HomeMy WebLinkAboutHeating Permit 95-0088 1. Pink - File
O F PRIp,Q �'"� 3. Yellow - Contractor
����� � LAKE TYPE OF STRUCTURE
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� j rn r 16200 Eagle Creek Av. S.E. permit No. R.�-- F� � Single Family � Two Multi
` ��� Pri� �' MN 55372
�' � `' "� � Commercial Industrial Public Other
EATING APPLICA / PERMIT
Date PID # -� ,� � � _ d JOB VALUATION FEE
/ , $0 - $1,000 2% of job value, min. $20.00
Site Address !� �lIT i
,s • $1,001 -$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
Lot ,�, Blodc Addition /e� �'i $100.00 or fraction thereof to and including $10,000.
Owne�'s Name /�'���i�rl.Se �iiSG /2
$10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address �3 �� � Ue� _ .t ��� tional $100.00 or fraction thereof, to and including
Heating Contractor PS �r1 J � $�,000.
Address ,� - $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
tional $1,000 or fraction thereof.
Telephone # �.S _S`'I�,Sf armit includes one rough-in and one final inspection.
Furnace Make & Model TYPE OF SYSTEM CLOSED DUE TO ���ed at �25.0o ea�n
�� � Warm Air Plants �ACTIVITY 8/30/01 9
Model Size Gravity ,,r ust be submitted with bui{din �ermit number before huild-
Conn. Load Mechanical I be issued.
Air Conditioning
Fuel a lue Size _�_ Vent. System HFAT 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 wfth sup-
Supply Openings Steam ply and return locations shown. HEAT LOSS CALCULATIONS, PAYMENT AND
Return Openings Hot Water APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 4629 Dakota St.
Op 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-{N AND F{NAL) - CALL CITY HALL
�m. 447-4230.
S��p1+...J� �
TYPE OF WORK 1 hereby apply for mechanical systems permit and 1 acknowledge lhat 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 buAding/mechanical codes; that this form
Repair Est. Comp. Date does not become a permft until signed by the BUILDING OFFICIAL; that the work will be
E � . �� $ 1/ � � in accordance with the approved plan in the case of all work which requires review and
o Building Permit # approv ns.
HEATING PERMIT FEE $ ��-� � �,l
STATE SURCHARGE $ .50 li nYs Sig ar� e
TOTAL PERMIT FEES $ �� ° � � Receipt # „? �,� �
` uildi�g icial's Signature Date