HomeMy WebLinkAboutHeating Permit 11-1265 0 O 0 000000 ° 0 > E0
§> a k k\ g M> C 0 m m XI
om \
%§ m m 0 m z > Ecr § $ d
% t ¥ q q -4 m 0 � 7 � ` zk
' 0 m @ 0Z° Z 2
G c ^ � o E § r
§ Q • 0 % z 0 x
\ 0 ° ....
•
k 73 r a
Q ¥ m 13
§ 73 0 0 �m� / 00200
73 X m • m - ■ � "* ■ r _�
2 % rs 0 -10
I ■§m =■ 0 0
3 r K 3 0 E zIX Z xi 0 0
- n1 2 �� Q §
~ § \ Z
■ � Z 77 x) 11 r
/ 2 § m ��� R 0
/ 0 �� 2
m o 0 r k \ �� 0DD00 o
) > k §k§�§ 2
2 E1:113 11 xp
§ o >
m �� ■ � r 2
§ z - § m
a
r
t ■ - Q OS1
0 sLk. S°
! r Rl o CITY OF PRIOR LAKE Date Rec'd
/ . HEATING /AIR CONDITIONING/FIREPLACE PERMIT el H , ;
4 14 o`c ' 1. rh "k r'l` l PERMIT NO
NES Green Ci • / / / / „S
3 .
/
Yellow ApApplicant (' I C��/
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
1 4Iy 0 - L1\ooa C f ) Pct 0r zA
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) t) 1 \ ` l 01 G•P).-1 J/I (Phone)
(Address) _ . i 0 VL)OO $ • (.('_1r- t a r('Dr La c Ailiki 553
APPLICANT /1
(Name) Li e,t11 Pi cLV (Phone) q5)- 7 Col -1000
(Address) D t'f ` k- j 1 3 Wes 1 R t,-1'V1 S V t 11 e ( M I v 55337
(Alddress) (City) (Zip Code)
(Contact Person) e l 1 DI -.1)(1.,S dew (Phone) Sc2. — 7(07- 7(7—
APPLICANT SIGNATURE 6 - DATE
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION [REPLACEMENT ❑ ALTERATIONS 11
FURNACE MAKE AND MODEL Levi io C I I Pov 3(Qb "0'1 � FUEL rJt V_{ GG{S
FLUE SIZE RETURN OPENINGS INPUT (P(P 000 OUTPUT (Q ?., D 0
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
❑Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
❑Gravity ❑ Hot Water into Required Side Yard Setbacks.
❑ Mechanical ❑ Radiation Fireplaces with Box Additions or
,®Air Conditioning ❑ Special Devices
❑Vent. System 0 Other Devices Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL
FEE SCHEDULE
Industrial, Commercial & Multi Family I% 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 N 3261. 1411
HEATING PERMIT FEE $ �� . t0 "SURCI IAR(iye has been hanged for one
year effective c
STATE SURCHARGE $ 5,61 July 1, 2010, until June 30, 2011.
TOTAL PERMIT FEE $ 5%.1,, The minimum surcharge for a "fixed fee" permit
(Office Use Only) is SS beginning July 1.20111
This Application Becomes Your Building Permit When Approved Paid z-4 SZ Receip 'EVo. 616,7
Date Bye
Building Official Date /1- j
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372