HomeMy WebLinkAboutHeating Permit 95-0044 �..--�—�� � t. Pink - File
�� �� TYPE OF STRUCTURE 3. Yellow - C nbactor
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� �� PR10R LAKE ^
� m r4628 dAKOTA STREET S.E. pQrmit No. ����'1 Single Family Two-Family Multi-Family
2 2 t9 �� PR��F�' KE, MN 55372
`U Commercial Industrial Public Other
LICATION i PERMIT
Date PID # ,.�.�' D I�O — (�J' � D �OB VALUATION FEE
Site Address I tny-ag �rt"QS�A_ '�U2 v'E $� �$� ��� 2% of job value, min. $20.00
$1,001 -$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
Lot Block Addition $100.00 or fraction thereof to and including $10,000.
Owner's Name �f�5t3i.� 1 Vv►n��i.l.�Y '" `�1'1 "'o�J(� $10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address �(2� [�0.�SCQ. {�11�p �'� tional $100.00 or fraction thereof, to and inciuding
Heating Contractor �n me.AY7QY)1 C�1 , ��C � $50,000.
Address �RI o2 �Q�S'� ��t,�IQ.LP 7�Y�217Ue. $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
tional $1,000 or fraction thereof.
Telephone # `i'Y`•J — SS�J�
The price oi your heating permit includes one rough-in and one final inspection.
Furnace Make & Mode1 ��l�7PSTI�7'L TYPE OF SYSTEM Additional inspections will be billed at $25.00 each.
Warm Air Plants
. Model Size /V U� 5Il�Z� �1�� Gravity House Heating Test Record must be submitted with bui'Iding nermit number before build-
. Conn. Load Mechanical ing certi�icate of occupancy will be issued.
Air Conditianing
� Fuel �� Flue Size Vent. System HEAT CALCULATIONS RE�UIRED with number of supp{y and retum openings fisted
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 APPL{CATIONS MAY BE MAfLED TO TfiE CITY OF PRfOR LAKE, 4629 Dakota St.
Radiation S.E. Prior Lake, MN. 55372.
lnput � 0 Output Special Devices
City Hall business hours are 8 a.m. - 4:30 p.m.
Edr.
Other Devices ALL WORK MUST BE INSPECTED (ROUGFWN AND FINAL) - CALL CITY HALL
Cfm. qq7-423p,
TYPE OF WORI� 1 hereby apply for mechanical systems permit and I acknow4edge that the information
� above is complete and acxurate; that the work wif{ be in conformance with the ordi-
Afterations ReplacemeM f/ Alew Construction
nances and oodes of the city and with the state building/mechanical codes; that this form
Repair Est. Comp. Date does not beoome a permk uMil signed by the BUILDING OFFICIAL; that the work will be
�_ in accordanoe wtth the approved plan in the case of all work which requires review and
Est. Cost $ �S��IY� Building Permit # approval of plans.'
HEATfNG PERMIT FEE $ �� � o� S �`�d�Q�9S
STATE SURCHARGE $ .50 ' nYs Signature Date
TOTAL PERMIT FEES $ D7 �o L 7� Receipt # ��� 6 Z^ ���
ui g Off'�cial's Signature Dade