HomeMy WebLinkAboutFurnace/Air 13.1301 I OX O rJ - n ooOCOC o �n 0 5 0
n n 6 o 53 _ 0 cok - � �� x § 0 M � In k r § k IFS
. rn B a k - 0 - • z ��
- n 2 t Q_® _ z
§ § R �' . B
>0 _ 0 §
t o r 2 ; :nozi
%
§ _ \
r ° I . .
II § � � ■ U7
§ -1 z m m ~ . ( rsjoaaa
� @§m
� .
co �
\ � oo % \ . • w � � 7 �■ � � � _ [ 2 < 0 i
Q do o 0 §2 §8 ° c
§ z \ � i1 .xx f
2 k o . •* ■ \ "-- v vi
m ~ , 1 _
c .. ,
<
�. 0 � cOOOO
R. t / o �' §m3152§� ..
> §§1t
oz , s ; c §
4 pi ► ]� z §
"4 r 0
f
•
E,a
•
o� pR10� CITY OF PRIOR LAKE Date Rec'd
HEATING /AIR CONDITIONING/FIREPLACE PERMIT
d fl Esdo ;:=`„ Pik PERMIT NO. /
is Yellow ci ► :3 ' /.3 0/
(Please type or print and sign at bottom)
ADDRESS ZONING (office me)
1`1 al Sv...nv C\v' )
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) Siv.l i\'COz\\ov■ \\ovwQS (Phone) S01 ^ 3 -10939
(Address) a(o a (o $ S t. E Q\oo` r\' 1nt w
ran , ■v�. • 5s' as
APPLICANT J
(Name) Ovw■oi.. Wnu.C.ANAA \.\ c cLSL (Phone) 5O1 ^ s.$8 - \R O$ •
(Address) at\\ `1'"^ S-t i\ fkochQStur, rm X 101
(Address) (City) (Zip Code)
(Contact Person) - LLL .V... CO \e.vn cAn. (Phone) S0.a v~..e,
APPLICANT SIGNA' DATE \\ ^ \3 ^ VI
APPLICANT PLEASE COMPLETE BELOW ,
:NEW CONSTRUCTION ® REPLACEMENT 0 ALTERATIONS •
FURNACE MAKE AND MODEL C0. - i vr S sc. a %o%O FUEL t•-) Cm
FLUE SIZE 9 a./. RETURN OPENINGS INPUT %O k OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT .
❑warm Air Plants PLEASE NOTE: Air Conditioner
❑ Steam Units and Fireplaces Cannot Encroach
❑Gravity C ❑ Hot Water into Required Side Yard Setbacks.
• Mechanical - `uo. N /►c ❑ Radiation
•Air Conditioning ❑ Special Devices Fireplaces with Box Additions or
:Went. 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
Estimated Cost $ Building Permit #
The Minnesota Statutes § 326B.148
HEATING PERMIT FEE $ "SURCHARGE" has been changed for one
year effective
STATE SURCHARGE $ ..$8' July 1, 2010. until June 30, 2011.
TOTAL PERMIT FEE $ SM .S0 The minimum surcharge for a "fixed fee" permit
(Office Use Only) is $f, beginning July 1.2010
it
This Application Becomes Your Building Permit When Approved Paid Receipt No. / /
e ,�
Building Official Date Date 1 : / J i� 1 q/ By ti
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372