HomeMy WebLinkAboutHeating Permit 95-0048 1. Pink - File
P 2. Green - City
�.��� ��, r;�I�� LAKE � TYPE OF STRUCTURE 3. Yellow - Convacror
u m �� �Z9 dA�I��A STREET S.E. Perm t No J��� ingle Family � Two-Fami�y Multi-Family
f_ I��RIOR LAKE, MN 55372
�� Commercial industrial Public Other
� HEATING A�d CATlON / PERMlT
Date - g -�t J P�p #�� �� ��,Z Q JOB VALUATION FEE
Site Address i$1 �g $0 -$1,000 2% of job value, min. $20.00
$1,001 -$10,000 $20.00 for the first $1,000 plus $1.25 for each additionaf
Lot �_ Block 1_ Addition $100.00 or fraction thereof to and including $10,000.
Owner'sName� 0 1,�„�ri�ll�r�,�,fi�
$10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address s G'�� � � . �?�_u,,r � tional $100.00 or fraciion thereof, to and including
$50,000.
Heating Contractor ������
Address � 410 WESTLAKE STREET $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
�s� ��� tional $1,000 or fraction thereof.
Telephone # st2-824-2�8
The price of your heating permit includes one rough-in and one final inspection.
Furnace Make & Model TYPE OF SYSTEM Additional inspections will be billed at $25.00 each.
Warm Air Plants
Model Size Gravity House Heat+ng Test Record must be submitted with building �ermit number before build-
Conn. Load Mechanical ing certificate of occupancy will be issued.
Air Conditioning
Fuei Flue Size Vent. System H�AT CALCULATIONS REQUIRED wfth number 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 APPLtCATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 4629 Dakota St.
Radiation S.E. Prior Lake, MN. 55372.
Input Output Special Devices
City Hall business hours are 8 a.m. - 4:30 p.m.
Edr.
Other Devices I�� t h 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 Replacemer�t ✓ New Construction 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 3` -� S does not become a ermit unti! signed by the BUILDING OFFICIAL; that the work will be
in accordance wit th approved plan in the case of aN work which requires review and
Est. Cost $ I I a..� ��Ctti Building Permit # approval of p
HEATING PERNNT FEE $ �Z � S� ,� _�� �- j S
STATE SURCHARGE $ .50 p icanYs Signature Date
TOTAL PERMIT FEES $ ,�?� � � � Receipt # o�...���u� `—"'"����
Building Official's Signature Date
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