HomeMy WebLinkAboutMechanical Permit #13-106 � O O� C) ❑O❑000 � O D Zc�
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� � HEATING/AIR CONDITIONING/FIREPLACE PERMIT
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�IMVES��P �. P�� File PERMIT NO. l�
2. �� c��y �,
3. Yellow Applicant
ease or ' t and si at bottom
ADDRESS ZONING (o�sce use)
o. Ka �'y � c �' r o.ke
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER �
(Name) � e �O �'r S �a�1lG S (Phone)
(Address) L� c � � S,�-
APPLICANT
(Name) �cx.-1-i on,: /►1�c k�w.'c� S'�tv�: �S l l � . (Phone) �/o� - G l� � '01�,6 �/
(Address) _��56 �c�c� `' 5�1. 6,A CT �'v.r.•,; �.. �01 S 5 �`/
(Address) (City) (Zip Code)
(ContactPerson) �c��.,c .�'�n� S�n (Phone) � 1�� qG�( —�GG�/
APPLICANT SIGNATURE � DATE ��.'LdC� — l3
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION �REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL � v�� S; /�/k � FUEL IUCr.�� r� L c� q S
FLUE SIZE ��� RETURN OPENINGS A � .�1�! G INPUT OUTPUT 7,$�, oc,c�
TYPE OF SYSTEM HEATING OR POWER PLANT
❑Warm Air Plants PLEASE NOTE: Air Conditioner
❑ Steam Units and Fireplaces Cannot Encroach
❑Gravity ❑ Hot Water
0 Mechanical ❑ Radiation into Required Side Yard Setbacks.
❑Air Conditioning ❑ Special Devices Fireplaces with Boz Additions or
�Vent. System ❑ Other Devices Cantilevers to the Outside of Buildings
�`'urnra �C 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
Cost $ Building Permit #
The Minnesota Statutes § 326B.148
" SURCHARGE " has been extended HEATING PERMIT FEE $
unril june 30, 2013, STATE SURCHARGE $ .50
The minimum surcharge for a TOTAL PERMIT FEE $ �(.� .�'Q
"fixed fee" permit is $5.00
This App ' atio� es Your Building Permit When Approved Pai�i �� Rece�pt
� / C._ CO
�C.�� / 3 Date By s �
Building Official Date � � �� " � J" �
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372