HomeMy WebLinkAboutFIREPLACE PERMIT 16-1386 DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE SCHEDULED
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ADDRESS ) _' I r
OWNER CONTR.
PHONE NO. PERMIT NO. 16. (3F-4-
0
L i❑ FOOTING 0 PLUMBING RI 0 EX/GRAD/FILLING
❑ FOUNDATION 0 MECH RI 0 COMPLAINT
❑ FRAMING 0 WATER HOOKUP ❑ FIREPLACE RI
❑ INSULATION 0 SEWER HOOKUP XFIREPLACE FINAL
❑ FINAL 0 PLUMBING FINAL `Mr GASLINE AIR TST
❑ SITE INSPECTION ❑ MECH FINAL 0
COMMENTS:
C> V--- C
WORK SATISFACTORY,PROCEED
❑ CORRECT ACTION AND PROCEED
❑ CORRE97 WORK,CALL FOR REINSPECTION BEFORE COVERING
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Inspector: — �. Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH&SAFETY!
INSNOTI
4 PR/0,/
CITY OF PRIOR LAKE Date Rec'd
lAill HEATING/AIR CONDITIONING/FIREPLACE PERMIT 7/ 3e /6
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2.
1.PiCnnkeen File
City //.I PERMIT NO. /pW" -13%
3. Yellow Applicant I "
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
LEGAL DESCRIPTION(office use only) /n�
LOT L BLOCK Z ADDITION / Cie/9 3ALCPID 4 �--- 69- C)
OWNER ,
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(Name) \-&-1.1 . -- -*\r'\/
(Phone) 3
(Address) 3 \x1 S�r ,rc
APPLNamI) T� i 1 a - e Sa- L c ��\a
(Name) �`��� t"�'�� � � t`-"' ' `�-- (Phone) � �,
�sA b4r. a. .5'5-x-.
(Address)TDO �l
(Address) (City) , (Zip Code)
(Contact Person) R ,p p t�l�
(Phone) 6S Tal\AO
APPLICANT SIGNATURE ___ DATE \` -& `ko
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION ❑REPLACEMENT `ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT Itl,.,e... ') erk-A"
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
❑Warm Air Plants ❑Steam Units and Fireplaces Cannot Encroach
❑Gravity ❑Hot Water into Required Side Yard Setbacks.
❑Mechanical ❑Radiation Fireplaces with Box Additions or
:kir Conditioning ❑Special Devices Cantilevers to the Outside of Buildings
❑Vent.System 0 Other Devices
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Require a Building Permit.
FIREPLACE MAKE AND MODEL 4i � CIA./ 4D-
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 $49.50
Estimated Cost$ Building Permit #‘Al-
HEATING PERMIT FEE $ S-\
STATE SURCHARGE $ 1.00
TOTAL PERMIT FEE $ 55''0-.-'0
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid
��..5?) Receipt No. /51 0
Date ,...g. .( (‘) By
C3 6'..‘
Building Official Date L
24 hour notice for all inspections(952)447-9850
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372