HomeMy WebLinkAboutHeating Permit 95-0007 � �D�"`� 1. Pink - File
�� TYPE OF STRUCTURE 3. Yellwn - C nuactor
F PRIpR` CITY OF PRIOR LAKE
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� rn 4629 DAKOTA STREETS.E. permit No. � S Single Family Two-Family Multi-Family
PRIOR LAKE, MN 55372
Commercial Industrial Public Other
HEATING APPLICATION / PERMIT �� _ p
JOB VALUATIOM FEE
Date � 2 � � '�" �4 PID # ,�.� ",t � � � �''�'�
$0 -$1,000 2% of job value, min. $20.00
Site�dress 4�� ,�
,�; �// r $1,001 -$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
Lot � Block � Addition t1 7�-s✓ �- G�•�✓ $100.00 or fraction thereof to and including $10,000.
Owner's Name Yl ��.. $10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address � C, tional $100.00 or fraction thereof, to and including
Heating Contractor � \�E„ � �E $50,000.
Address � v ^�f��� �\4.� � - � $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
-1 ` �=--�� tional $1,000 or fraction thereof.
Telephone #� '� The orice of your heating permit includes one rough-in and one final inspection.
Furnace Make & Model nrPE oF sYSn CLOSED DIJE TO >ns will be billed at $25.00 each.
Warm Air Plants
Model Size Gravity �ACTIVITY 8/30/O 1 � Record must be submitted with building �ermit number before build-
Conn, Load Mechanical _ �upancy will be issued.
Air Conditioning
Fuel Flue Size Veni. System 'IONS REQUIRED with number of supply and return openings listed
HEATING OR POWER PLANT per room with CFM's per opening. New structures or additions send floor plan with sup-
Supply Openings ply and return locations shown. HEAT LOSS CALCt1LATIONS, PAYMEIVT AND
Steam
Return Openings Hot Water APPLICATlONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 4629 Dakota St.
Radiation S.E. Prior Lake, MN. 55372.
Input Output Special Devices
City Hall business hours are 8 a.m. - 4:30 p.m.
Edr.
Ot Dev�es �6!cv,� �Gt�2.Mo.— A!L WORK Ml1ST 8E lNSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
Cfm. � �G`r� 447-4230.
IYPE OF WORK 1 hereby apply for mechanical systems permit and I acknowledge that the information
Afterations "�" Replacemer�t � 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/mechanical codes; that this form
Repair Est. Comp. Date does not become a permit until signed by the BUILDING OFFICIAL; that the work will be
�- `� e D O s in ac�rdance with the approved plan in the case of all work which requires review and
Est. Cost $�� ��� Building Permit # �T— � roval of plans.
HEATING PERMIT FEE $ �' / 5 \ 2,- �— �,C�
STATE SURCHARGE $� .SO Applica Sig e Daie
TOTAL PERMIT FEES $ � Receipt # ,�,�3j.�
Building Official's Signature Date