HomeMy WebLinkAboutHeating Permit 11-0470 5 ❑ ❑ 0 00000 0 I) 0 > 20
N 0 cn T - mi nm 0 a -9
=i z cn m z
� o o � z o o z mp
b D o x 73 0 C z f- C 3 o 0 m m 0
r
rli x 73
r�� n D Z p � � � O zp
t0 (n .1 n Z z ZO r
� \ • T 1 o
c -• n \ z n 7C
Q - m
�+ n D p r� m
N.
7 0 r z
r °
* "' 7J o o Q__ . ❑❑❑❑❑
' m m m m mrr
* 0 ° ° N v t i 3 rti -40C 3 -v C) i 0 o z m m W X z 7) = m 0 0
'' O 13 CD m z is -z x z 2
m m -I >° 00 0 3 -1 m
0 0
o z z 7 7 - Z c
m
o z m f'` ✓ '�1� r '� a
A 0 •
`
r =O m f —
0000❑❑ 1 •
o
y m G)i1mnm -e ---
— D
D Cnmm3G)
R. ° ❑vvv
rzi Z Dmmz-r1
y m 'A -Ti 1 m I
p Rr CITY OF PRIOR LAKE Date Rec'd
r
HEATING /AIR CONDITIONING /FIREPLACE PERMIT
F '?-
4 'iPvNESO� P
I. Pink File
2. Green City PERMIT NO. //` 4-70
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
V $rpnS � SU)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(Na L\ \LQ MUITO-G1 (Phone)CIS D "- L f G S PO
(Address) 1 �1L ,,( I1 S t r � \S Ar
` S (4'
APPLICANT BURNSVILLE HEATING & A/C, INC +
(Name) 3451 W. Burnsville Parkway (Phone) �� 9U LT D.
Suite 120
(Address) Burnsvil( s )55337 (City) (Zip Code)
(Contact Person) f—ML-Oa, t I
(Phone)
APPLICANT SIGNATURE d--r& 0 _ DATE Lc" CO — 1 1
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION 'IZ REPLACEMENT ❑ ALTERATIONS
M K E AND MODEL 3 Fjc- o () FUEL
FLUE SIZE RETURN OPENINGS INPUT ) OUTPUT` — L2Wt)
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
❑Warn Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
❑Gravity ❑ Hot Water into Required Side Yard Setbacks.
'® Mechanical ❑ Radiation
ir Conditioning ❑Special Devices Fireplaces with Box Additions or
IIUI V ent. System ❑Other Devices Cantilevers to the Outside of Buildings
L v n ,� ]n Require a Building Permit.
AKE AND MODEL 1 pl.�J\1O1)
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 $ Building Permit #
The Minnesota Statutes § 326B.148
HEATING PERMIT FEE $ LA C l , "SURCHARGE" has been changed for one
STATE SURCHARGE $ S, sr* year effective
C 1 J u l y 1 , 2010, until June 30, 2011.
TOTAL PERMIT FEE $
-1 t30 The minimum surcharge fora "fixed fee" permit
(Office Use Only) is 55, beginning July 1, 2010
This Application Becomes Your Building Permit When Approved Paid sir so Rece t o.
2J'7
Building Official Date Date/ r / Q ✓ l B •
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372