HomeMy WebLinkAboutFIREPLACE PERMIT 16-1318 DATE TIME
CITY OF PRIORNOTICE LAKE SCHEDULED ' I _ '
INSPECTION
ADDRESS 0 �v
OWNER CONTR.
PHONE NO.
PERMIT NO.
0 PLUMBING RI ❑ EX/GRAD/FILLING
❑ FOU DG 0 MECH RI 0 COMPLAINT
❑
FOUNDATION
ATION 0 WATER HOOKUP 0 FIREPLACE RI
❑ FRA0 SEWER HOOKUP FIREPLACE FINAL
❑ INSULATION
❑ SITE
FINAL 0 PLUMBING FINAL 0 GASLINE AIR TST
❑
❑ SINSPECTION 0 MECH FINAL
COMMENTS:
wviiimagawir
\FLWORK SATISFACTORY,PROCEED
❑ CORRECT ACTION AND PROCEED
O CORRE RK,CALL FOR REINSPECTION BEFORE COVERING
Inspector:
Owner/Contra
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH&SAFETY!
1NSNOTI
CITY OF PRIOR LAKE Date Rec'd
..-!'() ...\"( �c HEATING/AIR CONDITIONING/FIREPLACE PERMIT
fA'NES°
21. PiGrnkeen Fatty PERMIT NO.A, i_3
. Ci
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
51& \\A-A- ( N.. se_
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER � O _f7 � Jsi A� QOuV`' (Phone) . Q " --).:1_17//5"
I (Address) 3 3o Lk....,`. C .,(-- s,—
APPLICANT` r\ \\ (Phone) � 4 L `, 1 Co
(Name) Q�\ ��c�''�`�,�- 1C 1 �
(Address) ‘040 E—A O�Q C - 53
(Address) (City) (Zip Code)
(Contact Person) q(Phone) `' q' t artke
APPLICANT SIGNATURE f ` DATE L LI-I
APPLICANT PLEASE COMPLETE BELOW
['NEW CONSTRUCTION ❑ REPLACEMENT ❑ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
❑Warm Air Plants PLEASE NOTE: Air Conditioner
❑Steam Units and Fireplaces Cannot Encroach
Gravity ❑Hot Water
❑Mechanical ❑Radiation into Required Side Yard Setbacks.
:kir Conditioning ❑Special Devices Fireplaces with Box Additions or
❑Vent.System El Other Devices Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL Ni \A-ea-V- C N-,
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 $49.50
Estimated Cost$ al53•50 Building Permit #
HEATING PERMIT FEE $ 44:A• 510
STATE SURCHARGE $ 1.00
TOTAL PERMIT FEE $ 5 0 . SQ
(Office lise Only)
This Application Becomes Your Building Permit When Approved Paid ct
%� Rece. t No..__ f j
Building Official Date Date 1 i. 1 (
By –
24 hour notice for all inspections(952)447-9850
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372