HomeMy WebLinkAboutHeating Permit 04-0999
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U CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
DATE TIME
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SCHEDULED
OWNER
CONTR.
PHONE NO.
PERMIT NO.
~/- 9T7
o FOOTING 0 PLUMBING RI 0 EXIGRADIFILLlNG
o FOUNDATION 0 MECH RI 0 COMPLAINT
o FRAMING 0 WATER HOOKUP 0 FIREPLACE RI
o INSULATION 0 SEWER HOOKUP 0 FIREPLACE FINAL
o FINAL 0 PLUMBING FINAL 0 GASLlNE AIR TST
o SITE INSPECTION ~CH FINAL 0
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d4,ORK SATISFACTORY, PROCEED
/6'~ORRECT ACTION AND PROCEED
o CORRECT WORK, CAL FOR REINSPECTION BEFORE COVERING
Inspector:
Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETY!
INSNOTl
;& PRI~
fUr
~N":V
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
ase type or print and si~ at bottom)
JDRESS
/Sd~ {S/l1e~rJt} C/rG/e.
LEGAL DESCRIPTION (office use only)
LOT /OBLOCK / ADDITION s~;JWI'U LA'
OWNER
(Name) a \ \ e.~
(Address) I S:J l/J
(!,'e rKe
g/lAe~rAJ {! ;r-cJe..
APPLICANj1\ , .A J".
(Name) t"'~,O, _~ \-\-\-0.. ~~
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(Address) -LG,~t:::;8!I felab/e ~rcJl)K lj
(Address)
(Contact Person) l:)e..o...~_A r-e... \r\~':\
APPLICANT SIGNATURE )~ ~
Date Rec'd
10,5. ()4-
~: ~~n ~!:y PERMIT NO. 0 A-. oaq a
3. Yellow Applicant 7- 7 J
ZONING (office use)
/Usa
PID 25. /~s: 010.0
(Phone)
(Phone) 9SJ-l/~ 7- 8/ J 0
fr,'l)r L~K~ I11AJ .sS37:).
(City) (Zip Code)
(Phone) 9,-<;:;; -~ '17-- <;<11 D
DATE JI)~-dCJO'l.
APPLICANT PLEASE COMPLETE BELOW
"
DNEW CONSTRUCTION ~REPLACEMENT 0 AL TERA TIONS
. LJRNACE MAKE AND MODEL FUEL
FLUE SIZE l:, if RETURN OPENINGS INPUT ./ tJ tJ OlJ iL OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
~ arm Air Plants
DGravity
~ Mechanical
-~ir Conditioning
DVent. System
8C>DC>O
D Steam
D Hot Water
o Radiation
D Special Devices
D Other Devices
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
FEE SCHEDULE
1 % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
FIREPLACE MAKE AND MODEL
Industrial, Commercial & Multi-Family
Residential, Heating & AIC (New Construction)
Residential, Heating Only (New Construction)
Estimated Cost $
HEA TING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIt. FEE
(Office Use Only)
~his Application Becomes Your Building Permit When Approved
Building Official
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
$39.50
$39.50
$39.50
Building Permit # () f-', 0 9 CJ 7
$ 39J-Sn
$ .50
$ lftJJN\
Paid 4--'(). 0 0
Date I (), s: () .,.....
Receipt No. ~7eS5
, By 41Jif
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.JobAddr_.6.I~~tN e ",.I e.1s:l,::l
.HeIding ConIrIlClor . - 'L ~Il/c
1--
.T estera/Signatur.
Q!!!
Time
Pounds
r ",."ur.
.Gas Une
Pressurized
Inspected
.Percent C~
PERFORMANCE TEST
'J .Pet'centCO {) o/D
~ .Stack Temp. :3 gs 0
Date IC>'~
.Pefcent O2
Final Inspection