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(.. RIO�
E.., � CITY OF PRIOR LAKE Date Rec'd
): HEATING /AIR CONDITIONING /FIREPLACE PERMIT
t
41 jA'NEso . 1. Pink File PERMIT NO. 2. Green City 1\ i. —ilji
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
(-
CoIorda St SE ?ior Ore
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION / PID
OWNER 3wce 81 aJd I Ield (Phol e ✓ �- 44 7 (-0a
(Address) 14 4 COlQrOdC) 9- SE (1Qr LE 55
r
- APPLICANT
,.(Name) Rons mecheanical Inc (Phone) 952 445 - 8585
(Address) 12010 Old Brick yard Road Shakopee MN 55379
(Address) (City) (Zip Code)
(Contact Person) Lind '• / (Phone) 952
(�
APPLICANT SIGNATURE � id , YOJA0k DATE "I — 8O . D--
APPLI NT PLEAS COMPLETE BELOW
❑NEW CONSTRUCTION f,, 1 L EPLACEMENT ❑ ALTERATIONS 11
FURNACE MAKE AND MODEL RtWD Rh le). 1J FUEL N til
FLUE SIZE RETURN OPENINGS INPUT g'OiO) OUTPUT , ,, Oc t /
TYPE OF SYSTEM HEATING OR POWER PLANT
// PLEASE NOTE: Air Conditioner
T arm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
❑Gravity ❑ Hot Water into Required Side Yard Setbacks.
[► "Mechanical ❑ Radiation
[Air Conditioning 111 Special Devices Fireplaces with Box Additions or
['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 'ost $ Building Permit #
"SURCHARGE" has been extended '
until June 30, 2013, HEATING PERMIT FEE $ y . ~
The minimum surcharge for a STATE SURCHARGE $ — NO .50
"fixed fee" permit is $5.00 COTAL PERMIT FEE $ '!I)
wince use only,
This Application Becomes Your Building Permit When Approved Paid Date / � s t Receipt No. 6 4 4/6
7' c
gi j / f By
Building Official Date 7/
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372