HomeMy WebLinkAboutHeating Permit 95-0031 1. Pink - File
2. Green - Ciry
�F PR��R TYPE OF STRUCTURE 3. Yellow - Convactor
.� �.� CITY OF PRIOR LAKE
�
u m 4629 DAKOTA STREET S.E Permit No. � a �� Single Family Two-Family Mufti-Family
PRIOR LAKE, MN 55372
Commercial Industrial Public Other
HEATtNG APPLICATION / PERMIT
Date Z�`J /�S� PID # �� "' b�'I C" (� � 2 � �OB VALUATION FEE
y �� s �� y � , $0 -$1,000 2°/a of job value, min. $20.00
Site Address
�1e-�cs ��,, �,s $1,001 -$10,000 $20.00 for the iirst $1,000 pius $1.25 for each additionat
Lot Block Addition � ti, d� $100.00 or fraction thereof to and including $10,000.
Owner's Name ��K ff �,r,t�,« f�
$10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address { /�S7Jn S'/�DY �r.��' T.�1�C. tional $100.00 or fraction thereof, to and including
� �—��� $50,000.
Heating Contractor �,4-/� �/f r¢ 1 �
Address �U6 �S` ��}� ,�/� ��� � $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
tional $1,000 or fraction thereof.
Telephone # �0 — �3�{�
The price ot your heatina n orm:• °- '- �e rough-in and one final inspection.
Furnace Make & Model ��'"'�C�ew TYPE OF SYSTEM A��� UE T� n.
� Warm Air Plants OSED
� Model Size �.�� �� ��' Gravity H ' CI '' D y g/30/01 '�h building nermit number befo�e build-
Conn. Load Mechanical ��! �ACTIV
Air Conditioning
�i }g _....., ����noer of supply and return openings listed
Fue! N.o-1'�i7S' Flae Size � Vent. System
HEATlNG OR NT per ,.,���� wRn GFM's per opening. New structures or additions send floor plan with sup-
Supply Openings Steam ply and return locations shown. HEAT LOSS CALCULATtONS, PAYMENT AND
Return Openings Hot Water APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 4629 Dakota St.
��p� �U �'OV p Radiation S.E. Prior Lake, MN. 55372.
�_ o�t „t 3�' �� specia� �e�ices
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 sysiems permit and I acknowledge that the information
Afterations Replacement � New Construction above is complete and axurate; that the work will be in conformance with the ordi-
nances and codes of the ciry and with the state building/mechanical codes; that this form
Repair Est. Comp. Date � �4.5" does not become a permft until signed by the BUILDING OFFICIAL; that the work wilt be
�.,� /' C� �<«r�r, ,� in �cordance with the approved plan in the case of all work which requires review and
Est. Cost $ ?�-�� b Building Permit # �`""" � a rov �lan
HEATING PERMIT FEE $ � �S � �" r � �' �'f'
STATE SURCHARGE $ .50 ticanYs Signat�re Date
TCITAL PERMIT FEES $ ��• � � Receipt # 2J � 3� ����1( S�
Building ' S�nature Date