\~. ~II~ ~Qr5 1304$ ~os ~Ga~s 216"1 1 ....Paz R'*1 Suite C 1.1tG~nl NiQ\ltl. CPUfamia 92G77 MADI~g~ 8431 MtJfpny Pri"e MladlelOO. Wi:i~gnsin 53562 MiTRO NEW YORK 90 CQRlm...~ W.,. Unil IS TQla~. NfnW J..-say 075'2 Mlh~~POL.lS 7435 4ln SlI'.ll Norm O~.... M.on.~Qla 55128 MQ~T"EAI. 1 B2' 32nd A,,-.nulI I..Khffll. a..O~IC.. CANAgA HaT 3.11 Report No. NER-TLS13 Roi.s$ued Aug"sr 1. 1997 ""- PtTTSaURG 530 GiII'c;tD Ay,,,,,. Pln$b..rv. Clllifornia 94565 PORTLANl) 3QG3N "3m DriYo "212 a_emm. Qflean 81001 aN FMN~1ICO 13&5 Ad... Cfawl Mtnlo P.. Clllfornia S4G25 TQRQNTQ 3210 Am.iean Privt Mi.liIIIlNSI. anlwtD. CANADA &.4'" 113 VANCOUVER 2 1 1 SchQC)lhOU'1 SVIOl Coqui~lam. lritiah Cal...mJ)i:a. CANADA V31t 4X9 1,0 S\J8JI:"-' J "'~DaraIOrt for fire & env,rooment;~I. ~1I...mDins fixtures & mile,i41s.. 5't'I.d:(~' assemohls. ~nermal ;n~lalIQn. eic:arlCiI/Qc.S/Dil & soliCS fwel f.reQ lappliancf:$ & acc:eSliQr.es. am~ wOOCl QastG praCSl,lcl5 leStlnQ. 2.0 Pf'OPERTY fOR \Nt1ICH EVALUATION IS SOUGHT Tenln; LiDQra'tor, 3.Q DESCRIPTION ImC!fl~~ TeStioG Sc="'i~e$ Nl5 prQvICU!Q QQCumenla'toGn of l:ne t.'lh~ eq....pmenT. pilrsonnea iIN expe~se lQ pertonn ~ng ,n .,corQanc:e w.ln me ~QnQaros uSteQ in Tatne ,. Il t$ me respQt\sJO.1a1'l of Interte~ ~s,inQ Senr,ces 'tg attermine apphcaraihty gf tne ;wrrint f;Qttion of me mnaafQS ,iSled In laDle 1 of tr1t$ repqtl ~"en cooo~eLng J~:it$ reliltng 10 me rnCQel cQde ,.msQlctlQn \ 1Jw ItpQff tJ ,.,..4 10 _ ~" ~, ." _<I ., (fif r~porr3 s....."... b 1M y,ficMr f" fl$ ."l(:4rkMt '.III1Of:~n., 111I$ 14p"". No ~"f "AI ~ p.!Ptwtl ~ * IIMQ1t4l E ....>>114_ ~U,". ln~. (NESl. M4 NJS !P~dJ''''''' ., ~ ".., IIfI) ~'rtlN)- ,'IIe~, ",,..4 _ ~.". Q~ fa 4':) ~ Of oiAt, .... In df~ r~p(lrr (II AI ,.... 4(1'( pt'H..~, ~tJ~rH II) lJwz "/HNI. 7Jr,J$ .,eMf".' :M''''S. .ttll~ ~ ~IH IQ. .rclaauuuh) , nul "qHiJr, ,I . Wp" It> Jb "..,I4IiQII 'iiI'" : t'r"'- . J Plge'oI' A~r-27-01 Ol:35P Apr-l{-UI IZ:14P1 ~'QI- " 1 ;. ... . t . ;. P.02 T-591 P.QZ/D2 F-5T5 I ~ lntertek Testing Services pOll No. J9S026742A-231 Client Jotul U S.A Inc - Poruand, ME Report Date 17-Dcc-98 Pa~e 1 of? Mod~1 :; 0 V -II Gas Fireplace Heat~r LISTING REPORT NO. J9&026742A-231 SAFETY BV ALUATION OF MODEL 3DV.ll Om.ECT VENT GAS FIREPLACE HEA TER FOR. JOUTL U S.A, rNC 400 RIVERSIDE STREET PORTLAND I ~~"E 04104 BY l~ERTEK TESTING SERVICES 1\iA me &431 MURPHY DRJVE MIDDLETON. WISCONSlN 53562 INTRODUCTION Intertek Testing Services ~A In<: (ITS) ofMiddleto~ Wtsconsin. exammed lIld tested a model 3DV.ll direct vent gas fireplace: heater manufactured and furnished by Jorul U S.A. lne ofPonlan<1, Moline The te$;$ were' conducted on November)O - December 7, 1998 for comphance wlth ANSI Z21.88-1998-CS.A 2.33-M9S "Standard for Vented Gai Fireplace Heaters~' and CA...~iCGA-2 17- ~f91 "Gas-fire4 Appliances for Use at fLgh .AJtiwdes'l The reSUlts an this repotl are .LuniTed to :he Items :rubnuned. The test data ~ on file a.t ITS. M.iddleton, Wi~consin A.lt SctVtCct uniknaken ar~ subJcct 1.0 tbf: fQl~ eena-al pOlley: a~Ott5 ~~ ~l.tbnua<<l for ~Xeh1:i1."( \J$E ut"~ cb~n[S to "ham they ~ addresse4. ~r S4~'anc~ Z5 ~JC:C[ rn the adequacy IInJ kprC'3el1tiUVr cl1-ncter o{'U\c J4t1lplcs #l4 to llk tOtnpteheniiv~"S of \be te.$b. e'Cammauons. or $Uf\'t:~'s made. No q\lola~ from rc:ports Or ~ O~. th.! In......:1I:. T c;S'Qq ServiCes NA (I1'S) nam~. logo. 4)t re1!i.:nt;Ted (Win} =W"-. A$ p"nn'tl~d c'(c;~'C 1$ ~~:;ly iutn0ri7ed b) lntero:k. r ~ Sd'VICes NA lr..i:. U\ Wh~g. Jr)A r/<. J...~OO - 797- C; ~ Ie -r(ch S.evtJ/ces DATE TIME , CITY OF PRIOR LAKE INSPECTION NOTICE ADDRESS ~MiB. 01 /133 -=s /I()/C.-IZ-O N '""e... SCHEDULED A.I . OWNER CONTR. PHONE NO. PERMIT NO. 01- () 313 o FOOTING o FOUNDATION o FRAMING o INSULATION o FINAL o SITE INSPECTION o PLUMBING RI o MECH RI o WATER HOOKUP o SEWER HOOKUP o PLUMBING FINAL o MECH FINAL o EX/GRAD/FILLING o COMPLAiNT o FIREPLACE RI o FIREPLACE FINAL GASLINE AIR TST -4tiS -<.I7JV6 ~.?~~9f'~ ~~. ; ~'""?_ ,~~. ..<<,i COMMENTS: )/} WORK SATISFACTORY, PROCEED b CORRECT ACTION AND PROCEED o CORRECT ~ALL FOR REINSPECTION BEFORE COVERING Inspector: ~"\'?---h Owner/Contr: / CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE. CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI INSNOTI