HomeMy WebLinkAboutHeating Permit 95-0071 � r, � � � -\
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d , � ,� 1. Pink - File
2. Green - City
� � RIOR LAKE TYPE OF STRUCTURE 3. Yellaw - Convacror
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� m 16200 e Creek Av. S.E. P N �(.s �( Single Family Two-Family Multi-Family
i ke, MN 55372
Commerciat Industrial Publ�c Other
ICATION / PERMIT
�� p �� '/ P'D #� 5 ,_� �� O/ � ^� JOB VALUATION FEE
Date'. IlJ
I ` $0 -$1,000 2% of job value, min. $20.00
Site Address �� � � .� �N � h h�/ �'�`
Lot � Bbdc Addition �1 �001 -$10,000 $20,00 for the first $1,000 plus $1.25 for each additional
� �_ �pI^/^r'omt �� ��S $i00.00 or fraciion thereof to and including $10,000.
Owner's Name /� �� �����5'�l� o!�'l l��oao Y�' � 7� $10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address 1� ��s L'�`1 �e/^/+V �� tional $100.00 or fraction thereof, to and inciuding
Heatin Contractor �c � e� � v 1� �� $50,000.
s /�—t�i� �/n��r�'� 1T
Address (" S�_S' C^ �7D f ti.5`�' $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
n--- tional $1,000 or fraction thereof.
Tetephone # � � � '^ v�' � l �
The price of your heating permit inciudes 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 u�„�o NQ�r��n TA�t Record must be submitted with building permit number before build-
Conn. Load Mechanical �ncy will be issued.
Air Conditioning �7 cL'OSED DUE T�
Fuel Flue Size Vent. System �JACTIVITY 8/30/01 S REQUIRED with number of supply and return openings listed
HEATING OR POWI �er opening. New structures or addftions send floor plan wfth sup-
Supply Openings �ns shown. HEAT LOSS CALCULATtONS, PAYMENT AND
Steam
Return Openings Hot Water Hrru�h i iv��o m... 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 ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
�m. 447-4230.
TYPE OF WORK I hereby apply for mechanical systems permit and I acknowledge that the information
Afterations �� ReplacemeM New Construction above is complete and accurate; that the work will be in conformance with the ordi-
nances and oodes of the city and wiih 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 accordance with the approved plan in the case of all work which requires review and
Est. Cost $�� O O� 00 app val of plans �
HEATING PERMIT FEE $ =�o2-J� 3�.J�V /���5
STATE SURCHARGE $ .SO lican s Sig ure Date
9� � �-9�
TOTAL PERMIT FEES $ oN. �� Receipt #_,( ��,'S� ding icial's Signaturs Date