HomeMy WebLinkAboutHeating Permit 95-0023 1. Pink - File
� (,� �� � ,.�"" 2. Gteen - City
.�.� p$I �� Pf'�I, R LAKE � - TYPE OF STRUCTURE 3. Yellow - Conuactor
� �OTp ,�EET S.E. permit o. `�� °`'�'� S' gle Family �_ Two-Family Mufti-Family
`� ����RU1K �1 55372
Commercial Industrial Public Other
7'�ON / PERMIT
Date �� PID # 5�.�6 — O1O �n �OB VALUATION FEE
$0 -$1,000 2% of job value, min. $20.00
Site Address �J� � �
Lot �_ Block � Addition �� ,L $1,001 -$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
$10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address � tional $100.00 or fraction thereof, to and including
Heating Contractor _��' �.Gt'��L�V'r.�CLI � ` $50,000.
Address J"� $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
tional $1,000 or fraction thereof.
Telephone # �S — ��
The price of your heating permit includes one rough-in and one final inspection.
Furnace Make & Model D c J ` PE OF SYSTEM 0 each.
Warm Air P�ants CLOSED DUE TO
Model Size � Gravity tted with buildi nermit number before build-
Conn. Load Mechanical INACTIVITY 8/30/Ol
Air Conditioning
Fuel �_ Flue Size .� Vent. System wmber 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 CALCULATIONS, PAYMENT AND
Steam
Return Openings Hot Water APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 4629 Dakota St.
Radiation S.E. Prior Lake, MN. 55372.
Input , oZl, 000 Output Speciat Devices
City Hall business hours are 8 a.m. - 4:30 p.m. �
Edr.
Other Devices ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
Cfm. 447-4230.
TYPE OF WORK I hereby apply for mechanical systems permit and I acknowledge that the information
Alterations Replacement FVew Construction �_ above is complete and accurate; that the work will be in conformance with ihe ordi-
nances and codes of the city and with the state building/mechanical codes; that this form
Repair Est. Comp. Date ��. �t does no! become a permit until signed by the BUILDING OFFICIAL; that the work will be
oU �� Z ' in accordance with the approved plan in the case of all work which requires review and
Est. Cost $ �(,'C�� Building Permit # Q3 a� 7 approval of plans.
HEATING PERMIT FEE $ c� �� D � f r'� "�S�
STATE SURCHARGE $ .50 plicant's Signat e �'`-' Date �
9 � — � — �i �
TOTAL PERMIT FEES $ � �� S� Receipt # �C�.3 � 7 Building Officia ignature Date `'