HomeMy WebLinkAboutHeating Permit 95-0058 � � � � t. Pink - File
D - OF PRIOR LAKE 2. G �� - cm
. 9 .
TYPE OF STRUCTURE 3. Yellan - Contractor
�� � 9 DAKOTA STREET S.E. permit No� �� � U Single Family � Two-Family Multi-Family
RIOR LAKE, MN 55372
Commercial Industrial Public Other
HE 1 APPLICATION / PERMIT
Date �-"��" .� PID # ��- BOaZ— O 1 - 7�� �OB VALUATION FEE
Sfte ddress y� y� �y eigs /9irdd�` .S'1'� S, � $� -$�'�� 2% of job value, min. $20.00
r
Lot (v � B k Addition (_� /,(_i���Ll�Ge,.�/ $1,001 -$10,000 $20.00 for the first $1,000 plus $1.25 for each additionai
$100.00 or fraction thereof to and including $10,000.
Owner'sName pr9/r ��e.�z� ������,�.t�
,_ $10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address y�o Y� !��-°A�� ..5�. S• .� tional $100.00 or fraction thereof, to and including
Heffiing Contractor _ _s[/�- e' 2'� ��j' � y� /�, �,, $50,000.
Address __ 7' �'� �e �s,.� �iq�� ���+c , C -j%��.J��01 and over $532.50 for the first $50,000 plus $7.50 for each addi-
��. tional $1,000 or fraction thereof.
Telephone # ��07' c�/� �'
� 7he price of your heating permit includes one rough-in and one final inspection.
Furnace Make & Model C%�/'/�°� ° '` S� / �'� F SYSTEM � Additional inspections will be billed at $25.00 each.
� � D �O � T Warm Air Plants
Model Size � Gravity House Heatinc ►ermit number before build-
Conn. Load Mechanical ing certificate c CLOSED DUE TO
Air conditionin9 N INACTIVITY 8/30/O 1 P 9
Fuel �Ftue Size �,� Vent. System EAT CALCU and return o enin s listed
Supply Openings � C�a X�d� HEATING OR POWER PLANT per room with is send floor plan with sup-
Steam ply and retun ITIONS, PAYMENT AND
Return Openings ��X c�i !? Hot Water APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 4629 Dakota St.
In ut Gf dt?a�� Radiation S.E. Prior Lake, MN. 55372.
p utput Special Devices
Edr. City Hall business hours are 8 a.m. - 4:30 p.m.
� /��� Other Devices ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
447-4230.
TYPE OF WORK I hereby apply for mechanical systems permit and I acknowledge that the information
Afterations Replacement � FVew Construction above is complete and accurate; that the work will be in conformance with the ordi-
nances and cades of the city and with the state building/mechanical codes; that this form
Repair Est. Comp. Date does not become a permit until signed by the BUILDING OFFICIAL; that the work will be
����, in acxordance with the approved pfan in the cas of all work which requires review and
Est. Cost $ �a Building Permit # approval of plans.
HEATING PERMIT FEE $ 3 �. �� �'`�� l� �
STATE SURCHARGE $ .50 li t s Signature Date
/ � 1 a— �'i >
TOTAL PERMIT FEES $ � �. �Q Receipt # �/C,�
Building Official's Signature Date