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CITY OF PRIOR LAKE
IIlSPECTIOIlIlOTICE
SCHEDULED
ADDRESS
!,[/ .~ ~,.V\ ~V
CONTR.
OWNER
PERMIT NO.
PHONE NO.
o PLUMBING RI
o MECH Rl
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o FOOTING
o FOUNDATION
o FAAMING
o INSULATION
o FINAL
o SITE INSPECTION
DATE
TIMe
~-(3
;,..-
~-rOd~
o EJUGAADIFILLING
o COMPLAINT
~PLACERI
~~pl.ACE FINAL
;.:ruASLINE AIR TST
0_
COMMENTS:
-
-
/~
U7
.............
-
.-
-
=
~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT ~~LL FOR REINSPECTION BEFORE COVERING
Inspector. -f.1I- ~ /(). -0" Owner/conlr
CALL 447-9850 FO" THE NE,XT INSPECJ'0N 24 HQIJRS IN I'.DVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH .l SAFETY!
,NSf<<}fJ
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
7. ? 9. (j3
;;;~ ~::y I PERMITNO.,-..,?-/ooO I
3. Yellow Applicant L.t.J
(Please .!,VDe or orint and sign at bottom)
ADDRESS
/..!?/?(f ~eLJYI
OalJ 1f'1
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID Z5. 1J'/. ()04- ,0
. (Address)
/J rJ /.1AfX.1' k /A-
Oak~ 7/-/.
APPLICANT \ If ({ ..f.- '-- I {(
(Name)~r',^ -"-.JrtYJ>. IJ t"Ov"I~ '\;f"- 11 t1 )IVlt:J (Phone) 95/:)- -19'/1 ~07c,-g.'
~R'S'/) (A2:..~ ffuy 13 /JUY)4 tcr:/!k:. /l1/V (t-!:3::;Z
(Contact Person) _tlJ.....2Jr....Cf'/'j. (Phone) CJ''7~:fyC,... o7~~
APPLICANT SIGNATURE # ^ j DATE '%y ;;l..t1f~h'?
APPLIC NT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION 0 REPLACEMENT ~ AL TERA TIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
~ IJ V'll {In
(5/5 ff (}'.1'.qPYl
(phone)
qs~ ~/fif7-3q52
OWNER
(Name)
(Address)
TYPE OF SYSTEM
HEATING OR POWER PLANT
DWarm Air Plants 0 Steam
DGraviIy 0 Hot Water
o Mechanical 0 Radiation
OAir Conditioning 0 Special Devices
OVent. System 0 Other Devices
FIREPLACE MAKE AND MODEL ;l,)uJf"1) h ''((1 #" (J /J 1. 3D
PLEASE NOTE:
Air Conditioner Unils
Cannot Encroach into
Required Side Yard
Setbacks
oat; Ifrls,t)V'!:
"......
Residential, Heating & Ale (New Construction)
Residential, Heating Only (New Construction)
FEE SCHEDULE
1 % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64.50 Resideotial, AC Ooly
$39.50
Industrial, Commercial & Multi-Family
$39.50
$39.50
Estimated Cost $
Building Penn it #
Os' / 06 0
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
39..sv
cP.SO
4tJ.
fiee Use Only)
Building Official
Date
I Paid 1'1J. {IV
I Dat~? VI. 0 3
ReceiPt~s
By -:::f- .
U
This 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