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( ?RIN F CITY OF PRIOR LAKE Date Recd
\ HEATING /AIR CONDITIONING/FIREPLACE PERMIT
h NESO
1. G F it PERMIT NO .70 //�'''� 1
2. Yreen City
3. Yellow Applicant
Please or print and Bien at hnttn,
ADI ZONING (office use)
10-238 ELITE EXTERIORS
16573 FIVE HAWKS AVE
LEG PRIOR LAKE, MN 55372
651 - 470 -50
LO' ----- ___, PID
OWNER
(Name) (Phone)
(Address)
APPI ' "T
(Nan MIDLAND HEATING AND AIR (Phone)
413 WEST 60TH ST
(Addr MINNEAPOLIS, MN 55419
(City) (Zip Code)
612- 869 -
(Conti (Phone)
APPLICANT SIGNATURE DATE
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION ❑ REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL C (. i(l> 12, �j ' 10 S0 1 ` J L FUEL t C,
FLUE SIZE RETURN OPENINGS INPUT C) > OUTPUT 'lc ft2,,,, 4
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 Cantilevers to the Outside of Buildings
❑Vent. System ❑ Other Devices
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 i Cost $ Building Permit #
"SURCHARGE" has been changed for one
year effective HEATING PERMIT FEE $ 4 CO
July 1, 2010, until June 30, 2011.
The minimum surcharge for a "fixed fee" permit STATE SURCHARGE $ l � / 0 °. ✓ �
is 55, beginning July 1, 2010 TOTAL PERMIT FEE $ S%
This Application Becomes Your Building Permit When Approved Paid 5 --- ; / 5- Rece t No. & r (a 3-2
Date //
Buildine Official Date / /' By
•
24 hour notice for all inspections (952) 447 - 98.50, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372