HomeMy WebLinkAboutMech Permit 04-0579
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
I. Pink File PERMIT NO () ~'
2. Green City . ',i -"..,r
3. Yellow Applicant 7 :J
(Please type or print and sign at bottom)
ADDRESS
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ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
,
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OWNER
(Name)
s~tt
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(Phone) 9S2- '-1"-17-703 (
Pr;.1r Lq~ /'/It'J
(Address) I~~ b 7 t:!,SA P~".1\+ ROttJ ~C
APPLICANT *
(Name) S.:..c
:rok: ne"-.
(Address) 1$;5:6 7 ~:sh R:,: ^ ~ RJ
(Address)
(Contact Person) S<..o* :r"k~ ne"
~ PPLICANT SIGNATURE ~&.Q.).-
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(Phone) q 5[::J.- 4'/J - I ~"3 I
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(City) (Zip Code)
(Phone) 9S.2- 't'77-7a3 J
DATE c::./ 1<1> /2oo'f
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION D REPLACEMENT D AL TERA TIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM
HEATING OR POWER PLANT
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
DWarm Air Plants
DGravity
~echanical
Air Conditioning
ent. System
FIREPLACE MAKE AND MODEL
Industrial, Commercial & Multi-Family
FEE SCHEDULE
1 % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
$39.50
Residential, Heating & AlC (New Construction)
Residential, Heating Only (New Construction)
$39.50
$39.50
Estimated Cost $
Building Permit #
REA TING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$ ~39",-C;-D
$ .50
$ 40.-
lice Use Only)
Building Official
Date
Paid LIt}"
Date 0-' /1- tf
~
ReceipL/6 f {;; J
BYe
~
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This Application Becomes Your Building Permit When Approved
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372
ADDRESS
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DATE TIME
SCHEDULED ~~,~
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CITY OF PRIOR LAKE
INSPECTION NOTICE
OWNER
CONTR.
PHONE NO.
PERMIT NO.
~-~77'
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
".Ja-MECH FINAL
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
COMME~TS:.; ,-
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~ORKSATI~RY. PROCEED~
o CORRECT ACTION AND PROCEED
o CORRECT W~R~ ~AL'L7 REINSPECTION BEFORE COVERING
Inspector: /JfL/7 L Owner/Contr:
,. ~
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETYl
lNSNOTl