HomeMy WebLinkAboutHeating Permit 95-0097 1. Pink - File
� 2. (3reen - City
�,��� PR ���---��`--CITY-OF P IOR LAKE �PE OF STRUCTURE 3. YeNow - Con7actor
�- 1620Q Eagle , reek Av. S.E. p�,rmit No. C� Single Family Two �_ Mufti
� � � i:�.x�or Lra MN 55372 �
� � Commercial Industrial Public Other
lNfa. ATION / PERMIT
Date �--- PtD # �ZS — � 3 " D���U JOB VALUATIOIV FEE
�... . $0 -$1,000 2% of job value, min. $20.00
Site Address 4 �J` i
Lot T Bbck � Addition ,�y'�d�U�o��� ��-O' 7 ,,..� $1,001 -$10�000 $20.00 for the first $1,000 plus $1.25 for each additionai
$100.00 or fraction thereof to and including $10,000.
Owne�s Name _ �:U�IUft� �ZOG' tl �-�J
$10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address 3�YC����rf- ���,` tional $100.00 or fraction thereof, to and including
Heating Contractor ` � $50,000.
Address $50,001 and over $532.50 for the first $50,000 pius $7.50 for each addi-
tional $1,000 or fraction thereof.
Telephone # �� S"�a,s
The price of your heating permit includes one rough-in and one final inspection.
Furnace Make & Modei TYPE OF SYSTEM Additional inspections will be billed at $25.00 each.
� ����/,+2�/ Warm Air Plants
Model Size �_�� � �� Gravity House Heating Test Record must be submitted with building �ermit number before build-
Conn. Load Mechanical ing certificate of occupancy will be issued.
Air Condition
Fuel Flue Size Vent. System HEAT CALCULATIONS RE�UIRED 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 APPUCATIONS 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 Devices ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
Cfm. 447-4230.
TYPE OF WORK I hereby apply for mechanical systems permft and I acknowledge that tt�e information
Afterafwns X Replacement New Construction above is complete and accurate; that the work wilt be in conformance with the ordi-
� nances and codes of the city and with the state building/mechanical codes; that this form
Repair Est. Comp. Date .S � does not become a permit until signed by the BUILDING OFFICIAL; that the work will be
—7 in accordance with the approved plan in the case of all work which requires review and
Est. Cost $ �3�T � �d Building Permit # approval plans.
HEATING PERMIT FEE $ �S l�Q � ,� ��
STATE SURCHARGE $ .50 i nt's Sig ature Date -
TOTAL PERMIT FEES $ �S. �O Receipt # � � � �'`�� ^ �
Building ial's Signature Date