HomeMy WebLinkAboutMechanical Permit #13-112 y � 0 � n 00�000 = � � N�?
n � � � �� 3�zu�,�og z � 7 �o mp
0 0 ��� 3 �" Z � a�i �'�
b r � m f � m v SZD � y 0 �
� r � > - m ��� —
�, � -� � z ° Z �
10 r n y N � Z � �[
ee� o _ z- = � m m
� o > z � � �'
� � r � j �
-� � � v �
� m � O O "'� ❑O�O�❑
t:� Z m m m m�
o ..�� z v v �� -���
x3�mx3 � � �
� oo w m o
� � m y� 3 = m
� � Ri � "� r r �I v O � � � \ C
�� o Z ycc p m
7e z � m r vv � G
`� �
�
� A �
� 0 m N
''Z C n �
� � � ❑C�❑OO❑ I C9
Z z �mm�� � � �
D � r���
� < m�5�� N
� a ��Z�
z >_mm�� ,�
� m � T � Z m
� � � 4�
O � p RIp� CITY OF PRIOR LAKE Date Rec'd
F � HEATING/AIR CONDITIONING/FIREPLACE PERMIT
� �
�j�'NES��P �. r��k File
2. G,ee„ �;, PERMIT NO. �3 _�/ L
3. Yellow Applicant
lease e or ' t and si at bottom
ADDRESS ZONING (ofle�ce use)
`SS ll� ' /��/ —
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) ���C_..� _ � l [ r�� (Phone)�s ������ Z-�
(Address)
APPLICANT
(Name) (Phone)
(Address)
(Address) (City) (Zip Code)
(Contact Person) (Phone)
APPLICANT SIGNATURE DATE � 7
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION ❑ REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
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 ❑ 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
The Minnesota Statutes § 326B.148
"SURCHARGE" has been extended �ost $ Building Permit #
until June 30, 2013,
The minimum surcharge for a HEATING PERMIT FEE $
"fixed fee" permit is $5.00 STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ ���. 3
(Oftice Use Only)
This Application Becomes Your Building Permit When Approved Paid�� Receipt No. �� �y �j
� Y �
Date �� By
Buildin¢ Official Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372