HomeMy WebLinkAboutHeating Permit 95-0094 ��` -' -, ,- .. --, 1. Plnk - File
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� ��6��OTl�. REET S.E, permit No. �'""!i Single Family !i Two-Family Mufti-Family
: P �1 55372
� I Commercial Industrial Public Other
ION / PERMIT
Date J� — ' #�.� _o�G 7- (� a3 _.D JOB VALUATION FEE
Site Address 1 J` S�� _ O�Y/ �'G A 7i2,� 7�. ��� $0 -$1,000 2% of job value, min. $20.00
� $1,001 -$10,000 �o, c�o $20,00 for the iirsi $1,000 plus $1.25 for each additiona!
Lot � Block 1 Addition ,,,L,Q� � Ti.s�a/ � Z 'y - $100.00 or fraction thereof to and including $10,000.
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Owner's Name �/� �1..,� �{ � /-�12 � t-. Y /V �A � �L,,� $�0,001 - $50,000 3 $132.50 for the first $10,000 plus $1.00 for each addi-
Address � � Y� C�7� /� i2,�Q tional $100.00 or fraction thereof, to and including
�-�f ntractorA�-.L.l�k� ��°t(L�vl�� �'12r�5in�' (;.a2�✓ $50,000.
Address � O- — XII t2,1/I�tn.) p �L�,,, �� �� $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
tional $1,000 or fraction thereof.
Telephone #�.3 3°-� Z�' 6 1
The price of your heating permit includes one rough-in and one final inspection.
e& Model�'r I� -G�L.� TYPE OF SYSTEM •�J-�--�� ����o�tions will be biiied at $25.00 each.
�-. � b � Warm Air Plants CLOSED D 9
Model Size Gravity UE TO st be submitted with buildin �ermit number before build-
Conn. toad Mechanical �ACTI�I•I,y be issued.
Air Condit'bning g�3 Q�� 1
Fuel � �IO S Flue Size p�2� u � Vent. System l,�F�Q wfth number of supply and retum openings listed
HEATING OR POWER PLANT r-. .__ �ng. 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 APPLICATlONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 4629 Dakota St.
Radiation S.E. Prior Lake, MN. 55372.
Input Z a� Output Specia! 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
Cfm.
447-4230.
7YPE OF WORK I hereby apply for mechanical systems permft and I acknowledge ihat the information
Afterations Replacement New Construction above is complete and accurate; that the work will be in �nformance with the ordi-
nances and codes of the city and with the state building/mechanical codes; that this form
Repair Est. Comp. Date .�'�' �-' `f S does not beoome a permit until signed by the BUILDING OFFICIAL; that the work will be
�„�,_,.._, in accordance wit the approved plan i the case of all work which requires review and
Est. Cost $ ZoJ�, 4d Bui(din Permit # ap I pla
HEATING PERMIT FEE $ �oZ � ��-- � —q$`�
STATE SURCHARGE $ .50 i nYs Signature Date
TOTAL PERMIT FEES $�3� D � Receipt #� I`7` 7 ��� ��
' ing O f fi s Signature Date