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1 YRi04, CITY OF PRIOR.LAKE Date Rec'd
it C HEATING/AIR CONDITIONING/FIREPLACE PERMIT / / i q
�jN �P 1.Pink File
2.Green City PERMIT NO.
NESo
3.Yellow Applicant / •
L.( G' s)
(Please type or print and sign at bottom)
ADDRESS 16 a i o $.7: P 6, 1 /01,e ZONING ir,office use)
12-2-
LEGAL
2-zLEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID as CO3 • 02
;d
OWNER ,,II
(Name) N9�ve 3Q.ArC e L 6 �., N (Phone) 7 C 7 347- 5-3?...6
(Address) 1>t:/0 /\-)43 ca) 1k4 i ct) / /4 off-ryo if,
APPLICANT,. //
(Name) /Y►PT rio Ojj K'd Ii ti - 414'.g
(Phone)
(Address) Co ¶ l s-12- ( AVP �� - Ala-10 AI ke 4761 s—s'Da
(Contact Person) 41 w ) at Q Jet'' (Phone) (, S":5--9'iq '
APPLICANT SIGNATURE DATE 6....1' (�—'/ 9
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION ❑REPLACEMENT ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE:Air Conditioner
❑Warm Air Plants 0 Steam Units and Fireplaces Cannot Enc roach
❑Gravity DHot Water into Required Side Yard Setbacks.
❑Mechanical ❑Radiation Fireplaces with Box Additions or
DAir Conditioning ❑Special Devices Cantilevers to the Outside of Buildings
Vent. System ❑Other Devices 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) 64.50Residential,AC Only $49.50
Cost$ 'II5
. 0 Building Permit#
HEATING PERMIT FEE $ I/9, .p
STATE SURCHARGE $ 5.00
TOTAL PERMIT FEE $ ..r 2/ SO
This Application Becomes Your Building Permit When Approved Paid 54,6t)sp Receipt No. /1l 5,1;9
Building Official Date Date (/- it,.I'L ( By <y 4.)
24 hour notice for all inspections(952)447-9850
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372
I L
DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS / 2. &T: / J M-i/
NATURE OF WORK j 822/e-0)//-7 /N' 1--viiLt/ )'1-- b —
USE OF BUILDING L /L71
/
PERMIT NO. ` DATE ISSUED 7_
CONTRACTOR DSL- e y /f?,°it.,e47Gj. T PHONE -760'.? , +6' ' . l4 0
INSTALL EROSION CONRI'OL AND MAINTAIN CLEAN STREETSS
AT ALL TIME,
INSPECTOR DATE
11111111111111111111111
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING B Rill l .P WI tj®ov -X:: .E-- -11, 151 I -
INSULATION
C __/
ELECTRICAL —'
HEATING )1--c.., --\. 1 i ( Sill.-
COVER NO WORK UNTIL THE ABOVE HAS BEEN SIGNED
IdiNINIMP LATH IJ
FINALS
B ILDING l - t --\
ELECTRICAL —
4111.11.111111 —
HEATING
DO NOT OCCUPY UNTIL ABOVE HAS BEEN SIGNED
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