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CITY OF PRIOR LAKE Date Rec:'d
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HEATING/AIR CONDITIONING/FIREPLACE PERMIT , , .1
2. GreenFink File
2. PERMIT // /7/66
6
. �
3. YellowCity NO. /Applicant
(Please type or print and sign at bottom)
ADDRESS _ ZONING(office use)
q vtkA f to l 241 f 5 F ja i
LEGAL DESCRIPTION(office use only)
LOT 1/
BLOCK jADDITION a4j��� .,b 6e 6 9 t A( c✓ / 3r...e9 �� - 0
OWNER n 111
—
(Name) I ( l CInik ► t (Phone)
(Address)
APPLICANT 1 /
(Name) se,C 610 k P/U_Fn.KJitn (Phone) T B/02 ���p SQ5
// � �� P �
(Address) talo� ape— 5e-9 R 6 chL�t e_tC7
(Address) (City) (Zip Code)
(Contact Person) e-L.. 1 (Phone) � I —Es'6 ---S61_5
I
APPLICANT SIGNATURE Arid /% DATE
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION El REPLACEMENT ].ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
❑Warm Air Plants 0 Steam
PLEASE NOTE: Air Conditioner
❑Gravity ❑Hot Water Units and Fireplaces Cannot Encroach
into Required Side Yard Setbacks.
p Mechanical 0 Radiation
DAir Conditioning 0 Special Devices Fireplaces with Box Additions or
El Vent. System ®Other DevicesCantilevers to the Outside of Buildings
b�+�rct01 _ r,�"4.1' Require a Building Permit.
FIREPLACE MAKE AND MODEL
FEE SCHEDULE
Industrial,Commercial&Multi-Family 1%of job cost Residential,Gas Fireplace $49.50
$49.50 minimum
Residential,Heating&A/C(New Construction) $149.50 Residential,Additions&Alterations $49.50
Residential,Heating Only(New Construction) $64.50 Residential,AC Only $49.50
Estimated Cost$ ��
G/�O Building Permit #
HEATING PERMIT FEE $
STATE SURCHARGE $ 5.00
TOTAL PERMIT FEE $ 5-Li<Q
(Office Use Only)
This Application Becomes Your Building Permit When Approved I : l[4 3 0 Receipt No// /
Datee `r • By
(a
/
Building Official Date '^ � �� ` I
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
00+frR/ CITY OF PRIOR LAKE BUILDING PERMIT,
�• ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE Date Rev'd
AND UTILITY CONNECTION PERMIT �1 'Ir��Ntvesotr
i. White File PERMIT NO.
2. Pink Pity /
30
(Please type or print and sign at bottom)
ADDRESS
l 0i\J\
\ (2 C ZONING(office nsc>
Q1 \� J
LEGAL DESCRIPTION(office use only) _
LOT BLOCK ADDITION ] ,
PID
OWNER 1,,\ ` �,
(Name) INrc.3, 1t�\.a` ^�- lie\,,.` ,V`
(Phone) (O\Z -NSs- 2-2-11 *
(Address) ir"\C3.�` —\--?L 5E
BUILDER
(Company Name)
(Phone)
(Contact Name)
(Address) (Phone)
TYPE OF WORK 0 New Constr ction ❑Deck ❑Porch
❑Re-Roofing MillirelnLower Level Finish 0 Fireplace
(]Addition Alteration ['Utility Connection
lNTe7e
CODE: ❑LR.C. ❑LB.C. tta�.
Mise. D��/pcs
Type of Construction: I II III IV V A B
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $ 7000. 00
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for the
above-mentioned property and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted 1
I official can revoke this permit for just use. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
_ pans. I am aware that the building
X ���
' Contractor's License No. 'Date
Permit Valuation Park Support Fee
$
Permit Fee $ SAC
Plan Check Fee $ �o4� Z, # $
/5—.7( Water Meter Size 5/8"; 1"; $
State Surcharge $
3-5—.. Pressure Reducer $
Penalty $
Sewer/Water Connection Fee # $
Plumbing Permit Fee $
Water Tower Fee # $
Mechanical Permit Fee $
Builder's Deposit $
Sewer&Water Permit Fee $
Other $
Gas Fireplace Permit Fee $
TOTAL DUE
This AP:� Date a Becomesour Building ,.�.r„L-i
Permit A pproved Paid
4eceipt No.
1 I. G.2 . IL+ I
ictal . Date
This is to certify that the clue: in the above application and accompanying docume, s i in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the Ci an constitutes a temporary Certificate of Zoning comp anc and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued. a
71/f5,per...4f i - Oder "Vo r- ��,a�b
Planning ctor 0:to -Gt1` pcs-�-i-=
Special Conditions,if any
24 hour no ice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street Prior Lake,MN 55372
PRIORLAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS t 41'5 MAP c-, (R, - ' E
NATURE OF WOR T AL-1150.44-10,•1 ��
USE OF BUILDING ^j '�I)� e,,,, "Ad-mss_ sev ,�
PERMIT NO. _2 DATISSUED �`
CONTRACTOR �t cr l4INSTALL EROSION CON TR OL AND MAINTAIN CLEAN ONE _ 71,�- zz�
STREETS AT ALL TIMES
INSPECTOR DATE
* 01.(Prior To Backfill)
R
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING
INSULATION 2y ( i`►
ELECTRICAL /0-1-c.- �� /
PLUMBING Of/,-.
illiallar6 tr-Lt ii 1
T
COVER NO WOR NTIL THE ABOVE HAS BEEN SIGNED
/
I HOUSEWRAP ni (,'LATH
FINALS I
PRIOR TO SODDING)
BUILDING
1 ELECTRICAL
PLUMBING (1'C6 U ,�l 81:3 /
42,4..f_el
DO NOT OCCUPY UNTIL ABOVE HAS B ENVs--//4.-
'
SIGN
NOTICE
This card must be posted near an electrical service cabinet prior to rough-in inspections and
maintained until all inspections have been approved. On buildings and additions where no
service cabinet is available, card shall be placed near main entrance.
FOR ALL INSPECTIONS (952) 447-9850