HomeMy WebLinkAboutHeating Permit 09-0250
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Job Address
Heating Contractor _Uv\....luJ
Name of Tester .J -)~-
Dale :) - [f _.:J 'I
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Percent 0
Percent C02
Percent CO
Stack Temp.
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CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
5;/& OJ
i ~i~~n ~~:;y I PERMIT NO. 01'7, 0'" ~I
3. Yellow Applicant -, ~V,
ADDRESS
I 55~ B h
ZONING (office use)
, ~C1.SE-
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNEfub
(Name) ~
c'
(Address) \:::F~ a>
(Phone)q~-4:f J - (0 70~
\::.
APPLICANT SIGNATU
.....----
(Phonep~1);- (+~\ ~ " (YR
Q C c: 1~4-
(City) (Zip Code)
(Phone) qS;)..- 4~31- '7 rJqq
DATE ,S-l \ L-y:'1
(Contact Person)
CL") DNEW CWRUCrION. ~FfLACEMENT 0 ALTERATIONS
11\ ex-- l . n . .-
FURNACE MAKE AND MODEL \ - -5&rf\\lC ~; I-~R DLf\-OlO FUELc-JcthiJClj
( \\ 9 l-GO~
FLUE SIZE /J RETURN OPENINGS INPUT \ _ uLoI (~ OUTPUT
I
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
DWarm Air Plants o Steam Units and Fireplaces Cannot Encroach
DGravity o Hot Water into Required Side Yard Setbacks.
~eChanical o Radiation
. Air Conditioning o Special Devices _ Fireplaces with Box Additions or
DVent. System o Other Devices Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL
APPLICANT PLEASE COMPLETE BELOW
Industrial, Commercial & Multi-Family
FEE SCHEDULE
1 % of job cost Residential, Gas Fireplace
$49.50 minimum
$149.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
$49.50
Residential, Heating & AlC (New Construction)
Residential, Heating Only (New Construction)
$49.50
$49.50
Estimated Cost $ <t -/ :::J.JLs:
I)
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
Building Permit #
$
$
$
4=\.~
.50
CX~
(Office Use Only)
Buildinl! Official
Date
Paid ~}
-...J v, Vt::>
Date S. I;/' u
This Application Becomes Your Building Permit When Approved
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372