HomeMy WebLinkAboutHeating Permit 95-0074 � 8303
� ( ; (� �,� (�� t 1. Pink - File
� O`=i i.! l:J LV �� �,� 2. Green - City
�°� � CITY Q� PRIOR LAKE �'ls �� TYPE OF STRUCTURE 3. Yellow - Contractor
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� �' �� — 5��9 D�lQ A STREET S.E. p���t No. � Single Famity �_ Two-Family Multi-Family
PRI ` � KE, MN 55372
Commercial Industrial Public Other
HEATING APP ICATION / PERMIT
Date PID# o�J —DIZ--� �OBVALUATION FEE
Site Address �� /i2 t �-►" (�'Sr p0� ��'" ( �l r`�Q , $0 -$1 2% of job vatue, 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 �UA Y� �� Jv�� 1. ��
$10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address ����Q. lJ�� c - �9�� tional $100.00 or fraction thereof, to and including
Heating Corttractor � � � � $50,000.
Address ���� ����� ��Q.�(� � �=��g�'�(`��0,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
( � � � 'Q tional $1,000 or fraction thereof.
Telephone # �`''1'�4� ' ��.J
The price of your heating permit includes one rough-irt and one final inspect�on.
Furnace Make & Model TYPE OF SYSTEM Additional inspections will be billed at $25.00 each.
Warm Air Plants
Model Size Gravity e submitted with building �ermit numbgs, before build-
Conn. Load Mechanical CLOSED DUE TO ssued.
Air Conditioning g with number of supply and return openings listed
Fue� F�ue size vent. system INACTIVITY 8/30/O l
New structures or additions send floor plan with sup-
Supply Openings HEATING OR POWER PLANT HEAT LOSS CALCULATIONS, PAYMENT AND
Steam
Return Openings Hot Water APPLICATIONS MAY BE MAILED TO 7HE CITY OF PRIOR LAKE, 4629 Dakota St.
Radiation S.E. Prior Lake, MN. 55372.
lnpui Outpui Special Devices
City Hall business hours are 8 a.m. - 4:3� p.m.
Edr.
Other Devices ALL WORK MUST BE lNSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
� 447-4230.
baseme,r��- �emn 2 -�-
TYPE OF WORK ��� r�`p��an I hereby apply for mechanical systems permit and I acknowledge that the information
Alterations �_ Replacement New Construction above is comptete and accurate; that the work wil! be in conformance with the ordi-
nances and oodes of the city and with the state building/mechanical codes; that this form
Repair Est. Comp. Date does noi become a permit until signed by the BUILDING OFFICIAL; that the work will be
�- in acxordance with the approved plan in the case of alf work which requires review and
Est. Cost $�� , Building Permit # ----------- " val of plans.
HEATING PERMIT FEE $ ` �- �'���
STATE SURCHARGE $ .50 Appli t's ' n Date
TOTAL PERMIT FEES $ � � Receipt #� 7� �� ���
Build' g Official's Signature Date