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CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
l{7~
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
/
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-
DATE TIME
SCHEDULED
S~2~
,Adrt"wt C:w
CONTR.
PERMIT NO.
.3 - s-&-<1
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXIGRADIFILLING
o COMPLAINT
,..erT=IREPLACE RI
o fIREPLACE FINAL
~GASLlNE AIR TST
o
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I (SC
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2f' WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WOy? CALL F~ .....ROINSPECTION BEFORE COVERING
Inspector: (/0 /' r;"..- ]) 7' Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNon
CITY OF PRIOR LAKE
ltEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
I. Pink File PERMIT NO .I /
2. Gt-een City . 3- c 0...,
3 . Yellow Applicant '-.:> 0
(Please type or print and si2ll at bottom)
ADDRESS
'-I ? /J 8 I) dY' lrJ Y} (! /t'
ZONING (office use)
"KISD
LEGAL DESCRLl'uON (office use only)
WT '1BLOCK I ADDITION Ufiz:..YHA ~
I V-V-()
OWNER --r'.. m
(Name) ! (1 ill . ~ ()' ~p,
~ g ~f}rI (' I ~a Y\ ;tJ I Y, c / to
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~;;~~ANTF(V't?~J~_ fUay,f.h q, ~(.) - (Phone) tf'~~- YC1(J-- ;:J.//?g
(Address) ?~~-O (j), ff fJ/ll I-=? Bar)1~l/b!IQ ,)n}J/. _~~5?/)
(Address) ~ ' (ity) I (Zip Code) r
(Contact Person) /)1 e I ti ') ar .. (phone) '2-'" ~-IJ?-s-IJ
APPLICANT SIGNATURE ._ 'a".-v~j ~ ~ · DATE /iJ~ If t;tJ-- 10;;>
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION 0 REPLACEMENT 0 AL TERA TIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
PID a 5 -0 q /-0 D tI
(Phone)
9~J-LjLj?-7rJ-8J,
(Address)
TYPE OF SYSTEM
DWarm Air Plants
o Gravity
o Mechanical
DAir Conditioning
DVent. System
HEATING OR POWER PLANT
Industrial, Commercial & Multi-Family
o Steam PLEASE NOTE:
o Hot Water Air Conditioner Units
o Radiation Cannot Encroach into
o Special Devices Required Side Yard
o Other Devices Setbacks
1k4f~ J1J-{;/O flt.IJJe):'~(~hg[,s,f't'rl:
FEE SCHE~ULE fJa.~ JreCI~ed
1 % of job cost Residential, Gas Fireplace $39.50
$39.50 minimum
$99.50
$64.50
Residential, Additions & Alterations
Residential, AC Only
$39.50
$39.50
FIREPLACE MAKE AND MODEL
Residential, Heating & NC (New Construction)
Residential, Heating Only (New Construction)
Estimated Cost $
Building Permit #
REA TING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$ $0.00
$ .' .50
$ '-10/
1ice Use Only)
Building Official
Date
Paid J j .--"
'-'1'IJ /
Date5 -' /5--D3
ReLJ~~ II~
By > t(v ,
fhis Application Becomes Your Building Permit When Approved
24 hour notice for all inspections (952) 447.9850, fax (952) 447-4245
~ 16200 Eagle Creek Avenue, Prior Lake, MN 55372