HomeMy WebLinkAboutHeating Permit 95-0100 r "r.-' •_ T "-, 1. Pink - File
O F PRIp �� � ^ TYPE OF STRUCTURE 3. Yellow - C nvactor
.� � . � ' -� C1TY OF PRIO LAKE
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� i ,', �� 4��� TA STREET S.E Permit No. �°�� Single Family �_ Two-Family Mufti-Family
� �� PRIOA'LL�►►KE, MN 55372
��;��j '�'�'� Commercial Industrial rublic Other
IpN / PERMIT
� JOB VALUATION FEE
Date ,� � / � # �� �4 Q — � �� — D
Site Address �(o d � ' $0 -$1,000 2% of job value, min. $20.00
Lot .3 Block � Addition ,� � $�.� -$�O,OOQ $20.00 for the first $1,000 plus $1.25 for each additional
$100.00 or fraction thereof to and including $10,000.
Owner's Name � ���r
. , $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 � $50,000.
Address �v / S�� � $50,001 and over $532.50 for the first $50,000 pfus $7.50 for each addi-
tional $1,000 or fraction thereof.
Telephone # s3 7— 9
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 ��--•-- ���+;�� Te�► Rom�d must be submitted with buildin�permit number before build-
Gravity
Conn. Load Mechanical issued.
Air Conditianing CLOSED DUE TO
Fuel Flue Size Vent. System INACTIVITY 8/3 0/O l � W�h number of supply and return openings listed
New structures or additions send floor plan with sup-
Supply Openings HEATING OR POWER PLAN7' . HEAT LOSS CALCULATIONS, PAYMENT AND
Steam
Return Opertings Hot Water APPUCa i i�r,5 nnAY 6C nr�„��cD 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. - 4:3D p.m.
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_ Other Devices ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
<iNR. `
447-4230.
TYPE WORK �� ( hereby apply for mechanical systems permit artd 1 acknowledge that the information
Alterafwns �_ Replacemertt FVew Construction above is complete and accurate; that the work will be in conformance with the ordi-
nances and oodes of the city and with the state building/mechanical codes; that this form
Repair Est. Comp. Date does nat become a permft until signed by the BUILDING OFFICIAL; that the work will be
c� v � in accordance with the approved plan in the case of all work which requires review and
Est. Cost $ ! J'�� Building Permit #
approval ns.
HEATING PERMIT FEE $ aa � U U �� � 5-- /cS �— �S'
STATE SURCHARGE $ .50 pplicanYs S' Date
TOTAL PERMIT FEES $ � Recei t# �9SL- ��� �""
P uilding icial's Signature Date
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