HomeMy WebLinkAboutHeating & A/C Permit #11-0794 y p❑� (� 000�0❑ � O D yA
n � � �� o T+ rt�� _ � � m o
� m m n
� � � � 3 r 70 tn �
t G r D r- � m m y m uz 5z> o a' o�
� � � D Z .� ��c� _�
e � � � � � Z Z °�
�° `�'� � � z m �
� � Z �
� � v
„ � v
'� r� � � �a0000
'a m m m m�
o� y v o �c ��c
�c = � = �7o� = W m p n
� ; � � � g"88�� � � o
b � o i r.n 7C 7t � Z ' C
�
� _ �• � � 'CO ' � O Q C
� A �
= m
� o �
� y � OO�OOO
� Z Z �p
A. 0 G� �In�i�� ` � n�
� � =�5�� �
� n >mm��
� m �„� � �
-�'+ � �
I
, ��xro CITY OF PRIOR LAKE Date Rec'
, °� �� �'� HEATING/AIR CONDITIONING/FIREPLACE PERMIT
� � i ; "Y
t� `"" ' !x
�i �. M�k File pERMIT NO.
' 2. Green City
I � 3. Yetloa• Applicant � / �
Please e or rint and si n at bottom
ADDRESS ZONIl�TG (o�'ice nse}
� I �r�L- S � O �-
LEGAL DESCR.IPTION (oE�ice use only)
LOT BLOCK .ADDTTION PID
�VV1�TE /�
(Name} � (Phone) ��'�Z � `7 � ��
(Address} ��'��'� �� �`"� �
(Name {Phone) � �o���G�� 0 `�
(Address) � � ! �� /�
(Ad ress) (City) (Zip Code)
(Contact Person) � (Phone) �n � � � � ��5� l./
APPLICANT SIGNATU + DATE �,�' � /
APPLICANT PLEASE COMPLETE BELOW
QNBW CONSTRUCT[ON PLACEMENT ❑ ALTERATIONS •
FURNACE MAKE AND MQDEI., FUEL
FI:,UE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HBATING OR POWER PLANT ,
❑Wa�m .Glir Plants PLEASE NOTE: Air Conditioner
ir ❑ Steam Units and Fireplaces Cannot Encroach
❑Gravity ❑ Hot Water
❑ hanical ❑ Radiation i�tto Required Side Yard Setbacks.
ir Conditioning ❑ Special bevices �'eplaces with Box Additions or
❑Vent. System ❑ Other Devices Cantilevers to #he Oatside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MObEL
FEESCHEDULE
lndastrial, Commercial & Multi-Family 1% of job cost Residential, Gas Fii�epltece $44.50
$A9.50 minimum
Itesidential, Heating & A/C (New Construction) $149.50 Residential, Additions & Alierations
Residential, Heating Only (New Construction) $64.50 Residential, AC Only $49.50
Fstimated Cost $���_� Building Permit #
The Ntinnesofa Statutes ,��' 326Q.1�38
HEATING PERMIT FSE $ �'�( ,� "S� iRCE-IARCiF.;" h�s been cht�n�rd !'or ane
vear effective
STATE SURCHARGE $ d�e1y t, 2�3iti ut�ti:.7�cnc 3l) 2tt� 1.
TOTAL PERMIT FEE $ � Thc minimum surehargc for � "�xccl fcc" permit
(Office Use Only) is ��, b innin�;,N�iy 1.2010
This Application Becomes Your Building Permit When Approved Paid� � Rec No. ��/
. (
Date / By
Bufldine Official Uate ✓ C r� • ,
24 hour notice for al1 inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372