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CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULlED
ADDRESS
ILII~r S4un
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OWNER
CONTR.
PHONE NO.
PERMIT NO.
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
COMMENTS:
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DATE TIME
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o EXlGRADfFlLLING
o COMPLAINT
o FIREPLACE RI
.....FIREPLACE FINAL
o GAS LINE AIR TST
o
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(C 1.
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~RK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT W~RK.' CAL OR REINSPECTION BEFORE COVERING
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Inspector: . . Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
''''''''n
- - --1
-. .~._------~--
Date Rec'd
CITY OF PRIOR LAKE
HEATING/AIR CONDlTIONINGIFIREPLACE PERMIT
(Please ~ or 'Orint and sillJl at bottom)
ADDRESS
0'3-
;~.:. ~:;y I PERMIT NO. 111- 3
3. Yellow Applicant CR
ZONING (office use)
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S.1 (Y y e..- iJl0 f..
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LEGAL DESCRlP. TION (office use only) i
LOT q B~O~K 3ADDITION CvV1 c1_ff
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APPLICANT \ A II ,/ ( al II
(Name)_KIV\!?('t'rJlQ. NfJ(1VTj1 'r(f/Jm?', (Phone)Jlf.--:J.~li!}-07~
(Address) '38"5' 0 I{), t-J /JL.lL..-J <, r3/;{y 1'/<;; 1// ift.., I/{J{/
(Addrei81' (City) (Zip Code)
(Contact Person) IJ1 () / (') \'t'!- . (Phone) et;~-R'j1/J~tJ ?.t;;9
f..) ,... . DATE qJ 3/(7."<
OWNER
(Name)
(Address)
APPLICANT SIGNATURE
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PID~5"- ~/c:;-03)-"
sl. ov (.J
L rill ~
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5Y337
APPLlCA T PLEASE COMPLETE BELOW
DNEW CONSTRUCTION ~ REPLACEMENT 0 AL TERA nONS
FURNACE MAKE AND MODEL . FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
HEATING OR POWER PLANT
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
1I-P.f.J '1- J1J~ rrl/J /lAo la/.' SCb7J1/2S f}/VfJ/fMulgar A~,1/~<L
FEE SCHEDULE
1 % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50
$64.50
TYPE OF SYSTEM
OWarm Air Plants
OGravity
o Mechanical
OAir Conditioning
OVent. System
FIREPLACE MAKE AND MODEL
Industrial, Commercial & Multi-Family
Residential, Heating & AIC (New Construction)
Residential, Heating Only (New Construction)
Estimated Cost $
$39.50
Residential, Additions & Alterations
Residential. AC Only
$39.50
$39.50
Building Permit #
REA TING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
39 t;V
.50
UO-
'')mee Use Only)
ihis Application Becomes Your Building Permit When Approved
I
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372
Building Official
Paid
RecetlS- 3l/ S I
~ I
{j
Date
L/ o. ---
tj-3-'?
7
Date