HomeMy WebLinkAboutHeating 13.0192 ().%),RIC; CITY OF PRIOR LAKE Date Rec'd
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HEATING /AIR CONDITIONING /FIREPLACE PERMIT
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NnNES.,,P 1. Pink File PERMIT NO .
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Green
llo City 13 / /
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
j Z— 7 / -- # 75 L.-7- d A/c / 0 C-e) , R / 5 -1)
LEGAL DESCRIPTION (office use only) 67 �(
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LOT BLOCK 1 ADDITION 75 , / AMA] PID
(Name) a•A, /" d (Phone) 6. /2- &
(Address) i 5 ,s-/ f T t // A. a. 4- J` Al te �Gr/� ^ad' (C � 32.E
APPLICAN l)) `" ,/f
(Name) - C —� 4: //^C ._ '14 (Pho / �. ■- ` - 1 ?'
(Address) - e, ._ d ,. / 11) '7, _„t) / ,,r i ;`c „--,,,,,./677.s-,?,
(Address) # (City) Q�- (Zip Code)
(Contact Person) '.. ��C- A _ (Phone) 3� � S f a?
APPLICANT SIGNATURE /j DATE _3_,./ja_b__3,
. _ APPLICANT PLEAS COMPLETE BELOW
['NEW CONSTRUCTION REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL C, s, p P • ,-G-d✓ ` 5J/ /!d 1 7 -(1 /,�Q • FUEL / et
FLUE SIZE ' __ RETURN OPENINGS INPUT 1v.61990 OUTPUT (�
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
❑Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
Gravity ❑ Hot Water
Mechanical into Required Side Yard Setbacks.
❑ 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 $ 'i /
"fixed fee" permit is $5.00 STATE SURCHARGE $ �
f OTAL PERMIT FEE $ `7 r- ,S `
(Office Use Only)
This Application Becomes Your Building Permit When Approved ' ' :d�1\ Ci-1 Receipt No. / pf2
Date + , [ ' I i B44 t
Buildine Official Date
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372