HomeMy WebLinkAboutHeating Permit 11-1200 = o n 000000 I o > 20
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� � I' Rip CITY OF PRIOR LAKE Date Rec'd
_ HEATING /AIR CONDITIONING /FIREPLACE PERMIT
, M
4',NNESO'c' 1. Pink File
2. Ye City PERMIT NO . 11 • 00
3. Yellow Applicant ��/��J/
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
Qi -S— 1/4 .r., 1 s 1 -Oa ... \ .. . (\., c j
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID 0.36, 01 q_ 0
(Name) �-- y `� rvti.^ �j 41 I (Phon \ c � ' `�, -1 C I V
(Address) \ 09 S S `ter S N r Y
APPLICANT ` �' �A \, 11
(Name) � Y O J � �-- (Phone) v \ S " "1 � "1
(Address) \O C \ 8 0 \ 2\ 1 o j ' Pr N1 o.. Q L N o-- c-N 0, 0 N -C S - S
(Address) (City) (Zip Code)
(Contact Person) ' ' J S \-N 3 -L,. (Phone) 'A C o - u - 1 - 1, "1
APPLICANT SIGNATURE‘......, DATE ‘0 ` al 5
APPLICANT PLEASE COMPLETE BELOW
[NEW CONSTRUCTION ,REPLACEMENT El ALTERATIONS
FURNACE MAKE AND MODEL 6 r \) c \- S C ( 1 1 V v �D U— 100 FUEL � c-1 '
FLUE SIZE RETURN OPENINGS INPUT \ Yd j 0 O Q OUTPUT cis, UAb
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
['Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
El Gravity ❑ Hot Water into Required Side Yard Setbacks.
❑ Mechanical ❑ Radiation
❑Air Conditioning ❑ Special Devices Fireplaces with Box Additions or
❑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 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
Fetimaterl Cost $' Building Permit #
The Minnesota Statutes § 326B.148
"SURCHARGE" has been extended HEATING PERMIT FEE $ _` c S O
until June 30, 2013, STATE SURCHARGE $ S C§0
The minimum surcharge for a Zt j
"fixed fee" permit is $5.00 COTAL PERMIT FEE $ 'S U`
This Application Becomes Your Building Permit When Approved Paid sl / ci/ R ipt Not 4,6 Ds —.
Dat 1 I I B
Buildine Official Date '
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372