HomeMy WebLinkAboutHeating Permit 95-0046 � � IS � � r(� � , 1. Pink - File
O F PR(p�, � 3. Ye{lan - ConVactor
� FEB ��;� �" �R LAKE � TYPE OF STRUCTURE
� O REET S.E. permit No. ��� "'� � Single Family � Two-Family Muni-Family
PRIOR LA N 55372
Commerciai industrial Public Other
LICA ON / PERMIT
Date L'� S 9 5 PID # f� �� ���� Z 2 O JOB VALUATION FEE
Site Address _ I J r 'J J I ST�EF}} �lf�(�� � $0 -$1,000 2% of job value, min. $20.00
Lot 7 Block � Addition �A`1�E�'l�A J� j�J"0 �„°ES $� �� '$� 0,000 $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 T dG� /'� �Li2L� -�1t�t.-YC7'� L/�-/�G(.�E��i�
$10,001 -$50,000 $132.50 for the tirst $10,000 plus $1.00 for each addi-
Address �SJ�� STEFi� �I�� � ��/d1e u7 tional $100.00 or fraction thereof, to and including
Heating Contractor _t� I� % ^ JY � �� $50,000.
Address �g 5 O �E5% �i�t�LL��� �3 �jrr15�L ml� $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
� � tional $1,000 orfraction thereof.
Telephone # b l � ° ��1 ��
ar heating permit includes one rough-in and one final inspection.
Fumace Make & Model TYPE OF SYS1 pSED DU� TO ions will be billed at $25.00 each.
warm Air P�ant: CL g�30/p 1
Model Size Gravity �ACTIVITY �st Record must be submitted with building �ermit number before build-
Conn. Load Mechanical _ xupancy will be issued.
Air Conditioning
Fuel Flue Size Vent. System �AT CALCULATIONS_ REQUIRED with numbe� of supply and retum open+ngs 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 C17Y OF PRIOR LAKE, 4629 Dakota St.
Radiation S.E. Prior Lake, MN. 55372.
Input Output Speaal Devices
City Hall business hours are 8 a.m. - 4:30 p.m.
Edr.
Other Devices CfFS F�rLpIA� 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
Atterations ReplacemeM New Construction X above is complete and accurate; that the work wi{I be in conformance with the ordi-
nances and codes of the city and with the state building/mechanical c�des; that this form
Repair Est. Comp. Date does not became a permit until signed by the BUILDING OFFICIAL; that the work will be
in accordance with the approved plan in the case of al4 work which requires review and
Est. Cost $ 14'Q� • �� Building Permit # approval of plans.
HEATING PERMIT FEE $ 25. �D' �—� � �',-r,
STATE SURCHARGE $ � .50 IicanYs Signatur Date
TOTAL PERMIT FEES $ 25 •� Receipt #„�.h ��aZ� ��'� S
ui{ding i ial's Signature Date