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2/8/2016
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Monday, February 08, 2016
Homeowner or Current Resident
4977 MARTINDALE ST NE
Prior Lake, Minnesota 55372
Re: Building Permit Number 13-1243. We request your help.
In review of the building permit files, it was discovered there is an open permit for a
Furnace at the above address. Please call by Monday, February 22, 2016 to set up an
inspection. If there has been no contact from you by this date, the City will deem the
permit abandoned and invalid. (Per State Building Code R105.3.2.) This permit
abandonment will be recorded in the permanent public record for this address.
Any new work relative to this type of building permit will require a new permit along
with new permit fees.
Please call the Building Department at 952-447-9850 to schedule your inspection date.
Thank you for your cooperation.
Sincerely,
Building and Inspections Department, City of Prior Lake
elei)
kJ'
o� rRto CCITY OF PRIOR LAKE Date Rec'd
H HEATING/AIR CONDITIONING/FIREPLACE PERMIT
v
jA'NESOo 1.2. PinkFile
ty PERMIT NO. /3.-I z 3
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
1977 h7ar*Adcae �ree-f- ,A). r
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PB)
OWNER ��}} ,,c --- ('1
(Name) ri Onei _� �LJ0 ad l �.J T rc2.71c1 (Phone) se. 4V-r— y/8
�
(Address) i'9 77 ,41a I',LT rude 6, Src r t A 6._ p3, ..NO r Z4 ke `nk
APPLIC / ,
(Name) UQ/ 1-.717 Pect-bn? ,,4/,e 'J?EC /'/ACe s 11c (Phone) (' ,.S—cal) ''O 3 .-// /a
(Address) 1c ?1a Vern-44/`t_ Cab to r"1" ' ZSMC-r '► 1-e. --.07/ SALt tp ee ss-37
(Addy 4) ity) (Zip Code)
(Contact Person) ip.7 s_ Ka° Z-r C. (Phone) ( 7 5-4 903 -/(1-b
a
APPLICANT SIGNATURE `.4 r DATE �/ % 43
APPLICANT PLEASE COMPLETE BELOW
['NEW CONSTRUCTION PLACEMENT ❑ALTERATIONS
FURNACE MAKE AND MODEL at tr L e/' S9S'5-4 fro �.r a/—e a FUEL XiAfL
FLUE SIZE RETURN OPENINGS INPUT /00j Op•e) OUTPUT 9 i 00,0
TYPE OF SYSTEM HEATING OR POWER PLANT
❑Warm Air Plants ❑Steam PLEASE NOTE: Air Conditioner
Units and Fire laces Cannot Encroach
iGelevchitYanical
❑Hot Water pinto Required Side Yard Setbacks.
0 Radiation Fireplaces with Box Additions or
:kir Conditioning 0 Special Devices p
OVent.System 0 Other Devices Cantilevers to the Outside of Buildings
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 $49.50
Estimated Cost$ 3'7',2S Building Permit #
HEATING PERMIT FEE $ '9• .Sb
STATE SURCHARGE $ L DO
TOTAL PERMIT FEE $ 545!Sb
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid `j L7JV Receipt No. rah 7 /
��
Date / By /
Building Official Date
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372