HomeMy WebLinkAboutHeating Permit 95-0098 � �
, � � T � - — . , 1. Pink - File
2. Green - City
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'�� y � CITY OF PRIOR LAKE TYPE OF STRUCTURE 3. Yellow - Contr�tor
� �,� �629,,QAKOTA STREET S.E, p�rmit No. �`� !�'' Single Family Two-Family Multi-Family
Pf� �LAKE, MN 55372
Commercial Industrial Public Other
HEA LICATION / PERMIT
Date � I� � PID # .�.�"" �— OOp —U �OB VALUATION FEE
$0 -$1,000 2% of job value, min. $20.00
Site Address � � � � c� i !'
Lot � Btock � Addition ,� ,� ' $���� -$10,000 $20.00 for the first $1,000 plus $1.25 for each additional
-^� $100.00 or fraction thereof to and inctuding $10,000.
Owner's Nam
$10,001 -$50,000 $132.50 for the first $10,000 plus $1.00 for each addi-
Address tional $100.00 or fraction thereof, to and including
Heating Contractor c� � � $50,000.
Address I�D 1 U � C� � s, £, $50,001 and over $532.50 for the first $50,000 plus $7.50 for each addi-
tional $1,000 or fraction thereof.
Telephone # � � � � �} a�
The price of your heating permit includes one rough-in and one final inspection.
Furnace Make & Model TYPE OF SYSTEM "-- 00 each.
Warm Air Plants CLOSED DUE TO
Model Size Gravity nitted with building r,�ermit number before build-
Conn. Load Mechanical INACTIVITY 8/30/Ol
Air Conditioning
Fuel Flue Size Vent. System
i number of supply and return openings iisted
HEATING OR POWER PLANT Per room with c:Fnn•s per open���y. �.a.. 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 Devices ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HAL�
Cfm. ���„ , 447-4230.
TYPE OF WORK I hereby apply for mechanical systems permit and I acknowledge that the information
Afteratfons h Replacemerrt �Vew Const►uction above is comp(ete and accurate; that the work will 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 does not become a permit until signed by the BUILDING OFFICIAL; that the work will be
Go in accordance with the approved plan in the case of aii work which requires review and
Est. Cost $�.��� � Building Permit # approval of plans.
HEATtNG PERMIT FEE $�J� . a�g S— IC7 ' ��
STATE SURCHARGE $ .50 plicant's Signa e Date %
TOTAI PERMIT FEES $� 1•��`� Receipt # ��7�f ��
Building ial's Signature Date