HomeMy WebLinkAbout1984-7657 - new heater GENERAL PERMIT CITYPERMITNO. "r65�I .
CITY OF ORONO , � �_
r.O.EOX 66 Date
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
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Owner � �� Address � � /���� �
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Contractor � �[-�--� Address / � ^
City License No. �f' � ��- State License No.
REMARKS AND PECIAL CONDITIONS
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PERMIT TYPE AND FEE: EW ❑ ADDITION ❑ REPAIR
Inside Plumbing (#fixtures_) Fee $ Water Well Fee $
Water Meter (Size_) Fee $ Mechanical Equipment Fee $��
Meter#
Remote;� Moving /Lifting Buildings Fee $
Municipal Water Connection Fee $ _ Land Alteration (Excavation, Fee $
� Grading, Filling, etc.)
❑Copper
Municipal Sewer Connection Fee $
Fire Fee $
❑ PVC ❑Cast n Sprinkler System (Fire) Fee $
MWCC SAC Charge Fee $ Other: Fee $
On Site Septic System Fee $ After-the-fact Investigation Fee $
ACKNOWLEDGEMENT TOTAL
The undersigned hereby acknowledges receipt of this limited
permit, including acceptance of all special information, ��
terms, conditions ox requirements written above. The ,
undersigned understands and a�ees under penalty of law State Surcharge: Fee $
that this permit is strictly limited in scope to the work, � `a
activity or improvement specified; that this permit does J
not grant any authority to do work or activities requiring Total Amount Paid to City Fee $
sepazate permit approvals; and that this pemlit does not
�ant authority to violate any provision of any City
ordinance or State law,rule or regulation. All work shall be
done in strict compliance with all City ordinances, building
�oaes �aior health department regulations, �a �8u be This permit is not valid until the proper fee is paid and
subiect to inspection, approval or rejection by the City. lt 1S 3 roved b an authorized Cit Official.
Whenever so ordered, the undersigned agrees to coxrect pp y y
any work found to be in violation of the conditions of
this permit.
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ature of A�� ican��" Sign r of City Offi 'al �j,�-,�
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Code:White—File Copy Canary—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt
HOUSE HEATING TEST RECORD
ADDRESS �.�i�� L��IV��1�� APT. FLOOR CITY ���✓CSUBURB
OCCUPANT OWNER /'7�Y C'� C1/�G� Jt`%
HEAT LOSS - �C ' DATE HTG. INST. I
SOLD BY 1-A- �—/¢��_�{�r� INSTALLED BY `� K� "/���
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Electrical Work By Gas Line By �� —
TYPE OF HEAT GA FA�HW STEAM SPACE HTR. UNIT HTR. OTHER
GAS DESIGN CONVERSION
MAKE C�� G � MAKE OF BURNER
Model � '
- Model
Serial ��t��� ����,�i Max. BTU Rating
INPUT �' eG'G MAKE OF FURNACE
Model
CONTROLS
THERMOSTAT� Heat Plug Vent Size S `/ CL��S �
Valve.�i�� �R��C KIND OF LINER SIZE NONE
Limit Draft Hood Regularor
Limit Setting �� e�� Filters $ize Number
0
Fan Setting ��� Chimney Location Inside Outside
Pilot Type S'���i�� Chimney Construction
Pilot Make —��,�,�
Pilot Model Smoke Bomb Wiring
Pilot Timing Draft Test Tag L'�
L.W. Cut Off Door Pressure Lighting Inst.
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Pressure 3� Percent CO2 7/ � Date Tested �� • ' �
Input CFH ��.�n _n Percent 0 F'�� Company Testing f- �
2
Stack Temp. -����_Percent CO 0 Name of Tester �� "v
Form 235
Dj1�E / � TIME
CITY OF ORONO CALLED-IN � �
INSPECTION NOT SCHEDULED p — �S_'-
PERMITNO. ��� COMPLE ED `�"�� /�`J�--
ADDRESS �� l�� �� �
OWNER �C'�-� • CONT
TELEPHONE NO.
❑ FOOTING ,O�PLUMBING RI ❑ SITE INSPECTION
❑ FRAMING �LVIECHANICAL �i..- O EXCAV./GRADING/FILLING
� ❑ INSULATION �� WATER HOOKUP ❑ LAKESHOREJWETLANDS
� ❑ WALL BD. ❑ METER SET/TURN ON ❑ LICENSING
W O FINAL ❑ SEWER HOOKUP ❑ COMPLAINT
� � PROGRESS ❑ SEPTIC INSTALL. ❑ FOLLOW-UP
� ❑ DEMOL. ❑ SEPTIC MAINT. ❑ SEPTIC FINAL
Q ❑ FIRE PREV. ❑ WELL TEST PUMP ❑ FIREPLACE/WOOD BURNER
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Q COMMENTS:
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W � WORK SATISFACTORY: PROCEED ❑PHOTO TAKEN
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O 0 CORRECT WORK&PROCEED
V ❑ CORRECT WORK. CALL FOR REINSPECTION BEFORE COVERING
❑ CORRECT UNSAFE CONDITION WITHIN HOURS. INSPECTOR WILL RETURN.
❑ STOP ORDER POSTED. CALL INSPECTOR.
p INSPECTION REQUIRED. CALLTO ARRANGE ACCESS.
call for the next inspection 24 hours in advance.
Owner/Contr. o site
I nspector 41.;-7357
White Copy/Inspector's File Gold Copy/Site Notice