HomeMy WebLinkAboutHeating Permit 95-0006 , , _ . 1
� � �S � � � 1. Pink - Fite
�F PR� � TYPE OF STRUCTURE 3. Yellav - C
., CITY OF � OR LAKE
� ����AK TREET S.E. permit No. -!� d� Single Family � Two-Family Mufti-Family
PRlOR MN 55372
Commercial Industrial Pubiic Other
HEATING APPLI TION / PERMIT
Date l��'� `�t JOB VALUATION FEE
PID#�� I��
� � �, � $o - $t,000 2% of �oa vaiue, m��. $20.00
Site Address (e C��-�%lW�ad� �
Lot b� Block Addition �/o��-� $1,00� -$�0,000 $20.00 for the first $1,000 plus $1.25 for each additional
�� �� $100.00 or fraction thereof to and including $10,000.
Owner's Name _ GL" ��
� ��� ' n � � $10,001 - $50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Addres �-Wt tionai $100.00 or fraction thereof, to and including
Heating Contractor �,�,��� _ $50,000.
Address $50,001 and over $�32.50 for the first $50,000 plus $7.50 for each addi-
tional $1,000 or fraction thereof.
Telephone #
The price of your heating permit includes one rough-in and one final inspection.
Furnace Make & Model TYPE OF SYSTEM Additronal inspections will be billed at $25.00 each.
Warm Air Plants
Model Size Gravity •'----- "-^*�^^ r��t Racord must be submitted with building t�ermit number betore build-
Conn. Load Mechanical CLOSED DUE Tp I b� issued.
Air Conditioning
Fuel Flue Size Vent. System INACTIVITY 8/30/O1 �Q W�h number of supply and return openings Gsted
HEATING OR POWER PLA iing. New structures or additions send floor plan with sup-
Supply Openings �wn. HEAT LOSS CALCULATIONS, PAYMENT AND
Steam
Return Openings Hot Water APPLlCA7lvN� nnH� o� �„�AILED TO THE CITY OF PRIOR LAKE, 4629 Dakota St.
Radiation S.E. Prior Lake, MM. 55372.
Input Output Special Devices
Edr. City Hall business hours are 8 a.m. - 4:30 p.m.
Other Devices ��.s �t/'t�g ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAI) - CALL CITY HALL
Cfm.
447-4230.
IYPE OF WORK I hereby apply for mechanical systems permit and I acknowledge that the information
ARerations Replacement New Construction � above is complete and accurate; that the work will be in conformance with the ordi-
nances and codes of the city and with the state building/mechanica� codes; that this form
Repair Est. Comp. Date does not become a permit until signed by the BUILDING OFFICIAL; that the work will be
.---�"---- irt acxordance ' h the approved plan in the case of all work which requires review and
Est. Cost $ �t�(��� Building Permit # approva pl ns.
pP
HEATING PERMIT FEE $ �. � � � � `g�
STATE SURCHARGE $ .50 p� nYs Signature Date
TOTAL PERMIT FEES $ � . Q U Receipt # 01.�•3 �7 ( � (� � �
Building Official's Signature Date