HomeMy WebLinkAboutA/C Permit 04-0610
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS .,'13 Is
OWNER
116 +fA
CONTR.
PHONE NO.
PERMIT NO.
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
o MECH FINAL
COMMENTS:
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DATE TIME
(,:21'01
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o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
~RTST
~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORREntRK. CALL FOR REINSPECTION BEFORE COVERING
Inspector: V JI . Owner/Contr.
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.,
INSNOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
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CITY OF PRIOR LAKE
HEA'l'lNG/AIR CONDl'l10NlNGIFIREPLALE PERMIT
Date Rec' d
1. Pink File PERMIT NO ~
2, Green City .~. 0/ / - / - (
3, Yellow Applicant '-f c..o
(Please type or print and si2D at lN~:&AA)
ADDRESS
ZONING (office use)
5?j~
I L _(] 1'n- CSt
/'
kJl:;
LEGAL DESCRIPTION (office use only) t~
wr5 BLOCK ADDmON jlcJ( ./IifJU {l(l/z;o/ /::;;-
PIDa5-6~~' O()3-Q
OWNER
(Name) ,J\~ ~.Df... \MA
(Address) S~~
(Phone) Cf5 ~ . 44S. SelJa-- :;l..
APPLICAW
(Name) ~\ r \\f\~--n-~ llUL-
(Address) . 5<btS 1.~.:!!.i1h ~T' ~." .... I C> ,
(Address)
(Contact Person)
"-'-:/
~'~./
/L~ .
/" d. DATE
~/~
ftPPLICANT PLEASE g>MPLETE BELOW
DNEW €ONSTRUCTION ~PLACEMENT 0 AL TERA TIONS
FURNACE MAKE AND MODEL ' FUEL
.. \p J\ f\\
(Phone) 9~~. '-l3...L5Q'"3 ~
'~:t f 6S(l).~-~
(City) (Zip Code)
~~
Co 111.4 ! ('() e-j
(phone)
APPLICANT SIGNATURE
FLUE SIZE
RETURN OP.ENINGS
TYPE OF SYSTEM
DWarm Air Plants
DGravity
o M~ical , ,
~ Conditioning
OVent. System
INPUT
HEATINGORPO~RPLANT
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
OUTPUT
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
FIREPLACE MAKE AND MODEL
[ndustrial. Commercial & Multi-Family
I
FEE SCHEDULE
1 % ef job cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
$39,50
Residential, Heating & NC (New Construction)
Residential. Heating Only (New Construction)
$39.50
~9,50 )
Estimated Cost $ ~ co
Building Permit #
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$ '39 <;(/)
$ .50
$ tz/ CD .(()((J
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Paid4~6, -
Date
&~iJ!'-o Lj
R1/t1t I
BY~
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24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245