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CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
Cj.:sO. 0 J
~. ~~n ~:~. I PERMIT NO. /I? _ n '71
3 . Yellow ApplIcant U..J I.J '-'
(Please type or print and si2ll at bv."'=)
ADDRESS
SYj{) Fo...\ '" \ o..w1\J -SAor~~ 7..1-
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID z5.. ()3/. 0&. 5-
OWNER n ,
(Name) L 0... ~ ~ ~ ~ Yf\ 0...<:\' e \ c- l"')o.... \. "CSl
(Address) S'IJ.D Fo....\r: \a...v...J IV' ~~ON:'5 ""L
(Phone) q ') .J-LJ Y '7 -t~ '/1/
APPLICANT (] , /
(Name) ,-" \. Or L..", Kt'- \4\-c" &-A c:
'-.)
(Address) It,-~~iJ Ikbh)~ Arc)()J:L!..J-
(Address)
(Contact Person) Ue.o....0 -A Ie. ~J. \-
A.PPLICANT SIGNATURE (~ ~
(Phone)
P/';LJr L 6.../(e
(City)
9,5;,:)-1../1.) 7- <is) } 6
/nM SS-3J~
(Zip Code)
(Phone) S)~.2 --1./'1 ;-R J) ()
DATE 9.-,~d-(\~
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION .e!\REPLACEMENT 0 AL TERA TIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE ~ I r RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
~Warm Air Plants
DGravity
9 Mechanical
DAir Conditioning
DVent. System
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
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
$39,50
Residential, Heating & NC (New Construction)
Residential, Heating Only (New Construction)
$39,50
$39,50
Estimated Cost $ ~DOO~
Building Permit # tJ J - J> z....../
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
~ 91 SO
.50
~DJtJQ
lice Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
pa~. ,rv
Da~. 30, 0 ~
Receipt N~5...?
~
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372
I -. --- ~
.Permit. -I-tl ~ ~ I
:~~:::~ C\~~~~
.'_ ~,U. .
, (! ) /J~~,4-~ &cor'
Q!!!
PotIIlds
Pr_re
Ii!!!!
.a. line
Pressurized
Inspected
PERFORMANCE TES!
.P"'cenI C'7 ~ ^ .Percenl CO () 910
.Percenl ~ q I 9 . .Slack Temp. j ~l) ·
Fin" Inspection
. Dale
DATE TIME
OITY OF PRIOR LAKE 11-IO"C/7
INSPECTION NOTICE SCHEDULED
ADDRESS ~4l-() r::-c, n-- J {w/V\
OWNER CONTR. 13d-/
PHONE NO. PERMIT NO. 3 - tJLf
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:
h""""ItL,..,
----
/' /1
I / I/}c,
~ L/' V~'--
""
--... --
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
/.4-C
/
~
~~
(--I { "" )
/
~
-IflJJORK SATISFACTORY. PROCEED
.If CORRECT ACTION AND PROCEED
o CORRECT ~o:~ "OR REINSPECTION BEFORE COVERING
Inspector: r vr ./ Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
lNSNOTI