HomeMy WebLinkAboutMechanical Permit #03-1275
- ,- CITY OF PRIOR LAKE DATE TIME
...
INSPECTION NOTICE SCHEDULED /1-1).-())
.
ADDRESS ~(,~L fA/ f II IIu ~v'1
OWNER CONTR.
PHONE NO. PERMIT NO. 3-127S-
o FOOTING o PLUMBING RI o EXIGRAD/FILLING
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 o PLUMBING FINAL o GASLlNE AIR TST
o SITE INSPECTION o MECH FINAL 0
COMMENTS: FvviI'JlU
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~RK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT ~~R~R REINSPECTION BEFORE COVERING
Inspector: ~ Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl
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HOUSE H EA TING TEST RECORD
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ADDRESS . ~ . 1df) 'L, ) 1 Lil':\ .~'T'" ,. t._.} APT. FLOOR CITy"rt' ( Lb%b~URB
OCCUPANT _/Y"l/-) (\).1 "9 i !-!.../- r.;......., ,'v--" \ OWNER "\,., _. "."-
HEAT LOSS DATE-HTG. INST. .c:y~ J ~ ~ .'"", ~
SOLD BY ~ J rY"' f r-...I f'v I ~ -/) (" r" , ......- -. INSTALLED BY ,,('r\"
"-'1 Q.XJI :/-l' -........J
Electrical Work By ,.:"':",1: >- C-1 Gas Line By ~,.
TYPE OF HEA T GA F~ HW I STEAM SPACE HTR'. UNIT HTR.
MAKE
Mo~el _
S.,iol
INPUT
"l ' GAS DESIGN
PC!)t /)
S?:,"", \J f;:') ) 1'1 - 1-,...") ~
.... ..-, ~ ,..." (...-' i...( I-V ) '5
___.j' /" l ~_d"') 11 f . t<.
, I ,.-~. r., ~ r-............
CONTROLS
THERMOSTATr,L,L :'L/ Heot Plug"
Va Ive _ . J,.-} "-.1_.J
. I . ~ J/
Limit 1 ',...:,r--:_ .~ I ""
Limit Setting / h ('\ <<>
Fan Setting -;"',1 ~ t' J"""')
Pilot Type'. !.. ("c. , .~
Pilot Malee "'" f' I'J ,'........
Pilat Model
Pilot Timing
L. W. Cut Off
,-F_
I': ,~.
Pressure.
Input CFH
Sto'ck Temp.
Form 235
"',. roo.'
" "
(\ ''C)
.;:. "', c::: 0-
'-,,,-' ,
\P~rcent CO2
Percent 0
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Percent CO
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/", ~ ~
,:;..:'} C"'"/ __
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MAKE OF BURNER
Model
Mox. BTU Rating
MAKE OF FURNACE
Model
j-/rfor::;;:
, /
OTHER
CONVERSION
......... -
X
"
Vent Size
KIND OF L1NER-r---. SIZE --.., NONF
-~---" ---
Draft Hood RegulaTor-
Fi Iter. Sizec.::--.'" l:;'''I_:"I l..... Y LHumber L.2;)
Chimney Location Inside V Outside
Chimney Construction c~ l C\<::;..r e. (,., II
-.......
Smoke Bomb . ~
Draft _____ ~
Door Pres-sUr~ C::Y... /<:::;
-It ~
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Dote Tested
Company Testing
Nome of Tester
Wiring
Test Tall
Lighting Inst.
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to,
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CITY OF PRIOR LAKE
HEATING/AIR CONDITIONINGIFTRF,PLACE PERMIT
REQUEST FOR FINAL
INSPECTION SENT TO
HOMEOWNER 11/03
Date Rec'd
(Please ~ or print and si2n at b. ..J._)
ADDRESS
~ ~:~. I PERMIT NO. ",-::2 _ J:::J/1 c"
low Apphcant U ../ 10-' ^1'
3&32-
LJ I <<-1-0 <-;;;>
'1) E:. <"\ c... H
s,. . S. w
LEGAL DESCRu- nON (office use only)
LOn BLOCK I ADDITION
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OWNER
(Name) M ~ (2.... s~ ALl..--
{4 0 bf-~tv ~o ~
(phone) q f> 2. - Lf L.f 7- Cf 7'i.ll
(Address)
b6?:>"L
s.w
W (L-L-O<.A.,.)
ST
"$ E:f"\: c.. r-J
ZONING (ofliceuse)
PID ~5-IO g - O/t:> t:?
APPLIC~
(Name) ~f-~I\"')~"t'\.""1 14t~\,-.a.(, ~ A\fL. (Phone) !,,2-72--Y- (85.3
(Address) f &I,~ ~ - ~,5' 5,- S v (JC:- A ~\~~~......F'a,-..s. MfIJ 5.5'-10 r-
(Address) (City) J (Zip Code)
AI'..).....C=-- L 1 n (Phone)
I~ cc. <~ DATE
(Contact Person)
,r4PPLICANT SIGNATURE
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION ~MENT 0 AL TERA TIONS
FURNACE MAKE AND MODEL LA~~<::R ~ R c..VA 110 FUEL N''fr G f\ ~
FLUE SIZE RETURN OPENINGS INPUT ( I 0 J tJ 00 OUTPUT ~ r> / 00 2)
TYPE OF SYSTEM
HEATINGORPO~RPLANT
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
OWarm Air Plants
OG~
(31Vfechanical
OAir Conditioning
OVent. System
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
Residential, Heating & A1C (New Construction)
Residential, Heating Only (New Construction)
Estimated Cost $
Building Permit #
~
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$ 3~ -5 w
$ .50
$ '-to ' 00
lice Use Only)
'$ Application Becomes Your Building Permit When Approved
Paid tj 0 .----
Date t!--/cf--.3
Building Official
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
$39.50
$39.50
$39.50
ReceiPll~ 3/f3
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