HomeMy WebLinkAboutHeating Permit 95-0009 • 1. Pink - File
9 R �� R PE OF STRUCTURE 3, Yellow - Contractor
,� ` ✓ �� CITY OF PRIOR LAKE �
� m 4625 DAKOTA STREET S.E. Permit o. v Single Family � Two-Family Mufti-Family
PRIOR LAKE, MN 55372
Commercial Industria! Public Other
HEATING APPLICATION / PERMIT
r --� JOB VALUATION FEE
Date / " �O —'�� PID # �u 'O (�L'd
SRe Address �J�Z. b ! ti �) b V /� `�7'�'� ( � � �� $0 - $1,000 2% of job value, min. $20.00
Lot -� Block � Addition _LI/Ot�/�c�s� (.a,rs,� p"� $y,001 -$10,000 $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 �� N l S � 7"'� t� �
$10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address �SZ6 �a oJo �l ���� S�� � tional $100.00 or fraction thereof, to and including
$50,000.
Heating Contractor l �5 ��
Address 27o c� /1� � �"� �,�rV+ ��,� �� � $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
tional $1,000 or fraction thereof.
Telephone # � 3 3 " 2 �6 �
� The price of yoar heating permit includes one rough-in and one final inspection.
Make & Model �T—ec1—F� TYPE OF SYSTEM Additional inspections will be b+lled at $25.00 each.
..
� � � T Warm Air Plants
Model Size Gravity House Neating Test Record must be submitted with building nermit number before build-
Conn. Load Mechanicai ing certificate of occupancy will be issued.
Air Conditioning
Fuel �IAT, �ipS Flue Size Vent, System 3>t12,re�rt' � HEAT CALCULATIONS REQUIRED wfth number of supply and return openings listed
HEATING OR POWER PLANT Per room wilh CFM's per opening. New structures or additions send floor plan with sup-
Su I O enin s • ��� �T ���c rrei nl II �TIf�NS PAYMENT AND
PP Y P 9 ply and return locatior
Steam
Return Openings Hot Water APPLICATIONS MAY � CLOSED DLJE TO 4629 Dakota St.
Radiation S.E. Prior Lake, MN. 5E
Input Z ?�fl a outP�t Special Devices INACTIVITY 8/30/O 1
City Hall business hour:
Edr.
Other Devices —� --�i'C.� ALL WORK MUST BE ��.... �.. .__ �. _____ CITY HALL
Cfm. �d� �V `�"i 447-4230.
T1fPE OF WORK I 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 perm' ntil signed by the BUILDING OFFICIAL; that the work will be
in rdance with t proved plan in t cas of all work which requires review and
Est. Cost $�� b b �� a Building Permit # �'' 6� Z� roval I s.
P P ��
HEATING PERMIT FEE $ ,3 � • �S f --(� � �
STATE SURCHARGE $ .50 'canYs Signature Date
TOTAL PERMIT FEES $ � 6• 7J� Receipt # o[.�h.� j 7 r��� ��
uild ng Official's Signature Date