HomeMy WebLinkAboutMech Permit 04-0941
ell i OF PRIOR LAKE
HEATING1Am eONDITIONING'''lKEPLACE PERMIT
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LEGAL DESCRl.t'110N (office use only) -
6 tf--lo i
O::R BLOCK ,~DDmT .f-,IIJ V; '5 l de. In un)
(Name) N\e..,\ \) \1 ~ ~ I ~ 0 IV
(Address)d97 7 I~flcl~~\ L-,~_r~_ gJ{
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ase we or print and silm at ~ttom)
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APPLICAN1h .
(Name) rt"" Or
(Address) /~....~'-/ I
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(Contact Person)' \ ') ~ .
APPLICANT SIGNATURE
'I
Date Rec'd
9~!7. w...
~. ~~ ~:~y. I PERMIT NO. 04. ~/J4ll
3. Yellow Apphcant .. .,.
ZONING (office use)
PID Z& .133 _ 694-. ()
(Phone)
(Phone)
fh... () r- kK<: mAl ss~"Q
(City) (Zip Code)
(Phone) ~\.~ ~-lf'l)- >51J ()
9--/7~,-!
DATE
DNlEW CONS
.lJRNACE MAKE AND MODEL
FLUE SIZE.1x fd\", ^ ~ RE
.-
TYPE OF SYS
PLICANT PLEASE COMPLETE BELOW
ucnON ~PLACEMENT 0 AL TERA nONS
~ ~4~~J FUEL Nil T
RN OPENINGS INPUT J DlJ, tx::n OUTPUT $;>Q. 00l)
..
HEATING OR POWER PLANT
~Wlll'nl Air Plants
DGravity
D Mec~anical
DAir qonditioning
DVent.! System
D Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
FEE SCHEDULE
1 % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
FIREPLACE MAKE AND !MODEL
Industrial, Commercial & Multi-Family
Residential, Heating & A/C (l' ew Constru ion)
Residential, Heating Only (Ne N Constructi n)
$39.50
$39.50
$39.50
i Estimated ost $
Building Permit # tJ,4... () '1~1
HEATING PERMIT FEE
STATE SURCHARGE
~'rrOTAL PERMIT FEE
(Office Use Only) i
r-"hl. Appll..lloo Becom!os Vour B, IIdlog Permit Wheo Approved
L \/ Building Official
$
$
$
:<9~
- .50
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Paid 4{). () 0
Date Dat9. /1.. (j 1-"
,. tur .011" for.1I ;u..."".. (951) ..7-9..... fa> (952) ..7-424.
,
Receipt NO+ 711 b
B:~:-
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VtITYOF PRIOR LAKE
0\ INSPECTION NOTICE
SCHEDULED
ADD~SS
I
OWN~R
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PHO NO.
~97? ~/"~7
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CONTR.
PERMIT NO.
o PLUMBING RI
o MECH RJ
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
~CH FINAL
COM ENTS~/7 / / ____
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DATE TIME
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h~d
CJ~ - 9'</ /'
o EXlGRADlFIWNG
o COMPLAINT
o FIREPLACE RJ
o FIREPLACE ANAL
o GASLINE AIR TST
o
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.Y~r-
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A: i
WOR~SATISFACTORY' PROCEED
o CORR CT ACTION AND PROCEED
o CORR' CT WORK, CAL FOR R NSPECTION BEFORE COVERING
Inspector:
Owner/Contr:
CALi. <<7,9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH If SAFETYI
INSNOT1
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PERFORMANCE rEST
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FinIIlnepIIdlon o.e 9 -,1$ iJtJdI