HomeMy WebLinkAboutHeating Permit 95-0043 '�� � `� � if; ,'_�; 1 �\ 2. Green - City
L � f ��� TYPE OF STRUCTURE 3. Yeilow - ConVac�or
;; � �-� �� CI�'Y OF PRIOR LAKE �
; �C�� �� �,9 DAKOTA STREET S.E. Permit No. �l J��{ 3 Single Family � Two-Family Multi-Family
� IOR I.AKE, MN 55372
�� V Commercial Industrial Pubtic Other
APPLICATiON / PERMIT
Date - PID # .�S - D�O S-- � Q 3� D �OB VALUATION FEE
^ ` $0 -$1,000 2% of job value, min. $20.00
s�e Aad�ess � �S� 5 Lt v�- f r/��.=-
Lot Btock Add'Rion $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 (..�� ,I�' � �_� Yr�
/- $10,Q01 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address ��S �-� �i (JyP �v /l/„� tiortal $100.00 or fraction thereof, to and including
$50,000.
Heating Contractor i L 1�ii G
Address � 10�o,f� ��°� � C/� ��jc��50,001 and over $532.50 tor the first $50,000 plus $7.50 for each addi-
" tional $1,000 or fraction thereof.
Telephone # � S � - �L� � c�
The price of your heating permit includes one rough-in and one final inspection.
del �SS� �'+-�� TYPE OF SYSTEM Aaaa���� :-���--�:-�- ...:"'-_ �illed at $25.00 each.
eF� �� �_�� M Warm Air Plants
Model Size Gravity CLOSED DLTE TO �st be submitted with building �ermit number before build-
Conn Load Mechanica! �JACTIVITY 8/30/O1 be issued.
Air Conditioning
Fuel Flue Size Veni. System ZlHEQ with number of suppty and return openings listed
HEATING OR POWER PLANT • �--.-- -�n9• 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 APPLlCATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 4629 Dakota St.
Radiation S.E. Prior Lake, MN. 55372.
Input Output Spscia( Devices
City Hall business hours are 8 a.m. - 4:30 p.m.
Edr.
Other Devices t��'^' ALL WORK MUST BE INSPECTED (ROUGH-iN AND PINAL) - CALL CITY HAtL
Cfm.
447-4230.
TYPE OF WORK I hereby apply for mechanica! systems permit and I acknowledge that the information
Afterations _�_ Replacemerrt � FVew Con ruction 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 becarr�e a permh until signed by the BUILDING OFFICIAL; that the work will be
i ,��- in �rdanc:e with the approved plan in the case of all work which requires review and
Est. Cost $ ���. ��Q Building Permit # approval of ns.
HEATING PERMIT FEE $ ZC� _ oV � �—�'�._ ��"
STATE SURCHARGE $ .50 ' nt's Signature Date
TOTAL PERMIT FEES $�'� � Receipt # �.�.�l0 9 Buildin Officiat's S' nature Date ��
9 �9