HomeMy WebLinkAboutHeating Permit 95-0085 �..r.... 1. Pink - File
PRIp � � �Q �' , -�- - 2. Green - Ciry
�.a�� R �.� $� ,�R LAKE TYPE OF STRUCTURE 3. Yellow - ConVacta
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� 07� � REET S.E. per i o. l�'� Single Family Two-Family Mufti-Family
�p� ���LA , N 55372
��,s`� Commercial Industrial Public Other
ION / PERMIT
Date # ��,r. _�� �_� 7 � O JOB VALUATION FEE
/,,_ $0 -$1,000 2% of job value, min. $20.00
Site Address a ��� r'! h9 �Ct /C!� Ls�'C �� �L�
Lot Block Addition /�,l,� e�-,��rw.�,�/ $1 �001 '$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
$100.00 or fraction thereof to and including $10,000.
Owner'sName �O� /uQt"�YY� " ��'7 ��/�
� � � �� $10,001 - $50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address 7 � Y tional $100.00 or fraction thereof, to and including
Heating Contractor � � �{�(� � � � $50,000.
Address / r� � Z— � Sv( ���j �� ��LIe {� C� e $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
tional $1,000 or fraction thereof.
Telephone # L-� � j' D� 0 5
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 Heating Test Record must be submitted with buildinq oermit number before build-
Conn. Load Mechanical ing certificate of occupancy will be issued.
Air Conditionin� Il �/y1��T� �1a7✓
Fuel Flue Size Vent. System HEAT CALCULATIONS REQUIRED with 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 APPLICATIONS 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 Dev�es ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
Cfm. 447-4230.
TYPE OF W�RK I hereby apply for mechanical systems permit and I acknowledge that the information
� above is complete and accurate; that the work will be in conformance with the ordi-
Afterations Replacemern V Plew Construction
nances and codes of the c'dy and with the state building/mechanical codes; that this form
Repair Est. Comp. Date `7��I-�'� ' does not become a permit until signed by the BUILDING OFFIClAL; that the work will be
�, � J in accordance with the approved plan in the case of all work which requires review and
Est. Cost $ �'Y� Building Permit # approv I of plans.
HEATING PERMIT FEE $ o�c `S p V ,�'
STATE SURCHARGE $ .50 pli s Signatur� Date
TOTAL PERMIT FEES $ oZJ�i ��/ Receipt # � (� �� `�( �
ilding Official's Signature Date
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